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See detailHemochromatose et diabete sucre: approche diagnostique et evolution clinique.
Thielen, Vinciane ULg; Radermecker, Régis ULg; Philips, Jean-Christophe ULg et al

in Revue Médicale de Liège (2005), 60(5-6), 448-54

We report the characteristics of diabetes mellitus in 10 patients with a suspicion of hereditary hemochromatosis. The results of this personal series were compared to literature's data described in a ... [more ▼]

We report the characteristics of diabetes mellitus in 10 patients with a suspicion of hereditary hemochromatosis. The results of this personal series were compared to literature's data described in a recent article. Early diagnosis and treatment by phlebotomy can improve blood glucose control in the early stages of the disease. If diagnosis occurs later, when the patient already needs insulin therapy, diabetes will not be improved by phlebotomy anymore. [less ▲]

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See detailReduction comparable des nouveaux cas de diabete de type 2 sous sartan et sous inhibiteur de l'enzyme de conversion de l'angiotensine: comparaison des meta-analyses des essais prospectifs randomises.
Scheen, André ULg

in Revue Médicale de Liège (2005), 60(5-6), 424-8

This paper aims at comparing two meta-analyses of clinical trials having investigated the effect of the inhibition of the renin-angiotensin system either with an angiotensin converting enzyme inhibitor ... [more ▼]

This paper aims at comparing two meta-analyses of clinical trials having investigated the effect of the inhibition of the renin-angiotensin system either with an angiotensin converting enzyme inhibitor (ACEI) or with a selective angiotensin receptor blocker (ARB) on the incidence of new cases of type 2 diabetes mellitus in subjects with arterial hypertension or with congestive heart failure. The protection appears similar with ACEIs in six trials in a total of 24.623 patients (hazard ratio: 0.77; CI 95% 0.72-0.81; p < 0.00001 and with ARBs in five trials in a total of 14.344 patients (hazard ratio: 0.79; CI 95% 0.73-0.85; p < 0.00001). It is consistent whatever the comparator, a thiazide diuretic agent, a beta-blocker, a dihydropyridine calcium channel blocker or a placebo. The large ongoing ONTARGET controlled study will allow a direct comparison between an ACEI, ramipril, and an ARB, telmisartan, and will also investigate the potential benefit of a combined treatment with both drugs. The inhibition of the renin-angiotensin system should be considered among pharmacological strategies of prevention of type 2 diabetes mellitus. [less ▲]

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See detailVers une tritherapie orale dans le traitement pharmacologique du diabete de type 2?
Scheen, André ULg

in Revue Médicale de Liège (2005), 60(5-6), 414-8

Type 2 diabetes is a complex disease combining several disturbances in various organs, especially a defect of insulin secretion by the pancreas, an increased production of glucose by the liver and a ... [more ▼]

Type 2 diabetes is a complex disease combining several disturbances in various organs, especially a defect of insulin secretion by the pancreas, an increased production of glucose by the liver and a reduced insulin-mediated glucose uptake by the skeletal muscle. Each of these abnormalities can be, at least partially, reversed by a specific pharmacological approach, an agent promoting insulin secretion (sulphonylurea, glinide), metformin and a thiazolidinedione (glitazone), respectively. A triple oral therapy with "sulphonylurea (glinide)--metformin--glitazone", targeting simultaneously the three main metabolic abnormalities of type 2 diabetes, deserves special attention. Promising results have been observed in recent clinical trials as far as blood glucose control and some other cardiovascular risk factors are concerned. The precise place of such oral triple therapy remains to be specified, at a late stage to delay the shift to insulin or earlier in the natural history of the disease, to avoid the decline of the number and/or function of beta cells and the resulting metabolic deterioration. [less ▲]

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See detailLes insulinosensibilisateurs.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2005), 60(5-6), 409-13

Insulin resistance has a genetic background and its phenotypic expression is triggered by fat diet, lack of physical activity and obesity. It provokes a stress on B cells, tends to increase blood glucose ... [more ▼]

Insulin resistance has a genetic background and its phenotypic expression is triggered by fat diet, lack of physical activity and obesity. It provokes a stress on B cells, tends to increase blood glucose levels, is intimately associated with the metabolic syndrome and represents a major cardiovascular risk factor. Insulin resistance may be favourably influenced by simple life-style changes. If necessary, drugs may be prescribed, such as metformin, the first choice antidiabetic oral agent in overweight individuals, or thiazolidinediones (glitazones), new insulin sensitizers with promising effects. New molecules are currently developed, especially PPAR alpha/gamma or pan-agonists. Targeting insulin resistance has several objectives: reducing hyperglycaemia in type 2 diabetic patients, protecting B cells in order to prevent type 2 diabetes in at risk individuals and limiting the progressive metabolic deterioration in diabetic patients, finally, and perhaps most importantly, ameliorating the global cardiovascular prognosis. [less ▲]

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See detailPrevention du diabete de type 2: un nouveau defi de sante publique.
Scheen, André ULg; Giet, Didier ULg

in Revue Médicale de Liège (2005), 60(5-6), 383-90

Owing to the epidemics of type 2 diabetes, it is important to develop strategies of prevention of the disease. The first step should detect patients at risk, in function of simple anamnesis, clinical and ... [more ▼]

Owing to the epidemics of type 2 diabetes, it is important to develop strategies of prevention of the disease. The first step should detect patients at risk, in function of simple anamnesis, clinical and biological criteria. Afterwards, those individuals should be encouraged to follow a prevention programme, which essentially comprises better lifestyle habits (diet and physical exercise), especially to prevent or correct weight excess. In at very high risk subjects, for instance because of moderately increased fasting or post-glucose load glucose levels, eventually in a context of family history of type 2 diabetes, a pharmacological approach could be considered. Various drugs (metformin, acarbose, glitazones, orlistat, inhibitors of the renin-angiotensin system) have proven their efficacy in reducing the incidence of type 2 diabetes, in particular in individuals with impaired glucose tolerance, with obesity and/or with arterial hypertension. [less ▲]

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See detailL'insulinotherapie par pompe externe a perfusion continue d'insuline.
Radermecker, Régis ULg; Hermans, M. P.; Legrand, Delphine ULg et al

in Revue Médicale de Liège (2005), 60(5-6), 329-34

Type I diabetes mellitus requires an exogenous supply of insulin that ideally mimics physiological insulin secretion. The treatment goal is to achieve normoglycaemia in order to prevent or delay chronic ... [more ▼]

Type I diabetes mellitus requires an exogenous supply of insulin that ideally mimics physiological insulin secretion. The treatment goal is to achieve normoglycaemia in order to prevent or delay chronic complications, while limiting the risk of hypoglycaemia. Numerous advances have been performed in the last 10 years, as far as nature of insulin formulations, home blood glucose monitoring devices and modes of insulin delivery. Among the latter, continuous subcutaneous insulin infusion (CSII) using portable pumps represents the most sophisticated treatment capable of best mimicking normal insulin secretion. Such treatment provides better glucose control and glucose stability as compared to conventional multiple injection insulin therapy. However, it is essential to respect well defined indications and to organize a structured management by a multidisciplinary team in order to get the best metabolic results. The present paper describes recommendations, advantages and limits as well as cost of CSII with portable pumps in type 1 diabetic patients. [less ▲]

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See detailLe cout du diabete de type 2: resume de l'enquete europeenne CODE-2 et analyse de la situation en Belgique.
Wallemacq, Caroline ULg; Van Gaal, L. F.; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(5-6), 278-84

Type 2 diabetes mellitus is a common chronic disease whose economic impact on both patients and society is constantly increasing. "The Cost of Diabetes in Europe--Type 2 study" is the first coordinated ... [more ▼]

Type 2 diabetes mellitus is a common chronic disease whose economic impact on both patients and society is constantly increasing. "The Cost of Diabetes in Europe--Type 2 study" is the first coordinated attempt to measure total healthcare costs of type 2 diabetes mellitus in Europe. On average, 3% of the population with type 2 diabetes accounted for 5% of the total healthcare expenditure. Complications have a substantial impact on the costs of managing type 2 diabetes. The prevention of complications, especially cardiovascular disease, will potentially reduce overall healthcare expenditure. [less ▲]

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See detailLe diabete sucre: une maladie exemplative a bien des egards. Preambule.
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2005), 60(5-6), 269-72

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See detailL'etude clinique du mois. Treating to New Targets": plaidoyer pour une valeur cible de cholesterol LDL egale ou inferieure a 75 mg/dl chez tout patient coronarien."
Scheen, André ULg

in Revue Médicale de Liège (2005), 60(4), 264-7

The "Treating to New Targets" (TNT) trial compared atorvastatin 80 mg (aiming at reducing LDL cholesterol < or = 75 mg/dl) and atorvastatin 10 mg (LDL < or = 100 mg/dl as target) in 10,001 patients with ... [more ▼]

The "Treating to New Targets" (TNT) trial compared atorvastatin 80 mg (aiming at reducing LDL cholesterol < or = 75 mg/dl) and atorvastatin 10 mg (LDL < or = 100 mg/dl as target) in 10,001 patients with stable coronary heart disease followed up for 5 years. A reduction of major cardiovascular events of 22% was observed in the atorvastatin 80 mg group as compared to the atorvastatin 10 mg group (hazard ratio: 0.78; 95 % interval of confidence: 0.69-0.89; p < 0.001). Such clinical efficacy was obtained while a good drug safety profile was maintained. Total mortality was not significantly different between the two groups. However, and remarkably, cardiovascular death was not the first cause of death anymore in this atorvastatin-treated population. The results of TNT in patients with stable coronary heart disease thus confirm the results of PROVE-IT in patients with acute coronary syndrome. These two randomised controlled trials should encourage considering a LDL cholesterol level of 75 mg/dl (rather than 100 mg/dl) as a new target in any patient with coronary heart disease. [less ▲]

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See detailRecommandations relatives a la prevention des maladies cardio-vasculaires en pratique clinique. Groupe de Travail Belge de Prevention des Maladies cardio-vasculaires.
De Backer, G.; De Bacquer, D.; Brohet, C. et al

in Revue Médicale de Liège (2005), 60(3), 163-72

These recommandations are largely based on the "European Guidelines on Cardiovascular Disease Prevention in Clinical Practice" proposed by the "Third Joint Task Force of European and other Societies on ... [more ▼]

These recommandations are largely based on the "European Guidelines on Cardiovascular Disease Prevention in Clinical Practice" proposed by the "Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice". The model used to assess the overall risk was adapted for Belgium. Otherwise, very few things were changed from the Exectutive Summary of the European Guidelines. [less ▲]

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See detailL'etude clinique du mois. Chirurgie bariatrique: les resultats a 10 ans de la Swedish Obese Subjects Study"."
Scheen, André ULg; Letiexhe, Michel ULg; Rorive, Marcelle ULg et al

in Revue Médicale de Liège (2005), 60(2), 121-5

The 10-year results of the prospective, controlled Swedish Obese Subjects Study were recently reported in the New England Journal of Medicine by L. Sjostrom and colleagues. This trial compared obese ... [more ▼]

The 10-year results of the prospective, controlled Swedish Obese Subjects Study were recently reported in the New England Journal of Medicine by L. Sjostrom and colleagues. This trial compared obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. The follow-up rate for laboratory examinations was 74.5 percent at 10 years. At that time, data of 627 patients of the control group (mean age of 48 years, body mass index of 41 kg/m2) were compared to those of 641 patients who were submitted to surgery (banding n = 156, vertical banded gastroplasty n = 451 and gastric bypass n =34). At 10 years, the body weight had increased by 1.6 percent in the control group and decreased by 16.1 percent in the surgery group (p < 0.001), and similar changes were observed for waist circumference (+2.8 percent versus -10.1 percent, respectively, p < 0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Ten-year rates of recovery from diabetes, hypertriglyceridaemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricaemia were more favourable in the surgery than in the control group. The surgery group had lower 10-year incidence rates of diabetes, hypertriglyceridaemia, and hyperuricaemia (but not of hypertension) than the control group. In conclusion, as compared with conventional therapy, bariatric surgery appears to be a valuable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolaemia that was not significantly affected, amelioration in cardiovascular risk factors that were elevated at baseline. Obtaining long-term data concerning the effect of weight loss on overall mortality and on the incidence rates of myocardial infarction, stroke, and cancer remains a key-objective of this landmark study. [less ▲]

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See detailRecepteurs PPAR-gamma, nouvelle cible therapeutique dans les pathologies metaboliques et cardio-vasculaires.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2005), 60(2), 89-95

PPARs ("Peroxisome Proliferator-Activated Receptors") belong to a superfamily of nuclear receptors with several isoforms, among which PPAR-alpha mainly located in the liver and PPAR-gamma mainly located ... [more ▼]

PPARs ("Peroxisome Proliferator-Activated Receptors") belong to a superfamily of nuclear receptors with several isoforms, among which PPAR-alpha mainly located in the liver and PPAR-gamma mainly located in the adipose tissue. These receptors are considered as major pharmacological targets since the discovery of their activation by specific agonists, which lead to various favourable metabolic effects. Improvement of lipid profile by fibrates is explained by the activation of liver PPAR-alpha receptors. However, PPAR-gamma receptors have focused most fundamental and clinical research in recent years after the demonstration of their activation by thiazolidinediones (pioglitazone, rosiglitazone), a new class of antidiabetic agents. Beyond their effects on insulin sensitivity, glitazones exert pleiotropic effects that may result in cardiovascular protection in high risk patients. It has been recently demonstrated that certain angiotensin AT1 receptor blockers (sartans) can also exert a partial agonist activity on PPAR-gamma. Among the molecules of this class, telmisartan appears to exert this effect at the lower concentrations. Thus, PPAR-y, as common pharmacological target, may, at least partially, explain some of the effects observed with both thiazolidinediones and inhibitors of the renin-angiotensin system, in particular the improvement in insulin sensitivity (in particular via an increase in adiponectin levels), the protection against type 2 diabetes, the reduction in arterial blood pressure and the prevention of cardiovascular complications. There is currently a major interest from the pharmaceutical industry in the development of new molecules able to activate both PPAR-alpha and PPAR-gamma. [less ▲]

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See detailEditorial
Kulbertus, Henri ULg; Scheen, André ULg

in Revue Médicale de Liège (2005), 60(1), 1-4

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See detailRecommandations relatives a la prevention des maladies cardiovasculaires en pratique clinique. Groupe de Travail Belge de Prevention des Maladies Cardiovasculaires.
De Backer, G.; De Bacquer, D.; Brohet, C. et al

in Revue Médicale de Bruxelles (2005), 26(2), 77-87

These recommendations are largely based on the Executive Summary of the "European Guidelines on Cardiovascular Disease Prevention in Clinical Practice" proposed by the "Third Joint Task Force of European ... [more ▼]

These recommendations are largely based on the Executive Summary of the "European Guidelines on Cardiovascular Disease Prevention in Clinical Practice" proposed by the "Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice". The model used to assess the overall risk was adapted for Belgium. Otherwise, very few things were changed from the Executive Summary of the European Guidelines. [less ▲]

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See detailEffects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study.
Van Gaal, Luc F; Rissanen, Aila M; Scheen, André ULg et al

in Lancet (2005), 365(9468), 1389-97

BACKGROUND: In animal models, cannabinoid-1 receptor (CB1) blockade produces a lean phenotype, with resistance to diet-induced obesity and associated dyslipidaemia. We assessed the effect of rimonabant, a ... [more ▼]

BACKGROUND: In animal models, cannabinoid-1 receptor (CB1) blockade produces a lean phenotype, with resistance to diet-induced obesity and associated dyslipidaemia. We assessed the effect of rimonabant, a selective CB1 blocker, on bodyweight and cardiovascular risk factors in overweight or obese patients. METHODS: patients with body-mass index 30 kg/m2 or greater, or body-mass index greater than 27 kg/m2 with treated or untreated dyslipidaemia, hypertension, or both, were randomised to receive double-blind treatment with placebo, 5 mg rimonabant, or 20 mg rimonabant once daily in addition to a mild hypocaloric diet (600 kcal/day deficit). The primary efficacy endpoint was weight change from baseline after 1 year of treatment in the intention-to-treat population. FINDINGS: Weight loss at 1 year was significantly greater in patients treated with rimonabant 5 mg (mean -3.4 kg [SD 5.7]; p=0.002 vs placebo) and 20 mg (-6.6 kg [7.2]; p<0.001 vs placebo) compared with placebo (-1.8 kg [6.4]). Significantly more patients treated with rimonabant 20 mg than placebo achieved weight loss of 5% or greater (p<0.001) and 10% or greater (p<0.001). Rimonabant 20 mg produced significantly greater improvements than placebo in waist circumference, HDL-cholesterol, triglycerides, and insulin resistance, and prevalence of the metabolic syndrome. The effects of rimonabant 5 mg were of less clinical significance. Rimonabant was generally well tolerated with mild and transient side effects. INTERPRETATION: CB1 blockade with rimonabant 20 mg, combined with a hypocaloric diet over 1 year, promoted significant decrease of bodyweight and waist circumference, and improvement in cardiovascular risk factors. [less ▲]

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See detailEnhanced vortex pinning by a composite antidot lattice in a superconducting Pb film
Silhanek, Alejandro ULg; Van Look, L.; Jonckheere, R. et al

in Physical Review. B : Condensed Matter (2005), 72(1),

The use of artificial defects is known to enhance the superconducting critical parameters of thin films. In the case of conventional superconductors, regular arrays of submicron holes (antidots ... [more ▼]

The use of artificial defects is known to enhance the superconducting critical parameters of thin films. In the case of conventional superconductors, regular arrays of submicron holes (antidots) substantially increase the critical temperature T-c(H) and critical current I-c(H) for all fields. Using electrical transport measurements, we study the effect of placing an additional small antidot in the unit cell of the array. This composite antidot lattice consists of two interpenetrating antidot square arrays with a different antidot size and the same lattice period. The smaller antidots are located at the centers of the cells of the large antidots array. We show that the composite antidot lattice can trap a higher number of flux quanta per unit cell inside the antidots compared to a reference antidot film without the additional small antidots. As a consequence, the field range in which an enhanced critical current is observed is considerably expanded. Finally, the possible stable vortex lattice patterns at several matching fields are determined by molecular-dynamics simulations. [less ▲]

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See detailEnchanting and enchanted dolphins. An analysis of human/dolphin encounters.
Servais, Véronique ULg

in Knight, John (Ed.) Animals in person. Cultural perspectives on human-aniaml intimacies (2005)

In occidental countries, the figure of the dolphin is permeated with love. Not only do people love dolphins, but the dolphins' anthropophilia belongs to their natural history as well : they rescue men at ... [more ▼]

In occidental countries, the figure of the dolphin is permeated with love. Not only do people love dolphins, but the dolphins' anthropophilia belongs to their natural history as well : they rescue men at sea, play in the bow waves of boats, and sometime develop enduring friendships with humans. People who have encountered dolphins in the open sea regularly speak about "falling in love" or feeling "pure love" from the dolphin ; others report telepathy, trance or mystic revelations. The emotions that people might experiment in an encounter with a dolphin are very powerful and embedded in numerous wondrous stories about dolphins. The paper begins with first hand accounts of persons who have encountered dolphins. A description of the practices of the encounter follows. Then I discuss some distinctive features of the human/dolphin communication (ethological signals, interactional patterns, the awareness of an alien consciousness) which might be associated with the emotions involved. The last part of the paper addresses the main representations of the dolphin in occidental countries (a messenger, a saviour, a healer). Those representations play a crucial role when the emotions or experiences are to be given a meaning. [less ▲]

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See detailA comparison of somatic cell count and antimicrobial susceptibility of subclinical mastitis pathogens in organic and conventional dairy herds
Boutet, Philippe; Detilleux, Johann ULg; Motkin, Michel ULg et al

in Annales de Médecine Vétérinaire (2005), 149(3), 173-182

A comparison of somatic cell count and antimicrobial susceptibility of subclinical mastitis pathogens in organic and conventional dairy herds.Bovine subclinical mastitis is the most important disease ... [more ▼]

A comparison of somatic cell count and antimicrobial susceptibility of subclinical mastitis pathogens in organic and conventional dairy herds.Bovine subclinical mastitis is the most important disease affecting dairy cows. The fluctuating increase in somatic cell count (SCC) that occurs causes major economic losses in dairy industry. This comparative study between conventional and organic dairy herds was conducted in the aim to better characterize which consequences might have different management practices on SCC but also on the frequency of pathogens isolated and their antimicrobial susceptibility. Four conventional and four organic herds, with bulk milk SCC >300x103cells/ml were selected, in which respectively 47 and 44 cows were investigated. Each quarter was sampled 3 times at 15 days interval for SCC, microbiological analysis and antimicrobial susceptibility. In both herd categories, major pathogens isolated were by order of importance Streptococcus uberis, Staphylococcus aureus and Streptococcus dysgalactiae with a great impact on SCC. Coagulase negative staphylococci were the most frequent minor germs and had a moderated but real impact on SCC. In certified organic dairy farms, the three most frequently isolated major pathogens were significantly more susceptible to antimicrobials in vitro. This study suggests that the limited use of antibiotics in organic dairy herds could explain, at least in part, the lower resistance obtained from analysed isolates. [less ▲]

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