Prevention of diabetic nephropathy: from microalbuminuria to end-stage renal insufficiency

peer reviewedDiabetic nephropathy is one of the leading causes of end-stage renal failure in western countries. This disease develops over several years. Early stages, if they are detected in time, can lead to preventive treatment at a moment when the disease is still reversible. This paper reviews the main primary and secondary preventive measures that have been proven efficacious. Those are essentially the optimal treatment of hyperglycaemia and hypertension, and probably the use of agents that specifically block the renin-angiotensin axis. We briefly discuss the results of the main studies that have led to those conclusions

Cliente, datore di lavoro e lavoratore : cartografia di una triangolazione complessa

Molti studi nel campo del diritto, della sociologia e del management si interrogano sulla trasformazione del vincolo della subordinazione che lega datore di lavoro e lavoratori. Tale trasformazione è spesso spiegata con una nuova articolazione, in senso trilaterale, della tradizionale relazione di lavoro bilaterale tra datore di lavoro e lavoratori. La triangolazione sarebbe dovuta in larga misura all'intrusione del cliente o di suoi rappresentanti nell'organizzazione del lavoro: tuttavia, in quegli studi non si procede alle opportune distinzioni tra i vari tipi di clienti, né tra il piano della realtà concreta e il discorso teorico sul ruolo e sul peso del cliente. Obiettivo di questo articolo è dunque di proporre una classificazione delle situazioni triangolari tra datore di lavoro, lavoratori e clienti, basata sul concetto di potere e di analizzare in ciascuna situazione l'impatto del cliente sui rapporti di lavoro e sulle condizioni di impiego

Client, employer and employee: Mapping a complex triangulation

Many studies in the fields of Law, Sociology and Management point out the transformation of subordination in the employment relation. This transformation of subordination is often explained by the triangulation of the traditionally bilateral employment relation between employer and employees, due in large part to the intrusion of clients or their representatives in the operational and organizational conditions of work, without necessarily distinguishing between the various types of clients, nor between the reality and the rhetoric of the role and the weight of the client. The objective of this paper is 1) to propose a classification of the triangular situations between employer, employees and clients based on the power concept and 2) to analyse the impacts of clients on work conditions and employment relations

Recent advances in the management of obesity

peer reviewedThe management of an obese patient aims not only at obtaining a durable weight loss, but also at attenuating various associated risk factors. This latter objective may already be obtained with a rather moderate weight reduction (5-10% of initial body weight). The first step should favour life-style changes (diet and physical exercise), eventually together with a psychological support. In case of insufficient success, a pharmacological approach may be considered, in addition to life-style advices. Pharmacotherapy currently includes drugs that act on the central nervous system to decrease appetite (sibutramine), in the gastrointestinal tract to diminish fat absorption (orlistat) or at both central and peripheral sites (rimonabant). In case of extreme obesity or severe obesity associated with comorbidities, refractory to medical approaches, bariatric surgery may represent the only solution to obtain a major and sustained weight loss, together with a significant improvement of associated risk factors. Gastroplasty, especially laparoscopic gastric banding, has become very popular in our country. However, because of several limitations, it is increasingly replaced by derivative procedures, especially gastric bypass. In all cases, a multidisciplinary, integrated and individualized approach should be recommended, using realistic goals and targeting long-term weight reduction and improved health

Comment réguler les relations triangulaires de travail ?

Dans un nombre grandissant de secteurs, la régulation des rapports de travail est aujourd’hui fragilisée par l’intrusion de plus en plus importante d’autres acteurs dans la relation traditionnellement bilatérale entre employeur et salariés. Le défi posé au droit du travail par l’intrusion des acteurs-tiers favorise l’émergence, à côté du droit du travail, de nouvelles formes de régulation des rapports de travail, élaborées et mises en œuvre par différents acteurs. On note en particulier un développement des initiatives de responsabilité sociale des entreprises se traduisant par des engagements de ces dernières concernant des personnes travaillant pour leur compte sans être liées à elles par un contrat de travail, comme les salariés de leurs fournisseurs et sous-traitants. L’objectif de cet article est de comparer les enjeux de la régulation des relations de travail par le droit du travail et la responsabilité sociale des entreprises, en analysant deux secteurs particulièrement emblématiques de l’intrusion d’acteurs-tiers dans les rapports de travail : le travail intérimaire d’une part, et les centres d’appels d’autre part.In an increasing number of economic sectors, the regulation of working situations is weakened by the intrusion of new actors in the traditionally bilateral relation between workers and employers. Given the challenges for labour law created by the involvement of these new actors, new forms of regulation developed by different actors emerge. There is in particular a development of initiatives in the field of corporate social responsibility illustrated by companies’ commitment towards persons working for them without being linked to them through a contract of employment, such as employees of suppliers and subcontractors. The aim of this article is to compare the regulation of working relations by labour law and by corporate social responsibility initiatives. Two sectors in which the intrusion of third actors is particularly developed are analysed: temporary working agencies and call centres

Radiotherapy in breast cancer: current standards of treatment, prediction of local recurrence and open questions

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Symmetric dithiodigalactoside: strategic combination of binding studies and detection of selectivity between a plant toxin and human lectins

Thioglycosides offer the advantage over O-glycosides to be resistant to hydrolysis. Based on initial evidence of this recognition ability for glycosyldisulfides by screening dynamic combinatorial libraries, we have now systematically studied dithiodigalactoside on a plant toxin (Viscum album agglutinin) and five human lectins (adhesion/growth-regulatory galectins with medical relevance e.g. in tumor progression and spread). Inhibition assays with surface-presented neoglycoprotein and in solution monitored by saturation transfer difference NMR spectroscopy, flanked by epitope mapping, as well as isothermal titration calorimetry revealed binding properties to VAA (Ka: 1560 ± 20 M-1). They were reflected by the structural model and the affinity on the level of toxin-exposed cells. In comparison, galectins were considerably less reactive, with intrafamily grading down to very minor reactivity for tandem-repeat-type galectins, as quantitated by radioassays for both domains of galectin-4. Model building indicated contact formation to be restricted to only one galactose moiety, in contrast to thiodigalactoside. The tested lycosyldisulfide exhibits selectivity between the plant toxin and the tested human lectins, and also between these proteins. Therefore, glycosyldisulfides have potential as chemical platform for inhibitor design

Diagnosis of lower limb pain in a diabetic patient

peer reviewedBy presenting this clinical case, we aim at discussing the diagnosis between arteriopathy, neuropathy and osteoarticular pathology in a patient with type 2 diabetes who complains of lower limb pain. We emphasize the role of a global medical approach based upon anamnesis and clinical exam, which should contribute to select the most helpful paraclinical investigations