B Acad Nat Med Paris
-
Brain nutrient sensing permits fine regulation of physiological functions such as food intake and blood glucose regulation related to energy homeostasis. The mechanism of glucose sensing is the most extensively studied, and parallels have been drawn between pancreatic beta cells and neurons. Two types of glucose-sensing neuron have been identified, namely those whose activity is directly proportional to the glucose concentration, and those whose activity is inversely proportional to the glucose concentration. ⋯ Glucose sensing can be modulated by other nutrients (particularly fatty acids) and also by hormones (insulin, leptin and ghrelin) and peptides (NPY). The subtle cellular and molecular mechanisms involved in glucose sensing probably explain reported discrepancies in the expression of glucose transporters, hexokinases and channels. Astrocytes might also be involved in one type of response, thus adding a new level of complexity.
-
B Acad Nat Med Paris · Apr 2007
Comparative Study Historical Article[Controlled randomized clinical trials].
It is generally agreed that the first comparative clinical trial in history was done by James Lind in 1747, in the treatment of scurvy. The general bases of modern experimental medicine were published by Claude Bernard in 1865. However, it is the development of new drugs and the evolution of methodological concepts that led to the first randomized controlled clinical trial, in 1948, which showed that the effects of streptomycin on pulmonary tuberculosis were significantly different from those of a placebo. ⋯ Controlled clinical trials are lacking in various fields of biomedical research, either because drug companies consider them unprofitable, or because they concern public health issues that are outside the scope of the private sector In such cases, controlled clinical trials must be undertaken and funded by the public sector Today, only North American institutions such as NIH and the National Heart Blood and Lung Institute are capable of sponsoring such trials. This creates a potential problem for extrapolation to European patient populations, which may be different. Large controlled clinical trials must start to be sponsored by public funding in Europe if European practitioners are to receive the evidence-based results they need to rationalize their medical practice.
-
B Acad Nat Med Paris · Apr 2007
Historical Article[The Pharo School: a century of teaching in tropical medicine].
1907-2007: one hundred years separate this year's intake from the first students to enroll at the Pharo School. 1907: in February, the first class, called the "Marseillaise", entered the new School of Colonial Medicine (Ecole d'application du Service de santé des troupes coloniales), where they received theoretical and practical training in tropical medicine. 2007: the latest class, recruited through a national examination, will join the Tropical Medicine Institute of the Army health service in May, for the first autonomous training program in supervised ambulatory primary care. The past hundred years have seen many upheavals. After the colonial period and the two world wars, followed by decolonization and technical assistance for young independent nations, globalization has brought the continents together, shrunk distances, and led to an intermingling of populations. ⋯ It can be completed by diplomas in different disciplines (epidemiology, medical biology, special surgeries, pediatrics, vaccination, combating malaria, etc.), possibly during continuous medical training. Cutting-edge training will be reserved for physicians who are called on to practice far from their university or hospital base, in isolated or difficult situations. Thus, a hundred years after their peers of the old "Marseillaise", the 2007 Pharo class will be first to take a diploma in overseas medical missions--the latest in a series of change intended to keep pace with a rapidly changing world