Altered stomatal dynamics of two Euramerican poplar genotypes submitted to successive ozone exposure and water deficit

The impact of ozone (O₃) pollution events on the plant drought response needs special attention because spring O₃ episodes are often followed by summer drought. By causing stomatal sluggishness, O₃ could affect the stomatal dynamic during a subsequent drought event. In this context, we studied the impact of O₃ exposure and water deficit (in the presence or in the absence of O₃ episode) on the stomatal closure/opening mechanisms relative to irradiance or vapour pressure deficit (VPD) variation. Two genotypes of Populus nigra x deltoides were exposed to various treatments for 21 days. Saplings were exposed to 80 ppb/day O₃ for 13 days, and then to moderate drought for 7 days. The curves of the stomatal response to irradiance and VPD changes were determined after 13 days of O₃ exposure, and after 21 days in the case of subsequent water deficit, and then fitted using a sigmoidal model. The main responses under O₃ exposure were stomatal closure and sluggishness, but the two genotypes showed contrasting responses. During stomatal closure induced by a change in irradiance, closure was slower for both genotypes. Nonetheless, the genotypes differed in stomatal opening under light. Carpaccio stomata opened more slowly than control stomata, whereas Robusta stomata tended to open faster. These effects could be of particular interest, as stomatal impairment was still present after O₃ exposure and could result from imperfect recovery. Under water deficit alone, we observed slower stomatal closure in response to VPD and irradiance, but faster stomatal opening in response to irradiance, more marked in Carpaccio. Under the combined treatment, most of the parameters showed antagonistic responses. Our results highlight that it is important to take genotype-specific responses and interactive stress cross-talk into account to improve the prediction of stomatal conductance in response to various environmental modifications.

Integrated analysis of the detoxification responses of two Euramerican poplar genotypes exposed to ozone and water deficit: Focus on the ascorbate-glutathione cycle

Ozone (O₃) and drought increase tree oxidative stress. To protect forest health, we need to improve risk assessment, using metric model such as the phytotoxic O₃ dose above a threshold of y nmol·m^-2·s^-1 (PODy), while taking into account detoxification mechanisms and interacting stresses. The impact of drought events on the effect of O₃ pollution deserves special attention. Water deficit may decrease O₃ entrance into the leaves by reducing stomatal opening; however, water deficit also induces changes in cell redox homeostasis. Besides, the behaviour of the cell antioxidative charge in case of stress combination (water deficit and O₃) still remains poorly investigated. To decipher the response of detoxification mechanisms relatively to the Halliwell-Asada-Foyer cycle (HAF), we exposed poplar saplings (Populus nigra × deltoides) composed of two genotypes (Carpaccio and Robusta), to various treatments for 17 days, i.e. i) mild water deficit, ii) 120 ppb O₃, and iii) a combination of these two treatments. Ozone similarly impacted the growth of the two genotypes, with an important leaf loss. Water deficit decreased growth by almost one third as compared to the control plants. As for the combined treatment, water deficit protected the saplings from leaf ozone injury, but with an inhibitory effect on growth. The pool of total ascorbate was not modified by the different treatments, while the pool of total glutathione increased with POD₀. We noticed a few differences between the two genotypes, particularly concerning the activity of monodehydroascorbate reductase and glutathione reductase relatively to POD₀. The expression profiles of genes coding for the dehydroascorbate reductase and glutathione reductase isoforms differed, probably in link with the putative localisation of ROS production in response to water deficit and ozone, respectively. Our result would argue for a major role of MDHAR, GR and glutathione in the preservation of the redox status.

Antioxidative responses of three oak species under ozone and water stress conditions

Plants are frequently exposed to adverse environmental conditions such as drought and ozone (O₃). Under these conditions, plants can survive due to their ability to adjust their metabolism. The aim of the present study was to compare the detoxification mechanisms of three oak species showing different O₃ sensitivity and water use strategy. Two-year-old seedlings of Quercus ilex, Q. pubescens and Q. robur were grown under the combination of three levels of O₃ (1.0, 1.2 and 1.4 times the ambient O₃ concentration) and three levels of water availability (on average 100, 80 and 42% of field capacity i.e. well-watered, moderate drought and severe drought, respectively) in an O₃ Free Air Controlled Exposure facility. Ozone and drought induced the accumulation of reactive oxygen species (ROS) and this phenomenon was species-specific. Sometimes, ROS accumulation was not associated with membrane injury suggesting that several antioxidative defence mechanisms inhibited or alleviated the oxidative damage. Both O₃ and drought increased total carotenoids that were able to prevent the peroxidation action by free radicals in Q. ilex, as confirmed by unchanged malondialdehyde by-product values. The concomitant decrease of total flavonoids may be related to the consumption of these compounds by the cell to inhibit the accumulation of hydrogen peroxide. Unchanged total phenols confirmed that Q. ilex has a superior ability to counteract oxidative conditions. Similar responses were found in Q. pubescens, although the negative impact of both factors was less efficiently faced than in the sympatric Q. ilex. In Q. robur, high O₃ concentrations and severe drought induced a partial rearrangement of the phenylpropanoid pathways. These antioxidative mechanisms were not able to protect the cell structure (as confirmed by ROS accumulation) suggesting that Q. robur showed a lower degree of tolerance than the other two species.

Both gravistimulation onset and removal trigger an increase of cytoplasmic free calcium in statocytes of roots grown in microgravity

Gravity is a permanent environmental signal guiding plant growth and development. Gravity sensing in plants starts with the displacement of starch-filled plastids called statoliths, ultimately leading to auxin redistribution and organ curvature. While the involvement in gravity sensing of several actors such as calcium is known, the effect of statolith displacement on calcium changes remains enigmatic. Microgravity is a unique environmental condition offering the opportunity to decipher this link. In this study, roots of Brassica napus were grown aboard the International Space Station (ISS) either in microgravity or in a centrifuge simulating Earth gravity. The impact of short simulated gravity onset and removal was measured on statolith positioning and intracellular free calcium was assessed using pyroantimonate precipitates as cytosolic calcium markers. Our findings show that a ten-minute onset or removal of gravity induces very low statolith displacement, but which is, nevertheless, associated with an increase of the number of pyroantimonate precipitates. These results highlight that a change in the cytosolic calcium distribution is triggered in absence of a significant statolith displacement.

Late toxicities and clinical outcome at 5 years of the ACCORD 12/0405-PRODIGE 02 trial comparing two neoadjuvant chemoradiotherapy regimens for intermediate-risk rectal cancer

Background

Outcome of intermediate risk rectal cancer may be improved by the addition of oxaliplatin during 5-fluoruracil concomitant neoadjuvant chemoradiotherapy. The purpose of this study is to analyze the main clinical results of the ACCORD12 trial (NCT00227747) in rectal cancer after 5 years of follow-up.

Patients and methods

Inclusion criteria were as follows: rectal adenocarcinoma accessible to digital examination staged T3-T4 Nx M0 (or T2 Nx distal anterior rectum). Two neoadjuvant chemoradiotherapy regimens were randomized: CAP45 (RT 45 Gy + capecitabine) and CAPOX50 (RT 50 Gy + capecitabine and oxaliplatin). Main end point was sterilization of the operative specimen. Acute and late toxicities were prospectively analyzed with dedicated questionnaires.

Results

Between November 2005 and July 2008, 598 patients were included in the trial. After a median follow-up of 60.2 months, there was no difference between treatment arms in multivariate analysis either for disease-free survival or overall survival (OS) [P = 0.9, hazard ratio (HR)=1.02; 95% confidence interval (CI), 0.76-1.36 and P = 0.3, HR = 0.87; 95% CI, 0.66-1.15, respectively]. There was also no difference of local control in univariate analysis (P = 0.7, HR = 0.92; 95% CI, 0.51-1.66). Late toxicities were acceptable with 1.6% G3 anal incontinence, and <1% G3 diarrhea, G3 rectal bleeding, G3 stenosis, G3-4 pain, G3 urinary incontinence, G3 urinary retention and G3 skeletal toxicity. There was a slight increase of erectile dysfunction over time with a 63% rate of erectile dysfunction at 5 years. There was no significant statistical difference for these toxicities between treatment arms.

Conclusions

The CAPOX50 regimen did not improve local control, disease-free survival and overall survival in the ACCORD12 trial. Late toxicities did not differ between treatment arms.

Ozone exposure and flux-based response functions for photosynthetic traits in wheat, maize and poplar

Ozone exposure- and dose-response relationships based on photosynthetic leaf traits (CO2 assimilation, chlorophyll content, Rubisco and PEPc activities) were established for wheat, maize and poplar plants grown in identical controlled conditions, providing a comparison between crop and tree species, as well as between C3 and C4 plants. Intra-specific variability was addressed by comparing two wheat cultivars with contrasting ozone tolerance. Depending on plant models and ozone levels, first-order, second-order and segmented linear regression models were used to derive ozone response functions. Overall, flux-based functions appeared superior to exposure-based functions in describing the data, but the improvement remained modest. The best fit was obtained using the POD0.5 for maize and POD3 for poplar. The POD6 appeared relevant for wheat, although intervarietal differences were found. Our results suggest that taking into account the dynamics of leaf antioxidant capacity could improve current methods for ozone risk assessment for plants.

Distinct responses to ozone of abaxial and adaxial stomata in three Euramerican poplar genotypes

Ozone induces stomatal sluggishness, which impacts photosynthesis and transpiration. Stomatal responses to variation of environmental parameters are slowed and reduced by ozone and may be linked to difference of ozone sensitivity. Here we determine the ozone effects on stomatal conductance of each leaf surface. Potential causes of this sluggish movement, such as ultrastructural or ionic fluxes modification, were studied independently on both leaf surfaces of three Euramerican poplar genotypes differing in ozone sensitivity and in stomatal behaviour. The element contents in guard cells were linked to the gene expression of ion channels and transporters involved in stomatal movements, directly in microdissected stomata. In response to ozone, we found a decrease in the stomatal conductance of the leaf adaxial surface correlated with high calcium content in guard cells compared with a slight decrease on the abaxial surface. No ultrastructural modifications of stomata were shown except an increase in the number of mitochondria. The expression of vacuolar H(+) /Ca(2+) -antiports (CAX1 and CAX3 homologs), β-carbonic anhydrases (βCA1 and βCA4) and proton H(+) -ATPase (AHA11) genes was strongly decreased under ozone treatment. The sensitive genotype characterized by constitutive slow stomatal response was also characterized by constitutive low expression of genes encoding vacuolar H(+) /Ca(2+) -antiports.

The CHAP domain of Cse functions as an endopeptidase that acts at mature septa to promote Streptococcus thermophilus cell separation

Cell separation is dependent on cell wall hydrolases that cleave the peptidoglycan shared between daughter cells. In Streptococcus thermophilus, this step is performed by the Cse protein whose depletion resulted in the formation of extremely long chains of cells. Cse, a natural chimeric enzyme created by domain shuffling, carries at least two important domains for its activity: the LysM expected to be responsible for the cell wall-binding and the CHAP domain predicted to contain the active centre. Accordingly, the localization of Cse on S. thermophilus cell surface has been undertaken by immunogold electron and immunofluorescence microscopies using of antibodies raised against the N-terminal end of this protein. Immunolocalization shows the presence of the Cse protein at mature septa. Moreover, the CHAP domain of Cse exhibits a cell wall lytic activity in zymograms performed with cell walls of Micrococcus lysodeikticus, Bacillus subtilis and S. thermophilus. Additionally, RP-HPLC analysis of muropeptides released from B. subtilis and S. thermophilus cell wall after digestion with the CHAP domain shows that Cse is an endopeptidase. Altogether, these results suggest that Cse is a cell wall hydrolase involved in daughter cell separation of S. thermophilus.

Ozone-induced changes in photosynthesis and photorespiration of hybrid poplar in relation to the developmental stage of the leaves

Young poplar trees (Populus tremula Michx. x Populus alba L. clone INRA 717-1B4) were subjected to 120 ppb of ozone for 35 days in phytotronic chambers. Treated trees displayed precocious leaf senescence and visible symptoms of injury (dark brown/black upper surface stippling) exclusively observed on fully expanded leaves. In these leaves, ozone reduced parameters related to photochemistry (Chl content and maximum rate of photosynthetic electron transport) and photosynthetic CO(2) fixation [net CO(2) assimilation, Rubisco (ribulose-1,5-bisphosphate carboxylase oxygenase) activity and maximum velocity of Rubisco for carboxylation]. In fully expanded leaves, the rate of photorespiration as estimated from Chl fluorescence was markedly impaired by the ozone treatment together with the activity of photorespiratory enzymes (Rubisco and glycolate oxidase). Immunoblot analysis revealed a decrease in the content of serine hydroxymethyltransferase in treated mature leaves, while the content of the H subunit of the glycine decarboxylase complex was not modified. Leaves in the early period of expansion were exempt from visible symptoms of injury and remained unaffected as regards all measured parameters. Leaves reaching full expansion under ozone exposure showed potential responses of protection (stimulation of mitochondrial respiration and transitory stomatal closure). Our data underline the major role of leaf phenology in ozone sensitivity of photosynthetic processes and reveal a marked ozone-induced inhibition of photorespiration.

[Bone marrow necrosis in two patients with neoplastic disorders]

Bone marrow necrosis is defined by extensive necrosis of the myeloid tissue and bone marrow stroma. Diagnosis is done on characteristic cytological pattern of the bone marrow aspiration and/or biopsy. We report two observations. The first patient, aged 75, has been hospitalized for fever, asthenia and lower back pain. An haematological malignancy was suspected after observation of a few peripheral blood blast cells, but necrosis was found on the bone marrow aspiration and could not lead to further haematological diagnosis. Within next days, the white blood cell count and the number of blasts increased, leading to the diagnosis of acute monoblastic leukaemia. A chemotherapy was started but the patient died 20 days after admission. The second patient, aged 28, has been hospitalized for severe bleeding a few days after the diagnosis of a metastatic gastric tumour. The bone marrow aspiration, made for the evaluation of a thrombocytopenia, showed a massive necrosis. The patient deceased shortly after hospitalization. According to literature, bone marrow necrosis is in most instances secondary to either an haematological malignancy (60%) or to a solid tumour (30%), but only at times observed with a non-malignant disorder. Bone pain, fever, cytopenias and elevated serum lactic dehydrogenase and alkaline phosphatase are frequently reported, but are mostly non specific of the diagnosis in these malignant conditions. Examination of the bone marrow leads to the diagnosis: cells are pycnotic, scarcely recognizable in a background of amorphous extracellular eosinophilic proteinaceous material, and histology shows disappearance of fat spaces with preservation of the bone tissue. Tissue hypoxemia due to microcirculation failure may be the main mechanism leading to the necrosis, whatever the related disorder. Supportive care together with specific therapy of the causal disease must be started promptly. The prognosis depends on the underlying illness and is generally very poor when extensive necrosis is observed.

[Free and intracellular bacteria on peripheral blood smears: an uncommon situation related to an adverse prognosis]

Bacterial infections are responsible for several changes in the cell blood count, which are usually non specific, although some morphological changes of polymorphonuclear neutrophils may be indicative of sepsis. The presence of bacteria on peripheral blood smears is a rare but extreme situation, related in most instances to a fatal prognosis. The presence of both free and intracellular bacteria was observed in the peripheral blood smear of a critically ill patient with a pneumococcal septicaemia which led to a fatal outcome within the next following hours. If the finding of bacteria on the blood smear is a sign of severe sepsis, the literature review shows that less than 10% of septic patients demonstrate bacteria on the blood smear, and routine search for the diagnosis of sepsis is not recommended. Samples taken from infected central venous catheters are another situation of bacteraemia which must be known, but prognosis is usually not fatal if prompt medical care is performed. Some preanalytical conditions are also associated with the presence of bacteria on the peripheral blood smear, but unrelated to infection of the relevant patient.

Fungal hypaphorine reduces growth and induces cytosolic calcium increase in root hairs of Eucalyptus globulus

Root hairs are tubular cells resulting from a tip-localized growth in which calcium ions play a key role. Hypaphorine, an indole alkaloid secreted by the fungus Pisolithus microcarpus during the formation of ectomycorrhizae with the host plant Eucalyptus globulus, inhibits root hair tip growth. Hypaphorine-induced inhibition is linked to a transient depolarization of the plasma membrane and a reorganization of the actin and microtubule cytoskeletons. Here we investigated the activity of hypaphorine on calcium distribution in E. globulus root hairs with the ratiometric fluorochrome calcium indicator Indo-1. In 85% of actively growing root hairs, a significant but modest calcium gradient between the apex and the base was observed due to an elevated cytoplasmic calcium concentration at the apical tip. Following exposure to 1 mM hypaphorine, the apical and basal cytoplasmic Ca(2+) concentration increased in 70 and 77% of the hairs, respectively, 10 min after treatment. This led to a reduced calcium gradient in 81% of the cells. The hypothetical links between calcium concentration elevation, regulation of actin cytoskeleton dynamics, and root hair growth inhibition in response to hypaphorine treatment are discussed.

[Refractory anaemia with ringed sideroblasts (RARS) associated with marked thrombocytosis: a provisional entity in the WHO classification of haematological malignancies]

The WHO classification describes a group of myelodysplastic/myeloproliferative diseases, including a provisional entity, refractory anaemia with ringed sideroblasts (RARS) associated with marked thrombocytosis, underlining that is a provisional entity without consensus of belonging to myelodysplastic rather than to myeloproliferative syndromes. The authors report two cases with features of refractory anaemia with excess of ringed sideroblasts and marked thrombocytosis. In the first case, RARS is concomitant with thrombocytosis and fits the WHO criteria for this temporary entity. The second case is a typical RARS, who developed a thrombocytosis after several years and emphasizes that a link, at least progressive, exists between RARS and myeloproliferative disorders. The authors summed up the various situations related to secondary or primary acquired sideroblastic anaemia, likewise to primitive and reactive thrombocytosis. The cases of RARS + marked thrombocytosis reported in the literature are few in number and do not allow to settle between a particular form of myelodysplastic syndrome and a myeloproliferative disorder, a fully justified reason to classify these patients in a temporary group. To date, there is no codified therapy for this disorders.

[MODY types of diabetes mellitus]

Maturity-onset diabetes of the young (MODY) is a monogenic subtype of diabetes mellitus characterized by a young onset of type 2 diabetes, some abnormalities of the beta-cell function and an autosomal dominant inheritance with high penetrance. MODY types represent less than 5% of all cases of type 2 diabetes. Six genetic mutations have been described, one of them affecting the glucokinase gene (MODY 2) and the others various transcription factors HNF-1alpha, HNF-4alpha, HNF-1beta, IPF-1 and NeuroD (MODY 1,3,4,5,6, respectively). These different underlying gene mutations are associated with different clinical forms of the disease. Among the two most frequent forms, MODY 2 (mutation of the glucokinase gene) has a benign clinical evolution whereas MODY 3 (mutation of HNF-1alpha gene) has a much more severe evolution. The recognition of the MODY diabetes is important in clinical practice and may lead to the discovery of new more specific molecular therapeutic targets.

[Ghrelin and obesity]

Ghrelin is a peptide hormone secreted by the stomach. It was initially described as a stimulant of growth hormone secretion. Soon, however, it was discovered to play an important role in feeding behaviour in animals and in appetite regulation in man: ghrelin stimulates appetite, and as such is an orexigenic peptide implicated in energy balance mechanisms and weight gain. Abnormal ghrelin activity leads to over- or underweight. Additionally, the efficacy of different treatment strategies against obesity seems to be related to modifications in plasma ghrelin levels. This review summarizes the current knowledge about ghrelin and its implications in obesity medicine.

Les plastes des cellules-hotes des mycorhizes à vésicules et arbuscules

In nonmycorrhizal roots, the plastids of cortical cells developed either into leucoplasts (Plectranîhus australis) or into amyloplasts (Prunus avium and Pirus malus). In cells infected with the endophyte of vesicular-arbuscular mycorrhizas, in all three species studied, the plastids were very long secretory leucoplasts with a well-developed stromatic tubular net. In woody Rosaceae, the absence of starch is thought to result from a disturbance in carbon metabolism caused by the endophyte. Differentiation into secretory leucoplasts with a stromatic tubular net may be the expression of a defense reaction.

[Randomized, comparative study on the treatment of moderate arterial hypertension during pregnancy: methyldopa, acebutolol, labetalol]

The aim of this prospective, monocentric, opened study and with random order for antihypertensive sequence was to compare a betablocker with sympathomimetic activity (ACE) and an alphabetablocker (LAB) to the gold standard treatment (MD) in moderate HDP (BP greater than 90 mmHg). This study (January 1984 to December 1985) includes 63 women, mean age 28.2 years, divided into three comparable subgroups (age, parity, risk factors and initial level of SBP/DBP). Initial doses are 500 mg/bid (MD), and 400 mg/bid (ACE, LAB) and optimal dosages could not be respectively more than 1500 mg/bid (MD) or 1200 mg/bid (ACE, LAB). Usual criteria for maternal and foetal care are taken into account. The chi 2 test, the Student "t" test and the Kruskall Wallis test were used for statistical analysis. The results show: 1--A similar antihypertensive effect for MD and LAB, but significantly less for ACE (initial PAD-37th week PAD: MD +/- 18.8 +/- 2; LAB = -17.9 +/- 3; ACE = - 8.2 +/- 2.7 mmHg, p less than 0.02; 2--A more frequent adjustment of daily dosage with MD (n = 15) than with ACE (n = 10) or LAB (n = 7); 3--The absence of any significant difference for uricemia level, platelet counts, foetal cardiac rythm, and occurrence of pre-eclampsia (MD = 4; ACE = 3; LAB = 4; 4--An equivalent birth-weight (MD = 3110 +/- 628 g; ACE = 3115 +/- 645.(ABSTRACT TRUNCATED AT 250 WORDS)

[Voluntary chloralose poisoning]

The authors report 114 cases of acute poisoning by rodenticides (chloralose). The clinical symptoms associate coma, myoclonic jerks and bronchorrhea. Metabolic acidosis is a common finding. Despite the initial gravity, the prognosis of chloralose intoxication is excellent, provided that a symptomatic treatment is instituted early.

[Treatment of arterial hypertension in pregnancy with an alpha-beta blocker. 58 Cases treated with labetalol]

The results of the treatment in hypertension with pregnancy by a alpha-beta blocker in 58 women show: the good tolerance of the drug and its lack of teratogenic effect, its quasi-constant efficiency (91%) in hypertension, its benefit repercussion on neonatal weight. However, this therapeutics requires a maternal careful watching all along pregnancy, and especially of the new-born children, with regard to the risk of hypoglycemia.

Acarbose in reactive hypoglycemia: a double-blind study

This study investigates the effect of Acarbose, a complex oligosaccharide of microbial origin with glucosidase-inhibiting properties in alimentary hypoglycemia secondary to rapid gastric emptying and in reactive hypoglycemia either isolated or associated with impaired glucose tolerance. Twenty-four patients complaining of symptoms suggesting hypoglycemia which occurred after meals and who showed blood glucose values of 2.5 mmol/l (45 mg/dl) or below on one or more occasions during a 5-h oral glucose tolerance test were selected and divided into three groups. Group I comprized seven patients with demonstrated rapid gastric emptying; group II comprized eight patients with impaired glucose tolerance, whereas the nine patients of group III were considered to present with "isolated reactive hypoglycemia" since they had a normal glucose tolerance and did not have either glycosuria or gastroduodenal pathology. All patients were submitted to two oral 75-g sucrose tolerance tests. Acarbose (100 mg) or placebo was ingested with the first drought of the sucrose solution administered in a randomized order. The investigation was performed in a double-blind manner. In all three groups Acarbose significantly reduced the magnitude of post-sucrose reactive hypoglycemia. The blood glucose nadir also occurred later, but this effect was statistically significant in group II only. In patients of groups II and III, such improvement of the glucose nadirs was preceded by a significant reduction of the post-sucrose glycemic peak. In all three groups, the insulin response to oral sucrose was reduced by Acarbose. Another consistent finding was the lack of sucrose-induced glucagon suppression when Acarbose was given. These data suggest that Acarbose might be a useful adjunct to the management of functional hypoglycemia.

Improvement of metabolic control in insulin dependent diabetics treated with the alpha-glucosidase inhibitor acarbose for two months

Acarbose, an alpha-glucosidase inhibitor, delays starch digestion and inhibits intestinal sucrase and maltase activity. Twenty-eight insulin dependent diabetics were given Acarbose (3 x 100 mg daily) over a two month period, preceded and followed by a two month placebo period. Acarbose reduced post-breakfast and post-dinner blood glucose values by 25% (p less than 0.001) and 24% (p less than 0.05) respectively. It also significantly reduced mean daily blood glucose by 18% (p less than 0.05) and mean amplitude of glycaemic excursions from 8.0 +/- 0.6 to 5.5 +/- 0.4 mmol/l (p less than 0.0005). Weight did not change significantly. Daily caloric and carbohydrate intake remained constant throughout the study while insulin requirements decreased slightly but significantly. Out of the 28 patients, 18 had absent while ten had slight residual B cell function as assessed by plasma C-peptide measurements. Treatment with Acarbose did not significantly affect residual B cell function. The beneficial effect of Acarbose on blood glucose control was seen in patients both with and without residual B cell secretion. The major side-effect was flatulence which was never severe enough to interrupt treatment, but led to a 50% reduction of the dose in one patient. It is concluded that Acarbose represents a useful additional means of improving metabolic control in insulin dependent diabetics.

[Seminoma of the ovary. Clincopathological study. The role of radiotherapy in treatment based upon a series of 31 cases (author's tranls)]

The authors collected a series of 31 cases of seminoma of the ovary over a period of 12 years. Statistical data, including the results of of lymphography, indicate that the prognosis is good, the application of strict rules in treatment being an essential condition. Certain patients with a pure seminoma of the ovary (20% of cases) die despite early and appropriate treatment. Such a fatal outcome occurs usually during the first 18 months. The prognosis in such cases may be explained in part by the degree of extension initially but the course in certain patients, fortunately rare, is quite dramatic. This can be explained neither on the basis of the histological type nor any inadequacy in therapy. Some special unknown factor must be involved. In general combined surgery and radiotherapy, adapted to the degree of extension of the disease, give the best change of definitive cure and, for the majority of patients, an entirely normal life from a feminine and maternal standpoint. This possibility of combining cure with conservation remains the basis of treatment of seminoma of the ovary in favourable cases.