More than one quarter of Africa's tree cover is found outside areas previously classified as forest

The consistent monitoring of trees both inside and outside of forests is key to sustainable land management. Current monitoring systems either ignore trees outside forests or are too expensive to be applied consistently across countries on a repeated basis. Here we use the PlanetScope nanosatellite constellation, which delivers global very high-resolution daily imagery, to map both forest and non-forest tree cover for continental Africa using images from a single year. Our prototype map of 2019 (RMSE = 9.57%, bias = -6.9%). demonstrates that a precise assessment of all tree-based ecosystems is possible at continental scale, and reveals that 29% of tree cover is found outside areas previously classified as tree cover in state-of-the-art maps, such as in croplands and grassland. Such accurate mapping of tree cover down to the level of individual trees and consistent among countries has the potential to redefine land use impacts in non-forest landscapes, move beyond the need for forest definitions, and build the basis for natural climate solutions and tree-related studies.

ShcA promotes chondrocyte hypertrophic commitment and osteoarthritis in mice through RunX2 nuclear translocation and YAP1 inactivation

OBJECTIVE

Chondrocyte hypertrophic differentiation, a key process in endochondral ossification, is also a feature of osteoarthritis leading to cartilage destruction. Here we investigated the role of the adaptor protein Src homology and Collagen A (ShcA) in chondrocyte differentiation and osteoarthritis.

METHODS

Mice ablated for ShcA in osteochondroprogenitor cells were generated by crossing mice carrying the Twist2-Cre transgene with ShcA^flox/flox mice. Their phenotype (n = 5 to 14 mice per group) was characterized using histology, immuno-histology and western-blot. To identify the signaling mechanisms involved, in vitro experiments were conducted on wild type and ShcA deficient chondrocytes (isolated from n = 4 to 7 littermates) and the chondroprogenitor cell line ATDC5 (n = 4 independent experiments) using western-blot, cell fractionation and confocal microscopy.

RESULTS

Deletion of ShcA decreases the hypertrophic zone of the growth plate (median between group difference -11.37% [95% confidence interval -17.34 to -8.654]), alters the endochondral ossification process, and leads to dwarfism (3 months old male mice nose-to-anus length -1.48 cm [-1.860 to -1.190]). ShcA promotes ERK1/2 activation, nuclear translocation of RunX2, the master transcription factor for chondrocyte hypertrophy, while maintaining the Runx2 inhibitor, YAP1, in its cytosolic inactive form. This leads to hypertrophic commitment and expression of markers of hypertrophy, such as Collagen X. In addition, loss of ShcA protects from age-related osteoarthritis development in mice (2 years old mice OARSI score -6.67 [-14.25 to -4.000]).

CONCLUSION

This study reveals ShcA as a new player in the control of chondrocyte hypertrophic differentiation and its deletion slows down osteoarthritis development.

High-fidelity and large-scale reconfigurable photonic processor for NISQ applications

Reconfigurable linear optical networks are a key component for the development of optical quantum information processing platforms in the NISQ era and beyond. We report the implementation of such a device based on an innovative design that uses the mode mixing of a multimode fiber in combination with the programmable wavefront shaping of a SLM. The capabilities of the platform are explored in the classical regime. For up to 8 inputs and a record number of 38 outputs, we achieve fidelities in excess of 93%, and losses below 6.5dB. The device was built inside a standard server rack to allow for real world use and shows consistent performance for 2x8 circuits over a period of 10 days without re-calibration.

Determination of the optimal dose of ephedrine in the treatment of arterial hypotension due to general anesthesia in neonates and infants below 6 months old: the ephedrine study protocol for a randomized, open-label, controlled, dose escalation trial

BACKGROUND

Arterial hypotension induced by general anesthesia is commonly identified as a risk factor of morbidity, especially neurological, after cardiac or noncardiac surgery in adults and children. Intraoperative hypotension is observed with sevoflurane anesthesia in children, in particular in neonates, infants younger than 6 months, and preterm babies. Ephedrine is commonly used to treat intraoperative hypotension. It is an attractive therapeutic, due to its dual action on receptors alpha and beta and its possible peripheral intravenous infusion. There are few data in the literature on the use of ephedrine in the context of pediatric anesthesia. The actual recommended dose of ephedrine (0.1 to 0.2 mg/Kg) frequently leads to a therapeutic failure in neonates and infants up to 6 months of age. The use of higher doses would probably lead to a better correction of hypotension in this population. The objective of our project is to determine the optimal dose of ephedrine for the treatment of hypotension after induction of general anesthesia with sevoflurane, in neonates and infants up to 6 months of age.

METHODS

The ephedrine study is a prospective, randomized, open-label, controlled, dose-escalation trial. The dose escalation consists of 6 successive cohorts of 20 subjects. The doses studied are 0.6, 0.8, 1, 1.2, and 1.4 mg/kg. The dose chosen as the reference is 0.1 mg/kg, the actual recommended dose. Neonates and infants younger than 6 months, males and females, including preterm babies who undergo a surgery with general anesthesia inducted with sevoflurane were eligible. Parents of the subject were informed. Then, the subjects were randomized if presenting a decrease in mean blood pressure superior to 20% of their initial mean blood pressure (before induction of anesthesia), despite a vascular filling with sodium chloride 0.9%. The primary outcome is the success of the therapy defined as an mBP superior to 80% of the baseline mBP (prior to anesthesia) within 10 min post ephedrine administration. The subjects were followed-up for 3 days postanesthesia.

DISCUSSION

This study is the first randomized, controlled trial intending to determine the optimal dose of ephedrine to treat hypotension in neonates and infants below 6 months old.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02384876 . Registered on March 2015.

The potential to characterize ecological data with terrestrial laser scanning in Harvard Forest, MA

Contemporary terrestrial laser scanning (TLS) is being used widely in forest ecology applications to examine ecosystem properties at increasing spatial and temporal scales. Harvard Forest (HF) in Petersham, MA, USA, is a long-term ecological research (LTER) site, a National Ecological Observatory Network (NEON) location and contains a 35 ha plot which is part of Smithsonian Institution's Forest Global Earth Observatory (ForestGEO). The combination of long-term field plots, eddy flux towers and the detailed past historical records has made HF very appealing for a variety of remote sensing studies. Terrestrial laser scanners, including three pioneering research instruments: the Echidna Validation Instrument, the Dual-Wavelength Echidna Lidar and the Compact Biomass Lidar, have already been used both independently and in conjunction with airborne laser scanning data and forest census data to characterize forest dynamics. TLS approaches include three-dimensional reconstructions of a plot over time, establishing the impact of ice storm damage on forest canopy structure, and characterizing eastern hemlock (Tsuga canadensis) canopy health affected by an invasive insect, the hemlock woolly adelgid (Adelges tsugae). Efforts such as those deployed at HF are demonstrating the power of TLS as a tool for monitoring ecological dynamics, identifying emerging forest health issues, measuring forest biomass and capturing ecological data relevant to other disciplines. This paper highlights various aspects of the ForestGEO plot that are important to current TLS work, the potential for exchange between forest ecology and TLS, and emphasizes the strength of combining TLS data with long-term ecological field data to create emerging opportunities for scientific study.

Classifying ecosystems with metaproperties from terrestrial laser scanner data

In this study, we introduce metaproperty analysis of terrestrial laser scanner (TLS) data, and demonstrate its application through several ecological classification problems. Metaproperty analysis considers pulse level and spatial metrics derived from the hundreds of thousands to millions of lidar pulses present in a single scan from a typical contemporary instrument. In such large aggregations, properties of the populations of lidar data reflect attributes of the underlying ecological conditions of the ecosystems.In this study, we provide the Metaproperty Classification Model to employ TLS metaproperty analysis for classification problems in ecology. We applied this to a proof-of-concept study, which classified 88 scans from rooms and forests with 100% accuracy, to serve as a template.We then applied the Metaproperty Classification Model in earnest, to separate scans from temperate and tropical forests with 97.09% accuracy (N = 224), and to classify scans from inland and coastal tropical rainforests with 84.07% accuracy (N = 270).The results demonstrate the potential for metaproperty analysis to identify subtle and important ecosystem conditions, including diseases and anthropogenic disturbances. Metaproperty analysis serves as an augmentation to contemporary object reconstruction applications of TLS in ecology, and can characterize regional heterogeneity.

Glucantime-resistant Leishmania tropica isolated from Iranian patients with cutaneous leishmaniasis are sensitive to alternative antileishmania drugs

Cutaneous leishmaniasis (CL) is a major health problem in endemic areas of Iran. The pentavalent antimony (SbV) based drug Glucantime is the first line of treatment for CL in Iran, but recently SbV-resistant Leishmania tropica isolates derived from unresponsive patients were reported. We show in this study that these resistant parasites are cross-resistant to the other SbV-containing drug Pentostam and at least for one isolate also to amphotericin B. However, these resistant isolates were shown to be sensitive to miltefosine and paromomycin. The latter two drugs could thus be useful alternatives for the treatment of leishmaniasis in Iran even for SbV-resistant isolates.

Nonlinear Receding-Horizon Control of Rigid Link Robot Manipulators

The approximate nonlinear receding-horizon control law is used to treat the trajectory tracking control problem of rigid link robot manipulators. The derived nonlinear predictive law uses a quadratic performance index of the predicted tracking error and the predicted control effort. A key feature of this control law is that, for their implementation, there is no need to perform an online optimization, and asymptotic tracking of smooth reference trajectories is guaranteed. It is shown that this controller achieves the positions tracking objectives via link position measurements. The stability convergence of the output tracking error to the origin is proved. To enhance the robustness of the closed loop system with respect to payload uncertainties and viscous friction, an integral action is introduced in the loop. A nonlinear observer is used to estimate velocity. Simulation results for a two-link rigid robot are performed to validate the performance of the proposed controller.

Hepatic lipogenesis and cholesterol synthesis in hyperthyroid patients

To determine the effect of hyperthyroidism on hepatic lipogenesis and cholesterol synthesis we measured these metabolic pathways (deuterated water method) in euthyroid and hyperthyroid subjects investigated in the postabsorptive state. Hyperthyroid patients had increased concentrations of glucose (P < 0.05), insulin (P < 0.05), nonesterified fatty acids (P < 0.01), and triglycerides (P < 0.05) and decreased levels of plasma cholesterol (P < 0.01). The contribution of hepatic lipogenesis to plasma triglycerides was largely increased in hyperthyroid subjects (23.0 +/- 1.8% vs. 7.5 +/- 0.2%; P < 0.001), whereas the fractional synthetic rate of cholesterol was moderately higher (5.0 +/- 0.8% vs. 3.3 +/- 0.2%; P < 0.05). mRNA levels of beta-hydroxy-beta-methyl glutaryl-coenzyme A reductase, measured in circulating mononuclear cells, were increased (P < 0.05), whereas those of low density lipoprotein (LDL) receptor and LDL receptor-related protein were unchanged. Sterol responsive element binding protein-1c mRNAs were undetectable in mononuclear cells from both groups of subjects. The large stimulation of hepatic lipogenesis in hyperthyroid patients is probably explained by both a direct action of thyroid hormones and the increase in insulin. It could contribute to their moderate rise in triglycerides levels. The decreased plasma cholesterol level is observed despite an enhanced synthetic rate and is thus related to an increased clearance rate. The lack of increased expression of LDL receptor and LDL receptor-related protein suggests that other receptors are implicated.

Nutritional parameters modify muricidal behavior of male Wistar rats: preventive effects of amino acids and 4' Cl diazepam

In male Wistar rats fed a diet enriched in polyunsaturated fatty acids and starch (PUFA+S), the percentage of muricidal (Mu) rats increased to 82% within 60 days. Mu rats had higher serum triglyceride levels and lower cholesterol levels than non-Mu rats. Water intake decreased in all rats on the PUFA+S diet concurrently with the increase in the proportion of Mu rats; protracted water restriction in rats fed standard diet also increased the percentage of Mu rats. In the offspring of two Wistar females fed the PUFA+S diet, the proportion of young Mu rats was 67%. When the PUFA+S diet was replaced with standard diet, the induced Mu behavior was not reversed. PK11195 (6 mg/kg i.p.), clonazepam (0.2 mg/kg i.p.), and flumazenil (15 mg/kg i.p.) were ineffective in reversing the induced Mu behavior, whereas 4'-chlorodiazepam (5 mg/kg i.p.) or muscimol (0.5 mg/kg i.p.) caused reversals of 63% or 50%, respectively. A 5-hydroxytryptophan overload (60 mg/kg i.p.) also reversed Mu behavior by 71%. All reversal effects were temporary. Pretreatment with yeast for 7 days before the PUFA+S diet was given prevented induction for more than 90 days on the PUFA+S diet, while similar pretreatment 4'Cl-diazepam resulted in 71% prevention of induction. The results are analyzed in terms of the involvement of endozepin, vasopressin, and serotonin receptors, and of possible genetic parameters.

Effects of isoenergetic high-carbohydrate compared with high-fat diets on human cholesterol synthesis and expression of key regulatory genes of cholesterol metabolism

BACKGROUND

High-carbohydrate diets improve plasma cholesterol concentrations but increase triacylglycerol concentrations; the latter effect increases the risk of cardiovascular disease (CVD). Triacylglycerol concentrations increase only during very-high-carbohydrate diets consisting mainly of simple sugars.

OBJECTIVE

We compared the CVD risk profile, cholesterol metabolism, and glucose tolerance of 7 healthy subjects during 2 isoenergetic diets: a high-fat, low-carbohydrate diet (HF diet) and a moderately high-carbohydrate, low-fat diet (HC diet).

DESIGN

In a randomized crossover study, we measured the effects of the HF diet [40% carbohydrate and 45% fat (15% saturated, 15% monounsaturated, and 15% polyunsaturated)] and HC diet [55% carbohydrate (mainly complex) and 30% fat (10% saturated, 10% monounsaturated, and 10% polyunsaturated)] (3 wk each) on plasma lipid concentrations, oral glucose tolerance, cholesterol synthesis rate, and the messenger RNA (mRNA) concentrations of beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase, the LDL receptor, and the LDL-receptor-related protein (LRP).

RESULTS

Compared with the HF diet, the HC diet lowered total, LDL, and HDL cholesterol (P < 0.05 for all) without modifying the ratio of LDL to HDL cholesterol; triacylglycerol concentrations were unchanged. Lower cholesterol concentrations occurred despite a higher cholesterol synthesis rate (P < 0.05) and higher HMG-CoA reductase mRNA concentrations (P < 0.05). LDL receptor mRNA concentrations were unchanged, LRP mRNA concentrations were lower (P < 0.01), and oral glucose tolerance was better (P < 0.05) with the HC diet.

CONCLUSION

The beneficial effects of the HC diet on glucose tolerance and plasma cholesterol concentrations without increases in triacylglycerol show that this diet had favorable effects on both insulin sensitivity and the plasma lipid profile.

[Randomized controlled trial of medical and medico-surgical treatment of Hansen's neuritis]

The aim of the study was to compare the results of the medical treatment alone and of the medico-surgical treatment on leprous neuritis. The patients were followed-up during 2 years, with regular neurological evaluations. The statistical study was performed using the Tukey test. Ninety-three nerves (ulnar, median, common peroneal and posterior tibial) with a deficit of less than 6 months duration have been studied in 31 leprosy patients. All the patients were treated by steroids but in some of them a nerve surgical decompression was performed. An improvement of the sensitive and motor deficit was observed in both groups. No significant statistical differences appeared between the 2 groups according to the nerve involved, the duration of the deficit, the form of leprosy and the type of antibacillary treatment. However, the medico-surgical treatment had a significant better result on pain and on major but incomplete nervous involvement. This study included a limited number of nerves, thus, it would be useful to perform others randomized assays to better define the indications of surgical decompression in the management of leprous neuritis.

Dietary lipids affect human ethanol-inducible CYP2E1 gene expression in vivo in mononuclear cells

We tested the hypothesis that dietary cholesterol modulate human ethanol-inducible CYP2E1 expression in vivo in circulating mononuclear cells. Healthy volunteers (n= 10) were submitted to a low fat low cholesterol diet for 4 days (day 0-day 3, LFLC). Cholesterol (595 +/- 56 mg/day) was then reintroduced for 7 days (day 4-day 10, LFHC). In the same time, controls subjects (n=7) did not change their habitual daily diet. CYP2E1 mRNA levels, evaluated in mononuclear cells, decreased in experimental subjects during both LFLC and LFHC from 100% to 53 +/- 5%, (p<0.001) with a main decrease during LFLC period (100% to 71 +/- 16%, p=0.05). Immunoreactive CYP2E1 showed a similar pattern and decreased from 100 to 62 +/- 12% during the trial (p<0.05). No significant change occured in control subjects. Between day 0 and day 11, changes in CYP2E1 mRNA correlated positively with plasma cholesterol (r2=0.67, p<0.001) and HDL cholesterol concentrations (r2=0.61, p<0.001). In contrast, no correlation was found between plasma fatty acids concentrations and CYP2E1 expression. The present results suggest that lipid factors regulate CYP2E1 expression, in vivo, in human mononuclear cells. In particular, plasma cholesterol concentrations may play an important role in this regulation.

Thiopurine S-methyltransferase gene polymorphism is predictive of azathioprine-induced myelosuppression in heart transplant recipients

Azathioprine (AZA) is metabolized via the cytosolic enzyme thiopurine S-methyltransferase (TPMT). TPMT activity exhibits genetic polymorphism with four prevalent (75%) mutant alleles TPMT*2 (G238C) and TPMT*3 (A719G and/or G460A) and a wild-type allele TPMT*1. To test the hypothesis that presence of these mutations is associated with greater toxicity of AZA in heart transplant recipients, 30 consecutive patients treated with AZA were followed up for the first month after heart transplant. Mutation of TPMT gene (mutation-specific polymerase chain reaction-based methods) was observed in four patients (A719G: n = 2; A719G plus G460: n = 2). Agranulocytosis did not occur in patients with the wild genotype. It occurred in the two patients with mutation A719G and there was a 40% drop in neutrophils in the two other patients. Discontinuation of AZA in the four mutant patients corrected for the drop. Presence of TPMT mutations is associated with a greater likelihood of agranulocytosis. Determination of these mutations could reduce the risk for hematological side-effects.

Effect of dietary cholesterol on low density lipoprotein-receptor, 3-hydroxy-3-methylglutaryl-CoA reductase, and low density lipoprotein receptor-related protein mRNA expression in healthy humans

We investigated the possibility that dietary cholesterol downregulates the expression of low density lipoprotein (LDL) receptor and 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase genes of circulating mononuclear cells in vivo in healthy humans. We also studied the variations of the LDL receptor-related protein (LRP) gene in the same conditions. Dieters (n = 5) were submitted to a 4-d fat restriction (mean cholesterol intake: 6+/-4 mg/d), followed by a 7-d cholesterol (a mean of 791+/-150 mg/d) supplementation. Controls (n = 3) did not change their diet. During fat restriction, serum total and LDL cholesterol decreased significantly (P < 0.05), and LDL receptor and HMG-CoA reductase mRNA copy numbers in mononuclear cells increased by 57 and 147%, respectively (P < 0.05). After reintroducing cholesterol, serum cholesterol was stable whereas LDL receptor and HMG-CoA reductase mRNA decreased by 46 and 72% (P < 0.05) and LRP mRNA increased by 59% (P < 0.005). The changes in LDL receptor and HMG-CoA reductase mRNA abundance were correlated (r = +0.79, P = 0.02) during cholesterol reintroduction as were LDL receptor and LRP mRNA levels, but negatively (r = -0.70, P = 0.05). Also, 70% of the variability in LRP mRNA (P < 0.005) was explained by dietary cholesterol. Thus, the basic mechanisms regulating cellular cholesterol content, the coordinate feedback repression of genes governing the synthesis and uptake of cholesterol, are operating in vivo in humans. However, serum cholesterol did not increase in response to dietary cholesterol, suggesting that these mechanisms may not play as predominant a role as previously believed in the short-term control of serum cholesterol in vivo in humans. A new finding is that LRP gene is also sensitive to dietary cholesterol, suggesting that it may participate in the control of serum cholesterol. Further in vivo studies in humans are warranted to explore the molecular mechanisms of the physiological response to dietary cholesterol in humans.

Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate

BACKGROUND

The Mediterranean dietary pattern is thought to reduce the risk of cancer in addition to being cardioprotective. However, no trial has been conducted so far to prove this belief.

METHODS

We compared overall survival and newly diagnosed cancer rate among 605 patients with coronary heart disease randomized in the Lyon Diet Heart Study and following either a cardioprotective Mediterranean-type diet or a control diet close to the step 1 American Heart Association prudent diet.

RESULTS

During a follow-up of 4 years, there were a total of 38 deaths (24 in controls vs 14 in the experimental group), including 25 cardiac deaths (19 vs 6) and 7 cancer deaths (4 vs 3), and 24 cancers (17 vs 7). Exclusion of early cancer diagnoses (within the first 24 months after entry into the trial) left a total of 14 cancers (12 vs 2). After adjustment for age, sex, smoking, leukocyte count, cholesterol level, and aspirin use, the reduction of risk in experimental subjects compared with control subjects was 56% (P=.03) for total deaths, 61% (P=.05) for cancers, and 56% (P=.01) for the combination of deaths and cancers. The intakes of fruits, vegetables, and cereals were significantly higher in experimental subjects, providing larger amounts of fiber and vitamin C (P<.05). The intakes of cholesterol and saturated and polyunsaturated fats were lower and those of oleic acid and omega-3 fatty acids were higher (P<.001) in experimental subjects. Plasma levels of vitamins C and E (P<.05) and omega-3 fatty acids (P<.001), measured 2 months after randomization, were higher and those of omega-6 fatty acids were lower (P<.001) in experimental subjects.

CONCLUSIONS

This randomized trial suggests that patients following a cardioprotective Mediterranean diet have a prolonged survival and may also be protected against cancer. Further studies are warranted to confirm the data and to explore the role of the different lipids and fatty acids in this protection.

Gait problems in diabetic neuropathic patients

OBJECTIVE

To examine whether a reduced peripheral sensibility caused by diabetic neuropathy increases the attentional demands necessary for controlling and regulating gait.

DESIGN

Nonrandomized control trial.

SETTING

University motor performance laboratory.

SUBJECTS

Twelve diabetic patients with peripheral neuropathy and 7 control subjects, all volunteers.

INTERVENTIONS

All subjects first performed a control seated reaction time task. For the walking task, auditory stimuli were randomly presented in the third, fourth, or fifth walking cycle on left foot toe off on left foot heel contact. The subject's task was to respond verbally as fast as possible to the auditory stimulus, while maintaining progression.

MAIN OUTCOME MEASURES

Simple reaction times and kinematics of the gait pattern (cycle amplitude, cycle duration, cycle speed, cadence and percentage of time spent in the single support phase) were evaluated.

RESULTS

For the walking task, diabetic neuropathic patients had a smaller cycle amplitude, cycle speed, and percentage of time spent in the single support phase than control subjects. Also, reaction times while walking were higher for diabetic neuropathic patients than for control subjects.

CONCLUSIONS

Diabetic neuropathic patients show a less destabilizing and more conservative gait than control subjects. The increased attentional demands in gait for the diabetic neuropathic patients, along with their more conservative gait pattern, suggest that a lack of proprioception from the legs affects the control of gait. Diminished sensory information makes gait control more cognitively dependent in diabetic neuropathic persons than in control subjects.

Spermoculture: improvement of the bacteriological quality of samples by direct verbal counseling before semen collection

OBJECTIVE

To compare the bacteriologic quality of samples after direct verbal or written counseling for semen collection.

DESIGN

Prospective randomized comparative study.

SETTING

Laboratories of biology of reproduction and microbiology in university hospitals.

PATIENTS

Male partners of infertile couples on their first attempt to collect semen were assigned randomly into two groups.

INTERVENTION

In one group (n = 52) the patients were given direct verbal instruction by one of the investigators on how to avoid bacterial contamination during semen collection. In the other group (n = 52) the patients were asked to follow the usual written instructions.

MAIN OUTCOME MEASURE

Bacterial count, number of species, classification of the samples in positive, negative, and noninformative cultures.

RESULTS

Direct verbal teaching significantly reduced the bacterial count (2.06 +/- 1.6 versus 3.29 +/- 1.6 log cfu/mL; mean +/- SD) and number of species (1.44 +/- 2.02 versus 3.25 +/- 2.25), increased the percentage of sterile cultures (59.6% versus 23.1%), and decreased the percentage of noninformative cultures (29.9% versus 50%).

CONCLUSION

Direct verbal counseling on how to avoid bacterial contamination during semen collection significantly improves the bacteriologic quality of the samples.

Modern war surgery: the experience of Bosnia. 2: The clinical experience

A Canadian field surgical hospital was deployed in the former Yugoslavia to support the medical needs of Canadian and other United Nations troops. Over a 6-month period, 5661 patients were seen and 50 surgical procedures performed. Gunshot, shrapnel and other blast injuries were responsible for the injury in only 10 patients seen at the hospital. Strict adherence to the concepts of hygiene, safety and trauma prevention is essential for the proper health care of large groups of peacekeepers abroad. Civilian involvement was limited by political restrictions, but a few civilians were helped. The ability to provide modern medicine in the field of battle boosted the morale of the Canadian troops.

Modern war surgery: the experience of Bosnia. 1: Deployment

In the first of two papers on the experience of a Canadian military surgical team in the former Yugoslavia, the authors describe the deployment of the field surgical hospital, the medical structure that supported the Canadian battle group. The hospital was made up of tent sections erected within an unfinished concrete factory building. The hospital comprised a treatment area for sick parades and reception, a pharmacy, a resuscitation area for nonambulatory casualties, a laboratory, an x-ray section, an operating room and sterilization section and a ward. The hospital could be mobilized if necessary. The setup proved to be functional for the treatment of injured soldiers. Although long delays were expected because of difficulties in transporting the injured, the patients reached the hospital in a reasonable time after injury and could be treated satisfactorily. During the period of its deployment, this hospital was used more than any other Canadian hospital in the United Nations mission. This experience allowed the authors to identify deficiencies and to correct them quickly.

Postural stability in diabetic polyneuropathy

OBJECTIVE

To examine whether sensory changes in lower limbs associated with diabetic sensory polyneuropathy compromise postural stability in different visual sensory conditions.

RESEARCH DESIGN AND METHODS

The presence and severity of sensory neuropathy was evaluated with a clinical scale and measures of nerve conduction velocity in the lower limbs. Balance control was evaluated by testing subjects' postural stability (with a force platform) with vision, without vision, and during a recovery period after being without vision.

RESULTS

Neuropathic patients showed larger ranges of sway, a faster sway speed, and a greater dispersion of sway than control subjects in all conditions. They also exhibited similar or less stable postural performance with vision than that of control subjects without vision. There was a strong relationship between the severity of the neuropathy and the postural stability.

CONCLUSIONS

This experiment highlights that even with vision, the postural stability of neuropathic patients is impaired and may put them at higher risk of falling when performing more challenging daily tasks.

Comparison of two HLA-DRB high resolution microtiter plate reverse hybridization typing methods: advantage of a codon-86 valine or glycine PCR segregation

Two rapid, nonisotopic, high-resolution HLA-DRB typing methods have been developed for DRB1, DRB3, DRB4 and DRB5 alleles. These methods are based on a single procedure consisting of the reverse hybridization of biotinylated amplicons to oligonucleotide probes that are covalently attached to a microtiter plate. Detection is by an enzymatic reaction with a fluorescent substrate. The 1 Generic Amplification (1GA) method amplifies all HLA-DRB alleles in the same reaction mix. The 2 Allelic Subset Amplification (2SA) method uses two distinct amplification reactions that distributes all DRB alleles into two equal-size subsets, according to the codon 86 Gly or Val polymorphism; this adds an extra discrimination level to the typing. 108 samples were typed using the 1GA and the 2SA methods and no discrepancies were found. Typing indeterminations due to overlapping probe combinations were compared; it was found that the 2SA method, with the extra discrimination level at the PCR step, greatly improved resolution.

Inhibition of proteolysis and cell cycle progression in a multiubiquitination-deficient yeast mutant

The degradation of many proteins requires their prior attachment to ubiquitin. Proteolytic substrates are characteristically multiubiquitinated through the formation of ubiquitin-ubiquitin linkages. Lys-48 of ubiquitin can serve as a linkage site in the formation of such chains and is required for the degradation of some substrates of this pathway in vitro. We have characterized the recessive and dominant effects of a Lys-48-to-Arg mutant of ubiquitin (UbK48R) in Saccharomyces cerevisiae. Although UbK48R is expected to terminate the growth of Lys-48 multiubiquitin chains and thus to exert a dominant negative effect on protein turnover, overproduction of UbK48R in wild-type cells results in only a weak inhibition of protein turnover, apparently because the mutant ubiquitin can be removed from multiubiquitin chains. Surprisingly, expression of UbK48R complements several phenotypes of polyubiquitin gene (UB14) deletion mutants. However, UbK48R cannot serve as a sole source of ubiquitin in S. cerevisiae, as evidenced by its inability to rescue the growth of ubi1 ubi2 ubi3 ubi4 quadruple mutants. When provided solely with UbK48R, cells undergo cell cycle arrest with a terminal phenotype characterized by replicated DNA, mitotic spindles, and two-lobed nuclei. Under these conditions, degradation of amino acid analog-containing proteins is severely inhibited. Thus, multiubiquitin chains containing Lys-48 linkages play a critical role in protein degradation in vivo.

Neutralizing antibodies and immunoprotection against pertussis and tetanus obtained by use of a recombinant pertussis toxin-tetanus toxin fusion protein

The currently available diphtheria-tetanus-whole-cell pertussis (DTP) vaccines are associated with a variety of problems, including undesirable side effects and inconsistent efficacy. These problems are probably related to the poor definition of such vaccines, especially with respect to the whole-cell component against pertussis. Ideal vaccines should include only immunoprotective antigens with no toxin activity. As an initial step towards obtaining a well-defined and simplified DTP vaccine, a pertussis toxin-tetanus toxin chimeric protein was constructed. A soluble form of the pertussis toxin S1 subunit was fused to the protective fragment C of tetanus toxin, and the recombinant hybrid protein was produced in Escherichia coli. The 75-kDa fusion protein (p75) was overexpressed as a soluble molecule and purified to near homogeneity by two consecutive chromatographic steps. Purified p75 retained its ability to bind to ganglioside GT1b, the receptor for tetanus toxin, and to be recognized by protective and neutralizing anti-pertussis toxin antibodies specific for conformational epitopes. When administered to mice, the hybrid protein was found to be nontoxic but immunogenic. In addition, it was capable of inducing strong protection against tetanus and some protection against pertussis, as well as eliciting a pertussis toxin-neutralizing antibody response. Although the levels of anti-pertussis toxin antibodies were rather low, neutralizing titers of the immunized mice correlated well with anti-pertussis toxin titers, indicating that protective epitopes are conserved in the recombinant protein.

[Treatment of leprotic neuritis. Exclusive medical treatment or combined with decompression]

The authors consider the evolution of the treatment of leprotic neuritis based on homogenous series of numerous observations (a minimum of 250-300). These observations are well registered and documented with some results dimensioned by the classical A. L. E. R. T. tests carried out at intervals of time and verified by comparison between series only medical treatment and series of medico-surgical treatment. Considering some remote results and some comparative series, the indications of the exclusive medical treatment have been well defined, and the ones of the surgical decompression have been reduced. The early case finding of a leprotic neuritis by the mean of easy methods as well as its monitoring during its early specific treatment is essential. By this way we get an important proportion of functional results: satisfactory (50 p.c.) or interesting (20 p.c.). In the case of painful hypertrophia, the complementary decompression secure not only the functional recovery of mortricity, but also the epicritic sensibility.

Mapping of functional domains within the v-erb A oncogene protein: the remnants of the hormone binding domain play multiple, vital roles in protein action

The v-erb A oncogene represents a virally-transduced variant of a thyroid hormone receptor. Biochemical characterization of a series of mutant v-erb A proteins demonstrates that nuclear localization and DNA binding are both necessary for v-erb A function in the neoplastic cell and are mediated by multiple, overlapping domains within the v-erb A polypeptide. Domains of the v-erb A protein necessary for sequence-specific and sequence-independent DNA binding are distinguishable from one another, and encompass sequences projecting beyond the zinc-finger motifs themselves. Although unable to bind T3 thyroid hormone, the remnants of the hormone binding domain continue to play unanticipated essential roles in v-erb A protein function.

Myocardial perfusion imaging with a new radiotracer, technetium-99m-hexamibi (methoxy isobutyl isonitrile): comparison with thallium-201 imaging

Technetium-99m-hexamibi (methoxy isobutyl isonitrile) is a Tc-99m-hexakis analog that can be used as a myocardial perfusion imaging agent. This is a report of an initial study that was performed in four institutions to assess the feasibility of Tc-99m-hexamibi myocardial imaging for the detection of coronary artery disease in patients undergoing treadmill stress test. Thirty-three patients referred for evaluation of chest pain had two exercise stress tests, one with Tl-201 and at least 24 hours after, and a second one with Tc-99m-hexamibi. Myocardial planar imaging started 60 minutes after injection at stress of 10-20 mCi of Tc-99m-hexamibi. Because this agent does not redistribute in myocardium after a stress injection, a second injection of 10-20 mCi of Tc-99m-hexamibi was performed with the patient at rest a few days later. Qualitative assessment of both Tl-201 and Tc-99m-hexamibi myocardial distribution was performed in 297 left ventricle segments (three segments of each of three views). There was a good correlation for the presence of normality, scar, or ischemia with the two radiopharmaceuticals, both on a segment by segment (259/297, or 87.2%) and patient-by-patient basis (29/33, or 87.9%). The number of segments found ischemic with Tl-201 and with Tc-99m-hexamibi were nearly equal, as were the number that were normal with one radiopharmaceutical and ischemic by the other. This initial study demonstrates that it is possible to detect stress-induced abnormalities of myocardial perfusion with Tc-99m-hexamibi similar to Tl-201 imaging.

Genetic dissection of functional domains within the avian erythroblastosis virus v-erbA oncogene

The avian erythroblastosis virus v-erbA locus potentiates the oncogenic transformation of erythroid and fibroblast cells and is derived from a host cell gene encoding a thyroid hormone receptor. We report here the use of site-directed mutagenesis to identify and characterize functional domains within the v-erbA protein. Genetic lesions introduced into a putative hinge region or at the extreme C-terminus of the v-erbA coding domain had no significant effect on the biological activity of this polypeptide. In contrast, mutations introduced within the cysteine-lysine-arginine-rich center of the v-erbA coding region, a DNA-binding domain in the thyroid and steroid hormone receptors, abolished or severely compromised the ability of the viral protein to function. Our results suggest that the mechanism of action of the v-erbA protein in establishing the neoplastic phenotype is closely related to its ability to interact with DNA, presumably thereby altering expression of host target genes by either mimicking or interfering with the action of the normal c-erbA gene product.

The avian erythroblastosis virus erbA oncogene encodes a DNA-binding protein exhibiting distinct nuclear and cytoplasmic subcellular localizations

The protein product of the v-erbA oncogene of avian erythroblastosis virus was analyzed by use of site-specific antisera. The v-erbA protein was found to exist in distinct nuclear and cytoplasmic forms. Both nuclear and cytoplasmic species of the v-erbA protein were capable of binding to DNA, a property predicted based on the structural relatedness the v-erbA polypeptide shares with the thyroid and steroid hormone receptors. A mutation within the v-erbA coding region which inhibited DNA binding and nuclear localization also inhibited the ability of the v-erbA protein to potentiate erythroid transformation, consistent with a model of the v-erbA protein as a transcriptional regulator.

[Remote results of the surgical decompression of the posterior tibial nerve in the neuropathies of Hansen's disease]

Results are reported of surgery to the posterior tibial nerve affected by leprosy in 50 patients. A total of 90 neurolyses were performed using a similar technique. Study of the effect of surgery on the course of plantar sensitivity showed that 3 groups of nerves can be distinguished. Nerves in group 1 (21 totally paralyzed nerves) responded poorly to surgery (38% useful results) while on the contrary nerves in group 3 (non-paralyzed nerves) represented the ideal indication, surgery being truly prophylactic. In group 2 nerves a useful result was obtained in 82%. Indications for use of this surgical procedure are discussed, and more particularly the parameters affecting the quality of the results: severity of lesion, immunologic type of disease.

[Multi-drug therapy trials for leprosy in Senegal: first observations relative to liver tolerance of multibacillary patients. Therapeutic consequences]

The authors have studied tolerance of multibacillary patients to 4 MDT regimens. These 4 regimens consist of: One supervised part in which RMP-ETH combination in once-monthly administered; furthermore, in 2 of these regimens, is included one "starter phase" with daily doses of that combination for 2 months. One self-administered part during which CLO is associated either to DDS for new cases, or to ETH for relapses. Clinical Supervision: Out to 310 multibacillary patients, 7 cases of hepatitis with or without icterus, but no death due to the treatment. Interruptions of MDT have been temporary and have been observed in 0.9 to 5.6% of the patients according to the therapeutic regimen. Checking SGOT: The SGOT were abnormally high in 16.3% of the patients before treatment. These pre-existing liver damages do not favour the appearance of intolerance disorders. During MDT, abnormal increases in SGOT are observed in 27% of the patients but there is no exact correlation between the absorbed doses of ETH and the frequency in SGOT increases. The clinical or biological evidence of liver damages occur rather early (1st, 2nd month) in regimens with "starter phase", and later (4th-8th month) in those without "starter phase". But introduction of "Starter phase" does not increase the global frequency of such intolerance accidents. ETH combined with RMP, must be used under steady clinical and biological supervision. Recalling the results of a previous survey, the authors consider that a long duration of MDT is not necessary. For the multibacillary leprosy treatment, they propose a diphasic regimen, more easily applicable in the field than the WHO protocols. In this diphasic regimen, the only part which must be supervised is the initial "starter phase" of 2 month. It consists of daily administration of 3 antibacillary drug among which RMP and ETH. The second phase is a relay treatment using 2 drugs, CLO combined with DDS or ETH, self-administered until smear negativity.

[Analysis of the results of treatment of Hansen's neuritis]

The authors expose a retrospective study about 133 nervous contingents treated exclusivement by steroid-therapy. The objective is to study the influence on nerve-function recovery of the following parameters: clinic form, function (sensitive or motor) of the nerve, position of the nerve (ulnar, median...), nature of the antibiotherapy. The method is based on the comparison for average progress in relation with the initial score. It appears that tuberculoid nerves recovery is better and faster than the lepromatous one. But lepromatous nerves improvement keeps on the end of the second year. On the other hand, the results are not influenced by the nerve itself or its function. Concerning antibiotherapy, our results show à significant difference, in consideration of a better improvement in PCT-treated nerves. Nevertheless, these results have to be confirmed by a comparative experimentation.

[A trial of polychemotherapy of leprosy in the Dakar region. Initial observations on the acceptability of the protocols used]

Since 1982, in Dakar, a controlled essay tests the suitability of several short protocols of multidrug therapy (MDT), some of them being close to those advised by the WHO, others showing a starter stage of a two month daily MDT. In three years, 198 paucibacillary and 123 multibacillary patients have been treated. The short duration of these treatments leads to an important decrease in the load of the Department. The total rate of those who have not attended for the treatment is of 15.2% whereas it was of 52% with DDS monotherapy for a similar treatment duration. Those who gave up don't seem to live in Dakar. To judge by the diligence of the patients, the compliance seems excellent even for the protocols requiring a daily dose of ethionamide: 95% of paucibacillary, 76% of multibacillary patients have maximal attendance. The authors think that any MDT program: must be preceded by a retraining of staffs; must give a priority to the health education of the patients; must involve a home patient search for system.

[Prevention of perforating plantar ulcers: trial directed by a mobile team]

AIMS

to prevent the appearance of plantar ulcerations and then mutilations, by going in the field in order to: make suitable footwear, educate the patients, train the paramedical staff. Means: 1 fitted lorry, 1 physiotherapist, 1 shoemaker, and 1 educator.

RESULTS

In one year, 206 patients have been provided with shoes and followed up. Advice have been taken exactly in the leper villages in which the attendance rate is of 98%; this rate varies between 47 to 70% in the all-purpose dispensaries. Paramedical workers of all-purpose Health Centers did not take great interest in this action. After 6-12 months under observation: 84% of good results for the feet without deformity or slightly deformed; 51% for the deformed feet. The results are quite satisfactory for the feet without plantar ulcer at the beginning, and that whatever the food deformity stage. But for the feet wounded by plantar ulcer at the beginning, 33% of recovery have been reported after wearing these shoes.

[The value of electromyographic studies in leprosy]

In Dakar, during a definite period of time, all the new leprosy cases have been subjected to an electromyographic examination before treatment: a total of 37 patients and 518 examined nerves including all clinical forms: NCV: 33% of the examined nerves are found to be affected. The sensory nerves are frequently and early involved. In frequency order: sural (54%), posterior tibial (50%), sensory ulnar (35%), sensory median (29%), motor ulnar (28%), lateral popliteal (17%) and motor median (12%). The study of the SCV seems relatively more reliable than the sensory testing in the case of the ulnar and the median (75 comparisons): concordance in 69% of the cases; SCV only abnormal in 19%; sensory testing only abnormal in 12%. The EMG detection is superior to the motor testing and to the motor nerve conduction for the lateral popliteal (32 comparisons): 41% of concordant examination; 59% of differences among which 44% of anomalies revealed only by detection.

[Correction of the Hansen claw hand using direct Zancolli lasso procedures and 2 of its variations]

The procedure of the Zancolli "Lasso" or V direct Zancolli uses a flexor superficialis tendon which after a distal section is turned inside out and is fixed on itself after forming a loop around the proximal pulley of the sheath of the flexor. The mode of distal fixation being the same, the authors also study two different methods which resort either to one tendon for two, three or four fingers, or only to one strip of the flexor tendon for one finger. 45 cases of this kind of operation are reported. In the most important series in which the principle procedure has been used, the results are good in 80% of the mobile claws and average in 70% of the stiffened claws. The cases operated according to the two different methods, less numerous, give approximately the same results. The suggested indications are in favour of the changes in the procedure.