A new case of sodium-dependent multivitamin transporter defect occurring as a life-threatening condition responsive to early vitamin supplementation and literature review

BACKGROUND

Biallelic pathogenic variants in SLC5A6 resulting in sodium-dependent multivitamin transporter (SMVT) defect have recently been described as a vitamin-responsive inborn error of metabolism mimicking biotinidase deficiency. To our knowledge, only 16 patients have been reported so far with various clinical phenotypes such as neuropathy and other neurologic impairments, gastro-intestinal dysfunction and failure to thrive, osteopenia, immunodeficiency, metabolic acidosis, hypoglycemia, and recently severe cardiac symptoms.

METHODS

We describe a case report of a 5-month-old girl presenting two recurrent episodes of metabolic decompensation and massive cardiac failure in the course of an infectious disease. We compare clinical, biological, and genetic findings of this patient to previous literature collected from Pubmed database (keywords: Sodium-dependent multivitamin transporter (SMVT), SMVT defect/disorder/deficiency, SLC5A6 gene/mutation).

RESULTS

We highlight the life-threatening presentation of this disease, the stagnation of psychomotor development, the severe and persistent hypogammaglobulinemia, and additionally, the successful clinical response on early vitamin supplementation (biotin 15 mg a day and pantothenic acid 100 mg a day). Metabolic assessment showed a persistent increase of urinary 3-hydroxyisovaleric acid (3-HIA) as previously reported in this disease in literature.

CONCLUSION

SMVT deficiency is a vitamin-responsive inborn error of metabolism that can lead to a wide range of symptoms. Increased and isolated excretion of urinary 3-hydroxyisovaleric acid may suggest, in the absence of markedly reduced biotinidase activity, a SMVT deficiency. Prompt supplementation with high doses of biotin and pantothenic acid should be initiated while awaiting results of SLC5A6 sequencing as this condition may be life-threatening.

Assurer le contrôle qualité d'un essai clinique pendant la pandémie de COVID-19 : l'expérience de l'étude Inserm C20-15 DisCoVeRy en France

Introduction

Les mesures sanitaires mises en place pendant la pandémie, telles que la distanciation sociale et les confinements, ont profondément modifié les pratiques de recherche clinique en restreignant l'accès aux participants en raison des risques de contamination, et en limitant la disponibilité du personnel des sites en raison de la surcharge de travail. Dans le même temps, la demande de résultats issus des essais COVID-19 était urgente et soumise à la pression de la communauté scientifique, de la société civile et des médias. Ainsi, l'objectif de cette communication est de partager l'expérience de l'Inserm pour assurer le contrôle qualité d'un essai clinique dans ce contexte particulier.

Methodes

DisCoVeRy est une étude de phase III adaptative et randomisée qui visait, dans sa première phase, à évaluer la sécurité et l'efficacité de 4 stratégies thérapeutiques chez des patients adultes hospitalisés pour COVID-19 ayant un besoin de supplémentation en oxygène. Entre le 22 mars 2020 et le 20 janvier 2021, 1176 patients ont été inclus en France. Afin de garantir la qualité des données recueillies, le promoteur a dû s'adapter aux mesures sanitaires en vigueur et à leur impact sur l'activité de recherche clinique. Il s'agissait notamment : d'adapter les objectifs du Plan de Monitoring (vérification des données sources pour 100% des données critiques de tous les participants), d'impliquer les Direction de la Recherche et de l'Innovation (DRI) des hôpitaux participants, de solliciter un réseau d'assistants de recherche clinique (ARC) et des personnels Inserm.

Resultats

Au total, 91 ARCs ont été impliqués en France et ont effectué 834 visites de monitoring du 24 avril 2020 au 15 octobre 2021, donnant lieu à 539 rapports de monitoring. Parmi les 1176 patients inclus et randomisés, un consentement a été obtenu permettant l'analyse de toutes les données chez 1112 (94,6%), des données jusqu'à la levée de la sédation chez 23 (1,9%), des données jusqu'au retrait du consentement ou à la décision de l'investigateur principal chez 32 (2,7%). Neuf (0,8%) patients n'ont pu être analysés en l'absence de consentement conforme. Le contrôle de 100% des données critiques pour tous les patients inclus dans l'analyse a été réalisé, conformément au Plan de Monitoring. Les résultats de l'étude ont été publiés en mai et septembre 2021. Au regard de l'importance de rendre les résultats publics, ces premières publications ont été soumises sans que toutes les données critiques aient été contrôlées. Le monitoring du consentement, des critères de sélection et du critère d'évaluation principal avait été priorisé afin d'assurer la fiabilité des résultats sur ces éléments majeurs.

Conclusion

Malgré le démarrage contraint de l'étude avant la mise en place de l'équipe de monitoring, le rythme d'inclusion très élevé, et les contraintes majeures liées au contexte pandémique, l'ensemble des données critiques selon le Plan de Monitoring initial a été monitoré en seulement 18 mois. Ce résultat est notamment dû à la mobilisation de ressources en personnel considérables, dans un délai très court. Cependant, la mise en place d'une telle organisation souligne l'importance de disposer d'indicateurs faciles à consulter en temps réel pour aider au pilotage de l'étude et à la planification de l'utilisation de la base de données et de la publication des résultats.

Mots clés contrôle qualité ; monitoring ; consentement ; promotion

Déclaration de liens d'intérêts Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts

De novo DHDDS variants cause a neurodevelopmental and neurodegenerative disorder with myoclonus

Subcellular membrane systems are highly enriched in dolichol, whose role in organelle homeostasis and endosomal-lysosomal pathway remains largely unclear besides being involved in protein glycosylation. DHDDS encodes for the catalytic subunit (DHDDS) of the enzyme cis-prenyltransferase (cis-PTase), involved in dolichol biosynthesis and dolichol-dependent protein glycosylation in the endoplasmic reticulum. An autosomal recessive form of retinitis pigmentosa (retinitis pigmentosa 59) has been associated with a recurrent DHDDS variant. Moreover, two recurring de novo substitutions were detected in a few cases presenting with neurodevelopmental disorder, epilepsy and movement disorder. We evaluated a large cohort of patients (n = 25) with de novo pathogenic variants in DHDDS and provided the first systematic description of the clinical features and long-term outcome of this new neurodevelopmental and neurodegenerative disorder. The functional impact of the identified variants was explored by yeast complementation system and enzymatic assay. Patients presented during infancy or childhood with a variable association of neurodevelopmental disorder, generalized epilepsy, action myoclonus/cortical tremor and ataxia. Later in the disease course, they experienced a slow neurological decline with the emergence of hyperkinetic and/or hypokinetic movement disorder, cognitive deterioration and psychiatric disturbances. Storage of lipidic material and altered lysosomes were detected in myelinated fibres and fibroblasts, suggesting a dysfunction of the lysosomal enzymatic scavenger machinery. Serum glycoprotein hypoglycosylation was not detected and, in contrast to retinitis pigmentosa and other congenital disorders of glycosylation involving dolichol metabolism, the urinary dolichol D18/D19 ratio was normal. Mapping the disease-causing variants into the protein structure revealed that most of them clustered around the active site of the DHDDS subunit. Functional studies using yeast complementation assay and in vitro activity measurements confirmed that these changes affected the catalytic activity of the cis-PTase and showed growth defect in yeast complementation system as compared with the wild-type enzyme and retinitis pigmentosa-associated protein. In conclusion, we characterized a distinctive neurodegenerative disorder due to de novo DHDDS variants, which clinically belongs to the spectrum of genetic progressive encephalopathies with myoclonus. Clinical and biochemical data from this cohort depicted a condition at the intersection of congenital disorders of glycosylation and inherited storage diseases with several features akin to of progressive myoclonus epilepsy such as neuronal ceroid lipofuscinosis and other lysosomal disorders.

Acute ischemic myelopathy treated with intravenous thrombolysis: Four new cases and literature review

Background

Intravenous thrombolysis is a well-established treatment of ischemic stroke within 4.5 h. However, its effectiveness in acute ischemic myelopathy is unknown.

Purpose

We describe a series of four acute ischemic myelopathy patients treated with intravenous thrombolysis within 4.5 h and review the current literature to explore this treatment feasibility, potential safety, and efficacy.

Methods

We reviewed all routinely collected clinical, radiological, and follow-up data of patients with a final acute ischemic myelopathy diagnosis who received acute intravenous thrombolysis in our stroke network. We also reviewed thrombolyzed acute ischemic myelopathy patients in the literature.

Results

Four patients (three women) aged 57 to 83 years presented with acute uni- or bilateral extremity paresis, considered initially as cerebral strokes in two of them. After excluding contraindications by brain imaging in three, spinal computed tomography in one and confirmation of acute ischemic myelopathy on spinal magnetic resonance imaging in one patient, intravenous thrombolysis was administered at 135, 190, 240, and 245 min accordingly. Subacute diffusion-weighted imaging-magnetic resonance imaging confirmed acute ischemic myelopathy in all but one patient. Favorable outcome was achieved in two patients rapidly and in three patients at three-month follow-up. We identified seven other thrombolyzed acute ischemic myelopathy patients in the literature, who showed variable recovery and no hemorrhagic complications.

Conclusions

With appropriate acute imaging, intravenous thrombolysis after acute ischemic myelopathy is feasible and potentially safe within 4.5 h. Given the potential of benefit of thrombolysis in acute ischemic myelopathy, this treatment warrants further efficacy and safety studies.

[Comorbidities: which drug for which patient ?]

The new antiepileptic drugs (AED) are not significantly more efficient than the older ones, but they are better tolerated and with a lower drug interactions. Despite the existing guidelines, the evidence-based medicine cannot answer unequivocally the question of the best AED for a given patient. The treatment must be individually tailored; in this article, we present some principles and important factors to guide that choice.

[Pharmacology and epilepsy : update on the new antiepileptic drugs]

New antiepileptic drugs are regularly approved for treatment and offer large therapeutic opportunities. Efficacy of these drugs is relatively similar on-label with different mechanisms to be combined for a synergic effect. Treatments such as cannabidiol have benefitted from large media coverage despite limited clinical evidence so far. The objective of antiepileptic drugs is to stop the recurrence of epileptic seizures with as few adverse events as possible. When confronted to a difficult-to-treat epilepsy, referral to a specialised centre is strongly advised. The aim is to confirm that the diagnosis is correct, that the treatment is well adapted (indication, pharmacokinetic and compliance) and to evaluate the indication for non-pharmacological treatments such as epilepsy surgery.

A robust viologen and Mn-based porous coordination polymer with two types of Lewis acid sites providing high affinity for H2O, CO2 and NH3

A water stable PCP with two kinds of Lewis acid sites, open Mn²⁺ cations and viologen, shows high affinity for H₂O, CO₂ and NH₃.

Fractures of the distal humerus operated on using the Lambda® plate: report of 75 cases at 9.5 years follow-up

INTRODUCTION

The study sought to assess the functional results and complications of osteosynthesis using the Lambda(®) plate (Zimmer, Étupes, France) in treating fracture of the distal extremity of the humerus.

MATERIALS AND METHODS

The initial series comprised 115 patients (116 fractures), treated between 1992 and 2008. Forty-one (mainly foreigners) were lost to follow-up. The final series thus comprised 74 patients (75 fractures): 44 female and 30 male, with a mean age of 46±23 years (range, 16-95 years), 22 (29%) being aged 65 years or over. According to AO classification, 22 of the fractures of the distal extremity of the humerus (29%) were diaphyseal-metaphyseal, corresponding to a particular grade of type A2, 12 (16%) were type A2 or A3, six (8%) type B, and 35 (47%) type C. Eight were open fractures: seven grade 1 and one grade IIa on Gustilo's classification. The Lambda(®) plate is an inverted Y shape, with a stem of up to ten holes and sectile arms that can be remodeled to adapt perfectly to the type of fracture and the shape of the distal end of the humerus. A posterior approach was used in all cases: in 26 cases, an extra-articular transolecranal approach and otherwise a transtricipital approach, either vertical for diaphyseal-metaphyseal fracture or inverted V for type-C fracture.

RESULTS

Mean follow-up was 115±64 months (range, 24-227 months). There were no cases of infection, non-union of olecranial osteotomy or disassembly of the internal fixation; there was, on the other hand, one case of non-union of the lateral condyle and one of the distal extremity of the humerus, two cases of dysesthesia in the ulnar nerve territory and one in the radial nerve territory (following preoperative paralysis), and four cases of stiffness requiring surgical arthrolysis between 6 and 12 months postoperatively. At follow-up, mean active elbow flexion was 133°±13° (range, 90°-150°) and active extension -12°±14° (range, -45°-0°). Mean elbow flexion range of motion exceeded 100° in 58 patients (77%), was between 50° and 100° in 16 (21%) and was less than 50° in one. Mean Mayo Elbow Performance Score (MEPS) was 97±7 points (range, 40-100), and mean Quick DASH Score (converted as a score out of 100) was 10±18 (range, 0-54). There were 67 excellent results (MEPS, 90-100 points), five good (75-89), two moderate and one poor. The 35 type-C fractures displayed no significant differences from the series as a whole (P=1.24 for MEPS).

CONCLUSION

Osteosynthesis using the Lambda(®) plate gave excellent medium-term results in terms of both fixation stability and recovery of elbow function after fracture of the distal extremity of the humerus, even in elderly osteoporotic patients.

LEVEL OF EVIDENCE

Level IV: retrospective study.

Impairment of JCV-specific T-cell response by corticotherapy: effect on PML-IRIS management?

OBJECTIVE

To investigate the impact of corticosteroids (CS) on the viral-specific T-cell response, in particular the JC virus (JCV)-specific one, in an attempt to determine the optimal timing of CS in the management of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome (PML-IRIS).

METHODS

A blood draw was performed before and 7 days after the administration of IV CS to 24 patients with relapsing multiple sclerosis (MS). The phenotypic pattern of T cells was determined by CCR7 and CD45RA. To assess the impact of CS treatment on proliferative response of JCV-, influenza-, and Epstein-Barr virus (EBV)-specific T cells, a thymidine incorporation proliferation assay was performed. An intracellular cytokine staining assay was performed to determine the effect of CS treatment on the production of cytokine by virus-specific T cells. JCV T-cell assays were performed only in JCV-infected patients with MS as detected by serologies (Stratify) or detection of JCV DNA in the urine by PCR.

RESULTS

CS led T cells, CD4+ and CD8+, toward a less differentiated phenotype. There was a significant decrease of EBV-, influenza-, and JCV-specific T-cell proliferative response upon CS treatment. There was a significant decrease in the frequency of interferon (IFN) γ- and tumor necrosis factor (TNF) α-producing JCV-specific CD8+ T cells, but not EBV- or influenza-specific CD4+ or CD8+ T cells.

CONCLUSIONS

CS have a profound impact on the virus-specific T-cell response, especially on JCV, suggesting that when CS are considered, they should not be given before the onset of clinical or radiologic signs of IRIS. Studies addressing directly patients with MS with natalizumab-caused PML are warranted.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that methylprednisolone treatment decreases the frequency of JCV-specific CD8+ T cells producing IFN-γ and TNFα, impairing control of JCV, suggesting this should be used to treat but not to prevent PML-IRIS. No clinical outcomes were measured.

Posterior approach and dislocation rate: a 213 total hip replacements case-control study comparing the dual mobility cup with a conventional 28-mm metal head/polyethylene prosthesis

INTRODUCTION

Dislocation is a frequent complication of total hip arthroplasties (THA) especially in older patients, especially when using a posterior approach. In these cases, dual mobility (DM) cups developed by Gilles Bousquet in 1975 can be indicated to reduce this complication risk.

HYPOTHESIS

Dual mobility cups reduce the rate of dislocation in primary total hip arthroplasty using posterior approach in a single-surgeon series.

AIM

Test this hypothesis in a controlled study to compare the rate of dislocation in primary total hip arthroplasties done in patients over 50 years old either with a dual mobility cup or a conventional metal-on-polyethylene 28-mm diameter head.

PATIENTS AND METHODS

Two consecutive series of primary total hip replacements were performed by a single surgeon using a posterolateral approach. The piriformis tendon was left intact. The DM series included 105 patients who underwent arthroplasty between January 2005 and June 2007 with a dual mobility cup (60 women and 45 men, mean age 76.6±5.65 years old [53-93]). The control series (S series) included 108 patients who underwent arthroplasty (56 women and 52 men, mean age 74.2±5.9 years old [53-87]) with a conventional 28-mm polyethylene cup between January 2003 and June 2005. All hip replacements included a 28-mm metal-polyethylene cup and a 12-14-mm Morse taper. Both groups were comparable for gender, diagnosis, body mass index, type of anesthesia and ASA score distribution. All patients included in this series had a minimum follow-up of 1 year.

RESULTS

There were no dislocations in the DM series and five early dislocations (before the third month) in the S series for a rate of 4.63%. Although the rate of dislocation was higher in the S series (4.63% vs 0%), the difference was barely significant (P=0.0597).

DISCUSSION

This study comparing the incidence of dislocations after THA with conventional or dual mobility cups, shows that even using a posterior approach and in older patients, dual mobility cups increase stability with no postoperative dislocations. Although results are barely significant, a larger series should confirm the benefit of this implant. In this series, morbidity was not increased with dual mobility cups.

LEVEL OF EVIDENCE

Level III: retrospective case-control study.

Harmonization of strategies for the validation of quantitative analytical procedures: a SFSTP proposal part IV. Examples of application

A harmonized approach for the validation of analytical methods based on accuracy profile was introduced by a SFSTP commission on the validation of analytical procedure. This fourth and last document aims at illustrating this methodology and the statistics used. Therefore the validation of real case methods are proposed such as methods for the quality control of drugs, for the quantitation of impurities in drug substances, for bioanalysis or for the determination of nutriments. Furthermore, different types of analytical methods are used in order to demonstrate the applicability of the proposed approach to a wide range of methods such as liquid chromatography (LC-UV, LC-MS), spectrophotometry or ELISA.

Limitation of adipose tissue enlargement in rats chronically treated with semicarbazide-sensitive amine oxidase and monoamine oxidase inhibitors

Inhibition of semicarbazide-sensitive amine oxidases (SSAO) and monoamine oxidases (MAO) reduces fat deposition in obese rodents: chronic administration of the SSAO-inhibitor semicarbazide (S) in combination with pargyline (MAO-inhibitor) has been shown to reduce body weight gain in obese Zucker rats, while (E)-2-(4-fluorophenethyl)-3-fluoroallylamine, an SSAO- and MAO-B inhibitor, has been reported to limit weight gain in obese and diabetic mice. Our aim was to state whether such weight gain limitation could occur in non-obese, non-diabetic rats and to extend these observations to other amine oxidase inhibitors. Prolonged treatment of non-obese rats with a high dose of S (900 micromol kg(-1) day(-1)) reduced body weight gain and limited white adipose tissue enlargement. When chronically administered at a threefold lower dose, S also inhibited SSAO activity but not fat depot enlargement, suggesting that effects other than SSAO inhibition were involved in adipose tissue growth retardation. However, combined treatment of this lower dose of S with pargyline inhibited SSAO, MAO, energy intake, weight gain and fat deposition. Adipocytes from treated rats exhibited unchanged insulin responsiveness but impaired antilipolytic responses to amine oxidase substrates. Phenelzine clearly inhibited both MAO and SSAO when tested on adipocytes. Obese rats receiving phenelzine i.p. at 17 micromol kg(-1) day(-1) for 3 weeks, exhibited blunted MAO and SSAO activities in any tested tissue, diminished body weight gain and reduced intra-abdominal adipose tissue. Their adipocytes were less responsive to lipogenesis activation by tyramine or benzylamine. These observations suggest that SSAO inhibition is not sufficient to impair fat deposition. However, combined MAO and SSAO inhibition limits adiposity in non-obese as well as in obese rats.

Harmonization of strategies for the validation of quantitative analytical procedures

In the first two documents [Ph. Hubert, J.J. Nguyen-Huu, B. Boulanger, E. Chapuzet, P. Chiap, N. Cohen, P.A. Compagnon, W. Dewé, M. Feinberg, M. Lallier, M. Laurentie, N. Mercier, G. Muzard, C. Nivet, L. Valat, J. Pharm. Biomed. Anal. 36 (2004) 579-586; Ph. Hubert, J.J. Nguyen-Huu, B. Boulanger, E. Chapuzet, P. Chiap, N. Cohen, P.A. Compagnon, W. Dewé, M. Feinberg, M. Lallier, M. Laurentie, N. Mercier, G. Muzard, C. Nivet, L. Valat, E. Rozet, J. Pharm. Biomed. Anal., in press], a recent SFSTP Commission on the validation of analytical procedure has introduced a harmonized approach for the validation of analytical procedures. In order to complete this guide, the statistical methodology allowing to correctly conclude about the validity of a procedure is proposed in this third part of the guide. Indeed all the steps to obtain the decision tool namely the accuracy profile are described and illustrated step by step by a numerical example. This tool, based on the concept of total error (bias+standard deviation) build with a beta-expectation tolerance interval, allows to easily take the right decision and simultaneously minimizing the risk of the future use of the analytical procedure.

Harmonization of strategies for the validation of quantitative analytical procedures. A SFSTP proposal--part II

As reported in a previous paper, the main objective of the new commission of the Société Française des Sciences et Techniques Pharmaceutiques (SFSTP) was the harmonisation of approaches for the validation of quantitative analytical procedures. In a series of meetings, members of this Commission have first tried to review the objectives of analytical methods and the objectives of validation methods and to recommend the use of two-sided beta-expectation tolerance intervals for total error of validation samples (accuracy profile) in the acceptance/rejection of analytical method in validation phase. In the context of the harmonization, the other objectives were: (i) to propose a consensus on the norms usually recognized, while widely incorporating the ISO terminology; (ii) to recommend to validate the analytical procedure accordingly to the way it will be used in routine; (iii) to elaborate a rational, practical and statistically reliable strategy to assure the quality of the analytical results generated. This strategy has been formalised in a guide and the three latter objectives made by the Commission are summarised in the present paper which is the second part of summary report of the SFSTP commission. The SFSTP guide has been produced to help analysts to validate their analytical methods. It is the result of a consensus between professionals having expertise in analytical and/or statistical fields. The suggestions presented in this paper should therefore help the analyst to design and perform the minimum number validation experiments needed to obtain all the required information to establish and demonstrate the reliability of its analytical procedure.

Harmonization of strategies for the validation of quantitative analytical procedures. A SFSTP proposal--Part I

This paper is the first part of a summary report of a new commission of the Société Française des Sciences et Techniques Pharmaceutiques (SFSTP). The main objective of this commission was the harmonization of approaches for the validation of quantitative analytical procedures. Indeed, the principle of the validation of theses procedures is today widely spread in all the domains of activities where measurements are made. Nevertheless, this simple question of acceptability or not of an analytical procedure for a given application, remains incompletely determined in several cases despite the various regulations relating to the good practices (GLP, GMP, ...) and other documents of normative character (ISO, ICH, FDA, ...). There are many official documents describing the criteria of validation to be tested, but they do not propose any experimental protocol and limit themselves most often to the general concepts. For those reasons, two previous SFSTP commissions elaborated validation guides to concretely help the industrial scientists in charge of drug development to apply those regulatory recommendations. If these two first guides widely contributed to the use and progress of analytical validations, they present, nevertheless, weaknesses regarding the conclusions of the performed statistical tests and the decisions to be made with respect to the acceptance limits defined by the use of an analytical procedure. The present paper proposes to review even the bases of the analytical validation for developing harmonized approach, by distinguishing notably the diagnosis rules and the decision rules. This latter rule is based on the use of the accuracy profile, uses the notion of total error and allows to simplify the approach of the validation of an analytical procedure while checking the associated risk to its usage. Thanks to this novel validation approach, it is possible to unambiguously demonstrate the fitness for purpose of a new method as stated in all regulatory documents.

Biometry of the radial head: biomechanical implications in pronation and supination

The aim of this study was to perform biometry of the proximal extremity of the radius and to characterize the shape of the radial head. Knowledge of the size and shape of the radial head is necessary for the creation of a radial head prosthesis that is anatomically and biomechanically correct. Twenty-seven measurements, focused on the proximal extremity, were done on 96 radii. The shape of the radial head was determined by the difference between the maximum diameter and the minimum diameter. We considered the shape to be circular when the difference was less than 1 mm, and elliptical when the difference was greater than 1 mm. The shape of the radial head was compared with the neck/diaphysis angle. Fifty-seven percent of radial heads were elliptical and 43% were circular. When the head was elliptical the maximum diameter was 22 mm +/-2.9 and the minimum diameter was 20 mm +/-2.8 ( P<0.001). When the head was circular the maximum diameter was 21.2 mm +/-2.4 and the minimum diameter was 20.4 mm +/-2.4 ( P<0.14). The angle between the neck and the diaphysis varied with regard to the shape of the radial head. It was 166.75 degrees +/-3 for the circular heads and 168.62 degrees +/-3.2 for the elliptical heads ( P<0.01). The biomechanics of the circular shape and the elliptical shape are different, involving an adaptation of the angle between the neck and the radial diaphysis. This difference must be taken in consideration in the design of a radial head prosthesis.

S-position isomers of BEDT-TTF and EDT-TTF: synthesis and influence of outer sulfur atoms on the electrochemical properties and crystallographic network of related organic metals

The synthesis and characterization of new modified tetrathiafulvalenes (TTF), the S-position isomers of BEDT-TTF and EDT-TTF, are described. The synthetic strategy presented in this work is based on an efficient and unprecedented two-step sequence for the conversion of a vicinal bis(hydroxymethyl) functionality into a disulfide ring. Different routes are discussed in terms of efficiency for the synthesis of the symmetric S-position isomer of BEDT-TTF and that of EDT-TTF. Their electrochemical properties are combined with data obtained from UV/Vis spectroscopy and orbital calculations, and the electronic influence of peripheral sulfur atoms on the neutral and oxidized species is discussed. The introduction of these outer sulfur atoms at the periphery of the TTF core gives rise to specific intermolecular S...S interactions in the corresponding organic materials. Crystallographic studies of radical cation salts synthesized upon electrocrystallization clearly showed that the network obtained is dictated by the outer sulfur atoms, which are responsible for a characteristic and unprecedented "windmill" array.

Comparative morphology and paleobiology of Middle Pleistocene human remains from the Bau de l'Aubesier, Vaucluse, France

The discovery of later Middle Pleistocene human remains from the Bau de l'Aubesier, France reinforces an evolutionary model of the gradual accumulation of Neandertal-derived facial and dental features during the Middle Pleistocene of the northwestern Old World. The pronounced maxillary incisor beveling of Aubesier 4 helps to extend the antiquity of nondietary use of the anterior dentition. The interproximal "toothpick" groove on the Aubesier 10 molar increases the sample for these lesions. The pathological loss of the mandibular dentition of Aubesier 11 indicates advanced antemortem masticatory impairment, at a level previously undocumented before the Late Pleistocene. These remains support a view of later Middle Pleistocene humans able to support debilitated individuals despite the considerable use of their bodies to accomplish routine activities.

Semicarbazide-sensitive amine oxidase activation promotes adipose conversion of 3T3-L1 cells

Semicarbazide-sensitive amine oxidase (SSAO) is an amine oxidase related to the copper-containing amine oxidase family. The tissular form of SSAO is located at the plasma membrane, and is mainly expressed in vascular smooth muscle cells and adipocytes. Recent studies have suggested that SSAO could activate glucose transport in fat cells. In the present work, we investigated the potential role of a chronic SSAO activation on adipocyte maturation of the 3T3-L1 pre-adipose cell line. Exposure of post-confluent 3T3-L1 pre-adipocytes to methylamine, a physiological substrate of SSAO, promoted adipocyte differentiation in a time- and dose-dependent manner. This effect could be related to SSAO activation, since it was antagonized in the presence of the SSAO inhibitor semicarbazide, but not in the presence of the monoamine oxidase inhibitor pargyline. In addition, methylamine-induced adipocyte maturation was mimicked by 3T3-L1 cell treatment with other SSAO substrates. Finally, the large reversion of methylamine action by catalase indicated that hydrogen peroxide generated by SSAO was involved, at least in part, in the modulation of adipocyte maturation. Taken together, our results suggest that SSAO may contribute to the control of adipose tissue development.

Tetrathiafulvalene crowns: redox-switchable ligands

A series of redox-responsive ligands that associate the electroactive tetrathiafulvalene core with polyether subunits of various lengths has been synthesized. X-ray structures are provided for each of the free ligands. The requisite structural criteria for reaching switchable ligands are satisfied for the largest macrocycles, that is, planarity of the 1,1',3,3'-tetrathiafulvalene (TTF) pi system and correctly oriented coordinating atoms. The ability of these ligands to recognize various metal cations as a function of the cavity size has been investigated by various techniques (LSIMS, 1H NMR, and UV/Vis spectroscopy, cyclic voltammetry). These systems exhibit an unprecedented high coordination ability among TTF crown ethers. Their switchable ligating properties have been confirmed by cyclic voltammetry, and metal-cation complexation has been illustrated by X-ray structures of three of the corresponding metal complexes (Pb2+, Sr2+, and Ba2+). Solid-state structures of these complexes display original packing modes with channel-like arrangements.

Human platelet glycoprotein IIIb binds to thrombospondin fragments bearing the C-terminal region, and/or the type I repeats (CSVTCG motif), but not to the N-terminal heparin-binding region

Major blood membrane platelet glycoprotein IIIb (GPIIIb), also termed GPIV or CD365, has been identified as a receptor for thrombospondin (TSP), collagen and Plasmodium falciparum-infected erythrocytes. The aim of the present study was to identify region(s) of TSP involved in binding of GPIIIb. Proteolytic fragments of TSP (M(r) 140 kDa, 120-18 kDa and 27 kDa on SDS/PAGE under reducing conditions) were purified by f.p.l.c. and identified by N-terminal gas-phase sequencing, e.l.i.s.a. and Western blots using monoclonal antibodies directed against defined domains of TSP. The 140 kDa and 120-18 kDa fragments (C-terminal region), but not the 27 kDa fragment (N-terminal region), were shown to bind to GPIIIb by using e.l.i.s.a. and affinity-chromatography systems. TSP binding to a GPIIIb-affinity column was Ca(2+)-dependent and reduced by 45% in the presence of EDTA. Moreover, TSP was only partially eluted with EDTA from a Ca(2+)-equilibrated GPIIIb column. A fragment of 68 kDa, obtained by further digestion of the 140 kDa fragment, bound to the GPIIIb-Sepharose affinity column. This fragment, or stalk-like region, bears the TSP type I repeats that show sequence similarity to regions on properdin, Plasmodium falciparum proteins and antistasin. Peptides (CSVTCG or SVTCGGGV) representing these repeats bound isolated GPIIIb in a Ca(2+)-independent way, but did not completely inhibit the GPIIIb and TSP interaction. These studies indicate that GPIIIb binds to the TSP via the C-terminal region and/or the CSVTCG motif, but not to the N-terminal region. Interaction between GPIIIb and the TSP C-terminal region or the CSVTCG motif is respectively Ca(2+)-dependent and -independent.

Modeling of transient deformation of piezoelectric ceramics [US NDE]

A method based on a finite-element analysis that permits the calculation and the visualization of deformations of ultrasonic transducers, in different configurations is presented. The method uses a Fourier series synthesis giving deformation of the free surface and electrical admittance for wide frequency bands by the use of finite-element procedures previously developed at Universite de Technologie de Compiegne (UTC). The method was originally developed for the monochromatic case. The authors report on the adaptation and validation of the method for the multifrequency excitation case, which is a more realistic approach used in the field of ultrasonic NDE. Several geometries were tested. In spite of the limitations of the method, due to the calculation requirements, the results show the role of the radial displacement behavior usually neglected in monodimensional analysis.

Thermoluminescence dating of the late Neanderthal remains from Saint-Césaire

Anatomically modern humans have long been thought to have been responsible for the Aurignacian and Châtelperronian industries of the early Upper Palaeolithic of Western Europe, whereas the Middle Palaeolithic Mousterian industry has been attributed to Neanderthals. The presence of both Middle and Upper Palaeolithic strata at Saint-Césaire in France offers an excellent opportunity for studying the cultural transition between the two. Saint-Césaire is the only Châtelperronian site that has yielded really diagnostic hominid fossils, and the discovery there of Neanderthal remains alongside Châtelperronian tools cast doubt on the exclusive association between industries and taxon. We report thermoluminescence dates for 20 burnt flints from the site. Those found near the Neanderthal remains were dated at 36,300 +/- 2,700 years BP (before present), making this specimen the youngest Neanderthal dated so far. This date places the stratum close in age to several French but much younger than some Spanish Aurignacian sites believed to have been occupied by modern humans. The possibility of contact between the West European Neanderthals and the intrusive modern humans who replaced them cannot therefore be excluded.