Evaluation of a combined screening programme for breast, cervical and colorectal cancers in France.

A combined breast, cervical and colorectal cancer screening programme was set up in 1990 in Isère, for women aged 50-69 years (target population 100,000) comprising an initial medical visit. The programme was evaluated in 1997. The evaluation covered uptake results, sensitivity, specificity, two opinion surveys among 1025 physicians and 400 women to measure the impact, and three surveys regarding radiologists', gastroenterologists' and pathologists' attitudes. Sensitivity and specificity rates were 74 and 87% for breast, 83 and 99% for cervical and 43 and 97% for colorectal screening. The number of cervical smears completed by women aged 60-69 years doubled with the programme. Acceptability of the faecal occult blood test was 88%. Eighty percent of physicians were in favour of the programme but 67% said that they often prescribed outside the programme. Overall, 71% of the interviewed women said they had had a breast screen, 69% a Pap smear and 53% a faecal occult blood test when only 25-35% of the target population was actually recorded in the programme. This programme increased the uptake of women not previously screened both within and outside the programme. It showed discrepancies between beliefs and practices of physicians. Protocol changes were implemented after this evaluation.     

Evaluation of the biocompatibility of a Ni-Cr-Mo dental alloy with human gingival explant culture in vitro: morphological study, immunodetection of fibronectin, and collagen production

This study was undertaken to evaluate the biocompatibility of a Ni-Cr-Mo dental casting alloy by an in vitro explant culture method. Through ultrastructural features, the immunolabelling of fibronectin, and the immunodetection of type I and III collagen production, we investigated the behaviour of gingival cells (both fibroblasts and epithelial cells) in contact with the alloy in comparison with control cultures. Our results indicate that cultured gingival cells present a well preserved ultrastructure and synthesized fibronectin (the main glycoprotein involved in adhesion to substrates). The alteration of collagen production concerned only type III collagen which decreased significantly in the cultures on the dental alloy.     

Immunolocalization of estrogen and androgen receptors in the caput epididymidis of the fat sand rat (Psammomys obesus): Effects of seasonal variations,castration and efferent duct ligation

The fat sand rat (Psammomys obesus) is a model to study seasonal reproductive cycle changes and several metabolic disorders. In order to show a possible involvement of estrogens in the male reproductive functions, the expression of estrogen receptors (ESR1 and ESR2) and androgen receptor (AR) were investigated in the caput epididymidis of fat sand rats during the breeding season, resting season, after castration, after castration followed by testosterone treatment, and after ligation of efferent ducts. In the breeding season, principal cells presented a strong immunostaining of AR in both nuclei and cytoplasm, a strong staining of ESR1, mainly in the apical zone, and a strong immunoexpression of ESR2, mainly in nuclei. In the resting season, a moderate immunostaining of AR in both cytoplasm and nuclei was observed. ESR1 staining showed a strong immunoreactivity in the nuclei. In contrast, the nuclei were negative for ESR2. After castration, a low and selective signal distribution was observed: the nuclei were moderately positive for AR and ESR2, and negative for ESR1. After castration and testosterone treatment, an androgen-dependence for AR and the restoration of ESR1 but not ESR2 immunoexpression were observed. After ligation of the efferent ducts, a considerable reduction of AR immunoreactivity was observed in contrast to ESR1 and ESR2, which gave a strong immunostaining signal. These results illustrate the complexity of the regulation of the androgen and estrogen receptor expression in the epididymis and argue for the coexistence of both androgenic and estrogenic pathways.     

Hypertriglyceridemia-induced pancreatitis in pregnancy. A case report

We report the case of a 31-year-old pregnant patient in the 33rd week of gestation, with no history of dyslipidaemia, admitted for sub-acute epigastric pain. The milky aspect of blood samples was remarkable. Blood analysis showed a moderate increase in pancreatic enzymes but a major hyperlipaemia: triglyceridaemia 113 g/l and total cholesterolaemia 25 g/l. We suspected a hypertriglyceridemia-induced pancreatitis in pregnancy. The diagnosis was confirmed by CT-scan. Abdominal echography showed no abnormalities in biliary duct. After few hours, a caesarean was performed for acute fetal distress. The patient was admitted to the intensive care unit where a decrease of hypertriglyceridemia was already observed. Only one plasmapheresis was performed. Heparin was introduced. Rapid clinical improvement allowed discharge from intensive care at day 3. This case report illustrates lipid decrease with undertaken treatments. We discuss the management of hypertriglyceridemia-induced pancreatitis in pregnancy.     

Moisture content of Hemoccult slides influences test sensitivity

BACKGROUND: Mass screening programmes in Europe and in the USA have shown that a 15-18% decrease in mortality rate from colo-rectal cancer can be achieved with biannual testing. In a 10 year screening programme in the Isère region (France), we have noticed that the positivity percentage of Hemoccult II changes significantly with seasons: it varies from 1.61% in summer to 2.80% in winter, while intermediate values occur in spring (1.69%) and autumn (2.50%). During transport in the mail, Hemoccult slides are stored in unheated rooms, without air-conditioning, and are thus being exposed to outdoor conditions of temperature and humidity. In this paper, we show that the moisture content of Hemoccult slides influences test sensitivity. METHODS: In an in-vitro experiment, we smeared slides from the same batch all with the same blood-spiked stool sample. Positivity rate varies from 58%, when slides contain 0.46% moisture, to 84% when they contain 10.90% moisture (P = 0.0066). Positivity rates are not different in rehydrated and in saturated Hemoccult slides. RESULTS: Data collected from the Grenoble meteorological centre were compared to positivity percentages. Regression studies show that moisture deficit in the air is strongly correlated (r = 0.794, P < 0.01) to positivity percentage and explains most of its seasonal variations. CONCLUSIONS: These results would suggest that Hemoccult slides should be allowed to equilibrate for 24 h at the same level of moisture in all seasons at least in regions where large temperature variations are observed between winter and summer, and between day and night. Indeed, positivity percentages are probably too high in winter, and too low in summer.     

The decadal state of the terrestrial carbon cycle: Global retrievals of terrestrial carbon allocation,pools, and residence times

The terrestrial carbon cycle is currently the least constrained component of the global carbon budget. Large uncertainties stem from a poor understanding of plant carbon allocation, stocks, residence times, and carbon use efficiency. Imposing observational constraints on the terrestrial carbon cycle and its processes is, therefore, necessary to better understand its current state and predict its future state. We combine a diagnostic ecosystem carbon model with satellite observations of leaf area and biomass (where and when available) and soil carbon data to retrieve the first global estimates, to our knowledge, of carbon cycle state and process variables at a 1° × 1° resolution; retrieved variables are independent from the plant functional type and steady-state paradigms. Our results reveal global emergent relationships in the spatial distribution of key carbon cycle states and processes. Live biomass and dead organic carbon residence times exhibit contrasting spatial features (r = 0.3). Allocation to structural carbon is highest in the wet tropics (85–88%) in contrast to higher latitudes (73–82%), where allocation shifts toward photosynthetic carbon. Carbon use efficiency is lowest (0.42–0.44) in the wet tropics. We find an emergent global correlation between retrievals of leaf mass per leaf area and leaf lifespan (r = 0.64–0.80) that matches independent trait studies. We show that conventional land cover types cannot adequately describe the spatial variability of key carbon states and processes (multiple correlation median = 0.41). This mismatch has strong implications for the prediction of terrestrial carbon dynamics, which are currently based on globally applied parameters linked to land cover or plant functional types.The terrestrial carbon (C) cycle remains the least constrained component of the global C budget (1). In contrast to a relatively stable increase of the ocean CO₂ sink from 0.9 to 2.7 Pg C y⁻¹ over the past 40 y, terrestrial CO₂ uptake has been found to vary between a net 4.1-Pg C y⁻¹ sink to a 0.4-Pg C y⁻¹ source, and accounts for a majority of the interannual variability in atmospheric CO₂ growth. The complex response of terrestrial ecosystem CO₂ exchanges to short- and long-term changes in temperature, water availability, nutrient availability, and rising atmospheric CO₂ (2–6) remains highly uncertain in C cycle model projections (7). As a result, there are large gaps in our understanding of terrestrial C dynamics, including the magnitude and residence times of the major ecosystem C pools (8, 9) and rates of autotrophic respiration (10). Moreover, the impact of climatic extremes on C cycling, such as recent Amazon droughts (11), highlights the importance of understanding the terrestrial C cycle sensitivity to climate variability. To understand terrestrial CO₂ exchanges in the past, present, and future, we need to better constrain current dynamics of ecosystem C cycling from regional to global scales.C uptake, allocation, pool stocks, residence times, respiration, and disturbance together drive net CO₂ exchanges (12) on subdaily to millennial timescales; these C state and process variables also determine the temporal sensitivity of the net C balance to climatic variability. For example, global changes in photosynthetic uptake could lead to a rapid response from short-lived C pools (such as foliage, fine roots, and litter) or a prolonged response from the long-lived C pools (such as woody biomass and soil C), with very different outcomes on ecosystem source–sink behavior. Quantitative knowledge of terrestrial C pathways is, therefore, central to understanding the temporal responses of the major terrestrial C fluxes—including heterotrophic respiration (13), fires (14, 15), and wetland CH₄ emissions (16, 17)—to interannual variations in C uptake.Although C dynamics have been extensively measured and analyzed at site level (18–21), the respiration and allocation of fixed C and its residence time within the major C pools are difficult and expensive to measure at site level and remain poorly quantified on global scales. As a result, global terrestrial C cycle models rely on land cover type-specific C cycling parameters—based on spatially preassigned plant functional types—to determine C fluxes and C pools (22). Globally spanning C cycle observations can provide a much-needed constraint on the spatial variability and associated dynamics of the terrestrial C cycle. Over the past decade, a growing number of datasets has enhanced understanding of the terrestrial C cycle, including global-scale canopy dynamics [National Aeronautics and Space Administration Moderate Resolution Imaging Spectroradiometer (MODIS) leaf area index (LAI)], empirically derived global soil C data [Harmonized World Soil Database (HWSD)] (23), satellite-based above- and belowground biomass (ABGB) maps for the tropics (24, 25), and Greenhouse Gases Observing Satellite CO₂ and plant fluorescence (26, 27). These spatially and temporally explicit datasets provide an enhanced view of the terrestrial C cycle and can be used together to retrieve consistent global C state and process variables. Significant efforts in data-driven estimates of the global C fluxes have been made over the past decade. These efforts include estimates based on atmospheric CO₂ concentrations (1, 28, 29), high-resolution global primary production maps (30) based on eddy covariance tower datasets (FLUXNET) (18), mean residence time of terrestrial C (31), ecosystem respiration dependence on temperature based on FLUXNET data (32), and global C cycle data assimilation systems (33).Given an increasing number of C cycle observations, what remains an outstanding challenge is to produce a data-consistent analysis of terrestrial C cycling—including retrievals of C fluxes, C pools, autotrophic respiration, allocation fractions, and residence times—based on multiple global-scale earth observations and datasets. Current global-scale terrestrial biosphere models, because of their complexity and structures, are ill-equipped to ingest an ever-increasing volume of earth observations to estimate (rather than prescribe) model parameters based on the currently available observations. To overcome this challenge, we use a model–data fusion (MDF) approach to retrieve terrestrial C state and process variables during the period 2001–2010 without invoking plant functional type or steady-state assumptions. We bring together global MODIS LAI, a tropical biomass map (24), a soil C dataset (23), MODIS burned area (34), and a diagnostic ecosystem C balance model [Data Assimilation Linked Ecosystem Carbon Model version two (DALEC2)] (19, 35) to retrieve C state and process variables by producing a novel data-consistent and spatially explicit analysis of terrestrial C cycling on a global 1° × 1° grid (Fig. 1) [we henceforth refer to this MDF setup as the C data model framework (CARDAMOM)]. Specifically, we address the following questions: How is C uptake partitioned between the live biomass pools and respiration? What is the residence time of C within the major ecosystem C pools? How do estimates of C cycle states and processes vary spatially, and to what degree do emergent variable patterns match land cover maps? We use a Markov Chain Monte Carlo MDF algorithm to retrieve C state and process variables—and their associated uncertainty—within each 1° × 1° grid cell (Materials and Methods). The MDF approach retrieves the state and process variables that minimize the model mismatch against any available C cycle observations. Therefore, in the absence of extratropical biomass data or wintertime MODIS LAI observations, estimates of 2001–2010 C cycle state and process variables are achievable, albeit more uncertain.Open in a separate windowFig. 1.Diagnostic ecosystem C balance model DALEC2 (19, 35) and datasets used to retrieve 1° × 1° C state and process variables. GPP, a function of climate and foliar C, is partitioned into autotrophic respiration (Ra) and NPP. NPP is partitioned into the live biomass pools. Plant mortality provides input to the DOM pools. Heterotrophic respiration (Rh) is derived from decomposing DOM pools. Fire fluxes are derived from burned area data (35) and all C pools (SI Text, section S2). Within each 1° × 1° grid cell, we use a Bayesian MDF algorithm to retrieve C state/process variables and uncertainties; variables are retrieved without prior land cover type or steady-state assumptions. Data constraints consist of MODIS leaf area, total biomass (24) (tropics only), and soil C (23). Details on the Bayesian fusion approach are provided in Materials and Methods.