Online corrective responses following target jump in altered gravitoinertial force field point to nested feedforward and feedback control

Studies on goal-directed arm movements have shown a close link between feedforward and feedback control in protocols where both planning and online control processes faced a similar type of perturbation, either mechanical or visual. This particular context might have facilitated the use of an adapted internal model by feedforward and feedback control. Here, we considered this link in a context where, after feedforward control was adapted through proprioception-based processes, feedback control was tested under visual perturbation. We analyzed the response of the reaching hand to target displacements following adaptation to an altered force field induced by rotating participants at constant velocity. Reaching corrections were assessed through variables related to the accuracy (lateral and longitudinal end point errors) and kinematics (movement time, peak velocity) of the corrective movements. The electromyographic activity of different arm muscles (pectoralis, posterior deltoid, biceps brachii, and triceps brachii) was analyzed. Statistical analyses revealed that accuracy and kinematics of corrective movements were strikingly alike between normal and altered gravitoinertial force fields. However, pectoralis and biceps muscle activities recorded during corrective movements were significantly modified to counteract the effect of rotation-induced Coriolis and centrifugal forces on the arm. Remarkably, feedback control was functional from the very first time participants encountered a target jump in the altered force field. Overall, the present results demonstrate that feedforward control enables immediate functional feedback control even when applied to distinct sensorimotor processes.NEW & NOTEWORTHY We investigated the link between feedforward and feedback control when applying a double-step perturbation (visual target jump) during reaching movements performed in modified gravitoinertial environments. Altogether, kinematics and EMG analyses showed that movement corrections were highly effective in the different force fields, suggesting that, although feedforward and feedback control were driven by different sensory inputs, feedback control was remarkably functional from the very first time participants encountered a target jump in the altered force field.

Double-Step Paradigm in Microgravity: Preservation of Sensorimotor Flexibility in Altered Gravitational Force Field

The way we can correct our ongoing movements to sudden and unforeseen perturbations is key to our ability to rapidly adjust our behavior to novel environmental demands. Referred to as sensorimotor flexibility, this ability can be assessed by the double-step paradigm in which participants must correct their ongoing arm movements to reach targets that unexpectedly change location (i.e., target jump). While this type of corrections has been demonstrated in normogravity in the extent of reasonable spatiotemporal constraints underpinning the target jumps, less is known about sensorimotor flexibility in altered gravitational force fields. We thus aimed to assess sensorimotor flexibility by comparing online arm pointing corrections observed during microgravity episodes of parabolic flights with normogravity standards. Seven participants were asked to point as fast and as accurately as possible toward one of two visual targets with their right index finger. The targets were aligned vertically in the mid-sagittal plane and were separated by 10 cm. In 20% of the trials, the initially illuminated lower target was switched off at movement onset while the upper target was concomitantly switched on prompting participants to change the trajectory of their ongoing movements. Results showed that, both in normogravity and microgravity, participants successfully performed the pointing task including when the target jumped unexpectedly (i.e., comparable success rate). Most importantly, no significant difference was found in target jump trials regarding arm kinematics between both gravitational environments, neither in terms of peak velocity, relative deceleration duration, peak acceleration or time to peak acceleration. Using inverse dynamics based on experimental and anthropometrical data, we demonstrated that the shoulder torques for accelerating and decelerating the vertical arm movements substantially differed between microgravity and normogravity. Our data therefore highlight the capacity of the central nervous system to perform very fast neuromuscular adjustments that are adapted to the gravitational constraints. We discuss our findings by considering the contribution of feedforward and feedback mechanisms in the online control of arm pointing movements.

Telesonography: virtual 3D image processing of remotely acquired abdominal, vascular, and fetal sonograms

PURPOSE

To design and test a new telesonography technique using remote volume acquisition by untrained operators in locations without access to trained sonographers, postprocessing, and interpretation done at expert centers.

MATERIALS AND METHODS

The technique was tested with 84 sonograms of organs acquired in pregnant women (n = 8) and patients with various abdominal pathologic conditions (n = 11) located in French Guyana (France), Ceuta (Spain), and Murighiol (Romania). An operator inexperienced in sonography (US) placed the transducer over the predetermined acoustic window for each organ, then swept it from a -45° to a +45° position to scan the targeted organ. The acquired volume dataset was sent to an expert center via the Internet and reconstructed using a proprietary software, which allowed a trained sonographer to navigate through the appropriately reconstructed sonograms.

RESULTS

After three-dimensional processing at the expert center, the organs scanned in the obstetrical cases were adequately visualized by the expert in seven of eight (88%) examinations of the fetal head, femur, and umbilical cord and eight of eight (100%) examinations of the fetal abdomen and placenta, whereas in the general abdominal cases, the liver, gallbladder, portal vein, and right kidney were correctly visualized in 10 of 11 (91%) examinations.

CONCLUSIONS

Telesonography allowed untrained operators to scan and transfer the US volume datasets over the Internet to an expert center where an expert sonographer could navigate through the reconstructed US volume and visualize sonograms of diagnostic quality.

Online control of anticipated postural adjustments in step initiation: evidence from behavioral and computational approaches

Anticipatory postural adjustments (APAs) prior to step execution are thought to be immutable once released. Here we challenge this assumption by testing whether APAs can be modified online if a body perturbation occurs during execution. Two directions of perturbation (resisting and assisting) relative to the body weight transfer were used during the execution of APAs. We found that APAs are modified online (increase in both ground pressure and muscle activity) to compensate for resisting perturbations. The outcomes of a biomechanical model confirmed that the early changes in the APAs resulted from an active control of the APAs and were not merely mechanical consequences of the perturbation. However, no modification of the initial feedforward command was observed for assisting perturbations. The motor command changes for the resisting perturbation may originate from the mismatch between passively originated forces and those actively specified by the central command when acting in the opposite direction. The absence of a mismatch in the assisting perturbation might explain why the central nervous system was not prompted to modify the APAs in this condition.

Effect of gravity-like torque on goal-directed arm movements in microgravity

Gravitational force level is well-known to influence arm motor control. Specifically, hyper- or microgravity environments drastically change pointing accuracy and kinematics, particularly during initial exposure. These modifications are thought to partly reflect impairment in arm position sense. Here we investigated whether applying normogravitational constraints at joint level during microgravity episodes of parabolic flights could restore movement accuracy equivalent to that observed on Earth. Subjects with eyes closed performed arm reaching movements toward predefined sagittal angular positions in four environment conditions: normogravity, hypergravity, microgravity, and microgravity with elastic bands attached to the arm to mimic gravity-like torque at the shoulder joint. We found that subjects overshot and undershot the target orientations in hypergravity and microgravity, respectively, relative to a normogravity baseline. Strikingly, adding gravity-like torque prior to and during movements performed in microgravity allowed subjects to be as accurate as in normogravity. In the former condition, arm movement kinematics, as notably illustrated by the relative time to peak velocity, were also unchanged relative to normogravity, whereas significant modifications were found in hyper- and microgravity. Overall, these results suggest that arm motor planning and control are tuned with respect to gravitational information issued from joint torque, which presumably enhances arm position sense and activates internal models optimally adapted to the gravitoinertial environment.

Comparison of direct health care costs related to the pharmacological treatment of osteoporosis and to the management of osteoporotic fractures among compliant and noncompliant users of alendronate and risedronate: a population-based study

This population-based study aimed to compare direct health care costs related to the pharmacological treatment of osteoporosis and to the management of osteoporotic fractures among compliant and noncompliant users of alendronate and risedronate. During a 2-year follow-up period, compared to those with medication possession ratio (MPR) > or = 80%, women with MPR < 80% incurred significantly higher physician care costs and hospital care costs.

INTRODUCTION

This study aimed to compare direct health care costs related to the treatment of osteoporosis and osteoporotic fractures among compliant and noncompliant users of alendronate and risedronate.

METHODS

A cohort of 15,027 women having initiated alendronate or risedronate was identified. MPR and direct health care costs (physician care, hospital care, drugs) were assessed during a 2-year period. Regression models were used to estimate mean predicted cost for compliant (MPR > or = 80%) and noncompliant (MPR < 80%) women.

RESULTS

Mean predicted physician care cost (in Canadian dollars) was $51 among women with MPR < 80% and $34 among those with MPR > or = 80%: mean difference $17, 95% confidence interval (CI) $2-22. Mean predicted hospital care cost was $568 among women with MPR < 80% and $379 among those with MPR > or = 80%: mean difference $189, 95% CI $56-320. Mean predicted drug cost was $439 among women with MPR < 80% and $1,068 among those with MPR > or = 80%: mean difference $-639, 95% CI $-649 to -629.

CONCLUSION

Compared to compliant women, noncompliant women incurred significantly higher physician care and hospital care costs. Due to lower drug costs, total direct health care costs were lower among noncompliant women.

The high frequency of complement factor H related CFHR1 gene deletion is restricted to specific subgroups of patients with atypical haemolytic uraemic syndrome

BACKGROUND

Deletion of the complement factor H related 1 (CFHR1) gene is a consequence of non-allelic homologous recombination and has been reported to be more frequent in atypical haemolytic uraemic syndrome (aHUS) patients than in the normal population. Therefore, it is considered a susceptibility factor for the disease. aHUS is associated with hereditary or acquired abnormalities that lead to uncontrolled alternative pathway complement activation. We tested the CFHR1 deletion for association with aHUS in a population of French aHUS cases and controls. Furthermore, we examined the effect of the deletion in the context of known aHUS risk factors.

METHODS AND RESULTS

177 aHUS patients and 70 healthy donors were studied. The number of CFHR1 alleles was quantified by multiplex ligation dependant probe amplification (MLPA). The frequency of the deleted allele was significantly higher in aHUS patients than in controls (22.7% vs 8.2%, p<0.001). The highest frequency was in the subgroup of patients exhibiting anti-factor H (FH) autoantibodies (92.9%, p<0.0001 vs controls) and in the group of patients exhibiting a factor I (CFI) gene mutation (31.8%, p<0.001 vs controls). The CFHR1 deletion was not significantly more frequent in the cohort of aHUS patients when patients with anti-FH IgG or CFI mutation were excluded.

CONCLUSIONS

The high frequency of CFHR1 deletion in aHUS patients is restricted to the subgroups of patients presenting with anti-FH autoantibodies or, to a lesser degree, CFI mutation. These results suggest that the CFHR1 deletion plays a secondary role in susceptibility to aHUS.

Can prepared anticipatory postural adjustments be updated by proprioception?

Stepping over an obstacle is preceded by a center of pressure (CoP) shift, termed anticipatory postural adjustments (APAs). It provides an acceleration of the center of mass forward and laterally prior to step initiation. The APAs are characterized in the lateral direction by a force exerted by the moving leg onto the ground, followed by an unloading of the stepping leg and completed by an adjustment corresponding to a slow CoP shift toward the supporting foot. While the importance of sensory information in the setting of the APAs is undisputed, it is currently unknown whether sensory information can also be used online to modify the feedforward command of the APAs. The purpose of this study was to investigate how the CNS modulates the APAs when a modification of proprioceptive information (Ia) occurs before or during the initiation of the stepping movement. We used the vibration of ankle muscles acting in the lateral direction to induce modification of the afferent inflow. Subjects learned to step over an obstacle, eyes closed, in synchrony to a tone signal. When vibration was applied during the initiation of the APAs, no change in the early APAs was observed except in the case of a cutaneous stimulation (low frequency vibration); it is thus possible that the CNS relies less on proprioceptive information during this early phase. Only the final adjustment of the CoP seems to take into account the biased proprioceptive information. When vibration was applied well before the APAs onset, a postural reaction toward the side of the vibration was produced. When subjects voluntarily initiated a step after the postural reaction, the thrust amplitude was set according to the direction of the postural reaction. This suggests that the planned motor command of the APAs can be updated online before they are triggered.

[Complement factor I deficiency revealed by repeated systemic Streptococcus pneumoniae infection]

Recurrent and serious otitis media, and 2 Streptococcus pneumoniae bacteraemia episodes evoked an immune system deficiency in a 6-year-old girl. Upon investigation of the complement system, CH50 activity was moderately reduced and C4 antigen level was normal contrasting with low C3 antigen level. Factor 1 was undetectable. Factor I deficiency is rare, and its diagnosis has important practical consequences. Thanks to preventive antibiotic therapy with penicillin V and vaccinations against Neisseria meningitidis and S. pneumoniae, life expectancy and quality of this child can be significantly improved.

[Complement protein hereditary deficits during purulent meningitis: study of 61 adult Tunisian patients]

Sixty one Tunisian adult patients with bacterial meningitis were screened for complement deficiency. Functional activity of the classical and the alternative pathways of complement (CH50 and AP50 respectively) were measured according to standard haemolytic procedures. Serum concentrations of C3 and C4 were determined by nephelometry. Late complement component (C5-C9) and properdin concentrations were assessed by double-ligand EISA. Complement deficiency was found in eight patients (13%): Seven had late complement component deficiency (three C7 deficiency, two C5 deficiency, one C6 deficiency and one C8 deficiency) and one had partial properdin deficiency. Patients with late complement component deficiency had a mean age of 24 years (range 17-32 years). All deficient patients had meningococcal meningitis. Recurrent meningitis was reported in half of the patients. Our findings demonstrated a high prevalence of complement deficiency in Tunisia suggesting that screening for hereditary complement deficiency should be performed in case of bacterial meningitides and meningococcal disease patients.

[Neisseria meningitidis infection. Clinical criteria orienting towards a deficiency in the proteins of the complement]

OBJECTIVE

Complement protein deficiency of the classical pathway or in proteins of the alternate pathway is rare but considerably increase the risk of infection with Neisseria meningitidis. The aim of this study was to determine the clinical criteria of the group at risk.

METHODS

Retrospective study of the clinical and biological data of patients exhibiting complement protein deficiency associated with one or several N. meningitidis infections.

RESULTS

Forty cases were studied, including 35 classical pathway protein deficiencies, with a predominance of C7 deficiency, 3 properdin deficiencies and 2 acquired C3 deficiencies. More than 60% of the patients exhibited recurrent N. meningitidis infections. Serogroups of rare strains were isolated in 50% of cases. Properdin deficiency was associated with a fulminating form in 2 cases out of 3. The age at onset of the first manifestations varied from 2 months to 32 years.

CONCLUSION

A deficiency must be systematically searched for in all patients presenting with a N. meningitidis infection before the age of 6 months or after the age of 5 years. Identification of deficient patients permits the proposal of family screening and appropriate prophylaxis, including preventive vaccination.

Accuracy of spatial localization depending on head posture in a perturbed gravitoinertial force field

Spatial orientation is crucial when subjects have to accurately reach memorized visual targets. In previous studies modified gravitoinertial force fields were used to affect the accuracy of pointing movements in complete darkness without visual feedback of the moving limb. Target mislocalization was put forward as one hypothesis to explain this decrease in accuracy of pointing movements. The aim of this study was to test this hypothesis by determining the accuracy of spatial localization of memorized visual targets in a perturbed gravitoinertial force field. As head orientation is involved in localization tasks and carrying relevant sensory systems (visual, vestibular and neck muscle proprioceptive), we also tested the effect of head posture on the accuracy of localization. Subjects (n=10) were seated off-axis on a rotating platform (120 degrees s(-1)) in complete darkness with the head fixed (head-fixed session) or free to move (head-free session). They were required to report verbally the egocentric spatial localization of visual memorized targets. They gave the perceived target location in direction (i.e. left or right) and in amplitude (in centimeters) relative to the direction they thought to be straight ahead. Results showed that the accuracy of visual localization decreased when subjects were exposed to inertial forces. Moreover, subjects localized the memorized visual targets more to the right than their actual position, that was in the direction of the inertial forces. With further analysis, it appeared that this shift of localization was concomitant with a shift of the visual straight ahead (VSA) in the opposite direction. Thus, the modified gravitoinertial force field led to a modification in the orientation of the egocentric reference frame. Furthermore, this shift of localization increased when the head was free to move while the head was tilted in roll toward the center of rotation of the platform and turned in yaw in the same direction. It is concluded that the orientation of the egocentric reference frame was influenced by the gravitoinertial vector.

Restricted genetic defects underlie human complement C6 deficiency

Complement C6 homozygous deficiency (C6D) has been rarely observed in Caucasians but was reported at higher prevalence among African-Americans. We report on the molecular basis of C6D in seven unrelated black individuals of North or Central Africa descent who live in France. These patients have presented Neisseria meningitidis infection (four cases), focal and segmental glomerulosclerosis with hyalinosis (one case), systemic lupus erythematosus (one case) or Still's disease (one case). All patients exhibited undetectable antigenic C6 by using a sensitive ELISA assay. An additional four cases of complete C6 deficiency with no associated disease have been characterized after family studies. Exons 6, 7 and 12 have been described recently as the location of molecular defects on the C6 gene in randomly chosen black Americans. Genomic DNA from the seven patients were subjected to direct polymerase chain reaction amplification of these three exons. Nucleotide sequencing analysis of the amplified DNA fragments revealed a homozygous single-base deletion (1936delG) in exon 12 in three cases and four compound heterozygous deletions for a single base in exon 7 (1195delC) or in exon 6 (878delA) associated with the same deletion in exon 12 (1936delG). Our observations further establish the restricted pattern of genetic defects associated with homozygous C6 complement deficiency in individuals of African descent.

Galvanic vestibular stimulation in humans produces online arm movement deviations when reaching towards memorized visual targets

Using galvanic vestibular stimulation (GVS), we tested whether a change in vestibular input at the onset of goal-directed arm movements induces deviations in arm trajectory. Eight head-fixed standing subjects were instructed to reach for memorized visual targets in complete darkness. In half of the trials, randomly-selected, a 3 mA bipolar binaural galvanic stimulation of randomly alternating polarity was triggered by the movement onset. Results revealed significant GVS-induced directional shifts of reaching movements towards the anode side. The earliest significant deviations of hand path occurred 240 ms after stimulation onset. The likely goal of these online deviations of arm trajectory was to compensate for a vestibular-evoked apparent change in the spatial relationship between the target and the hand.

Molecular basis of a selective C1s deficiency associated with early onset multiple autoimmune diseases

We have investigated the molecular basis of selective and complete C1s deficiency in 2-year-old girl with complex autoimmune diseases including lupus-like syndrome, Hashimoto's thyroiditis, and autoimmune hepatitis. This patient's complement profile was characterized by the absence of CH50 activity, C1 functional activity <10%, and undetectable levels of C1s Ag associated with normal levels of C1r and C1q Ags. Exon-specific amplification of genomic DNA by PCR followed by direct sequence analysis revealed a homozygous nonsense mutation in the C1s gene exon XII at codon 534, caused by a nucleotide substitution from C (CGA for arginine) to T (TGA for stop codon). Both parents were heterozygous for this mutation. We used the new restriction site for endonuclease Fok-1 created by the mutation to detect this mutation in the genomic DNA of seven healthy family members. Four additional heterozygotes for the mutation were identified in two generations. Our data characterize for the first time the genetic defect of a selective and complete C1s deficiency in a Caucasian patient.

The gap effect for eye and hand movements in double-step pointing

The existence of a temporal gap between the offset of a fixation target and the onset of a peripheral target generally reduces the saccadic and manual reaction time in response to the peripheral target. Using a double-step paradigm, the present experiment investigated whether a temporal gap between the extinction of the first target and the presentation of the second target can help in reducing the time to trigger the corrective eye movements and to correct the arm trajectory towards the final target position. A gap was introduced between the presentation of the initial target and a new unexpected goal-target during the movement. The results replicated the gap effect for the corrective saccade to the second target, but revealed an opposite effect for the correction of the reaching movements as the arm correction occurred later in the Gap than in the No-Gap conditions. These results suggest that the information available for the arm motor system to correct the trajectory in relation to the second target was different in the Gap and No-Gap conditions. In the No-Gap condition, the correction of reaching movements would be based on retinal errors between the first and the second targets whereas, in the Gap condition, the correction would be based on information derived from the corrective saccade-related signals to the second target.

Visual feedback of the moving arm allows complete adaptation of pointing movements to centrifugal and Coriolis forces in human subjects

A classical visuo-manual adaptation protocol carried out on a rotating platform was used to test the ability of subjects to adapt to centrifugal and Coriolis forces when visual feedback of the arm is manipulated. Three main results emerge: (a) an early modification of the initial trajectory of the movements takes place even without visual feedback of the arm; (b) despite the change in the initial trajectory, the new external force decreases the accuracy of the pointing movements when vision is precluded; (c) a visual adaptive phase allows complete adaptation of the pointing movements performed in a modified gravitoinertial field. Therefore vision would be essential for subjects to completely adapt to centrifugal and Coriolis forces. However, other sensory signals (i.e. vestibular and proprioceptive) may constitute the basis for early but partial correction of the pointing movements.

No deleterious mutations in the FOXJ1 (alias HFH-4) gene in patients with primary ciliary dyskinesia (PCD)

The transcription factor FOXJ1 (alias HFH-4 or FKHL13) of the winged-helix/forkhead family is expressed in cells with cilia or flagella, and seems to be involved in the regulation of axonemal structural proteins. The knockout mouse Foxj1(-/-) shows abnormalities of organ situs, consistent with random determination of left-right asymmetry, and a complete absence of cilia. The human FOXJ1 gene which maps to chromosome 17q, is thus an excellent candidate gene for Kartagener Syndrome (KS), a subphenotype of Primary Ciliary Dyskinesia (PCD), characterized by bronchiectasis, chronic sinusitis and situs inversus. We have collected samples from 61 PCD families, in 31 of which there are at least two affected individuals. Two families with complete aciliogenesis, and six families, in which the affected members have microsatellite alleles concordant for a locus on distal chromosome 17q, were screened for mutations in the two exons and intron-exon junctions of the FOXJ1 gene. No sequence abnormalities were observed in the DNAs of the affected individuals of the selected families. These results demonstrate that the FOXJ1 gene is not responsible for the PCD/KS phenotype in the families examined.

Lack of evidence of a specific role for C4A gene deficiency in determining disease susceptibility among C4-deficient patients with systemic lupus erythematosus (SLE)

The aim of the present study was to investigate the prevalence of C4 and C2 deficiencies and to characterize genomic alterations in C4 genes in a large cohort of 125 unselected patients with SLE. We determined the protein concentration and functional activity of C2 and C4, as well as the C4 phenotype. C4 genotyping included Taq 1 restricted fragment lengh polymorphism (RFLP) analysis and polymerase chain reaction using sequence-specific primers (SSP-PCR). Type I C2 deficiency was diagnosed by PCR. Overall, 79.2% of the patients exhibited abnormalities of the C4 genes including deletion, non-expression, gene conversion and duplication. Among C4-deficient patients (n = 66, 52.8% prevalence), 41.0% of the patients exhibited a C4A deficiency and 59.0% a C4B deficiency. Half of the C4 deficiencies were due to a gene deletion. There was a strong association between C4A and C4B gene deletion and the presence of the DRB1*03 allele. Among the silent C4A genes, only two cases were related to a 2-bp insertion in exon 29 of the C4A gene. A gene conversion was demonstrated in eight patients (6.4%). One patient had a homozygous C4A deficiency. Three (2.4%) patients presented with a heterozygous type I C2 deficiency and none with homozygous deficiency. Our results argue against a specific role for C4A gene deficiency in determining disease susceptibility among patients with SLE that are C4-deficient.

Human complement factor H deficiency associated with hemolytic uremic syndrome

This study reports on six cases of deficiency in the human complement regulatory protein Factor H (FH) in the context of an acute renal disease. Five of the cases were observed in children presenting with idiopathic hemolytic uremic syndrome (HUS). Two of the children exhibited a homozygous deficiency characterized by the absence of the 150-kD form of Factor H and the presence, upon immunoblotting, of the 42-kD Factor H-like protein 1 (FHL-1) and other FH-related protein (FHR) bands. Southern blot and PCR analysis of DNA of one patient with homozygous deficiency ruled out the presence of a large deletion of the FH gene as the underlying defect for the deficiency. The other four children presented with heterozygous deficiency and exhibited a normal immunoblotting pattern of proteins of the FH family. Factor H deficiency is the only complement deficiency associated with HUS. These observations suggest a role for FH and/or FH receptors in the pathogenesis of idiopathic HUS.

Updating visual space during passive and voluntary head-in-space movements

The accuracy of our spatially oriented behaviors largely depends on the precision of monitoring the change in body position with respect to space during self-motion. We investigated observers' capacity to determine, before and after head rotations about the yaw axis, the position of a memorized earth-fixed visual target positioned 21 degrees laterally. The subjects (n=6) showed small errors (mean=-0.6 degrees) and little variability (mean=0.9 degrees) in determining the position of an extinguished visual-target position when the head (and gaze) remained in a straight-ahead position. This accuracy was preserved when subjects voluntary rotated the head by various magnitudes in the direction of the memorized visual target (head rotations ranged between 5 degrees and 60 degrees). However, when the chair on which the subjects were seated was unexpectedly rotated about the yaw axis in the direction of the target (chair rotations ranged between 6 degrees and 36 degrees ) during the head-on-trunk rotations, the performance was markedly decreased, both in terms of spatial precision (mean error=5.6 degrees ) and variability (mean=5.7 degrees). A control experiment showed that the prior knowledge of chair rotation occurrence had no effect on the perceived target position after head-trunk movements. Updating an earth-fixed target position during head-on-trunk rotations could be achieved through both cervical and vestibular signals processing, but, in the present experiment, the vestibular output was the only signal that had the potentiality to contribute to accurate coding of the target position after simultaneous head and trunk movements. Our results therefore suggest that the vestibular output is a noisy signal for the central nervous signal to update the visual space during head-in-space motion.

Encoding target-trunk relative position: cervical versus vestibular contribution

The contribution of cervical and vestibular cues in signaling the changes in target-trunk relative positions during self-motion was investigated. Normal subjects (Ss) were shown a LED flashed in the peripheral visual field in a dark room. Ss were then passively rotated about the vertical axis in one of three different conditions: (1) head chair-fixed (vestibular condition); (2) head earth-fixed (relaxed neck condition); and (3) head earth-fixed, but with the Ss actively attempting to turn it (activated neck condition). The Ss were then required to indicate, with their unseen index finger, the position of the previously flashed target. It was found that pointing at the memorized target was similarly accurate in the relaxed neck condition and in the activated neck condition. In the vestibular condition, pointing accuracy dropped significantly. These results suggest that neck proprioceptive signals are more effective than vestibular ones in signaling relative changes in the position of stationary objects with respect to the body during head-trunk motion. The finding that cervically mediated estimates were unchanged during active contraction of the neck muscles may suggests that efference copy signals may help interpret the change in the afferent signals caused by voluntary neck muscle activation.

Role of arm proprioception in calibrating the arm-eye temporal coordination

When subjects track with the eyes an arm-attached target, eye latency is shorter than when tracking an external target. This improved synchrony could result from either a common command addressed to the two systems or from an influence of the arm command on eye motion initiation. According to the first hypothesis, the eyes should start moving long before the arm, because of the difference in dynamics. We recorded arm and eye motion together with biceps muscle activity in controls and a deafferented subject. Data support the second hypothesis. Moreover, the deafferented subject showed a lesser correlation between arm and eye motions than controls, suggesting a role for arm proprioception in the calibration of the temporal relationship between arm and eye movements.

The role of ocular muscle proprioception during modifications in smooth pursuit output

The output of the smooth pursuit (SP) system can be increased by adding a portion of the recorded eye motion onto target motion, producing a situation analogous to that occurring with weakened ocular muscles. This change is most likely the result of alterations in the signals that code eye and target motion. We have assessed the contribution of one such signal, that arising from ocular proprioception, to the modification process during monocular SP by preventing the motion of the non-viewing eye with a suction scleral lens. The large increases normally observed for SP velocity following the modification period were substantially reduced under these conditions. Similar alterations were also observed in a manual tracking task. These results demonstrate that ocular proprioceptive signals serve to stabilize the output of the SP system following perturbations, via the recoding of eye and target motion.

Visual object localization through vestibular and neck inputs. 2: Updating off-mid-sagittal-plane target positions

The vestibular signal plays a significant role in sensing changes in head orientation during rotations and in determining the magnitude of the rotations, but has only minor contributions in updating the internal representation of object positions with respect to the body after body rotations. The small contribution of the vestibular signal in egocentric object localization was evidenced in experiments in which the subjects reported the remembered position of eccentric earth-fixed targets after passive body rotations. The experiment reported here tested whether motor systems, such as the oculomotor system, make use of vestibular signals to generate accurate goal-directed motor responses toward a target whose position needs to be updated with respect to the body during and after whole-body rotations. The results showed that although subjects can produce saccadic eye movements of about the same magnitude as passive whole-body rotations (as previously reported by a number of researchers), they failed to generate accurate saccades toward the position of an extinguished peripheral visual target after the rotation. Overall, these results combined with those found in the literature suggest different central processes for determining changes in body orientation in complete darkness and for updating a target position with respect to the body during and after body rotations.

Combined heterozygous deficiency of the classical complement pathway proteins C2 and C4

Genetic deficiencies of components of the classical pathway of complement activation are associated with an increased risk for the development of autoimmune and immune complex-mediated diseases. In the present study we report on the molecular and clinical features associated with combined heterozygous C4 and C2 deficiency in 15 individuals investigated within six families. Approximately 30% of the individuals manifested SLE or another autoimmune condition. Heterozygous C2 deficiency was related to a 28-bp deletion in the C2 gene (C2 deficiency type I), in most cases within the HLA-A25 B18 C2Q0 BfS C4A4B2 DR2 haplotype. Among 13 partial C4-deficient haplotypes transmitted, 8 carried C4A*Q0 alleles and 5 C4B*Q0 alleles. In seven cases the C4A*Q0 alleles were associated with a deletion of the C4A/CYP21P genes within the HLA-B8 C2C BfS C4AQ0B1 DR3 haplotype. In three cases, the C4B*Q0 allele was associated with a deletion of the C4B/CYP21P genes within the HLA-B18 C2C BfF1 C4A3BQ0 DR3 haplotype. In the other cases, C4A*Q0 or C4B*Q0 was dependent on as yet uncharacterized defects in the C4 gene or in C4 gene expression. In view of the relatively high frequency of heterozygous C4 deficiency in the normal Caucasian population, the expected frequency of the combined deficiency should approximate 0.001.

Self-moved target eye tracking in control and deafferented subjects: roles of arm motor command and proprioception in arm-eye coordination

1. When a visual target is moved by the subject's hand (self-moved target tracking), smooth pursuit (SP) characteristics differ from eye-alone tracking: SP latency is shorter and maximal eye velocity is higher in self-moved target tracking than in eye-alone tracking. The aim of this study was to determine which signals (motor command and/or proprioception) generated during arm motion are responsible for the decreased time interval between arm and eye motion onsets in self-moved target tracking. 2. Six control subjects tracked a visual target whose motion was generated by active or passive movements of the observer's arm in order to determine the role played by arm proprioception in the arm-eye coordination. In a second experiment, the participation of two subjects suffering complete loss of proprioception allowed us to assess the contribution of arm motor command signals. 3. In control subjects, passive movement of the arm led to eye latencies significantly longer (130 ms) than when the arm was actively self-moved (-5 ms:negative values meaning that the eyes actually started to move before the target) but slightly shorter than in eye-alone tracking (150 ms). These observations indicate that active movement of the arm is necessary to trigger short-latency SP of self-moved targets. 4. Despite the lack of proprioceptive information about arm motion, the two deafferented subjects produced early SP (-8 ms on average) when they actively moved their arms. In this respect they did not differ from control subjects. Active control of the arm is thus sufficient to trigger short-latency SP. However, in contrast with control subjects, in deafferented subjects SP gain declined with increasing target motion frequency more rapidly in self-moved target tracking than in eye-alone tracking. 5. The deafferented subjects also tracked a self-moved target while the relationship between arm and target motions was altered either by introducing a delay between arm motion and target motion or by reversing target motion relative to arm motion. As with control subjects, delayed target motion did not affect SP latency. Furthermore, the deafferented subjects adapted to the reversed arm-target relationship faster than control subjects. 6. The results suggest that arm motor command is necessary for the eye-to-arm motion onset synchronization, because eye tracking of the passively moved arm was performed by control subjects with a latency comparable with that of eye-alone tracking of an external target. On the other hand, as evidenced by the data from the deafferented subjects, afferent information does not appear to be necessary for reducing the time between arm motion and SP onsets. However, afferent information appears to contribute to the parametric adjustment between arm motor command and visual information about arm motion.

Autoantibodies to the collagen-like region of C1q are strongly associated with classical pathway-mediated hypocomplementemia in systemic lupus erythematosus

We have investigated the presence of autoantibodies to the collagen-like region (CLR) of C1q and its relationship with classical pathway-dependent hypocomplementemia in patients with SLE. Antibodies to CLR/C1q were quantitated in the plasma of 113 unselected patients with SLE by ELISA, using purified CLR as antigen. Plasma concentration of C3, CH50 activity and C2 hemolytic activity were determined according to standard procedures. The prevalence of IgG antibodies to CLR/C1q in the study population was 33.6%. Plasma titers of anti-CLR/C1q autoantibodies showed a strong negative correlation with CH50 activity (p < 0.0001) and with plasma levels of C3 (p < 0.0001). Eighty-five percent of patients with severe complement consumption exhibited high titers of anti-CLR/C1q antibodies in plasma, independently of clinical disease activity. Anti-CLR/C1q antibodies were present in the plasma of 38% of patients with moderate classical pathway consumption and 14% of patients with no evidence of complement consumption. Analysis of sequential samples from six patients over a period of 18 to 24 months demonstrated that changes in CH50 activity mirrored those of the plasma titers of anti-CLR/C1q antibodies. Acquired hypocomplementemia through the classical pathway is strongly associated with the presence of anti-CLR/C1q autoantibodies in SLE. The results suggest that anti-CLR/C1q antibodies may perpetuate classical pathway activation, independently of clinical disease activity.

The relative contribution of retinal and extraretinal signals in determining the accuracy of reaching movements in normal subjects and a deafferented patient

This experiment investigated the relative extent to which different signals from the visuo-oculomotor system are used to improve accuracy of arm movements. Different visuo-oculomotor conditions were used to produce various retinal and extraretinal signals leading to a similar target amplitude: (a) fixating a central target while pointing to a peripheral visual target, (b) tracking a target through smooth pursuit movement and then pointing to the target when its excursion ceased, and (c) pointing to a target reached previously by a saccadic eye movement. The experiment was performed with a deafferented subject and control subjects. For the deafferented patient, the absence of proprioception prevented any comparison between internal representations of target and limb (through proprioception) positions during the arm movement. The deafferented patient's endpoint therefore provided a good estimate of the accuracy of the target coordinates used by the arm motor system. The deafferented subject showed relatively good accuracy by producing a saccade prior to the pointing, but large overshooting in the fixation condition and undershooting in the pursuit condition. The results suggest that the deafferented subject does use oculomotor signals to program arm movement and that signals associated with fast movements of the eyes are better for pointing accuracy than slow ramp movements. The inaccuracy of the deafferented subject when no eye movement is allowed (the condition in which the controls were the most accurate) suggests that, in this condition, a proprioceptive map is involved in which both the target and the arm are represented.

Visual stability with goal-directed eye and arm movements toward a target displaced during saccadic suppression

This experiment tested whether the perceived stability of the environment is altered when there is a combination of eye and visually open-loop hand movements toward a target displaced during the eye movements, i.e., during saccadic suppression. Visual-target eccentricity randomly decreased or increased during eye movements and subjects reported whether they perceived a target displacement or not, and if so, the direction of the displacement. Three experimental conditions, involving different combinations of eye and arm movements, were tested: (a) eye movements only; (b) simultaneous eye and rapid arm movements toward the target; and (c) simultaneous eye and arm movements with a restraint blocking the arm as soon as the hand left the starting position. The perceptual threshold of target displacements resulting in an increased target eccentricity was greater when subjects combined eye and arm movements toward the target object, specially for the no-restraint condition. Subjects corrected most of their arm trajectory toward the displaced target despite the short movement times (average MT = 189 ms). After the movements, the null error feedback of the hand's final position presumably overlapped the retino-oculomotor signal error and could be responsible for the deficient perception of target displacements. Thus, subjects interpreted the terminal hand positions as being within the range of the endpoint variability associated with the production of rapid arm movements rather than as a change of the environment. These results suggest that a natural strategy adopted for processing spatial information, especially in a competing situation, could favour a constancy tendency avoiding systematic perception of a change of environment for any noise or variability at the central or peripheral levels.

Perception of passive whole-body rotations in the absence of neck and body proprioception

1. This study investigated whether accurate perception of body rotation after passive horizontal whole-body rotations in the dark requires the integration of both vestibular and neck-body proprioceptive signals. 2. In the first experiment, the gain of the vestibuloocular reflex (VOR) of normal subjects ("controls") and of a patient without proprioception of the neck and body muscles was assessed by the use of pulse and sinusoidal stimulation. In the second experiment, the subjects reported verbally the magnitude of the body rotations. Finally, in the third experiment, they shifted gaze to the position fixated before the rotation ("vestibular memory-contingent saccades" paradigm). 3. The VOR gain of the patient was similar to that of controls, although the body rotations of the patient were largely overestimated, regardless of whether the patient reported the perceived magnitude verbally or through a gaze shift toward the position gazed at before the rotation. 4. These results suggest that neck muscle proprioception contributes to the vestibular signal calibration at the perceptual level necessary for determining body orientation accurately after rotations in the dark.

Failure to update the egocentric representation of the visual space through labyrinthine signal

The present study evaluated the capacity to compare retinal and vestibular signals in a heterosensorial matching task. In the first experiment, subjects evaluated the magnitude of passive whole-body rotations in relation to the eccentricity of a visual target briefly presented before rotation. Such a task elicits multimodal sensory stimulations experienced by a subject during normal goal-oriented head movements, i.e., retinal and vestibular stimulations. A good capacity to evaluate vestibular signals in relation with retinal inputs might suggest that the labyrinthine output is part of a cognitive feedback-loop controlling active head movements oriented toward a visual target and/or that the labyrinthine signal might make a major contribution to judging the position of the target in space after goal-directed head movements. Results showed that body rotation magnitudes had to exceed the amplitude of the visual target by about 120 and 89% to be perceived as having a similar magnitude to a 10 degree and an 18 degree visual target, respectively. A second experiment was designed to test whether this major discrepancy originated either from (a) an overestimation of the peripheral visual target locations, (b) an underestimation of the labyrinthine signal, (c) a deficiency in matching sensory signals from different modalities, or (d) any combination of (a), (b), and (c). In the second experiment, the actual perception of retinal and labyrinthine signals, as indicated by verbal responses, was quantified. Results from this experiment showed that most of the large underestimation of the vestibular stimulation found in Experiment I ought to emerge from a poor capacity to integrate heterogeneous sensory signals by the perceptual system rather than from pure misperception of the retinal and/or labyrinthine signals. Overall, results from Experiments I and II argue for a deficiency of the CNS to integrate labyrinthine signals for updating the egocentric representation of the peripheral visual target during passive body (head) rotations.

[Partial properdin deficiency revealed by a septicemia caused by Neisseria meningitidis]

Properdin is one of the regulatory proteins of the alternative pathway of the complement system. Human properdin deficiency is an X-linked disorder strongly predisposing to meningococcal disease. Total deficiency (type I), partial deficiency (type II), and deficiency due to a dysfunctional molecule (type III) can be differentiated immunochemically. Four males in a family showed a selective partial deficiency of properdin. These individuals had 10% of normal properdin concentration in plasma, as measured by ELISA, while the other complement components were normal. Two of the properdin-deficient individuals in two generations had meningococcal infections. Two were clinically healthy at the time of investigation. Measurement of plasma levels of properdin has to be performed in the case of Neisseria meningitidis, especially where there is a previous history of severe bacterial infections in the same family as measurement of CH50 activity is ineffective for screening properdin deficiency.

Egocentric visual target position and velocity coding: role of ocular muscle proprioception

Limited knowledge is available regarding the processes by which the brain codes the velocity of visual targets with respect to the observer. Two models have been previously proposed to describe the visual target localization mechanism. Both assume that the necessary information is derived from the coding of the position of the eye in the orbit, either through a copy of the muscular activation (out flow model) or through eye muscle proprioception (in flow model). Eye velocity coding might be derived from velocity sensitive ocular muscle proprioceptors or from position coding signals through differentiation. We used techniques based on manual pointing and manual tracking of visual target, combined with passive deviation of one covered eye, to demonstrate that ocular muscle proprioception is involved in (i) eye-in-head position coding, hence in target localization function; (ii) long-term maintenance of ocular alignment (phoria); and (iii) sensing of visual target velocity with respect to the head. These observations support other data now available, describing the processes by which the brain codes position and velocity of visual targets. Such findings might interest engineers in the field of robotics who are facing the problem of providing robots with the ability to sense object position and velocity in order to create an internal model of their working environment.

Control of Rapid Arm Movements When Target Position Is Altered During Saccadic Suppression

This experiment examined whether rapid arm movements can be corrected in response to a change in target position that occurs just prior to movement onset, during saccadic suppression of displacement. Because the threshold of retinal input reaches its highest magnitude at that time, displacement of the visual target of a saccade is not perceived. Subjects (N = 6) were instructed to perform very rapid arm movements toward visual targets located 16, 20, and 24 degrees from midline (on average, movement time was 208 ms). On some trials the 20 degrees target was displaced 4 degrees either to the right or to the left during saccadic suppression. For double-step trials, arm movements did not deviate from their original trajectory. Movement endpoints and movement structure (i.e., velocity-and acceleration-time profiles) were similar whether or not target displacements occurred, showing the failure of proprioceptive signals or internal feedback loops to correct the arm trajectory. Following this movement, terminal spatially oriented movements corrected the direction of the initial movement (as compared with the single-step control trials) when the target eccentricity decreased by 4 degrees. Subjects were unaware of these spatial corrections. Therefore, spatial corrections of hand position were driven by the goal level of the task, which was updated by oculomotor corrective responses when a target shift occurred.

Encoding the position of a flashed visual target after passive body rotations

The capacity of the central nervous system (CNS) for processing vestibular signals during passive whole-body rotations to update the internal representation of a visual target position in relation to the body was assessed. Results showed that subjects mislocalized previously presented visual targets after body rotations in complete darkness. Detailed analysis of the results suggested that the large target mislocalization stemmed not only from a systematic underestimation of rotation magnitude but also from the incapacity of the CNS to use the vestibular signals to accurately update the internal representation of the target position in relation to the body after passive rotations.

Factors affecting dropout rate from cognitive-behavioral group treatment for bulimia nervosa

The aim of this study was to retrospectively identify clinical variables assessed prior to treatment which were predictive of patients' dropping out versus completing a 10 week group cognitive-behavioral treatment program for bulimia nervosa. Following a lengthy initial assessment, 81 women meeting DSM-III-R criteria for bulimia nervosa (BN) were referred to one of twelve 10-week groups of 8 to 12 patients having bulimic symptoms. The dropout rate for those meeting full DSM-III-R criteria for BN was found to be 28.7%. A series of seven discriminant function analyses were performed to determine whether dropouts differed from completers in terms of depression, anxiety, difficulties in trust and relating to others, bulimic symptom severity, family environment, weight history and symptom duration and severity of bulimic cognitions. Of these, only the factor assessing difficulties trusting and relating to others was found to significantly discriminate dropouts from completers. Implications of the findings are discussed in terms of clinical and research relevance in the field of eating disorders.

Internal representation of gaze direction with and without retinal inputs in man

The contribution of retinal and extraretinal signals to the coding of eye position in the head was studied in human subjects (Ss). Horizontal saccades were produced in darkness. For some trials, before returning gaze direction to the starting position, a visual signal briefly stimulated the foveal retina. Results showed that this retinal input helped Ss to perceive gaze orientation more accurately after the saccade suggesting that the internal representation of eye position was improved when both extraretinal and retinal signals were available.

Complete inherited deficiency of the fourth complement component in a child with systemic lupus erythematosus and his disease-free brother in a north African family

Although null alleles of complement C4 genes (C4A*Q0 and C4B*Q0) are frequent in the normal population, the occurrence of two null alleles on the same chromosome is very rare and therefore complete C4 deficiency is exceptional. We describe a 16-year-old North African boy who presented with systemic lupus erythematosus with renal involvement and persistent undetectable classical pathway activity and C4 protein and hemolytic activity in plasma, with normal C3 levels. Similar complement abnormalities were observed in his healthy 12-year-old brother. Complete C4 deficiency was documented in the two brothers by investigation of the family and the lack of C4A and C4B bands upon phenotyping of C4. Southern blot analysis of the C4/CYP21 gene organization in the family indicated that the deficiency resulted from a deletion of the C4B/CYP21A genes associated with nonexpression of a C4A gene. The double-null haplotype was found to be associated with homozygous A2 B17 C2C BFF C4 AQ0 BQ0 DR7 HLA haplotype. Thus, similar C4 deficiencies with HLA identity may lead to different clinical presentations.