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The study of the caper fermentation process through an experiment factorial plan allows us to determine a function ƒ such that (Y= ƒ(X1, X2, …, Xn)) existing between magnitude Y which is the decrease of pH (called response), and variables Xi , which are brine, lactic acid, citric acid and lactic ferment (called factors). A complete factorial plan 24 was made in order to determine the factors and the interactions among the factors which have a statistically significant influence on the studied response. Brine, lactic acid and citric acid have a significant effect on the fall of pH; by contrast, lactic ferment does not have a significant effect. On the other hand, the interactions between brine and lactic acid, between brine and lactic ferment , between lactic acid with citric acid and between lactic acid with lactic ferment have significant effects on the fall of pH (p < 0.0001). The fermentation was done in the research laboratory of the society Marocapres- Fez, international leader in the processing of capers, at a temperature of about 30°C, between June and July.

Abstract Production of tannase (tannin acyl hydrolase, EC 3.1.1.20) by Aspergillus nigerHA37 on a synthetic culture medium containing tannic acid at different concentrations has been studied. Maximal enzymatic activity increased according to the initial concentration of tannic acid; respectively 0.6, 0.9 and 1.5 enzyme activity units (EU) ml−1 medium in the presence of 0.2%, 0.5% and 1% of tannic acid. Tannase production by A. niger HA37 on fourfold diluted olive mill waste waters (OMWW) as substrate, was between 0.37 and 0.65 EU ml−1. Enzyme production on the diluted OMWW remained globally stable during more than 30 h. Growth of A. niger HA37 on OMWW was correlated with about 70% degradation of phenolic compounds present in the waste. This strain has therefore the capacity to degrade complex wastewaters which cause environmental damage to aquatic streams. [ABSTRACT FROM AUTHOR]

We study the relationship between crude oil price volatility and corporate environmental performance. Using an extensive dataset from 32 countries consisting of 18,464 firm-year observations, we provide strong evidence that oil price volatility significantly increases firms' environmental performance. Our main inference is robust when using alternative measures of oil price volatility and environmental performance, alternative econometric specifications and samples, and several approaches to control for endogeneity. In a set of additional analyses, we first conduct a difference-in-differences analysis that exploits the Arab Spring as an exogenous oil price volatility increase and document a stronger relationship between oil price volatility and environmental performance in the aftermath of the Arab Spring. We second identify (i) capital expenditures and (ii) alternative energy importation as two mechanisms through which oil price volatility influences environmental performance. We finally show that national culture plays a significant role in moderating the relationship between oil price volatility and environmental performance. Taken together, our empirical findings highlight the role of economic uncertainty in affecting firms' environmental performance and provide significant contributions to management and policymakers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Fly ash is a significant pollutant in thermal power stations. Although this waste harms the environment and humans, it is badly removed and managed, and only a few studies are interested in this waste. For that, this study aims to valorise fly ash into potential adsorbents to treat tannery effluents for the first time. The physicochemical characterisation showed that fly ash has a pHpzc of 9.78, a very porous structure, a high specific surface area of 3127.2 m 2 /g with a total pore volume of 3.27 cm 3 /g, and a high silica and aluminium percentage. SEM showed that the fly ash studied has a small particle size ranging between 32 nm and 100 μm. Batch adsorption experiments were done, and the effects of adsorption parameters were investigated. The kinetics and isotherms models indicate that the equilibriums were achieved in 30 min, where the maximum uptake capacity was 2496, 223.7 and 106.8 mg/g for Chemical Oxygen Demand (COD), chromium (VI) and sulfide ions, respectively. The kinetic data were well fitted to the pseudo-second-order model and showed that adsorption onto fly ash may be chemical and physical simultaneously. Freundlich's model gave a better fit for the experimental adsorption equilibrium data and displayed multilayer adsorption. The thermodynamic isotherm showed that the adsorption onto fly ash is thermodynamically spontaneous (ΔG° < 0) and endothermic (ΔH° > 0). In conclusion, fly ash, which is a free material, has a more robust adsorption capacity than other expensive materials. Thus, it can be a promising, eco-friendly, attractive adsorbent for industrial wastewater treatment., Competing Interests: The authors declare no conflict of interest., (© 2022 Published by Elsevier Ltd.)

Purpose: We report our experience of 86 consecutive patients with locally advanced nasopharyngeal carcinoma who were treated with volumetric modulated arc therapy., Materials and Methods: We retrospectively reviewed the medical records of 86 patients with histologically proven primary nasopharyngeal carcinoma treated with volumetric modulated arctherapy technique radiotherapy. Primary endpoints were local, regional, distant control, and overall survival, second endpoint was late toxicity., Results: The median age was 47.5 years (range: 13-79 years) with sex ratio 1.09. At diagnosis, rhinologic symptoms represented the most common clinical presentation, reported by 61 patients (70.9%). Almost 88.4% of patients presented non-keratinizing undifferentiated carcinoma histology (n=76). Most of the patients presented a locally advanced disease defined by stage III and IVa (95.3%). Therefore, 31 patients were treated by concurrent chemoradiation (36%), 52 patients received induction chemotherapy followed by concurrent chemoradiotherapy (57%), three patients received induction chemotherapy followed by exclusive radiotherapy (3.5%). and three patients treated with exclusive irradiation (3.5%). With a median follow up of 15.7 months (range: 4-33.3 months), nine patients died (10.4%), three presented local or locoregional relapse (3.4%), while nine patients presented distant recurrences (10.4%). The two years overall and disease-free survival rates were 88.7% and 83.1% respectively, locoregional control was 100% at 12 months and 96.2% at 24 months, and the two years distant failure-free survival was 86.7%. Time to relapse was the only prognostic factor in univariate analysis for overall survival in our study. The therapeutic tolerance was good with 61.7% of grade 3 and 2.3% grade 4 hyposialia respectively, 46.5% of otological disorders and no radionecrosis was noted., Conclusion: Volumetric modulated arctherapy technique with concurrent chemoradiotherapy is an effective treatment for nasopharyngeal carcinoma with excellent overall and locoregional control without severe toxicity. Distant metastasis is the major site of failure, so induction chemotherapy added to chemoradiotherapy must be discussed in multidisciplinary consultation meeting because it significantly improved recurrence-free survival and overall survival, as compared with chemoradiotherapy alone., (Copyright © 2021 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Composting is a promising source of mesophilic and thermophilic microorganisms directly involved in the decay of organic matter. However, there is a paucity of information related to bacterial and fungal diversity in compost and their enzymatic activities during the composting process. In this work, bacterial and fungal diversity during the mesophilic and thermophilic phases of textile waste composting was investigated as a way to explain the physical-chemical results obtained during the composting process. This was accomplished using a next-generation sequencing approach that targets either the 16S rRNA or ITS genomic regions of bacteria and fungi, respectively. It was observed that Proteobacteria, Bacteroidetes, and Actinobacteria were the dominant bacterial phyla present at the mesophilic phase but not at the thermophilic one. Composting textile waste exhibits a sustained thermophilic profile (above 55 °C) that usually precludes fungal activity. Nonetheless, the presence of fungi at the thermophilic phase was observed. Rozellomycota, Basidiomycota, and Ascomycota were the most dominant phyla during both composting phases. Such thermophilic fungi with great ability to decay organic matter could be isolated as pure cultures and used for the bioaugmentation of textile waste composting to achieve an advanced maturity level of textile waste compost., (© 2021. The Author(s).)

Purpose: The aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position., Patients and Methods: This study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]., Results: Using Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03mm, 5.42mm and 8.73mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5mm. The CTV to PTV margins ranged from 3.12mm to 3.25mm for external iliac vessels and from 3.12mm to 4.18mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction., Conclusions: We recommend CTV to PTV margins of 8mm, 6mm and 9mm in AP, ML and SI directions for prostate. And, we suggest 4mm and 5mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3weeks and especially the first week to check rectum volume., (Copyright © 2020 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

In the present study we aimed firstly to assess the resistance of a set of yeasts, isolated from the black olive pomace, to various phenolic compounds; and to evaluate their growth capacities on an olive leaf extract rich of oleuropein. The results showed that only three yeasts were able to both resist to the different phenolic compounds tested and grow on the olive leaf extract at a concentration of 1%. The second step was devoted to studying the bioconversion of oleuropein of an olive leaf extract into hydroxytyrosol by the above selected three yeasts. The oleuropein degradation and hydroxytyrosol formation were monitored by HPLC-UV. Only one yeast isolate; identified using molecular tools; was chosen to optimize the bioconversion throughout the optimization of the most influencing parameters: temperature, substrate concentration, cell concentration, and pH of the extract using a method of experimental design. The results showed that the three yeasts; F6, F4, and F12 were capable of producing hydroxytyrosol from oleuropein with different concentrations 317 ± 14 mg/l, 210 ± 14 mg/l, and 149 ± 21 mg/l; respectively. The strong oleuropienolytic activity manifested by the F6 isolate was further optimized, and the results showed that the optimal conditions for producing the maximum of hydroxytyrosol are: a temperature of 31 °C, a cell concentration of 2%, a substrate concentration of 1%, and a non-adjusted pH of the extract. Based on the molecular approaches F6 was identified as Nakazawaea molendini-olei., Competing Interests: Declaration of Competing Interest There is no any conflict interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This study investigates the performance of soil and OMW microfloras in OMW organic matter humification in soil. In order to highlight the role of OMW and soil microfloras in the processes of OMW organic matter humification, either OMW or soil was sterilized with autoclaving. The study was carried out in microcosms of 1l containing 500 g of raw or sterilized soil, to which was added 200 ml of raw or sterilized OMW. After 24 months of incubation, the amount of phenolic compounds in the different microcosms was statistically indifferent compared to the control. However, TG-DTA and FTIR analysis of soil humic acids showed that recalcitrant OMW phenolic compounds remain in soil humus in the microcosm: sterilized OMW + raw soil, even after 24 months. Results show that humic acids detected in presence of OMW microflora are loaded with proteins and carbonated compounds and deprived of phenolic compounds and aliphatics with long chain, while humic acids detected in absence of OMW microflora are loaded with phenolic compounds., (© 2020 Published by Elsevier Ltd.)

The aim of the present study is to firstly study the effect of the extraction solvents (ethanol, acetonitrile, distilled water), pH, temperature, and the extraction method (maceration, sonication, maceration in two steps) on the flavonoid and phenolic contents of olive leaves. Furthermore, qualitative and quantitative analyzes of phenolic compounds by (HPLC) were performed. Results showed that the extract macerated in two steps by ethanol followed by distilled water of dried leaves showed high contents of phenolic compounds and flavonoids compared to the extracts obtained by the other studied techniques and solvents. On the other hand, the macerated extracts were studied for their antibacterial activity against five pathogenic bacteria ( Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Bacillus subtilis and Listeria monocytogenes ). The results showed a strong antibacterial activity of the same macerated extract in two steps for dried leaves, which could be attributed to its richness in bioactive compounds such as oleuropein.

Human papillomavirus (HPV) persistent infection is the necessary but not sufficient cause of cervical cancer. Other co-factors are required to induce cell transformation that will evolve to malignant cervical cancer. These co-factors include physical elements, other sexually transmitted infections, and immune response. Chlamydia trachomatis the most common bacterial sexually transmitted infection is often asymptomatic but causes various syndromes such as cervicitis, endometritis, pelvic inflammatory disease, and infertility. It is established that this bacterium is involved in cell proliferation process and inhibit apoptosis. Furthermore, C. trachomatis may induce chronic inflammation, interfere with immune response by decreasing the number of antigen presenting cells, and reduce the cell-mediated immunity allowing the persistence of HPV. However, it is unclear whether this bacterium plays a particular role in cervical cancer induction. We therefore aimed at enlightening the actual knowledge about the relationship between C. trachomatis and cervical cancer or precursor lesions through a systematic literature review. We summarized and analyzed the epidemiological data on C. trachomatis and its co-infection with HPV and their association to cervical cancer.

Objectives: To assess the combination of electrocoagulation and anaerobic co-digestion of olive mill wastewaters (OMWW) with other substrates, such as chicken manure, in a continuous stirred tank reactor for biogas production., Results: Anaerobic digestion of OMWW treated by electrocoagulation allowed higher production of biogas, up to 0.74 l biogas g -1 COD introduced compared to untreated or diluted olive mill wastewaters (OMWW) (0.37 and 0.6 l biogas g -1  COD) respectively. Pretreated OMWW co-digested with chicken manure at different volumic ratios OMWW/manure in a continuous stirred tank reactor under mesophilic conditions revealed that OMWW/manure (7:3 v/v) was optimal for biogas production and process stability., Conclusion: Anaerobic digestion could achieve promising results in depollution and valorization of OMWW under a continuous stirred tank reactor.

Helicobacter pylori (H. pylori) infection induces inflammation of the gastric mucosa, which may progress to precancerous lesions leading to gastric cancer. Pathological determinism is associated to some virulence genes of the bacterium, notably the vacA and cagA genes. The present study aimed to determine the H. pylori genotypes distribution and their association with sex, age and gastric diseases in a Moroccan population. Gastric biopsy was taken from 1079 consenting patients. The specimens were processed by PCR to identify H. pylori and to determine the genotypic profile by PCR characterizing vacA s, vacA m and vacA i regions directly from biopsies H. pylori positives. VacA genotyping revealed the predominance of vacA m2 (53.2%), vacA s2 (52.9%) and vacA i2 (52%). The most virulent vacA alleles (s1, i1 and m1) are more predominant in men (47.3%, 41.9% and 46.1% respectively) than in women (38.3%, 33.3% and 37% respectively). However, the association between vacA genotypes and age did not reach a statistical significant value. Logistic regression analysis results show that vacA i1m1 and vacA i1m2 genotypes were strongly associated with the risk of GC, the Odds Ratio (95% confidence interval) was 29.73 [5.08-173.73] and 9.17 [2.06-40.82] respectively, while vacAs1/cagA+ seems to be a risk factor for DU since it is inversely associated with GC (OR was 0.13 [0.02-0.75]. The results of this study suggest that vacA i1 genotype independently to vacAm status may be of a clinical usefulness and will help to identify patients at a high risk of GC development., Competing Interests: The authors have declared that no competing interests exist.

Background: Finding a simple, accurate, and noninvasive diagnosis method is a substantial challenge for the detection of Helicobacter pylori. The aim of the present study was to compare the presence of H. pylori urease antigen in saliva with the presence of this bacterium in gastric mucosa., Methods: Saliva samples and gastric biopsies were taken from 153 consenting Moroccan patients. Saliva samples were analyzed using an immunochromatographic test for urease antigen H. pylori detection. Thereafter, the gastric biopsies were analyzed by histology and polymerase chain reaction (PCR) to detect this bacterium., Results: From a total of 153 recruited Moroccan patients, H. pylori was detected in 28 (18.30%), 87 (57.24%), and 69 (45.10%) cases by saliva test, histology, and PCR, respectively. A significant association was observed between the presence of H. pylori antigen in saliva and age. However, no association was found with sex, H. pylori virulence factors, gastric disease outcome, and density of the bacterium on the gastric mucosa. Considering that only 90 patients presented concordant results on H. pylori diagnosis (positive or negative) by both histology and PCR, the immunochromatographic test showed very low sensitivity (29.79%) and high specificity (90.70%). Of these two tests, the positive and negative predictive values were 77.78% and 54.17%, respectively. The accuracy of the test for salivary detection of urease antigen H. pylori was 58.89%., Conclusion: This study demonstrated a low detection rate of H. pylori antigens in saliva compared with the presence of this bacterium in gastric mucosa, suggesting that saliva cannot be used as a suitable sample for the diagnosis of H. pylori in our study population., (Copyright © 2016. Published by Elsevier Taiwan LLC.)

Objectives: To determine the distribution of cervical high-risk human papillomavirus genotypes and their association to cellular abnormalities in women from Fez and its neighborhood., Methods: Women attending the Hassan II University Hospital for cervical pap smears were recruited after an informed consent. Interviews and two cervical samples were performed for each woman. Cervical samples were used for cytological analysis and HPV DNA detection. HPV was typed using a method based on multiplex PCR with fluorescently labeled specific primers followed by capillary electrophoresis. The study was approved by the ethics committee of the Faculty of Medicine and Pharmacy of Fez., Results: The HPV prevalence in the studied population was 43.1% and the most prevalent types were HPV 53 (23 cases); HPV 16 (20 cases); HPV 35 (18 cases); HPV 51 (10 cases) and HPV 56 (7 cases). From the 619 confirmed pap smears, 20% were abnormal. The cytological abnormalities were significantly associated to HPV infection, women age, number of pregnancies and parity (p < 0.05)., Conclusion: More attention should be given to HPV in Morocco because it represents an important public health concern. The distribution of carcinogenic HPV types in the studied population is different from the data in other regions but epidemiological studies in other Moroccan regions are required.

Background: HPV is the most prevalent sexually transmitted infection and its effect in cancer induction is well documented. HPV infections are mostly asymptomatic, but it is unclear whether HPV infections can result in alterations of reproductive health., Objective: To determine the relationship between human papillomavirus infections and reproductive health in both men and women., Methods: A systematic literature review was performed in PubMed and ScienceDirect data bases from January 1994 through August 2014., Results: HPV infections are shown to be significantly associated to many adverse effects in the reproductive function. These adverse effects were reported in different levels from cells production to pregnancy and may be related to the infecting genotype., Conclusions: It appears from this study that HPV detection and genotyping could be of great value in infertility diagnosis at least in idiopathic infertility cases. Like for the risk of carcinogenesis, another classification of HPV regarding the risk of fertility alteration may be considered after deep investigations.

In this study, changes in viability, biomass production, essential oil yield and essential oil composition of Mentha spicata L. (spearmint) exposed to olive mill wastewater (OMW) were investigated. Spearmint cuttings were sensitive to OMW and, after 6h of incubation in raw or diluted OMW, their viability was null. The short contact of raw OMW with mint cuttings caused an irreversible damage in rhizogenesis and shoots development. Roots were more sensitive to phytotoxicity than shoots. In a field essay, spearmint showed a good capability to recover when OMW was spread at 8 l m(-2) at the vegetative phase of growth (45 days after plantation). At this dose, a slight increase of mostly of the mint essential oil constituents was obtained. When the dose applied was 16 l m(-2), phytotoxicity was manifested by a high reduction of biomass and essential oil yield. The essential oil composition was also affected and a disappearance of many of mint essential oil constituents was observed with an increase of 59% for carvone, the major compound of spearmint essential oil. As far as we know, this is the first report on the effect of field application of OMW on an aromatic plant essential oil yield and composition.

Coastal populations with high seafood consumption in the Mediterranean have a significant exposure to dietary methylmercury, and areas where environmental mercury pollution is an issue due to industrial activities are of special concern. The study was undertaken with the aim of assessing methylmercury exposure through fish consumption in a community of north Morocco and characterizing the relevant health risk. Concentrations of total mercury were determined in human hair, a biomarker of methylmercury exposure, and in locally consumed fish by cold vapour atomic absorption spectrophotometry. Based on consumption frequencies reported by the 108 subjects included in the study the weekly intake of methylmercury was estimated and biomarker data were evaluated in relation to the estimated intake and the sociodemographic characteristics of the population. Multiple regression analysis was employed for the interpretation of hair mercury data in relation to fish consumption frequency, gender and the age of individuals. Mercury concentrations in hair ranged from 0.22 to 9.56 microg g(-1) (geometric mean = 1.79 microg g(-1)) and were closely related to fish intake. Fisherman and their families consumed fish three to five times per week and were the most exposed population subgroup. A high proportion of women of child-bearing age (50%) had relatively high levels of mercury in their hair (3.08-7.88 microg g(-1)).

An anaerobic-anoxic sequencing batch reactor (A2 SBR) coupled with a fixed-bed nitrification reactor for simultaneous carbon, nitrogen and phosphorus removal was evaluated using slaughterhouse wastewater. Whereas the treatment could not be successfully carried out on the raw wastewater, the process showed very good nutrient removal performances after prefermentation. The removals of COD, N-NH4 and P-PO4 achieved were 99%, 85% and 99%, respectively. The increase in volatile fatty acid (VFA) and phosphate concentrations in the effluent after prefermentation may explain the high levels of biological carbon, nitrogen and phosphorus removal observed. A simple prefermentation is, therefore, necessary but sufficient to ensure good performances of the denitrifying enhanced biological phosphorus removal (EBPR) process.

Ataxia with vitamin E deficiency (AVED) is an autosomal recessive disease characterized clinically by neurological symptoms with often striking resemblance to those of Friedreich's ataxia (FA). Molecular analysis is needed for an early differential diagnosis, in order to initiate therapeutic vitamin E supplementation before damage develops. We studied 16 patients from seven Moroccan families presenting an autosomal recessive Friedreich-like ataxia with vitamin E deficiency. Our patients were homozygous for 744 del A mutation of alpha-TTP gene. Compilation of clinical records revealed a great phenotypic variability and some features indicating a new possible role of vitamin E in hypothalamo-hypophysial system regulation and cardiomyopathy prevention. Early vitamin E supplementation may provide considerable improvement of neurological signs and other associated abnormalities. Clinical heterogeneity is for involvement of other non-genetic defect and indicated another role of vitamin E, which should be better studied.

Experimental infections of two susceptible French populations of Lymnaea truncatula (Courcelles and Saint Ours) with an allopatric (Fès, Morocco) or a semi-sympatric (Limoges, France) isolate of Fasciola hepatica miracidia were performed to determine the effect of allopatric miracidia on redial and cercarial production. In both populations, cercarial release was significantly greater in allopatric than in semi-sympatric snails. Compared to semi-sympatric snails, the examination of allopatric snails killed from day 14 to day 35 post-exposure demonstrated (1) a significant decrease after day 28 in the number of daughter rediae (R2a group) exiting from the first-appearing mother redia (R1a redia), and (2) the differentiation of numerous daughter rediae (R2b group) in the body of second-appearing mother rediae (R1b group). These experiments demonstrated that the exposure of L. truncatula to an allopatric isolate of miracidia disturbed the usual developmental pattern of redial generations and caused the formation of numerous R2b rediae. The authors hypothesized that the increase in cercarial release noted in allopatric snails would be assured by the rediae from the R2b group after their emergence from the body of R1b mother rediae.

Spinocerebellar ataxias comprise a poorly understood group of inherited degenerative neurological diseases. Attempts to classify hereditary ataxias on the basis of the neurological features or specific clinical signs such as tendon reflex changes have proven to be unsatisfactory. Early onset cerebellar ataxia (EOCA) is generally inherited as an autosomal-recessive trait. Thus far, we do not have accurate answers to several questions about its classification. However, significant clinical heterogeneity observed in four Tunisian families with typical EOCA clinical features reinforces the hypothesis of genetic heterogeneity underlying this phenotype. We have demonstrated that three of the four families studied were not linked to Friedreich's ataxia (FA), vitamin E deficiency ataxia (AVED), and autosomal dominant cerebellar ataxia (ADCA) loci. The fourth family showed homozygosity for a large pathological expansion of GAA repeat in all patients, the parents being heterozygous for this mutation. We have also noted, in the case of the family studied, that there was instability in the transmission of the mutation, along with a phenomenon of anticipation comparable to that observed in dominant triplet repeat diseases. EOCA is thus clinically indistinguishable from FA, yet genetically independent of all known candidate genes. Genetic mapping is required for research into the causal gene and an understanding of the disease's physiopathologic mechanisms.