Enhancing clinical decision support with genomic tools in breast cancer: A Scottish perspective

INTRODUCTION

The Oncotype DX Breast RS test has been adopted in Scotland and has been the subject of a large population-based study by a Scottish Consensus Group to assess the uptake of the recurrence score (RS), evaluate co-variates associated with the RS and to analyse the effect it may have had on clinical practice.

MATERIALS & METHODS

Pan-Scotland study between August 2018-August 2021 evaluating 833 patients who had a RS test performed as part of their diagnostic pathway. Data was extracted retrospectively from electronic records and analysis conducted to describe change in chemotherapy administration (by direct comparison with conventional risk assessment tools), and univariate/multivariate analysis to assess relationship between covariates and the RS.

RESULTS

Chemotherapy treatment was strongly influenced by the RS (p < 0.001). Only 30 % of patients received chemotherapy treatment in the intermediate and high risk PREDICT groups, where chemotherapy is considered. Additionally, 55.5 % of patients with a high risk PREDICT had a low RS and did not receive chemotherapy. There were 17 % of patients with a low risk PREDICT but high RS who received chemotherapy. Multivariate regression analysis showed the progesterone receptor Allred score (PR score) to be a strong independent predictor of the RS, with a negative PR score being associated with high RS (OR 4.49, p < 0.001). Increasing grade was also associated with high RS (OR 3.81, p < 0.001). Classic lobular pathology was associated with a low RS in comparison to other tumour pathology (p < 0.01). Nodal disease was associated with a lower RS (p = 0.012) on univariate analysis, with menopausal status (p = 0.43) not influencing the RS on univariate or multivariate analysis.

CONCLUSIONS

Genomic assays offer the potential for risk-stratified decision making regarding the use of chemotherapy. They can help reduce unnecessary chemotherapy treatment and identify a subgroup of patients with more adverse genomic tumour biology. A recent publication by Health Improvement Scotland (HIS) has updated guidance on use of the RS test for NHS Scotland. It suggests to limit its use to the intermediate risk PREDICT group. Our study shows the impact of the RS test in the low and high risk PREDICT groups. The implementation across Scotland has resulted in a notable shift in practice, leading to a significant reduction in chemotherapy administration in the setting of high risk PREDICT scores returning low risk RS. There has also been utility for the test in the low risk PREDICT group to detect a small subgroup with a high RS. We have found the PR score to have a strong independent association with high risk RS. This finding was not evaluated by the key RS test papers, and the potential prognostic information provided by the PR score as a surrogate biomarker is an outstanding question that requires more research to validate.

Alteration of the maximal renal water excretion capacity with kidney function and age in human

PURPOSE

The kidney's capability to concentrate and dilute urine is crucial to maintaining body fluid compartments and plasma osmolality. Advanced age and chronic kidney disease (CKD) result in decreased maximal urine concentration. Less is known regarding urine dilution ability. The primary purpose of this study was to determine the relationship between maximal renal water excretion and renal function, age, and gender in humans.

METHODS

This monocentric retrospective study includes patients referred to the Department of Clinical Physiology in Toulouse University Hospital to measure the glomerular filtration rate (mGFR) between April 2013 and February 2018. mGFR was assessed using inulin renal clearance and required ample hydration. We quantified the effects of age, gender and mGFR have on water excretion ability, which was assessed by minimal urinary osmolality (minUosm) and maximal free water clearance (maxCH2O).

RESULTS

666 patients were included (mean age 51 ± 14 years, 53% female). Mean mGFR was 82 ± 25 mL/min/1.73m2. MinUosm after hydration was higher in patients with renal insufficiency while maxCH2O was markedly lower. Age was also, with a weaker effect, associated with decreased in water excretion, independently of mGFR. MaxCH2O clearance was similar in both genders, whereas minUosm was lower in women, possibly resulting from a lower osmotic load.

DISCUSSION

This study shows a decrease in maximal urinary dilution capacity and free water clearance with CKD and age, without gender difference. These alterations are mild but must be considered when a significant water intake is required or in the case of hyponatremia.

Evaluating newly approved drugs in combination regimens for multidrug-resistant tuberculosis with fluoroquinolone resistance (endTB-Q): study protocol for a multi-country randomized controlled trial

BACKGROUND

Treatment for fluoroquinolone-resistant multidrug-resistant/rifampicin-resistant tuberculosis (pre-XDR TB) often lasts longer than treatment for less resistant strains, yields worse efficacy results, and causes substantial toxicity. The newer anti-tuberculosis drugs, bedaquiline and delamanid, and repurposed drugs clofazimine and linezolid, show great promise for combination in shorter, less-toxic, and effective regimens. To date, there has been no randomized, internally and concurrently controlled trial of a shorter, all-oral regimen comprising these newer and repurposed drugs sufficiently powered to produce results for pre-XDR TB patients.

METHODS

endTB-Q is a phase III, multi-country, randomized, controlled, parallel, open-label clinical trial evaluating the efficacy and safety of a treatment strategy for patients with pre-XDR TB. Study participants are randomized 2:1 to experimental or control arms, respectively. The experimental arm contains bedaquiline, linezolid, clofazimine, and delamanid. The control comprises the contemporaneous WHO standard of care for pre-XDR TB. Experimental arm duration is determined by a composite of smear microscopy and chest radiographic imaging at baseline and re-evaluated at 6 months using sputum culture results: participants with less extensive disease receive 6 months and participants with more extensive disease receive 9 months of treatment. Randomization is stratified by country and by participant extent-of-TB-disease phenotype defined according to screening/baseline characteristics. Study participation lasts up to 104 weeks post randomization. The primary objective is to assess whether the efficacy of experimental regimens at 73 weeks is non-inferior to that of the control. A sample size of 324 participants across 2 arms affords at least 80% power to show the non-inferiority, with a one-sided alpha of 0.025 and a non-inferiority margin of 12%, against the control in both modified intention-to-treat and per-protocol populations.

DISCUSSION

This internally controlled study of shortened treatment for pre-XDR TB will provide urgently needed data and evidence for clinical and policy decision-making around the treatment of pre-XDR TB with a four-drug, all-oral, shortened regimen.

TRIAL REGISTRATION

ClinicalTrials.Gov NCT03896685. Registered on 1 April 2018; the record was last updated for study protocol version 4.3 on 17 March 2023.

Gitelman-Like Syndrome Caused by Pathogenic Variants in mtDNA

BACKGROUND

Gitelman syndrome is the most frequent hereditary salt-losing tubulopathy characterized by hypokalemic alkalosis and hypomagnesemia. Gitelman syndrome is caused by biallelic pathogenic variants in SLC12A3, encoding the Na⁺-Cl^- cotransporter (NCC) expressed in the distal convoluted tubule. Pathogenic variants of CLCNKB, HNF1B, FXYD2, or KCNJ10 may result in the same renal phenotype of Gitelman syndrome, as they can lead to reduced NCC activity. For approximately 10 percent of patients with a Gitelman syndrome phenotype, the genotype is unknown.

METHODS

We identified mitochondrial DNA (mtDNA) variants in three families with Gitelman-like electrolyte abnormalities, then investigated 156 families for variants in MT-TI and MT-TF, which encode the transfer RNAs for phenylalanine and isoleucine. Mitochondrial respiratory chain function was assessed in patient fibroblasts. Mitochondrial dysfunction was induced in NCC-expressing HEK293 cells to assess the effect on thiazide-sensitive ²²Na⁺ transport.

RESULTS

Genetic investigations revealed four mtDNA variants in 13 families: m.591C>T (n=7), m.616T>C (n=1), m.643A>G (n=1) (all in MT-TF), and m.4291T>C (n=4, in MT-TI). Variants were near homoplasmic in affected individuals. All variants were classified as pathogenic, except for m.643A>G, which was classified as a variant of uncertain significance. Importantly, affected members of six families with an MT-TF variant additionally suffered from progressive chronic kidney disease. Dysfunction of oxidative phosphorylation complex IV and reduced maximal mitochondrial respiratory capacity were found in patient fibroblasts. In vitro pharmacological inhibition of complex IV, mimicking the effect of the mtDNA variants, inhibited NCC phosphorylation and NCC-mediated sodium uptake.

CONCLUSION

Pathogenic mtDNA variants in MT-TF and MT-TI can cause a Gitelman-like syndrome. Genetic investigation of mtDNA should be considered in patients with unexplained Gitelman syndrome-like tubulopathies.

Impact of menopausal status on kidney adaptation after unilateral nephrectomy for kidney donation in women

INTRODUCTION

Although living kidney donation is not a high-risk surgery, there is still a need to identify situations at risk of kidney disease after uninephrectomy. Estrogens exhibit a protective role against various nephropathies. The aim of this study was to assess renal adaptation following nephrectomy according to menopausal status in women.

METHODS

A prospective bicentric study including living women donors measured glomerular filtration rate (GFR) (inulin or ^51-Cr-EDTA clearances) and kidney volume (using CT-scan and 3-dimensional reconstruction), before and after 1-year post-uninephrectomy. Renal adaptation was compared according to menopausal status.

RESULTS

Sixteen non-menopausal women and 18 menopausal women were included. One year following uninephrectomy, the mean decrease in GFR (global population) was - 32 ± 12 ml/min/1.73 m², and the mean increase in remnant kidney volume was + 32 ± 13 cm³/1.73 m². No significant difference was observed between the two groups for both the decrease in GFR (-32.9 ± 13.3 in non-menopausal vs - 31.5 ± 9.9 in menopausal, ml/min/1.73 m², p = 0.84), and the increase in kidney volume (+ 36.1 ± 13.4 in non-menopausal vs + 28.1 ± 12.5 in menopausal, cm³/1.73 m², p = 0.09).

DISCUSSION

Menopausal status did not influence kidney adaptation following uninephrectomy, and in this respect is not a potential limiting factor for living kidney donation.

Urine osmolality predicts calcium-oxalate crystallization risk in patients with recurrent urolithiasis

Our aim was to investigate the validity of osmolality from 24-h urine collection in examining the risk for calcium-oxalate (CaOx) kidney stone formation in patients with recurrent urolithiasis. Three hundred and twelve subjects (males/females: 184/128) from France with a history of recurrent kidney stones from confirmed or putative CaOx origin were retrospectively included in the study (46 ± 14 years, BMI: 25.3 ± 5.0 kg·m^-2). Tiselius' crystallization risk index (CRI) was calculated based on urinary calcium, oxalate, citrate, magnesium, and volume from 24-h samples. The diagnostic ability of 24-h urine osmolality to classify patients as high risk for kidney stone crystallization was examined through the receivers operating characteristics analysis. High risk for CaOx crystallization was defined as CRI > 1.61 and > 1.18, for males and females, respectively. The accuracy of urine osmolality to diagnose risk of CaOx stone formation (AUC, area under the curve) for females was 84.6%, with cut-off point of 501 mmol·kg^-1 (sensitivity: 83.3%, specificity: 76.0%). Males had AUC of 85.8% with threshold of 577 mmo·kg^-1 (sensitivity: 85.5%, specificity: 77.6%). A negative association was found between 24-h urine volume and osmolality (r = - 0.63, P < 0.001). Also, a positive association was found between 24-h urine osmolality and CRI (r = 0.65, P < 0.001), as well as urea excretion with CRI (r = 0.37, P < 0.001). In conclusion, urine osmolality > 501 and > 577 mmol·kg^-1, in female and in male, respectively, was associated with a risk for CaOx kidney stone formation in patients with a history of recurrent urolithiasis. Thus, when CaOx origin is confirmed or suspected, 24-h urine osmolality provides a simple way to define individualized target of urine dilution to prevent urine crystallization and stone formation.

Urinary citrate: helpful to predict acid retention in CKD patients?

Acid retention occurs early during the course of chronic kidney disease (CKD). Studies conducted in patients with CKD suggest that alkali supplementation may slow CKD progression. However, the diagnosis of acid retention is challenging when plasma bicarbonate concentration is still normal. In this issue, Goraya et al. suggest that urinary citrate may predict acid retention in eubicarbonatemic patients with stages 1 and 2 CKD . Although interesting, this claim yet requires confirmation by further studies.

Resistance to Insulin in Patients with Gitelman Syndrome and a Subtle Intermediate Phenotype in Heterozygous Carriers: A Cross-Sectional Study

BACKGROUND

Gitelman syndrome is a salt-losing tubulopathy caused by mutations in the SLC12A3 gene, which encodes the thiazide-sensitive sodium-chloride cotransporter. Previous studies suggested an intermediate phenotype for heterozygous carriers.

METHODS

To evaluate the phenotype of heterozygous carriers of pathogenic SLC12A3 mutations, we performed a cross-sectional study of patients with Gitelman syndrome, heterozygous carriers, and healthy noncarriers. Participants measured their BP at home for three consecutive days before hospital admission for blood and urine sampling and an oral glucose tolerance test.

RESULTS

We enrolled 242 participants, aged 18-75 years, including 81 heterozygous carriers, 82 healthy noncarriers, and 79 patients with Gitelman syndrome. The three groups had similar age, sex ratio, and body mass index. Compared with healthy noncarriers, heterozygous carriers showed significantly higher serum calcium concentration (P=0.01) and a trend for higher plasma aldosterone (P=0.06), but measures of home BP, plasma and urine electrolytes, renin, parathyroid hormone, vitamin D, and response to oral glucose tolerance testing were similar. Patients with Gitelman syndrome had lower systolic BP and higher heart rate than noncarriers and heterozygote carriers; they also had significantly higher fasting serum glucose concentration, higher levels of markers of insulin resistance, and a three-fold higher sensitivity to overweight. According to oral glucose tolerance testing, approximately 14% of patients with Gitelman syndrome were prediabetic, compared with 5% of heterozygous carriers and 4% of healthy noncarriers.

CONCLUSIONS

Heterozygous carriers had a weak intermediate phenotype, between that of healthy noncarriers and patients with Gitelman syndrome. Moreover, the latter are at risk for development of type 2 diabetes, indicating the heightened importance of body weight control in these patients.

Magnetically-responsive DDS

Magnetic-responsive drug delivery systems have received great attention due to the possibility of building theranostic systems. The application of a non-invasive external stimuli as a magnetic field that also allows the imaging and localization of the devices and the release of therapeutic drugs means a great opportunity for the development of new treatments to prevent diseases such as cancer. This chapter will focus on smart materials based on magnetic nanoparticles that have been studied for the formulation of such delivery systems and their synergic effect in combination with drugs for potential applications in the biomedical field. In addition, the possibility of applying hyperthermia at the macro and nanoscale levels and their implications will be discussed.

Beat note stabilization in dual-polarization DFB fiber lasers by an optical phase-locked loop

A fully fibered microwave-optical source at 1.5 µm is studied experimentally. It is shown that the beat note between two orthogonally polarized modes of a distributed-feedback fiber laser can be efficiently stabilized using an optical phase-locked loop. The pump-power-induced birefringence serves as the actuator. Beat notes at 1 GHz and 10 GHz are successfully stabilized to a reference synthesizer, passing from the 3 kHz free-running linewidth to a stabilized sub-Hz linewidth, with a phase noise as low as -75 dBc/Hz at 100 Hz offset from the carrier. Such dual-frequency stabilized lasers could provide compact integrated components for RF and microwave photonics applications.

Syndrome of inappropriate anti-diuresis induces volume-dependent hypercalciuria

Hyponatremia is associated with bone demineralization. We hypothesized that, during hyponatremia, calciuria and calcium balance depend on volemic status. We evaluated calciuria in patients with hyponatremia, secondary to SIAD or hypovolemia. Patients with SIAD exhibited a volemic expansion that was associated with hypercalciuria. Calciuria was proportional to markers of volemia.

INTRODUCTION

Chronic mild hyponatremia has been associated with bone demineralization of unknown mechanisms. During chronic hyponatremia, arginine-vasopressin secretion can result from hypovolemia or from syndrome of inappropriate anti-diuresis (SIAD) that leads to a slightly volemic expansion. Since volemia determines renal calcium excretion and balance, we evaluated calcium homeostasis in patients with chronic hyponatremia, related to SIAD or to hypovolemia.

METHODS

We retrospectively included all patients referred to our Department between May 2006 and May 2014 for hyponatremia, resulting from SIAD or chronic hypovolemia. None had edema, cirrhosis, cardiac, or renal insufficiency. Exploration included estimation of volemia, extracellular fluid volume (ECFV) measurement with inulin, and calcium homeostasis.

RESULTS

In total, the SIAD and hypovolemic groups included 22 and 7 patients, respectively. The SIAD group exhibited signs of increased volemia: higher glomerular filtration rate, higher fractional excretion of uric acid, and lower plasma renin. ECFV exceeded that of the hypovolemic group and was above usual values. There was no difference between the two groups regarding plasma calcium, PTH, and vitamin D. However, in the SIAD group, calciuria was higher than in the hypovolemic group, reaching levels of hypercalciuria. Furthermore, there was a positive correlation between calciuria and markers of volemia.

CONCLUSIONS

Our results show that SIAD results in a volemic expansion tendency that is associated with a decrease in renal calcium reabsorption and thus hypercalciuria, whereas in the hypovolemic group, calciuria was not increased. Therefore, renal loss of calcium and bone demineralization in SIAD patients could be partly induced by volemic expansion.

Antiphase domain tailoring for combination of modal and 4¯ -quasi-phase matching in gallium phosphide microdisks

We propose a novel phase-matching scheme in GaP whispering-gallery-mode microdisks grown on Si substrate combining modal and 4¯ -quasi-phase-matching for second-harmonic-generation. The technique consists in unlocking parity-forbidden processes by tailoring the antiphase domain distribution in the GaP layer. Our proposal can be used to overcome the limitations of form birefringence phase-matching and 4¯ -quasi-phase-matching using high order whispering-gallery-modes. The high frequency conversion efficiency of this new scheme demonstrates the competitiveness of nonlinear photonic devices monolithically integrated on silicon.

Indomethacin, amiloride, or eplerenone for treating hypokalemia in Gitelman syndrome

Patients with Gitelman syndrome (GS), an inherited salt-losing tubulopathy, are usually treated with potassium-sparing diuretics or nonsteroidal anti-inflammatory drugs and oral potassium and magnesium supplementations. However, evidence supporting these treatment options is limited to case series studies. We designed an open-label, randomized, crossover study with blind end point evaluation to compare the efficacy and safety of 6-week treatments with one time daily 75 mg slow-release indomethacin, 150 mg eplerenone, or 20 mg amiloride added to constant potassium and magnesium supplementation in 30 patients with GS (individual participation: 48 weeks). Baseline plasma potassium concentration was 2.8±0.4 mmol/L and increased by 0.38 mmol/L (95% confidence interval [95% CI], 0.23 to 0.53; P<0.001) with indomethacin, 0.15 mmol/L (95% CI, 0.02 to 0.29; P=0.03) with eplerenone, and 0.19 mmol/L (95% CI, 0.05 to 0.33; P<0.01) with amiloride. Fifteen patients became normokalemic: six with indomethacin, three with eplerenone, and six with amiloride. Indomethacin significantly reduced eGFR and plasma renin concentration. Eplerenone and amiloride each increased plasma aldosterone by 3-fold and renin concentration slightly but did not significantly change eGFR. BP did not significantly change. Eight patients discontinued treatment early because of gastrointestinal intolerance to indomethacin (six patients) and hypotension with eplerenone (two patients). In conclusion, each drug increases plasma potassium concentration in patients with GS. Indomethacin was the most effective but can cause gastrointestinal intolerance and decreased eGFR. Amiloride and eplerenone have similar but lower efficacies and increase sodium depletion. The benefit/risk ratio of each drug should be carefully evaluated for each patient.

Measuring the universal synchronization properties of driven oscillators across a Hopf instability

When a driven oscillator loses phase-locking to a master oscillator via a Hopf bifurcation, it enters a bounded-phase regime in which its average frequency is still equal to the master frequency, but its phase displays temporal oscillations. Here we characterize these two synchronization regimes in a laser experiment, by measuring the spectrum of the phase fluctuations across the bifurcation. We find experimentally, and confirm numerically, that the low frequency phase noise of the driven oscillator is strongly suppressed in both regimes in the same way. Thus the long-term phase stability of the master oscillator is transferred to the driven one, even in the absence of phase-locking. The numerical study of a generic, minimal model suggests that such behavior is universal for any periodically driven oscillator near a Hopf bifurcation point.

Optical fiber Sagnac interferometer for sensing scalar directional refraction: application to magnetochiral birefringence

We present a setup dedicated to the measurement of the small scalar directional anisotropies associated to the magnetochiral interaction. The apparatus, based on a polarization-independent fiber Sagnac interferometer, is optimized to be insensitive to circular anisotropies and to residual absorption. It can thus characterize samples of biological interests, for which the two enantiomers are not available and/or which present poor transmission. The signal-to-noise ratio is shown to be limited only by the source intensity noise, leading to a detection limit of Δϕ = 500 nrad Hz(-1/2). It yields a limit on the magnetochiral index nMC < 4 × 10(-13) T(-1) at 1.55 μm for the organic molecules tested.

Renal β-intercalated cells maintain body fluid and electrolyte balance

Inactivation of the B1 proton pump subunit (ATP6V1B1) in intercalated cells (ICs) leads to type I distal renal tubular acidosis (dRTA), a disease associated with salt- and potassium-losing nephropathy. Here we show that mice deficient in ATP6V1B1 (Atp6v1b1-/- mice) displayed renal loss of NaCl, K+, and water, causing hypovolemia, hypokalemia, and polyuria. We demonstrated that NaCl loss originated from the cortical collecting duct, where activity of both the epithelial sodium channel (ENaC) and the pendrin/Na(+)-driven chloride/bicarbonate exchanger (pendrin/NDCBE) transport system was impaired. ENaC was appropriately increased in the medullary collecting duct, suggesting a localized inhibition in the cortex. We detected high urinary prostaglandin E2 (PGE2) and ATP levels in Atp6v1b1-/- mice. Inhibition of PGE2 synthesis in vivo restored ENaC protein levels specifically in the cortex. It also normalized protein levels of the large conductance calcium-activated potassium channel and the water channel aquaporin 2, and improved polyuria and hypokalemia in mutant mice. Furthermore, pharmacological inactivation of the proton pump in β-ICs induced release of PGE2 through activation of calcium-coupled purinergic receptors. In the present study, we identified ATP-triggered PGE2 paracrine signaling originating from β-ICs as a mechanism in the development of the hydroelectrolytic imbalance associated with dRTA. Our data indicate that in addition to principal cells, ICs are also critical in maintaining sodium balance and, hence, normal vascular volume and blood pressure.

Lidar-radar velocimetry using a pulse-to-pulse coherent rf-modulated Q-switched laser

An rf-modulated pulse train from a passively Q-switched Nd:YAG laser has been generated using an extra-cavity acousto-optic modulator. The rf modulation reproduces the spectral quality of the local oscillator. It leads to a high pulse-to-pulse phase coherence, i.e., phase memory, over thousands of pulses. The potentialities of this transmitter for lidar-radar are demonstrated by performing Doppler velocimetry on indoor moving targets. The experimental results are in good agreement with a model based on elementary signal processing theory. In particular, we show experimentally and theoretically that lidar-radar is a promising technique that allows discrimination between translation and rotation movements. Being independent of the laser internal dynamics, this scheme can be applied to any Q-switched laser.

Renal functional decline and glomerulotubular injury are arrested but not restored by release of unilateral ureteral obstruction (UUO)

Murine unilateral ureteral obstruction (UUO), a major model of progressive kidney disease, causes loss of proximal tubular mass and formation of atubular glomeruli. Adult C57BL/6 mice underwent a sham operation or reversible UUO under anesthesia. In group 1, kidneys were harvested after 7 days. In group 2, the obstruction was released after 7 days, and a physiological study of both kidneys was performed 30 days later. Renal blood flow (RBF), glomerular filtration rate (GFR), urine protein, and albumin excretion were measured after ligation of either the left or right ureter. Glomerular volume (periodic acid-Schiff), glomerulotubular integrity and proximal tubular mass (Lotus tetragonolobus lectin), and interstitial collagen (Sirius red) were measured by histomorphometry. Obstructed kidney weight was reduced by 15% at 7 days but was not different from sham after a 30-day recovery. Glomerular volume and proximal tubular area of the obstructed kidney were reduced by 55% at 7 days, but normalized after 30 days. Interstitial collagen deposition increased 2.4-fold after 7 days of UUO and normalized after release. However, GFR and RBF were reduced by 40% and urine albumin/protein ratio was increased 2.8-fold 30 days after release of UUO. This was associated with a 50% reduction in glomerulotubular integrity despite a 30-day recovery (P < 0.05 for all data). We conclude that release of 7-day UUO can arrest progression but does not restore normal function of the postobstructed kidney. Although the remaining intact nephrons have hypertrophied, glomerular injury is revealed by albuminuria. These results suggest that glomerulotubular injury should become the primary target of slowing progressive kidney disease.

Dual-polarization mode-locked Nd:YAG laser

A mode-locked solid-state laser containing a birefringent element is shown to emit synchronously two frequency combs associated to the two polarization eigenstates of the cavity. An analytical model predicts the polarization evolution of the pulse train, which is determined by the adjustable intracavity birefringence. Experiments realized with a Nd:YAG laser passively mode locked by a semiconductor saturable absorber mirror are in perfect agreement with the model. Locking between the two combs arises for particular values of their frequency difference, e.g., half the repetition rate, and the pulse train polarization sequence is then governed by the relative overall phase offset of the two combs.

Familial hypomagnesemia with hypercalciuria and nephrocalcinosis: phenotype-genotype correlation and outcome in 32 patients with CLDN16 or CLDN19 mutations

BACKGROUND AND OBJECTIVES

Familial hypomagnesemia with hypercalciuria and nephrocalcinosis is a rare autosomal recessive renal tubular disease. It is caused by mutations in CLDN16 and CLDN19, encoding claudin-16 and -19, respectively. Familial hypomagnesemia with hypercalciuria and nephrocalcinosis is usually complicated by progressive CKD. The objectives of this study were to describe the clinical and genetic features of familial hypomagnesemia with hypercalciuria and nephrocalcinosis and analyze phenotype-genotype associations in patients with CLDN16 or CLDN19 mutations.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Data from 32 genetically confirmed patients (9 patients with CLDN16 and 23 patients with CLDN19 mutations) from 26 unrelated families were retrospectively reviewed.

RESULTS

Diagnosis was based on clinical criteria at a median age of 9.5 years and confirmed by genetic testing at a median age of 15.5 years. In total, 13 CLDN16 or CLDN19 mutations were identified, including 8 novel mutations. A founder effect was detected for the recurrent CLDN16 p.Ala139Val mutation in North African families and the CLDN19 p.Gly20Asp mutation in Spanish and French families. CKD was more frequently observed in patients with CLDN19 mutations: survival without CKD or ESRD was 56% at 20 years of age in CLDN19 versus 100% in CLDN16 mutations (log rank P<0.01). Ocular abnormalities were observed in 91% of patients with CLDN19 mutations and none of the patients with CLDN16 mutations (P<0.01). Treatments seem to have no effect on hypercalciuria and CKD progression.

CONCLUSIONS

Patients with CLDN19 mutations may display more severe renal impairment than patients with CLDN16 mutations. Ocular abnormalities were observed only in patients with CLDN19 mutations.

Non-linear optoelectronic phase-locked loop for stabilization of opto-millimeter waves: towards a narrow linewidth tunable THz source

We propose an optoelectronic phase-locked loop concept which enables to stabilize optical beat notes at high frequencies in the mm-wave domain. It relies on the use of a nonlinear-response Mach-Zehnder modulator. This concept is demonstrated at 100 GHz using a two-axis dual-frequency laser turned into a voltage controlled oscillator by means of an intracavity electrooptic crystal. A relative frequency stability better than 10⁻¹¹ is reported. This approach of optoelectronic down conversion opens the way to the realization of continuously tunable ultra-narrow linewidth THz radiation.

Resonance assisted synchronization of coupled oscillators: frequency locking without phase locking

Frequency locking without phase locking of two coupled nonlinear oscillators is experimentally demonstrated. This synchronization regime is found for two coupled laser modes, beyond the phase-locking range fixed by Adler's equation, because of a resonance mechanism. Specifically, we show that the amplitudes of the two modes exhibit strong fluctuations that produce average frequency synchronization, even if the instantaneous phases are unlocked. The experimental results are in good agreement with a theoretical model.

A pseudo-dominant form of Gitelman's syndrome

Gitelman’s syndrome is an autosomal recessive salt losing nephropathy caused by inactivated mutations of the SLC12A3 gene, encoding the NaCl cotransporter of the distal convoluted tubule. We report a French family with five affected members over two generations suggesting a dominant transmission. After SLC12A3 sequencing of seven individuals, four mutations were detected. Pseudo-dominant transmission was explained by the union of a compound heterozygous woman (two mutations on one allele and one mutation on the other) with a heterozygous healthy man. This study shows the importance of complete genetic analysis of families with unusual presentation.

Beat note stabilization of a 10-60 GHz dual-polarization microlaser through optical down conversion

Down-conversion of a high-frequency beat note to an intermediate frequency is realized by a Mach-Zehnder intensity modulator. Optically-carried microwave signals in the 10-60 GHz range are synthesized by using a two-frequency solid-state microchip laser as a voltage-controlled oscillator inside a digital phase-locked loop. We report an in-loop relative frequency stability better than 2.5×10⁻¹¹. The principle is applicable to beat notes in the millimeter-wave range.

An analysis of communication in conversation in patients with dementia

Patients with degenerative dementia often show language disorders, but little is known about their verbal (VC) and non-verbal communication (NVC). Our aim was to analyse VC and NVC in patients with standard criteria of mild-moderately severe dementia (MMSE ≥14/30) resulting from Alzheimer's disease (AD; 29 cases), behavioural variant of frontotemporal dementia (FTD; 16), or dementia with Lewy bodies (DLB; 13). We used the Lille Communication Test, which addresses three domains: participation in communication (PC: greeting, attention, participation), VC (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback), and NVC (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). Patients were compared with 47 matching control subjects. AD patients were partially impaired (p≤0.01) in PC (greeting), and more definitely in VC, especially by verbal comprehension and word finding difficulties and to a much lesser degree in verbal pragmatics (responding to open questions, presenting new information), while NVC was mostly preserved. FTD patients were severely impaired in PC. VC difficulties were related to lexical-semantic, syntactic and more specifically pragmatic problems. NVC was impaired by difficulties in affective expressivity, pragmatics and feedback management. DLB patients showed modest difficulties with VC. PC, VC and NVC strongly correlated with performance in the dementia rating scale. In conclusion, the profile of communication difficulties was quite different between groups. FTD patients showed most severe difficulties in PC and verbal and non-verbal pragmatics, in relation to their frontal lesions. AD patients had prominent impairment of lexical-semantic operations.

Intensity dependence of auditory-evoked cortical potentials in fibromyalgia patients: a test of the generalized hypervigilance hypothesis

On the basis of recent evidence concerning the amplification of incoming stimulation in fibromyalgia (FM) patients, it has been proposed that a generalized hypervigilance of painful and nonpainful sensations may be at the root of this disorder. So far, research into this issue has been inconclusive, possibly owing to the lack of agreement as to the operational definition of "generalized hypervigilance" and to the lack of robust objective measures characterizing the sensory style of FM patients. In this study, we recorded auditory-evoked potentials (AEPs) elicited by tones of increasing intensity (60, 70, 80, 90, and 105 dB) in 27 female FM patients and 25 healthy controls. Fibromyalgia patients presented shorter N1 and P2 latencies and a stronger intensity dependence of their AEPs. Both results suggest that FM patients may be hypervigilant to sensory stimuli, especially when very loud tones are used. The most noteworthy difference between patients and control subjects is at the highest stimulus intensity, for which far more patients maintained increased N1-P2 amplitudes in relation to the 90-dB tones. The larger AEP amplitudes to the 105-dB tones suggest that defects in an inhibitory system protecting against overstimulation may be a crucial factor in the pathophysiology of FM. Because a stronger loudness dependence of AEPs has been related to weak serotonergic transmission, it is hypothesized that for many FM patients deficient inhibition of the response to noxious and intense auditory stimuli may be due to a serotonergic deficit.

PERSPECTIVE

The study of auditory-evoked potentials in response to tones of increasing intensity in FM patients may help to clarify the pathophysiology of this disorder, especially regarding the role of inhibition deficits involving serotonergic dysfunction, and may be a useful tool to guide the pharmacologic treatment of FM patients.

A dipole interaction model for magnetochiral birefringence

We have developed a classical model to investigate the magnetochiral birefringence of an isotropic chiral medium submitted to a longitudinal magnetic field. This model, which is an extension of the atom dipole interaction model, yields direct calculations from the polarizabilities and positions of the atoms of the considered molecules. The numerical values obtained for the magnetochiral birefringence, as well as for the optical activity and Faraday rotation, are supported by the previously published experimental results on limonene, proline, and tartaric acid.

Pendrin regulation in mouse kidney primarily is chloride-dependent

Recent studies indicate that pendrin, an apical Cl-/HCO3- exchanger, mediates chloride reabsorption in the connecting tubule and the cortical collecting duct and therefore is involved in extracellular fluid volume regulation. The purpose of this study was to test whether pendrin is regulated in vivo primarily by factors that are associated with changes in renal chloride transport, by aldosterone, or by the combination of both determinants. For achievement of this goal, pendrin protein abundance was studied by semiquantitative immunoblotting in different mouse models with altered aldosterone secretion or tubular chloride transport, including NaCl loading, hydrochlorothiazide administration, NaCl co-transporter knockout mice, and mice with Liddle's mutation. The parallel regulation of the aldosterone-regulated epithelial sodium channel (ENaC) was examined as a control for biologic effects of aldosterone. Major changes in pendrin protein expression were found in experimental models that are associated with altered renal chloride transport, whereas no significant changes were detected in pendrin protein abundance in models with altered aldosterone secretion. Moreover, in response to hydrochlorothiazide administration, pendrin was downregulated despite a marked secondary hyperaldosteronism. In contrast, alpha-ENaC was markedly upregulated, and the molecular weight of a large fraction of gamma-ENaC subunits was shifted from 85 to 70 kD, consistent with previous results from rat models with elevated plasma aldosterone levels. These results suggest that factors that are associated with changes in distal chloride delivery govern pendrin expression in the connecting tubule and cortical collecting duct.

[Surveillance of infections in chronic hemodialysis patients]

OBJECTIVE

To confirm rates of infections from a previous survey in chronic hemodialysis patients; to get information about incidents and manipulations of vascular access-site, number and reasons of hospitalisation; to asses a relationship between the frequency of vascular access-site infections (VASI) and quality of care during the procedures of vascular access-site use.

DESIGN

Prospective, multicenter survey performed from February 2000 to January 2001, including all patients underwent chronic hemodialysis in 5 participating centers. Standardized definitions used and different clinical and biological risk factors recorded.

RESULTS

429 patients for a total of 4273 dialysis months (DM) were enrolled. 245 infections in 164 infected patients were reported. The overall rate was 5.73 infections per 100 DM (18 VASI, 25 bacteraemia, 84 respiratory, 29 urinary tract, 1 endocarditis and 88 other infections). 50% of infections were microbiologically documented. 19 of 21 antibiotics resistant microorganisms were meticillin resistant Staphylococcus aureus. Compared to the incidence rate of fistula (0.05 per 1000 days of follow-up) or prosthesis related VASI (0.11), the incidence rate of catheter related VASI (0.65) was significantly higher. Poor hygiene and duration of catheter use were the significant risk factors for VASI showed by logistic analysis regression. VASI and bacteraemia occurred more frequently after incident or manipulation of the vascular access-site. The decrease of VASI between the 2 periods of survey was significantly higher in centers having reduced the catheter use and implemented written protocols.

CONCLUSIONS

This second period of surveillance has confirmed the frequency of infections rate in chronic hemodialysis patients and particularly bacteraemia and VASI. This study has allowed to establish risk factors for infections and showed that VASI in hemodialysis are related to factors in part preventable.

Ferromagnetism in fcc twinned 2.4 nm size Pd nanoparticles

The onset of ferromagnetism has been experimentally observed in small Pd particles of average diameter 2.4 nm. High-resolution studies reveal that a high percentage of the fcc particle exhibits single and multiple twinning boundaries. The spontaneous magnetization close to 0.02 emu/g seems to indicate that only a small fraction of atoms holds a permanent magnetic moment and contributes to ferromagnetism. The possible origin of ferromagnetism is briefly discussed according to different models recently reported.

Similar effect of family history of psychosis on Sylvian fissure size and auditory P200 amplitude in schizophrenic and bipolar subjects

Several cerebral studies point to the non-specificity of structural and functional changes described in schizophrenia and bipolar disorders. Furthermore, the origin of these changes is still unclear. The present study investigated the effect of a family history (FH) of psychotic disorders in first-degree relatives on computed tomographic (CT) measures (ventricular, cerebral and Sylvian fissure size) and auditory event-related potentials (amplitudes and latencies of peak components in oddball paradigms) in 30 schizophrenic patients and 24 bipolar type I patients. We found a significant correlation between FH and the size of the right Sylvian fissure, and between FH and auditory P200 amplitude. More specifically, the schizophrenic and bipolar patients with negative FH (n=36) had larger right Sylvian fissures and smaller P200 amplitude than patients with positive FH (n=18). These findings were independent of the specific diagnosis, gender, and age of subjects. Our results suggest some underlying process common to schizophrenia and bipolar I disorder, and they provide support for the continuum view of the nosologic structure of psychotic illness.

The use of REE determination in a clinical setting applied to respiratory disease

The determination of a patient's nutritional condition is an important moment of clinical evaluation in everyday experience. Quite often, it is important to identify symptoms, signs and objective parameters that may reveal a malnourished condition. To satisfy this request, clinicians recur to clinical examination and biochemical tests. It is also possible to use indirect calorimetry. Through the evaluation of oxygen consumption (VO2) and carbon dioxide production (VCO2), indirect calorimetry permits the respiratory quotient (RQ) to be calculated and the exact energy consumption during resting conditions to be determined. This technology, currently used in research departments and in hospital units, is more accurate for the estimation of resting energy expenditure (REE) than the Harris-Benedict equation, especially in the case of patients affected by respiratory diseases or other systemic conditions. The evaluation of REE through indirect calorimetry is a useful monitoring and prognostic index in acutely and chronically ill patients.

Existence of two coupling constants in microchip lasers

We implemented two different experimental setups to probe directly the nonlinear coupling between modes in microchip lasers. We show that, remarkably, the results can be interpreted by use of Lamb's coupling constant. In an Er, Yb:glass microchip laser, we measured C(12) = 0.80 between longitudinal modes and C(xy) = 0.95 between orthogonally linearly polarized eigenstates. The high values obtained give some physical insight into the single-frequency operation of such lasers.

[P300 and neuropsychological tests in schizophrenia and bipolar patients]

INTRODUCTION

A smaller P300 amplitude has been found in schizophrenic patients in the majority of the studies done. And this occur in spite of treatment, sex, clinical stage and evolution time of the illness. It has been already described an association between this amplitude reduction and a poor result on the neuropsychological tests. But these changes in the P300 amplitude are not specific of the schizophrenic patients and they can be found in affective patients.

OBJECTIVES

This study try to value the influence of the clinical stage and the cognitive results on the P300 values in the bipolar patients and to compare these results with the schizophrenic patients.

PATIENTS AND METHODS

It has been evaluated the evoked potentials and the results of a neuropsychological battery of tests in three patient groups: schizophrenics in patients with acute symptomatology (n = 18), schizophrenic out patients without acute symptomatology (n = 15) and bipolar in patients during a maniac period (n = 16).

RESULTS

It has not been found any differences between schizophrenic and maniac patients nor in the amplitude or in the latency of the P300. The results of the neuropsychological tests have not any relation with P300 amplitude and latency except for the verbal fluidity (VF) which has a good correlation with a longer P300 latency. At the same time this was the only test in which schizophrenic patients have smaller results than affective patients with a good correlation.

CONCLUSIONS

These results suggest a similar pattern of neuropsychological and neurophysiological damage in schizophrenic and affective patients in acute period of mania.

GM and KM immunoglobulin allotypes in a Spanish Pyrenean population: Val d'Aran

Four hundred and thirteen unrelated individuals (202 autochthonous and 211 non-autochthonous) of Val d'Aran (Catalan Pyrenees) have been analysed for the GM and KM immunoglobulin genetic system using the inhibition haemagglutination method. This population was defined by eight GM haplotypes (GM*3 23 5*, GM*3 5*, GM*1,17 21,28, GM*1,2,17 21,28, GM*1,17 5*, GM*1,17 5,6,11,24, GM*1,17 10,11,13,15 and GM*1,17 10,11,13,15,16) inferred from the 17 observed phenotypes. The Val d'Aran population frequencies conform to Hardy-Weinberg expectations. The frequencies of phenotypes and haplotypes show a definite homogeneity between the autochthonous and non-autochthonous people of Val d'Aran and 11 other Pyrenean populations (Mauléon, Macaye, St. Jean Pied de Port, Vallée de L'Ouzom, Gavarnie, Barèges, Luz St. Sauveur, Esparros, Camurac, Capcir and Pays de Sault) that have already been studied for the same allotypes. A factorial correspondence analysis was performed for the 12 autochthonous Pyrenean populations, showing a high frequency of the GM*3 23 5* haplotype in the three Pyrenean regions (Western, Central and Eastern), while the GM*1,17 21,28 haplotype is mainly found in the Central region, GM*3 5* in the Eastern and Western zones, and the GM*1,2,17 21,28 is mainly present in the Central and Eastern populations. The results show a relative regional homogeneity, so there is no evidence of a frequency gradient in the Pyrenean populations for the GM and KM genetic systems. It may, however, be noticed that the Central Pyrenean populations form a group, with one population (Vallée de l'Ouzom) isolated from the rest, probably because of its particular model of inheritance by which the heritage is passed to the first born without sex consideration. It has been possible to point out some differences in the genetic structure of the autochthonous and non-autochthonous Val d'Aran population and to place the autochthonous Aranese group among its Pyrenean neighbours.

[Electroretinogram: technique and clinical applications]

INTRODUCTION

The retina is a neuronal membrane that covers the posterior part of the eye chamber and is formed by several layers. The retinal function can be synthesize as the light translation into nervous impulses in the optic nerve.

MATERIAL AND METHODS

The ERG is the expression of the changes of the electrical potential in the retina after a luminous stimulus. There are different types of retinal stimulators specially flash, ganzfeld and pattern which are the most used in the clinical neurophysiological explorations.

RESULTS

We expose the obtained responses, the morphology, amplitude and latencies of the (a) and (b) waves in scotopic and photopic conditions with ganzfeld or flash stimulator. In the ERG pattern we describe the waves for the transitory ERGP as well as for the Steady-State ERGP. We refer to the protocols proposed by the International Society of Electrophysiology of Vision (ISCEV). We mention the clinical applications of these techniques and we give our personal experience in diseases such retinitis pigmentosa, maculopathies, retinal degenerations, vascular diseases, cataracts and traumatic lesions of the retina.

Clinical and genetic aspects of two Spanish families with autosomal dominant retinitis pigmentosa (ADRP)

A study was made of two families with autosomal dominant retinitis pigmentosa (ADRP) from Valencia (Spain). One family (ADRP15) was found to have mutation in codon 114 of the rhodopsin gene that led to a substitution of a glycine for an aspartic acid. The second family (ADRP7) substituted an aspartic acid for valine in codon 173 of the peripherin-RDS gene. Rhodopsin is involved in 25% of ADRP cases and many mutations of this gene have been described as causing different forms of the disease, with variable severity and age at onset. ADRP has been classified as RP with a milder symptom evolution, a typical RP fundus pattern, and macular involvement occurring after the second decade of life. Peripherin-RDS gene mutations lead to RP or other retinopathies. Furthermore, two mutations in codon 172 have been described as causing macular dystrophy. In ADRP7, a mutation in neighboring codon 173 produced RP with an atypical fundus pattern and macular involvement within the first decade of life. These observations confirm the established clinical and genetic heterogeneity involved in this form of RP.

Supermirror phase anisotropy measurement

The high sensitivity of the eigenstates of a large-finesse passive Fabry-Perot cavity is used to measure the residual anisotropy of supermirrors at strictly normal incidence. An experimental demonstration leads to the measurement of phase retardances of the order of 10(-6) rad.