Microbiological assay on microtitre plates of folate in serum and red cells

AIMS

To develop a simple microbiological assay for serum and red cell folates on 96-well microtitre plates, suitable for use in routine clinical diagnosis.

METHODS

Use of a chloramphenicol resistant organism (NCIB 10463) saved time by avoiding aseptic precautions. Use of plate sealers facilitated mixing. Evaluation of assay performance included estimations of folate recovery, assay reproducibility, and response to reduced folate. Results obtained on sera (193) and red cell folates (150) were compared with those obtained using a traditional microbiological assay.

RESULTS

Good recovery of folic acid added to serum and also good interassay and intra-assay precision were obtained with both serum (CV% of less than 5) and red cell folate pools (CV% of less than 5). Equimolar assay responses were obtained with folic acid, 5-formyltetrahydrofolate (L-form), and 5-methyltetrahydrofolate (L-form). The microassay correlated well with a traditional assay for estimation of folate in both serum (n = 193, r = 0.975) and red cells (n = 150, r = 0.96).

CONCLUSIONS

This assay is more compact and less time consuming than the traditional assay. It is extremely economical and is easy to perform in a routine clinical laboratory.

Maternal hepatotoxicity with nevirapine as part of combination antiretroviral therapy in pregnancy

OBJECTIVES

To describe the maternal tolerability of nevirapine as part of combination antiretroviral therapy in pregnancy at three HIV centres in Dublin, Ireland and to determine risk factors for development of significant hepatotoxicity.

METHODS

A retrospective study was carried out of all women prescribed nevirapine as part of combination antiretroviral therapy in pregnancy at three HIV centres in Dublin, Ireland (October 2000 to February 2003). Toxicities experienced were graded according to the Division of AIDS toxicity guidelines for adults. Statistical analysis was performed to determine whether there were differences between those that did and those that did not experience significant hepatotoxicity.

RESULTS

A total of 123 women initiated nevirapine as part of combination antiretroviral therapy in the study period. Eight women developed significant hepatotoxicity, including two women who died from fulminant hepatitis. Women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts (P=0.01).

CONCLUSIONS

In this cohort, women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts, lending additional weight to the need for caution in using nevirapine as part of combination antiretroviral therapy in women not requiring antiretroviral therapy for their own health.

Dynamics of Fourier domain mode-locked lasers

An analysis of the dynamical features in the output of a Fourier Domain Mode Locked laser is presented. An experimental study of the wavelength sweep-direction asymmetry in the output of such devices is undertaken. A mathematical model based on a set of delay differential equations is developed and shown to agree well with experiment.

Excitability in optically injected semiconductor lasers: contrasting quantum-well- and quantum-dot-based devices

Excitability is a generic prediction for an optically injected semiconductor laser. However, the details of the phenomenon differ depending on the type of device in question. For quantum-well lasers very complicated multipulse trajectories can be found, while for quantum-dot lasers the situation is much simpler. Experimental observations show the marked differences in the pulse shapes while theoretical considerations reveal the underlying mechanism responsible for the contrast, identifying the increased stability of quantum-dot lasers to perturbations as the root.

Duodenal Dcytb and hephaestin mRNA expression are not significantly modulated by variations in body iron homeostasis

BACKGROUND AND AIMS

While the upregulation of duodenal cytochrome b (Dcytb) within duodenal enterocytes is reported in patients with iron deficiency, the expression of hephaestin (Hp) remains controversial in altered iron metabolism states, including HFE associated hereditary hemochromatosis (HH). The effect of iron depletion therapy on the expression of these molecules is unclear. This study examines the duodenal expression of these two molecules in HH patients (prior to and following phlebotomy), in patients with iron deficiency (ID) and in healthy controls.

METHODS

Using quantitative real-time polymerase chain reaction (qRT-PCR), Dcytb and Hp mRNA expression levels were measured in duodenal tissue of C282Y homozygous HH patients, in ID patients negative for the C282Y mutation with a serum ferritin concentration less than 20 mug/l, and in controls negative for C282Y and H63D mutations with normal iron indices.

RESULTS

Dcytb and Hp mRNA expression levels were not significantly different in either non-phlebotomized and phlebotomized HH patients or individuals with iron deficiency when compared with controls. There was no significant correlation between the gene expression levels and their respective serum ferritin or TS% values in any of the investigated groups. In HH patients, there was no significant association between gene expression and the degree of hepatic parenchymal siderosis identified by Perl's iron stain. Dcytb and Hp mRNA levels were significantly correlated to each other when all cohorts were analyzed together and separately.

CONCLUSIONS

These findings demonstrate that the duodenal ferroreductase Dcytb and ferroxidase Hp mRNA expression are not significantly altered by variations in iron homeostasis. The effect of phlebotomy-induced erythropoiesis did not alter either gene transcript mRNA expression.

Use of folic acid-fortified milk in the elderly population

Folic acid deficiency is common in the elderly population, resulting in anaemia, dementia, many neurological sequelae and an indirect role in atheromatous disease. An increase in natural food folate is relatively ineffective at increasing folate status and the use of folate fortification of foodstuffs is recommended. The aim of our study was to assess the benefits of folic acid-fortified milk to the folate status of an elderly institutionalised population. 49 subjects received fortified milk as part of their daily diet for at least 6 months (active group) and 40 subjects received unfortified milk (control group). Our results showed a mean serum folate level in the active group of 5.81 (1.1-17.6) microgram/l compared to the control group mean of 2.16 (0.5-9.4) microgram/l (p < 0.001; normal range for serum folate 2.7-20 microgram/l). Similarly the mean red cell folate level in the active group of 316.5 (130-905) microgram/l was significantly higher than the control group mean of 196.1 (95-490) microgram/l (p < 0.001; normal range for red cell folate 150-1,000 microgram/l). Our results suggest that folic acid-fortified milk is an efficacious and acceptable method of administration of folic acid in the elderly population and we recommend the use of folic acid-fortified milk in the regular daily diet of the elderly population.

Evaluation of serum transferrin receptor assay in a centralized iron screening service

This study assesses the impact of permitting unrestricted access to requests for soluble transferrin receptor (sTfR) analysis in screening for iron deficiency (ID). Biochemical data including sTfR, serum ferritin (sFn), transferrin saturation, zinc protoporphyrins (ZPP) and also erythrocyte indices are used to highlight the differences between hospital (H) and general practitioner (GP) patient groups. A significantly higher number of abnormal sFn values (40%) over abnormal sTfR values (25%) occurred in GP patients. This trend was reversed in the H patient group where high sTfR values predominated. Consequently, screening with sFn, exclusively, missed ID (sTfR > 28.1 nmol/l) in 5% of GP patients and in 20% of H patients. Some 40% of H patients had elevated CRP values (CRP > 10 mg/l) indicating inflammatory disease, however, ZPP was more efficient than CRP at screening the validity of normal sFn values in the group. Unrestricted access to sTfR, sFn and ZPP analyses should expedite diagnosis in all patients, particularly H patients, but may be costly. The high specificity (>90%) of the mean cell haemoglobin for ID may be under-utilized diagnostically.

Dynamics of a short cavity swept source OCT laser

We investigate the behaviour of a short cavity swept source laser with an intra cavity swept filter both experimentally and theoretically. We characterise the behaviour of the device with real-time intensity measurements using a fast digital oscilloscope, showing several distinct regimes, most notably regions of mode-hopping, frequency sliding mode-locking and chaos. A delay differential equation model is proposed that shows close agreement with the experimental results. The model is also used to determine important quantities such as the minimum and maximum sweep speeds for the mode-locking regime. It is also shown that by varying the filter width the maximum sweep speed can be increased but at a cost of increasing the instantaneous linewidth. The consequent impacts on optical coherence tomography applications are analysed.

Outcome Measures for Core Symptoms of Intellectual Disability: State of the Field

Intellectual disability (ID) is defined by impairments in intellectual and adaptive functioning. As such, tools designed to assess these domains would theoretically be ideal outcome measures for treatment trials targeting core symptoms of ID. However, measures of intellectual and adaptive functioning have rarely been used as primary outcome measures to date and further study is needed regarding their usefulness to measure change. This area of inquiry is important because promising, mechanism-modifying treatments for conditions leading to ID are being initiated. To show efficacy, these treatments need to demonstrate an impact on core features of ID. After reviewing literature on this topic, we suggest solutions to several problems outlined, including use of out-of-age-range testing, alternative metrics, and development of new measures.

Dimensional signature on noise-induced excitable statistics in an optically injected semiconductor laser

Noise-induced excitability is a prevalent feature in many nonlinear dynamical systems. The optically injected semiconductor laser is one of the simplest such systems and is readily amenable to both experimental and theoretical analysis. We show that the dimensionality of this system may be tuned experimentally and that this has a strong signature on the interspike statistics. The phase of the slave laser is resolved experimentally in the frame of the master laser, allowing an examination of the dynamics at extremely low injection strengths where intensity measurements alone cannot determine the dynamics fully. Generic phase equations are found for the different dimensional scenarios. When the dimensionality is greater than 1, we show that a precursor of a homoclinic bifurcation generates a noise-induced frequency and that the homoclinic bifurcation admits a bistability in the system.

Investigation of nickel supported catalysts for the upgrading of brown peat derived gasification products

A gasification test rig was designed in which peat was gasified under nitrogen over a temperature range 25-550 degrees C at 5 degrees C min(-1). The gasification unit resulted in 35.5 wt% of the carbon present in the peat being converted to a volatile fraction. The volatile fraction was transferred to a secondary catalytic reforming reactor at 800 degrees C. The thermal effect of the second reactor resulted in an increase in the CO, CO2 and CH4 content of the volatile fraction, a syngas ratio of 0.75 and a higher heating value (HHV) of 26.5 MJ kg(-1). Several nickel-supported catalysts were investigated with the intention that they should give an increase in the conversion of the condensable hydrocarbons in the volatile fraction to CO, CO2 and CH4, and a resultant gas stream suitable for use in an integrated gasification combined cycle plant (IGCC) (i.e. syngas ratio 2:1, low methane content and better HHV). Alumina-supported nickel catalysts investigated gave the highest activities and co-precipitated Ni/Al catalysts were most active. A Ni/Al 3:17 catalyst increased the conversion of the hydrocarbons to 91.5%, gave a syngas ratio of 1.81:1, increased the HHV by a factor of 5.3 and completely eliminated methane from the gas stream.

Single shot, time-resolved measurement of the coherence properties of OCT swept source lasers

A novel, time-resolved interferometric technique is presented that allows the reconstruction of the complex electric field output of a swept source laser in a single-shot measurement. The power of the technique is demonstrated by examining a short cavity swept source designed for optical coherence tomography (OCT) applications with a spectral width of over 100 nm. The novel analysis allows a time-resolved real-time characterization of the roll-off, optical spectrum, linewidth, and coherence properties of a dynamic, rapidly swept laser source.

Bounded phase phenomena in the optically injected laser

Two routes to phase-locking in the optically injected laser system are investigated both involving limit cycles where the phase of the slave laser is unlocked but is nevertheless bounded. We use an experimental phase-resolving technique to unambiguously demonstrate the phenomenon via explicit phasors for the slave laser electric field. Theoretical considerations show that for locking mechanisms involving Hopf bifurcations, such limit cycles of bounded phase are generic. For weakly damped devices, such as quantum well lasers, this can involve an excited resonance at the relaxation oscillation frequency. For highly damped devices there is no such excitation but the bounded phase behavior must persist. Phasor portraits for other regimes are also obtained including a chaotic regime.

Optical ultrafast random number generation at 1 Tb/s using a turbulent semiconductor ring cavity laser

A simple method of high-speed random bit generation is presented that utilizes the turbulent output of a fiber ring cavity semiconductor laser. Random bits are generated by multi-bit sampling of the chaotic optical waveform passed through a simple post-processing procedure, leading to generation rates up to and potentially exceeding 1 Tb/s. The resulting random bit streams are tested statistically using a software package designed to test random number generators, the NIST statistical test suite. The bit streams pass each of these test sets, indicating their suitability for use in random number generation applications. This novel technique allows the generation of random bits from less complex experimental conditions than previously reported, while improving upon recent previous studies in terms of bit rate and quality of bits.

Early neoplasias of the gallbladder and bile duct: an "unstable" biliary epithelium?

Benign tumours of the biliary tree are rare. In particular, only anecdotal cases of intraductal villous adenomas have been reported. The polyp-cancer sequence has not been observed in the biliary epithelium, in contrast to the paradigm of colorectal carcinogenesis. This report presents the case of a 64-year-old woman with a past history of cholelithiasis who had two early neoplasias involving the biliary epithelium: an adenocarcinoma in situ of the gallbladder and a common bile duct (CBD) villous adenoma with high-grade dysplasia. The tumours presented 4 years apart. The clinical features and combined radiological, cytological, and surgical modalities leading to the diagnosis of intraductal villous adenoma are presented. The endoscopic ultrasound (EUS) characteristics of villous adenoma of the CBD are described. While the prognosis on both occasions appears excellent following curative resections of both tumours detected at an early stage, it is possible that further neoplasia involving the biliary tree may recur. There are currently no data on optimal surveillance modalities. It may be hypothesized that the gallbladder and biliary epithelium share a similar mechanism for carcinogenesis to that observed in the colonic adenomacarcinoma sequence.

Excitable interplay between lasing quantum dot states

The optically injected semiconductor laser system has proven to be an excellent source of experimental nonlinear dynamics, particularly regarding the generation of excitable pulses. Typically for low-injection strengths, these pulses are the result of a small above-threshold perturbation of a stable steady state, the underlying physics is well described by the Adler phase equation, and each laser intensity pulse is accompanied by a 2π phase rotation. In this article, we show how, with a dual-state quantum dot laser, a variation of type I excitability is possible that cannot be described by the Adler model. The laser is operated so that emission is from the excited state only. The ground state can be activated and phase locked to the master laser via optical injection while the excited state is completely suppressed. Close to the phase-locking boundary, a region of ground-state emission dropouts correlated to excited-state pulses can be observed. We show that the phase of the ground state undergoes bounded rotations due to interactions with the excited state. We analyze the system both experimentally and numerically and find excellent agreement. Particular attention is devoted to the bifurcation conditions needed for an excitable pulse as well as its time evolution.

Excitation regeneration in delay-coupled oscillators

A network of phase-coupled oscillators constitutes a system in which excitable 2pi phase slips can be induced by noise. We show that such an excitation in one of the oscillators can be regenerated by subsequent oscillators and become self-sustained for certain topologies. We focus on the simplest such topology: two mutually coupled oscillators.Our analysis is bolstered [corrected] by an experimental confirmation of the phenomenon via a pair of mutually delay coupled quantum-dot lasers. Both the intensities and phases of the laser outputs were measured confirming the interpretation.

Delay induced high order locking effects in semiconductor lasers

Multiple time scales appear in many nonlinear dynamical systems. Semiconductor lasers, in particular, provide a fertile testing ground for multiple time scale dynamics. For solitary semiconductor lasers, the two fundamental time scales are the cavity repetition rate and the relaxation oscillation frequency which is a characteristic of the field-matter interaction in the cavity. Typically, these two time scales are of very different orders, and mutual resonances do not occur. Optical feedback endows the system with a third time scale: the external cavity repetition rate. This is typically much longer than the device cavity repetition rate and suggests the possibility of resonances with the relaxation oscillations. We show that for lasers with highly damped relaxation oscillations, such resonances can be obtained and lead to spontaneous mode-locking. Two different laser types--a quantum dot based device and a quantum well based device-are analysed experimentally yielding qualitatively identical dynamics. A rate equation model is also employed showing an excellent agreement with the experimental results.

Effectiveness of interferon-free therapy for the treatment of HCV-patients with compensated cirrhosis treated through the Irish early access program

BACKGROUND

We investigated the real-world effectiveness of interferon-free regimens for the treatment of patients with compensated cirrhosis infected with hepatitis C virus (HCV).

METHOD

Using the Irish national HCV treatment registry, the effectiveness and safety of interferon-free regimens for HCV-infected patients treated between April 2015 and August 2016, was determined.

RESULTS

A SVR12 was achieved in 86% of subjects treated with sofosbuvir/ledipasvir ± ribavirin (SOF/LDV±RBV), 93% treated with paritaprevir, ombitasvir and ritonavir combined with dasabuvir ± ribavirin (3D±RBV) and 89% treated with sofosbuvir/daclatasvir ± ribavirin (SOF/DCV±RBV). The discontinuation rate was 5% and the on-treatment mortality rate was 1%.

CONCLUSION

The availability of interferon-free regimens represents a significant breakthrough for the treatment of HCV infection. Treatments options, with high SVR12 rates, are now available for patients with compensated cirrhosis who were unsuitable for treatment with interferon-based regimens. Data obtained from studies conducted in real world practice provide robust information fundamental for input into future economic evaluations for agents used for the treatment of HCV infection.

Dissipative Phase Solitons in Semiconductor Lasers

We experimentally demonstrate the existence of nondispersive solitary waves associated with a 2π phase rotation in a strongly multimode ring semiconductor laser with coherent forcing. Similarly to Bloch domain walls, such structures host a chiral charge. The numerical simulations based on a set of effective Maxwell-Bloch equations support the experimental evidence that only one sign of chiral charge is stable, which strongly affects the motion of the phase solitons. Furthermore, the reduction of the model to a modified Ginzburg-Landau equation with forcing demonstrates the generality of these phenomena and exposes the impact of the lack of parity symmetry in propagative optical systems.

Optically injected quantum-dot lasers

The response of an optically injected quantum-dot semiconductor laser (SL) is studied both experimentally and theoretically. In particular, the nature of the locking boundaries is investigated, revealing features more commonly associated with Class A lasers rather than conventional Class B SLs. Experimentally, two features stand out; the first is an absence of instabilities resulting from relaxation oscillations, and the second is the observation of a region of bistability between two locked solutions. Using rate equations appropriate for quantum-dot lasers, we analytically determine the stability diagram in terms of the injection rate and frequency detuning. Of particular interest are the Hopf and saddle-node locking boundaries that explain how the experimentally observed phenomena appear.

Incoherent optical triggering of excitable pulses in an injection-locked semiconductor laser

We experimentally study the response of an injection-locked quantum dot semiconductor laser in the excitable regime to perturbations from an external, incoherent laser. We show that excitable pulses may be triggered both for perturbation wavelengths close to that of the quantum dot device and wavelengths detuned even by a few tens of nanometers.