Dynamical Scaling as a Signature of Multiple Phase Competition in Yb_{2}Ti_{2}O_{7}

Yb_{2}Ti_{2}O_{7} is a celebrated example of a pyrochlore magnet with highly frustrated, anisotropic exchange interactions. To date, attention has largely focused on its unusual, static properties, many of which can be understood as coming from the competition between different types of magnetic order. Here we use inelastic neutron scattering with exceptionally high energy resolution to explore the dynamical properties of Yb_{2}Ti_{2}O_{7}. We find that spin correlations exhibit dynamical scaling, analogous to behavior found near to a quantum critical point. We show that the observed scaling collapse can be explained within a phenomenological theory of multiple-phase competition, and confirm that a scaling collapse is also seen in semiclassical simulations of a microscopic model of Yb_{2}Ti_{2}O_{7}. These results suggest that dynamical scaling may be general to systems with competing ground states.

Implementing a rapid fetal exome sequencing service: What do parents and health professionals think?

OBJECTIVES

Prenatal exome sequencing (pES) for the diagnosis of fetal abnormalities is being introduced more widely in clinical practice. Here we explore parents' and professionals' views and experiences of pES, to identify perceived benefits, concerns, and support needs.

METHODS

Semi-structured interviews were conducted with 11 parents and 20 health professionals (fetal medicine and clinical genetics) with experience of rapid pES prior to implementation in the English National Health Service. Interviews were transcribed verbatim and analysed thematically.

RESULTS

Parents and professionals were largely positive about pES, emphasising clinical and psychosocial benefits of a timely, definitive diagnosis in pregnancy. Concerns included parental anxiety related to the timing of pES results or uncertain findings, a need for guidelines for case selection and reporting, and ensuring sufficient capacity for counselling, phenotyping and variant interpretation. Professionals were concerned non-genetics professionals may not be equipped to counsel parents on the complexities of pES.

CONCLUSION

These findings highlight important issues for clinical implementation of pES. Expert counselling is required to enable parents to make informed decisions during a stressful time. To achieve this, professionals need further education and training, and fetal medicine and genetics services must work closely together to ensure parental understanding and appropriate support.

Evaluating the Feasibility of Screening Relatives of Patients Affected by Nonsyndromic Thoracic Aortic Diseases: The REST Study

Background

Diseases of the thoracic aorta are characterized by a familial etiology in up to 30% of the cases. Nonsyndromic thoracic aorta diseases (NS‐TADs) lack overt clinical signs and systemic features, which hinder early detection and prompt surgical intervention. We hypothesize that tailored genetic testing and imaging of first‐degree and second‐degree relatives of patients affected by NS‐TADs may enable early diagnosis and allow appropriate surveillance or intervention.

Methods and Results

We conducted a feasibility study involving probands affected by familial or sporadic NS‐TADs who had undergone surgery, which also offered screening to their relatives. Each participant underwent a combined imaging (echocardiogram and magnetic resonance imaging) and genetic (whole exome sequencing) evaluation, together with physical examination and psychological assessment. The study population included 16 probands (8 sporadic, 8 familial) and 54 relatives (41 first‐degree and 13 second‐degree relatives) with median age 48 years (range: 18–85 years). No syndromic physical features were observed. Imaging revealed mild‐to‐moderate aortic dilation in 24% of relatives. A genetic variant of uncertain significance was identified in 3 families. Imaging, further phenotyping, or a form of secondary prevention was indicated in 68% of the relatives in the familial group and 54% in the sporadic group. No participants fulfilled criteria for aortic surgery. No differences between baseline and 3‐month follow‐up scores for depression, anxiety, and self‐reported quality of life were observed.

Conclusions

In NS‐TADs, imaging tests, genetic counseling, and family screening yielded positive results in up to 1 out of 4 screened relatives, including those in the sporadic NS‐TAD group.

Registration

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03861741.

Pathogenic variants causing ABL1 malformation syndrome cluster in a myristoyl-binding pocket and increase tyrosine kinase activity

ABL1 is a proto-oncogene encoding a nonreceptor tyrosine kinase, best known in the somatic BCR-ABL fusion gene associated with chronic myeloid leukaemia. Recently, germline missense variants in ABL1 have been found to cause an autosomal dominant developmental syndrome with congenital heart disease, skeletal malformations and characteristic facies. Here, we describe a series of six new unrelated individuals with heterozygous missense variants in ABL1 (including four novel variants) identified via whole exome sequencing. All the affected individuals in this series recapitulate the phenotype of the ABL1 developmental syndrome and additionally we affirm that hearing impairment is a common feature of the condition. Four of the variants cluster in the myristoyl-binding pocket of ABL1, a region critical for auto-inhibitory regulation of the kinase domain. Bio-informatic analysis of transcript-wide conservation and germline/somatic variation reveals that this pocket region is subject to high missense constraint and evolutionary conservation. Functional work to investigate ABL1 kinase activity in vitro by transient transfection of HEK293T cells with variant ABL1 plasmid constructs revealed increased phosphorylation of ABL1-specific substrates compared to wild-type. The increased tyrosine kinase activity was suppressed by imatinib treatment. This case series of six new patients with germline heterozygous ABL1 missense variants further delineates the phenotypic spectrum of this condition and recognises microcephaly as a common finding. Our analysis supports an ABL1 gain-of-function mechanism due to loss of auto-inhibition, and demonstrates the potential for pharmacological inhibition using imatinib.

BICRA, a SWI/SNF Complex Member, Is Associated with BAF-Disorder Related Phenotypes in Humans and Model Organisms

SWI/SNF-related intellectual disability disorders (SSRIDDs) are rare neurodevelopmental disorders characterized by developmental disability, coarse facial features, and fifth digit/nail hypoplasia that are caused by pathogenic variants in genes that encode for members of the SWI/SNF (or BAF) family of chromatin remodeling complexes. We have identified 12 individuals with rare variants (10 loss-of-function, 2 missense) in the BICRA (BRD4 interacting chromatin remodeling complex-associated protein) gene, also known as GLTSCR1, which encodes a subunit of the non-canonical BAF (ncBAF) complex. These individuals exhibited neurodevelopmental phenotypes that include developmental delay, intellectual disability, autism spectrum disorder, and behavioral abnormalities as well as dysmorphic features. Notably, the majority of individuals lack the fifth digit/nail hypoplasia phenotype, a hallmark of most SSRIDDs. To confirm the role of BICRA in the development of these phenotypes, we performed functional characterization of the zebrafish and Drosophila orthologs of BICRA. In zebrafish, a mutation of bicra that mimics one of the loss-of-function variants leads to craniofacial defects possibly akin to the dysmorphic facial features seen in individuals harboring putatively pathogenic BICRA variants. We further show that Bicra physically binds to other non-canonical ncBAF complex members, including the BRD9/7 ortholog, CG7154, and is the defining member of the ncBAF complex in flies. Like other SWI/SNF complex members, loss of Bicra function in flies acts as a dominant enhancer of position effect variegation but in a more context-specific manner. We conclude that haploinsufficiency of BICRA leads to a unique SSRIDD in humans whose phenotypes overlap with those previously reported.

Exome sequencing in patients with antiepileptic drug exposure and complex phenotypes

INTRODUCTION

Fetal anticonvulsant syndrome (FACS) describes the pattern of physical and developmental problems seen in those children exposed to certain antiepileptic drugs (AEDs) in utero. The diagnosis of FACS is a clinical one and so excluding alternative diagnoses such as genetic disorders is essential.

METHODS

We reviewed the pathogenicity of reported variants identified on exome sequencing in the Deciphering Developmental Disorders (DDD) Study in 42 children exposed to AEDs in utero, but where a diagnosis other than FACS was suspected. In addition, we analysed chromosome microarray data from 10 patients with FACS seen in a Regional Genetics Service.

RESULTS

Seven children (17%) from the DDD Study had a copy number variant or pathogenic variant in a developmental disorder gene which was considered to explain or partially explain their phenotype. Across the AED exposure types, variants were found in 2/15 (13%) valproate exposed cases and 3/14 (21%) carbamazepine exposed cases. No pathogenic copy number variants were identified in our local sample (n=10).

CONCLUSIONS

This study is the first of its kind to analyse the exomes of children with developmental disorders who were exposed to AEDs in utero. Though we acknowledge that the results are subject to bias, a significant number of children were identified with alternate diagnoses which had an impact on counselling and management. We suggest that consideration is given to performing whole exome sequencing as part of the diagnostic work-up for children exposed to AEDs in utero.

Negative Thermal Expansion in the Plateau State of a Magnetically Frustrated Spinel

We report on negative thermal expansion (NTE) in the high-field, half-magnetization plateau phase of the frustrated magnetic insulator CdCr_{2}O_{4}. Using dilatometry, we precisely map the phase diagram at fields of up to 30 T and identify a strong NTE associated with the collinear half-magnetization plateau for B>27  T. The resulting phase diagram is compared with a microscopic theory for spin-lattice coupling, and the origin of the NTE is identified as a large negative change in magnetization with temperature, coming from a nearly localized band of spin excitations in the plateau phase. These results provide useful guidelines for the discovery of new NTE materials.

Bi-allelic Loss-of-Function CACNA1B Mutations in Progressive Epilepsy-Dyskinesia

The occurrence of non-epileptic hyperkinetic movements in the context of developmental epileptic encephalopathies is an increasingly recognized phenomenon. Identification of causative mutations provides an important insight into common pathogenic mechanisms that cause both seizures and abnormal motor control. We report bi-allelic loss-of-function CACNA1B variants in six children from three unrelated families whose affected members present with a complex and progressive neurological syndrome. All affected individuals presented with epileptic encephalopathy, severe neurodevelopmental delay (often with regression), and a hyperkinetic movement disorder. Additional neurological features included postnatal microcephaly and hypotonia. Five children died in childhood or adolescence (mean age of death: 9 years), mainly as a result of secondary respiratory complications. CACNA1B encodes the pore-forming subunit of the pre-synaptic neuronal voltage-gated calcium channel Ca_v2.2/N-type, crucial for SNARE-mediated neurotransmission, particularly in the early postnatal period. Bi-allelic loss-of-function variants in CACNA1B are predicted to cause disruption of Ca²⁺ influx, leading to impaired synaptic neurotransmission. The resultant effect on neuronal function is likely to be important in the development of involuntary movements and epilepsy. Overall, our findings provide further evidence for the key role of Ca_v2.2 in normal human neurodevelopment.

Diagnosis of lethal or prenatal-onset autosomal recessive disorders by parental exome sequencing

OBJECTIVE

Rare genetic disorders resulting in prenatal or neonatal death are genetically heterogeneous, but testing is often limited by the availability of fetal DNA, leaving couples without a potential prenatal test for future pregnancies. We describe our novel strategy of exome sequencing parental DNA samples to diagnose recessive monogenic disorders in an audit of the first 50 couples referred.

METHOD

Exome sequencing was carried out in a consecutive series of 50 couples who had 1 or more pregnancies affected with a lethal or prenatal-onset disorder. In all cases, there was insufficient DNA for exome sequencing of the affected fetus. Heterozygous rare variants (MAF < 0.001) in the same gene in both parents were selected for analysis. Likely, disease-causing variants were tested in fetal DNA to confirm co-segregation.

RESULTS

Parental exome analysis identified heterozygous pathogenic (or likely pathogenic) variants in 24 different genes in 26/50 couples (52%). Where 2 or more fetuses were affected, a genetic diagnosis was obtained in 18/29 cases (62%). In most cases, the clinical features were typical of the disorder, but in others, they result from a hypomorphic variant or represent the most severe form of a variable phenotypic spectrum.

CONCLUSION

We conclude that exome sequencing of parental samples is a powerful strategy with high clinical utility for the genetic diagnosis of lethal or prenatal-onset recessive disorders. © 2017 The Authors Prenatal Diagnosis published by John Wiley & Sons Ltd.

WAC loss-of-function mutations cause a recognisable syndrome characterised by dysmorphic features, developmental delay and hypotonia and recapitulate 10p11.23 microdeletion syndrome

BACKGROUND

Rare de novo mutations have been implicated as a significant cause of idiopathic intellectual disability. Large deletions encompassing 10p11.23 have been implicated in developmental delay, behavioural abnormalities and dysmorphic features, but the genotype-phenotype correlation was not delineated. Mutations in WAC have been recently reported in large screening cohorts of patients with intellectual disability or autism, but no full phenotypic characterisation was described.

METHODS

Clinical and molecular characterisation of six patients with loss-of-function WAC mutations identified by whole exome sequencing was performed. Clinical data were obtained by retrospective chart review, parental interviews, direct patient interaction and formal neuropsychological evaluation.

RESULTS

Five heterozygous de novo WAC mutations were identified in six patients. Three of the mutations were nonsense, and two were frameshift; all are predicted to cause loss of function either through nonsense-mediated mRNA decay or protein truncation. Clinical findings included developmental delay (6/6), hypotonia (6/6), behavioural problems (5/6), eye abnormalities (5/6), constipation (5/6), feeding difficulties (4/6), seizures (2/6) and sleep problems (2/6). All patients exhibited common dysmorphic features, including broad/prominent forehead, synophrys and/or bushy eyebrows, depressed nasal bridge and bulbous nasal tip. Posteriorly rotated ears, hirsutism, deep-set eyes, thin upper lip, inverted nipples, hearing loss and branchial cleft anomalies were also noted.

CONCLUSIONS

Our case series show that loss-of-function mutations in WAC cause a recognisable genetic syndrome characterised by a neurocognitive phenotype and facial dysmorphism. Our data highly suggest that WAC haploinsufficiency is responsible for most of the phenotypic features associated with deletions encompassing 10p11.23.

Large-scale discovery of novel genetic causes of developmental disorders

Despite three decades of successful, predominantly phenotype-driven discovery of the genetic causes of monogenic disorders, up to half of children with severe developmental disorders of probable genetic origin remain without a genetic diagnosis. Particularly challenging are those disorders rare enough to have eluded recognition as a discrete clinical entity, those with highly variable clinical manifestations, and those that are difficult to distinguish from other, very similar, disorders. Here we demonstrate the power of using an unbiased genotype-driven approach to identify subsets of patients with similar disorders. By studying 1,133 children with severe, undiagnosed developmental disorders, and their parents, using a combination of exome sequencing and array-based detection of chromosomal rearrangements, we discovered 12 novel genes associated with developmental disorders. These newly implicated genes increase by 10% (from 28% to 31%) the proportion of children that could be diagnosed. Clustering of missense mutations in six of these newly implicated genes suggests that normal development is being perturbed by an activating or dominant-negative mechanism. Our findings demonstrate the value of adopting a comprehensive strategy, both genome-wide and nationwide, to elucidate the underlying causes of rare genetic disorders.

Two-dimensional ferromagnetism of a 3He film: influence of weak frustration

(3)He films adsorbed on the atomically flat surface of graphite provide a model system for the study of two-dimensional magnetism on a triangular lattice. We have made a study of the regime in which the T=0 ground state of the second (3)He layer is a fully polarized ferromagnet. NMR, using broadband SQUID detection, at a range of low fields above the spin-flop transition, and over a wide temperature range 0.3-200 mK, has enabled us to disentangle the influence of sample finite size effects and magnetic field on the spin-wave spectrum. We demonstrate that the spin-wave spectrum is governed by a different effective exchange constant than that determining the high temperature magnetism. This is understood in terms of frustrated atomic ring exchange.

Mainzer-Saldino syndrome is a ciliopathy caused by IFT140 mutations

Mainzer-Saldino syndrome (MSS) is a rare disorder characterized by phalangeal cone-shaped epiphyses, chronic renal failure, and early-onset, severe retinal dystrophy. Through a combination of ciliome resequencing and Sanger sequencing, we identified IFT140 mutations in six MSS families and in a family with the clinically overlapping Jeune syndrome. IFT140 is one of the six currently known components of the intraflagellar transport complex A (IFT-A) that regulates retrograde protein transport in ciliated cells. Ciliary abundance and localization of anterograde IFTs were altered in fibroblasts of affected individuals, a result that supports the pivotal role of IFT140 in proper development and function of ciliated cells.

Mutations in CEP57 cause mosaic variegated aneuploidy syndrome

Using exome sequencing and a variant prioritization strategy that focuses on loss-of-function variants, we identified biallelic, loss-of-function CEP57 mutations as a cause of constitutional mosaic aneuploidies. CEP57 is a centrosomal protein and is involved in nucleating and stabilizing microtubules. Our findings indicate that these and/or additional functions of CEP57 are crucial for maintaining correct chromosomal number during cell division.

Nicolaides-Baraitser syndrome: Delineation of the phenotype

Nicolaides-Baraitser syndrome (NBS) is an infrequently described condition, thus far reported in five cases. In order to delineate the phenotype and its natural history in more detail, we gathered data on 18 hitherto unreported patients through a multi-center collaborative study, and follow-up data of the earlier reported patients. A detailed comparison of the 23 patients is provided. NBS is a distinct and recognizable entity, and probably has been underdiagnosed until now. Main clinical features are severe mental retardation with absent or limited speech, seizures, short stature, sparse hair, typical facial characteristics, brachydactyly, prominent finger joints and broad distal phalanges. Some of the features are progressive with time. The main differential diagnosis is Coffin-Siris syndrome. There is no important gender difference in occurrence and frequency of the syndrome, and all cases have been sporadic thus far. Microarray analysis performed in 14 of the patients gave normal results. Except for the progressive nature there are no clues to the cause.

Directional field-induced metallization of quasi-one-dimensional Li0.9Mo6O17

We report a detailed magnetotransport study of the highly anisotropic quasi-one-dimensional oxide Li(0.9)Mo(6)O(17) whose in-chain electrical resistivity diverges below a temperature T_{min} approximately 25 K. For T < T_{min}, a magnetic field applied parallel to the conducting chain induces a large negative magnetoresistance and, ultimately, the recovery of a metallic state. We show evidence that this insulator-metal crossover is a consequence of field-induced suppression of a density-wave gap in a highly one-dimensional conductor. At the highest fields studied, there is evidence for the possible emergence of a novel superconducting state with an onset temperature T_{c} > 10 K.

Static magnetic order and superfluid density of RFeAs(O,F) (R=La,Nd,Ce) and LaFePO studied by muon spin relaxation: unusual similarities with the behavior of cuprate superconductors

Muon spin relaxation measurements in iron-oxypnictide systems have revealed: (1) commensurate long-range order in undoped LaFeAsO; (2) a Bessel function line shape in LaFeAs(O0.97F0.03) which indicates possible incommensurate or stripe magnetism; (3) anomalous weak magnetism existing in superconducting LaFePO, CeFeAs(O0.084F0.16), and NdFeAs(O0.88F0.12) but absent in superconducting LaFeAs(O0.92F0.08); and (4) scaling of the superfluid density with T_{c} in the Ce-, La-, and Nd-FeAs superconductors following a nearly linear relationship found in cuprates.

Local tunneling spectroscopy across a metamagnetic critical point in the bilayer ruthenate Sr3Ru2O7

The local spectroscopic signatures of metamagnetic criticality in Sr(3)Ru(2)O(7) were explored using scanning tunneling microscopy (STM). Singular features in the tunneling spectrum were found close to the Fermi level, as would be expected in a Stoner picture of itinerant electron metamagnetism. These features showed a pronounced magnetic field dependence across the metamagnetic critical point, which cannot be understood in terms of a naive Stoner theory. In addition, a pseudogap structure was observed over several tens of meV, accompanied by a c(2 x 2) superstructure in STM images. This result represents a new electronic ordering at the surface in the absence of any measurable surface reconstruction.

Patterning of sodium ions and the control of electrons in sodium cobaltate

Sodium cobaltate (Na(x)CoO2) has emerged as a material of exceptional scientific interest due to the potential for thermoelectric applications, and because the strong interplay between the magnetic and superconducting properties has led to close comparisons with the physics of the superconducting copper oxides. The density x of the sodium in the intercalation layers can be altered electrochemically, directly changing the number of conduction electrons on the triangular Co layers. Recent electron diffraction measurements reveal a kaleidoscope of Na+ ion patterns as a function of concentration. Here we use single-crystal neutron diffraction supported by numerical simulations to determine the long-range three-dimensional superstructures of these ions. We show that the sodium ordering and its associated distortion field are governed by pure electrostatics, and that the organizational principle is the stabilization of charge droplets that order long range at some simple fractional fillings. Our results provide a good starting point to understand the electronic properties in terms of a Hubbard hamiltonian that takes into account the electrostatic potential from the Na superstructures. The resulting depth of potential wells in the Co layer is greater than the single-particle hopping kinetic energy and as a consequence, holes preferentially occupy the lowest potential regions. Thus we conclude that the Na+ ion patterning has a decisive role in the transport and magnetic properties.

Determination of the androgenic potency of whole effluents using mosquitofish and trout bioassays

This study combined bioassay-derived and direct chemical analysis of steroidal compounds in pulp and paper and municipal sewage effluent in order to determine the cause of masculinization of female mosquitofish. The bioassays used in this study consisted of androgen and estrogen receptor binding, and aromatase inhibition using tissues from rainbow trout. This study observed no masculinization of female mosquitofish from a pulp and paper mill effluent that was previously observed to cause this effect. Mosquitofish sampled from the receiving environment of the same mill verified that masculinization was not occurring in the wild. The municipal sewage effluent also had no masculinizing effect. In vitro bioassays indicated significant sources of both androgens and estrogens in the effluents tested with sewage effluent having both the highest estradiol (41 ng/L) and testosterone (182 ng/L) equivalent concentration. These results could not be attributed to any particular compounds measured in the effluents. Two compounds implicated in the masculinization of mosquitofish by pulp and paper effluent, androstenedione and androstadienedione required relatively large (10-100 microg/L) waterborne concentrations to elicit a masculinizing effect and neither of these compounds are likely to occur at levels this high in the natural environment. The potent aromatase inhibitor, 4-hydroxyandrostenedione also did not cause masculinization at 100 microg/L indicating that masculinization did not occur through this mechanism. The mammalian anti-androgen, cyproterone acetate was only partially effective in mosquitofish and reduced the severity of masculinization in the presence of methyl testosterone. While neither effluent masculinized mosquitofish, there was a significant reduction of in vitro ovarian steroid production with the most severe effects observed with the sewage effluent. Overall, this study found the disappearance of a masculinizing effect that had been previously observed; concluded that based on 21 days aqueous exposures androstenedione and androstadienedione are not likely candidates for mosquitofish masculinization, and showed that masculinization and in vitro steroid production are unrelated biological endpoints.

Spin correlations in the paramagnetic phase and ring exchange in La2CuO4

Spin correlations in the paramagnetic phase of La(2)CuO(4) have been studied using polarized neutron scattering, with two important results. First, the temperature dependence of the characteristic energy scale of the fluctuations and the amplitude of the neutron structure factor are shown to be in quantitative agreement with the predictions of the quantum nonlinear sigma model. Second, a comparison of a high-temperature series expansion of the equal-time spin correlations with the diffuse neutron intensity provides definitive experimental evidence for ring exchange.

Constitutional aneuploidy and cancer predisposition caused by biallelic mutations in BUB1B

Mosaic variegated aneuploidy is a rare recessive condition characterized by growth retardation, microcephaly, childhood cancer and constitutional mosaicism for chromosomal gains and losses. In five families with mosaic variegated aneuploidy, including two with embryonal rhabdomyosarcoma, we identified truncating and missense mutations of BUB1B, which encodes BUBR1, a key protein in the mitotic spindle checkpoint. These data are the first to relate germline mutations in a spindle checkpoint gene with a human disorder and strongly support a causal link between aneuploidy and cancer development.

Intrinsic inhomogeneities in manganite thin films investigated with scanning tunneling spectroscopy

Thin films of La0.7Sr0.3MnO3 on MgO show a metal insulator transition and colossal magnetoresistance. The shape of this transition can be explained by intrinsic spatial inhomogeneities, which give rise to a domain structure of conducting and insulating domains at the submicrometer scale. These domains then undergo a percolation transition. The tunneling conductance and tunneling gap measured by scanning tunneling spectroscopy were used to distinguish and visualize these domains.

DNA flow cytometry does not predict 5- or 10-year recurrence rates for T1-2 node-negative breast cancer

BACKGROUND

A small proportion of T1 or T2 node-negative breast cancer tumors will recur in patients by 5 years, and more by 10 years. Results of recent studies have suggested improvement in overall survival with administration of adjuvant chemotherapy to all patients. More sensitive and specific methods are needed to identify patients at highest risk for recurrence who might benefit most from adjuvant therapy, saving others from unnecessary treatment. Some investigators have suggested DNA flow cytometry as a method to discriminate patients at greatest risk for recurrence.

HYPOTHESIS

DNA flow cytometry has predictive value for breast cancer recurrence in node-negative patients.

METHODS

The cancer registry of a medium-sized university-affiliated hospital was used to identify patients with T1-2 N0 M0 breast cancer treated with a uniform surgical approach and no adjuvant therapy who had completed at least 5 years of follow-up or had recurrence. Flow cytometric analysis was performed on paraffin-embedded specimens.

RESULTS

Of 115 patients, 92 (80%) had disease-free survival without recurrence and 23 (20%) had recurrence. Comparison of diploid and nondiploid tumors for likelihood of recurrence revealed no association (P = .79). Furthermore, the DNA index and S-phase fraction were not significantly different between recurrent and nonrecurrent groups.

CONCLUSIONS

The likelihood of recurrence of small node-negative breast cancers after mastectomy cannot be accurately predicted on the basis of DNA flow cytometric analysis. Traditional methods for determining risks-such as nuclear and histological grade, lymph node status, and tumor size-seem to be more useful. Sentinel lymph node biopsy techniques may increase the detection of micrometastases.

Costello syndrome: two cases with embryonal rhabdomyosarcoma

Costello syndrome is a well delineated mental retardation syndrome of unknown aetiology in which the occurrence of benign tumours, especially papillomata, is recognised. We report two children in whom the diagnosis of Costello syndrome was made in the first months of life, who both developed a retroperitoneal embryonal rhabdomyosarcoma. Although not previously reported, the occurrence of this relatively uncommon childhood tumour in two girls with Costello syndrome suggests that an increased risk of malignancy may be part of this condition. The genetic basis of this susceptibility requires further clarification.

Kitchen notes, 'the grapevine', and other writing in childhood

In semistructured interviews, 20 men and 20 women (10 deaf and 10 hearing) between the ages of 18 and 28 recalled instances of instrumental, social, and expressive writing from their childhood. In contrast to earlier research, we found that instrumental writing occurred as frequently between deaf children and their hearing parents as between deaf children and their deaf parents and that all homes with a deaf family member had telecommunication devices for the deaf(TTYs). Whereas all respondents engaged in some form of social writing, deaf respondents did less personal or expressive writing than their hearing peers. Implications for literacy instruction and further research are that (a) teachers should take advantage of the writing experience that students bring to the classroom, (b) writing should be used as a tool for learning and classroom communication, and (c) the effects of experience, genre, school setting, and technology on the writing of deaf students should be examined.

Determination of free thyroxin in serum by ultrafiltration: validation of a method and preliminary results

We describe the determination of concentrations of free thyroxin in serum by ultrafiltration based on the Amicon micropartition system. The assay is straightforward and requires about 4 h for 25 samples. Our results demonstrate a correlation coefficient of 0.81 compared with equilibrium dialysis, and of 0.88 compared with radioimmunoassay. For sera from 49 normal, 25 hyperthyroid, 24 hypothyroid, 50 euthyroid sick, and 13 pregnant subjects, the means (and SD) were respectively: 19.3 (4.9), 40.1 (13.6), 5.0 (2.9), 25.9 (10.5), and 16.1 (3.2) ng/L. The interassay CV was 9.9% and the intra-assay CV 7.2%. We conclude that this procedure is useful in the diagnosis of thyroid disease and offers advantages of simplicity, rapidity, and economy.

Determination of free thyroxin in serum by ultrafiltration: validation of a method and preliminary results

We describe the determination of concentrations of free thyroxin in serum by ultrafiltration based on the Amicon micropartition system. The assay is straightforward and requires about 4 h for 25 samples. Our results demonstrate a correlation coefficient of 0.81 compared with equilibrium dialysis, and of 0.88 compared with radioimmunoassay. For sera from 49 normal, 25 hyperthyroid, 24 hypothyroid, 50 euthyroid sick, and 13 pregnant subjects, the means (and SD) were respectively: 19.3 (4.9), 40.1 (13.6), 5.0 (2.9), 25.9 (10.5), and 16.1 (3.2) ng/L. The interassay CV was 9.9% and the intra-assay CV 7.2%. We conclude that this procedure is useful in the diagnosis of thyroid disease and offers advantages of simplicity, rapidity, and economy.

Subarachnoid-pleural fistula-case report and review of literature

The investigation and surgical closure of a subarachnoid pleural fistula following direct trauma to the dorsal spinal theca and spinal cord are described and a review of the literature on spinal subarachnoid-pleural fistula is presented.

Clinical features, investigation and treatment of post-traumatic syringomyelia

Thirteen patients who sustained spinal cord trauma causing persisting disability, developed new symptoms, the chief one of which was severe pain unrelieved by analgesics. The clinical diagnosis of post traumatic syringomyelia was confirmed in each case by means of myelography, as well as endomyelography in seven patients. In every case exploration of the spinal cord syrinx was performed. Ten patients were troubled by severe pain while three patients were mainly subject to altered sensation in the upper limbs. Of the six patients who had initially sustained complete cord transections, three were treated by cord transection and three were treated by syringostomy. The seven patients who sustained incomplete cord lesions were all treated by syringostomy. The patients who initially sustained incomplete sensory motor spinal cord damage had a better symptomatic response to surgery than hose who had sustained a complete spinal cord lesion. The ten patients whose main symptom was severe pain were completely relieved of their symptoms by surgery.

L4/5 and L5/S1 disc protrusions: analysis of 323 cases operated on over 12 years

A retrospective study of the results of excision of L4/5 and L5/S1 intervertebral discs in 323 patients operated on between January 1965 and January 1977 was undertaken. In every case the amount of disc excised was weighed immediately after operation. The patients had been followed up at the hospital for periods of between one and 14 years. As assessment was made of the clinical state of each patient at the end of follow-up. There was no evidence that the weight of disc excised affected the prognosis with respect either to the clinical state of the patient at the end of follow-up, or to the probability of recurrence of disc protrusion.