Clinical case seminar - Hypogonadotropic hypogonadism as a presenting feature of late-onset X-linked adrenal hypoplasia congenita

Mutations in the orphan nuclear receptor DAX-1 cause X-linked adrenal hypoplasia congenita. Affected boys usually present with primary adrenal failure in early infancy or childhood. Impaired sexual development because of hypogonadotropic hypogonadism becomes apparent at the time of puberty. We report adult-onset adrenal hypoplasia congenita in a patient who presented with hypogonadism at 28 yr of age. Although he had no clinical evidence of adrenal dysfunction, compensated primary adrenal failure was diagnosed by biochemical testing. Semen analysis showed azoospermia, and he did not achieve fertility after 8 months of treatment with gonadotropins. A novel Y380D DAX-1 missense mutation, which causes partial loss of function in transient gene expression assays, was found in this patient. This case demonstrates that partial loss-of-function mutations in DAX1 can present with hypogonadotropic hypogonadism and covert adrenal failure in adulthood. Further, an important role for DAX-1 in spermatogenesis in humans is confirmed, supporting findings in the Dax1 (Ahch) knockout mouse

Game saturation of intersecting families

We consider the following combinatorial game: two players, Fast and Slow, claim $k$-element subsets of $[n]=\{1,2,...,n\}$ alternately, one at each turn, such that both players are allowed to pick sets that intersect all previously claimed subsets. The game ends when there does not exist any unclaimed $k$-subset that meets all already claimed sets. The score of the game is the number of sets claimed by the two players, the aim of Fast is to keep the score as low as possible, while the aim of Slow is to postpone the game's end as long as possible. The game saturation number is the score of the game when both players play according to an optimal strategy. To be precise we have to distinguish two cases depending on which player takes the first move. Let $gsat_F(\mathbb{I}_{n,k})$ and $gsat_S(\mathbb{I}_{n,k})$ denote the score of the saturation game when both players play according to an optimal strategy and the game starts with Fast's or Slow's move, respectively. We prove that $\Omega_k(n^{k/3-5}) \le gsat_F(\mathbb{I}_{n,k}),gsat_S(\mathbb{I}_{n,k}) \le O_k(n^{k-\sqrt{k}/2})$ holds

Hybridizing Constraint Programming and Monte-Carlo Tree Search: Application to the Job Shop problem

International audienceConstraint Programming (CP) solvers classically explore the solution space using tree search-based heuristics. Monte-Carlo Tree-Search (MCTS), a tree-search based method aimed at sequential decision making under uncertainty, simultaneously estimates the reward associated to the sub-trees, and gradually biases the exploration toward the most promising regions. This paper examines the tight combination of MCTS and CP on the job shop problem (JSP). The contribution is twofold. Firstly, a reward function compliant with the CP setting is proposed. Secondly, a biased MCTS node-selection rule based on this reward is proposed, that is suitable in a multiple-restarts context. Its integration within the Gecode constraint solver is shown to compete with JSP-specific CP approaches on difficult JSP instances

Effect of particle size on the thermal conductivity of nanofluids containing metallic nanoparticles

A one-parameter model is presented for the thermal conductivity of nanofluids containing dispersed metallic nanoparticles. The model takes into account the decrease in thermal conductivity of metal nanoparticles with decreasing size. Although literature data could be correlated well using the model, the effect of the size of the particles on the effective thermal conductivity of the nanofluid could not be elucidated from these data. Therefore, new thermal conductivity measurements are reported for six nanofluids containing silver nanoparticles of different sizes and volume fractions. The results provide strong evidence that the decrease in the thermal conductivity of the solid with particle size must be considered when developing models for the thermal conductivity of nanofluids

Grassmannian flows and applications to nonlinear partial differential equations

We show how solutions to a large class of partial differential equations with nonlocal Riccati-type nonlinearities can be generated from the corresponding linearized equations, from arbitrary initial data. It is well known that evolutionary matrix Riccati equations can be generated by projecting linear evolutionary flows on a Stiefel manifold onto a coordinate chart of the underlying Grassmann manifold. Our method relies on extending this idea to the infinite dimensional case. The key is an integral equation analogous to the Marchenko equation in integrable systems, that represents the coodinate chart map. We show explicitly how to generate such solutions to scalar partial differential equations of arbitrary order with nonlocal quadratic nonlinearities using our approach. We provide numerical simulations that demonstrate the generation of solutions to Fisher--Kolmogorov--Petrovskii--Piskunov equations with nonlocal nonlinearities. We also indicate how the method might extend to more general classes of nonlinear partial differential systems.Comment: 26 pages, 2 figure

A review of the methodological features of systematic reviews in maternal medicine

Background In maternal medicine, research evidence is scattered making it difficult to access information for clinical decision making. Systematic reviews of good methodological quality are essential to provide valid inferences and to produce usable evidence summaries to guide management. This review assesses the methodological features of existing systematic reviews in maternal medicine, comparing Cochrane and non-Cochrane reviews in maternal medicine. Methods Medline, Embase, Database of Reviews of Effectiveness (DARE) and Cochrane Database of Systematic Reviews (CDSR) were searched for relevant reviews published between 2001 and 2006. We selected those reviews in which a minimum of two databases were searched and the primary outcome was related to the maternal condition. The selected reviews were assessed for information on framing of question, literature search and methods of review. Results Out of 2846 citations, 68 reviews were selected. Among these, 39 (57%) were Cochrane reviews. Most of the reviews (50/68, 74%) evaluated therapeutic interventions. Overall, 54/68 (79%) addressed a focussed question. Although 64/68 (94%) reviews had a detailed search description, only 17/68 (25%) searched without language restriction. 32/68 (47%) attempted to include unpublished data and 11/68 (16%) assessed for the risk of missing studies quantitatively. The reviews had deficiencies in the assessment of validity of studies and exploration for heterogeneity. When compared to Cochrane reviews, other reviews were significantly inferior in specifying questions (OR 20.3, 95% CI 1.1–381.3, p = 0.04), framing focussed questions (OR 30.9, 95% CI 3.7- 256.2, p = 0.001), use of unpublished data (OR 5.6, 95% CI 1.9–16.4, p = 0.002), assessment for heterogeneity (OR 38.1, 95%CI 2.1, 688.2, p = 0.01) and use of meta-analyses (OR 3.7, 95% CI 1.3–10.8, p = 0.02). Conclusion This study identifies areas which have a strong influence on maternal morbidity and mortality but lack good quality systematic reviews. Overall quality of the existing systematic reviews was variable. Cochrane reviews were of better quality as compared to other reviews. There is a need for good quality systematic reviews to inform practice in maternal medicine

Femoroacetabular impingement and classification of the cam deformity: the reference interval in normal hips

BACKGROUND AND PURPOSE: Most patients with femoroacetabular impingement (FAI) have a cam deformity, which may be quantified by measuring the alpha angle and anterior offset ratio (AOR). Knowledge of what constitutes a "normal" alpha angle and AOR is limited. We defined the reference intervals of these measurements from normal hips in the general population. PATIENTS AND METHODS: 157 individuals from the general population were reviewed clinically and radiographically. 74 individuals with clinical evidence of hip disease or radiographic evidence of osteoarthritis (OA) were excluded, leaving a study group of 83 individuals (mean age 46 (22-69) years, 44 females) with normal hips. The alpha angles and AORs were measured from cross-table lateral radiographs taken in 15 degrees internal rotation. A validation study consisting of a cadaver study and a measurement reliability study was also performed. RESULTS: The mean alpha angle was 48 degrees in men and 47 degrees in women. The mean AOR was 0.19, the same in men and women. Thus, sexes were combined to derive 95% confidence intervals for the population mean alpha angle (46-49 degrees ) and AOR (0.18-0.20). The 95% reference interval for the alpha angle was 32-62 degrees degrees, and for the AOR it was 0.14-0.24. The validation study confirmed that these measurements were resistant to a reasonable degree of variation in positioning and that the repeatability and reproducibility of the measurements was good. INTERPRETATION: These reference intervals indicate that clinically and radiographically normal hips may have alpha angles and AORs that have previously been considered "abnormal". The thresholds provided by this study will aid classification of individuals involved in longitudinal studies of FAI and OA, and may be of use to the practicing clinician in evaluating the young adult with hip pain

Modulation of adipocyte G-protein expression in cancer cachexia by a lipid-mobilizing factor (LMF)

Adipocytes isolated from cachectic mice bearing the MAC 16 tumour showed over a 3-fold increase in lipolytic response to both low concentrations of isoprenaline and a tumour-derived lipid mobilizing factor (LMF). This was reflected by an enhanced stimulation of adenylate cyclase in plasma membrane fractions of adipocytes in the presence of both factors. There was no up-regulation of adenylate cyclase in response to forskolin, suggesting that the effect arose from a change in receptor number or G-protein expression. Immunoblotting of adipocyte membranes from mice bearing the MAC16 tumour showed an increased expression of Gαs up to 10% weight loss and a reciprocal decrease in Gα. There was also an increased expression of Gαs and a decrease in Gα in adipose tissue from a patient with cancer-associated weight loss compared with a non-cachectic cancer patient. The changes in G-protein expression were also seen in adipose tissue of normal mice administered pure LMF as well as in 3T3L1 adipocytes in vitro. The changes in G-protein expression induced by LMF were attenuated by the polyunsaturated fatty acid, eicosapentaenoic acid (EPA). This suggests that this tumour-derived lipolytic factor acts to sensitize adipose tissue to lipolytic stimuli, and that this effect is attenuated by EPA, which is known to preserve adipose tissue in cancer cachexia. © 2001 Cancer Research Campaig

Time Variability of Molecular Line Emission in IRC+10216

We present the results of monitoring the molecular emission of the C-rich AGB star IRC+10216 over 3 years with the Herschel Space Observatory. Observations of rotational transitions of various vibrational levels of CO, 13CO, CS, CCH, H2O, SiO, SiS, SiC2, HCN and HNC have been collected with the HIFI, PACS and SPIRE instruments over multiple epochs. The intensity monitoring shows strong and periodic variations of most of the observed molecules, often with differential behavior depending on the transition level (larger variation at higher J), and generally enhanced modulations in the vibrational modes of some of these molecules (e.g. HCN). These results show that the effect of IR pumping through the different vibrational levels on the emergent line profiles of a given transition can be really significant. This implies that the IR radiation field of the circumstellar envelope and its time variation has to be taken into account in any radiative transfer model in order to derive accurately the physico-chemical structure of the envelope