Familial Hypercholesterolaemia: The Cape Town Experience

Familial hypercholesterolaemia (FH), an autosomal dominantly inherited disorder characterised by elevated plasma low-density lipoprotein (LDL) cholesterol levels, tendon xanthomata and premature ischaemic heart disease, is amenable to treatment with modern medication. The clinical and biochemical details of 1 031 patients with FH were analysed. FH is the most common monogenic disorder of lipoprotein metabolism presenting to the Lipid Clinic at Groote Schuur Hospital, accounting for about 20% of consultations. The hospital classified 55% of the FH patients as white, 43% as coloured, 1.5% as Asian and 0.5% as black. In the FH cohort (whose mean age at presentation was 44 years), 80% had tendon xanthomata, 36% had arcus cornealis, and 14% had xanthelasma. Tendon xanthomata was present in almost 90% of patients by the age of 50 years. Arcus cornealis was present in about 45% by the age of 40 years, further increasing in frequency with age. Cardiovascular complications included ischaemic heart disease (43%), stroke (1.5%), transient ischaemic attacks (1.3%), and peripheral vascular disease (3.7%). The mean age of death was 55 (±13) years; 51 (±10) years in men and 61 (±12) years in women. In 46% of the cohort, a defective gene was identified by testing for locally prevalent mutations.South African Medical Journal Vol. 98 (2) 2008: pp. 99-10

Coupled-mode theory for photonic band-gap inhibition of spatial instabilities

We study the inhibition of pattern formation in nonlinear optical systems using intracavity photonic crystals. We consider mean-field models for singly and doubly degenerate optical parametric oscillators. Analytical expressions for the new (higher) modulational thresholds and the size of the "band gap" as a function of the system and photonic crystal parameters are obtained via a coupled-mode theory. Then, by means of a nonlinear analysis, we derive amplitude equations for the unstable modes and find the stationary solutions above threshold. The form of the unstable mode is different in the lower and upper parts of the band gap. In each part there is bistability between two spatially shifted patterns. In large systems stable wall defects between the two solutions are formed and we provide analytical expressions for their shape. The analytical results are favorably compared with results obtained from the full system equations. Inhibition of pattern formation can be used to spatially control signal generation in the transverse plane

From one- to two-dimensional solitons in the Ginzburg-Landau model of lasers with frequency selective feedback

We use the cubic complex Ginzburg-Landau equation coupled to a dissipative linear equation as a model of lasers with an external frequency-selective feedback. It is known that the feedback can stabilize the one-dimensional (1D) self-localized mode. We aim to extend the analysis to 2D stripe-shaped and vortex solitons. The radius of the vortices increases linearly with their topological charge, $m$, therefore the flat-stripe soliton may be interpreted as the vortex with $m=\infty$, while vortex solitons can be realized as stripes bent into rings. The results for the vortex solitons are applicable to a broad class of physical systems. There is a qualitative agreement between our results and those recently reported for models with saturable nonlinearity.Comment: Submitted to PR

Drifting instabilities of cavity solitons in vertical cavity surface-emitting lasers with frequency selective feedback

In this paper we study the formation and dynamics of self-propelled cavity solitons (CSs) in a model for vertical cavity surface-emitting lasers (VCSELs) subjected to external frequency selective feedback (FSF), and build their bifurcation diagram for the case where carrier dynamics is eliminated. For low pump currents, we find that they emerge from the modulational instability point of the trivial solution, where traveling waves with a critical wavenumber are formed. For large currents, the branch of self-propelled solitons merges with the branch of resting solitons via a pitchfork bifurcation. We also show that a feedback phase variation of 2\pi can transform a CS (whether resting or moving) into a different one associated to an adjacent longitudinal external cavity mode. Finally, we investigate the influence of the carrier dynamics, relevant for VCSELs. We find and analyze qualitative changes in the stability properties of resting CSs when increasing the carrier relaxation time. In addition to a drifting instability of resting CSs, a new kind of instability appears for certain ranges of carrier lifetime, leading to a swinging motion of the CS center position. Furthermore, for carrier relaxation times typical of VCSELs the system can display multistability of CSs.Comment: 11 pages, 12 figure

Severe Hypertriglyceridaemia as a result of Familial Chylomicronaemia:

Lipoprotein lipase deficiency causes severe hypertriglyceridaemia due to chylomicronaemia, and leads to recurrent and potentially life-threatening pancreatitis. This disorder can only be managed by dietary fat restriction as drugs are ineffective. We review the experience with familial chylomicronaemia in patients who attended the lipid clinics at Groote Schuur Hospital and Red Cross Children's War Memorial Hospital in Cape Town. Criteria for inclusion were an initial plasma triglyceride concentration of >15 mmol/l and a typical type I Fredrickson hyperlipidaemia pattern on plasma lipoprotein electrophoresis. A total of 29 patients were seen over 25 years. The mean age of presentation was 10 years, but ranged from 0 to 43 years. The modes of presentation differed: pancreatitis (N=16), eruptive xanthomata (N=2), coincidental detection of hypertriglyceridaemia (N=2), screening relatives (N=7), and after death from pancreatitis (N=1). Plasma triglycerides responded rapidly and dramatically to dietary fat restriction, and some patients sustained good control of the hyperlipidaemia. The onset of pancreatitis was earlier in patients of Indian ancestry, suggesting a genotype/phenotype interaction within this disorder. Genetic work-up indicated founder effects in the Afrikaner and Indian patients. Lipaemic plasma should be taken seriously at all ages, and necessitates work-up at specialised clinics where the diagnosis of chylomicronaemia or type I hyperlipidaemia facilitates appropriate dietary management that can prevent pancreatitis. South African Medical Journal Vol. 98 (2) 2008: pp. 105-10

Frequency selection by soliton excitation in nondegenerate intracavity downconversion

We show that soliton excitation in intracavity downconversion naturally selects a strictly defined frequency difference between the signal and idler fields. In particular, this phenomenon implies that if the signal has smaller losses than the idler then its frequency is pulled away from the cavity resonance and the idler frequency is pulled towards the resonance and {\em vice versa}. The frequency selection is shown to be closely linked with the relative energy balance between the idler and signal fields.Comment: 5 pages, 3 figures. To appear in Phys Rev Let

Quaternary sea level changes in Scotland

This paper summarises developments in understanding sea level change during the Quaternary in Scotland since the publication of the Quaternary of Scotland Geological Conservation Review volume Quaternary of Scotland in 1993. We present a review of progress in methodology, particularly in the study of sediments in isolation basins and estuaries as well as in techniques in the field and laboratory, which have together disclosed greater detail in the record of relative sea level (RSL) change than was available in 1993. However, progress in determining the record of RSL change varies in different areas. Studies of sediments and stratigraphy offshore on the continental shelf have increased greatly, but the record of RSL change there remains patchy. Studies onshore have resulted in improvements in the knowledge of rock shorelines, including the processes by which they are formed, but much remains to be understood. Studies of Late Devensian and Holocene RSLs around present coasts have improved knowledge of both the extent and age range of the evidence. The record of RSL change on the W and NW coasts has disclosed a much longer dated RSL record than was available before 1993, possibly with evidence of Meltwater Pulse 1A, while studies in estuaries on the E and SW coasts have disclosed widespread and consistent fluctuations in Holocene RSLs. Evidence for the meltwater pulse associated with the Early Holocene discharge of Lakes Agassiz-Ojibway in N America has been found on both E and W coasts. The effects of the impact of storminess, in particular in cliff-top storm deposits, have been widely identified. Further information on the Holocene Storegga Slide tsunami has enabled a better understanding of the event but evidence for other tsunami events on Scottish coasts remains uncertain. Methodological developments have led to new reconstructions of RSL change for the last 2000 years, utilising state-of-the-art GIA models and alongside coastal biostratigraphy to determine trends to compare with modern tide gauge and documentary evidence. Developments in GIA modelling have provided valuable information on patterns of land uplift during and following deglaciation. The studies undertaken raise a number of research questions which will require addressing in future work

Severe hypertriglyceridaemia as a result of familial chylomicronaemia:The Cape Town experience

Lipoprotein lipase deficiency causes severe hypertriglyceridaemia due to chylomicronaemia, and leads to recurrent and potentially life-threatening pancreatitis. This disorder can only be managed by dietary fat restriction as drugs are ineffective. We review the experience with familial chylomicronaemia in patients who attended the lipid clinics at Groote Schuur Hospital and Red Cross Children's War Memorial Hospital in Cape Town. Criteria for inclusion were an initial plasma triglyceride concentration of >15 mmol/l and a typical type I Fredrickson hyperlipidaemia pattern on plasma lipoprotein electrophoresis. A total of 29 patients were seen over 25 years. The mean age of presentation was 10 years, but ranged from 0 to 43 years. The modes of presentation differed: pancreatitis (N=16), eruptive xanthomata (N=2), coincidental detection of hypertriglyceridaemia (N=2), screening relatives (N=7), and after death from pancreatitis (N=1). Plasma triglycerides responded rapidly and dramatically to dietary fat restriction, and some patients sustained good control of the hyperlipidaemia. The onset of pancreatitis was earlier in patients of Indian ancestry, suggesting a genotype/phenotype interaction within this disorder. Genetic work-up indicated founder effects in the Afrikaner and Indian patients. Lipaemic plasma should be taken seriously at all ages, and necessitates work-up at specialised clinics where the diagnosis of chylomicronaemia or type I hyperlipidaemia facilitates appropriate dietary management that can prevent pancreatitis