Bariatric surgery in an obese patient with Albright hereditary osteodystrophy: a case report

INTRODUCTION: We report for the first time the case of a patient with Albright hereditary osteodystrophy and pseudopseudohypoparathyroidism who underwent a Roux-en-Y gastric bypass. CASE PRESENTATION: A 26-year-old obese Caucasian woman with Albright hereditary osteodystrophy with pseudopseudohypoparathyroidism (heterozygous mutation (L272F) in GNAS1 exon 10 on molecular analysis) was treated with gastric bypass. She had the classical features of Albright hereditary osteodystrophy: short stature (138cm), obesity (body mass index 49.5kg/m2), bilateral shortening of the fourth and fifth metacarpals, short neck, round and wide face with bombed front and small eyes. Before the gastric bypass was performed, biochemical determination revealed a slightly low serum calcium level (2.09mmol/L; normal range 2.1 to 2.5mmol/l), and an elevated parathyroid hormone level (87ng/L; normal range 10 to 70ng/L) associated with low vitamin D level (19μg/L; normal range 30 to 50μg/L). Vitamin D supplementation was prescribed before surgery. After the Roux-en-Y gastric bypass, she achieved a progressive substantial weight loss, from 94kg (body mass index 49.5kg/m2) to 49kg (body mass index 25.9kg/m2) in one year. Her weight then stabilized at 50kg (body mass index 26kg/m2) during our three years of follow-up. Before the operation and every three months after it, she was screened for nutritional deficiencies, and serum markers of bone turnover and renal function were monitored. Considering the deficiencies in zinc, magnesium, calcium, vitamin D and vitamin B12, appropriate supplementation was prescribed. Before and two years after the Roux-en-Y gastric bypass, a dual-energy X-ray absorptiometry assessment of bone density was performed that showed no changes on her lumbar column (0.882g/cm2 and both T-score and Z-score of -1.5 standard deviation). In addition, bone microarchitecture with a measurement of her trabecular bone score was found to be normal. CONCLUSION: This is the first case of Roux-en-Y gastric bypass described in a patient with pseudopseudohypoparathyroidism showing that such a procedure seems to be safe in obese patients with Albright hereditary osteodystrophy and pseudopseudohypoparathyroidism if appropriately followed up. As obesity is a prominent feature of Albright hereditary osteodystrophy, such patients might seek bariatric surgery. After a Roux-en-Y gastric bypass, patients with Albright hereditary osteodystrophy associated with pseudopseudohypoparathyroidism need long-term follow-up on nutritional and metabolic issues

Decadal attribution of historic temperature and ocean heat content change to anthropogenic emissions

We present an alternative method of calculating the historical effective radiative forcing using the observed temperature record and a kernel based on the CMIP5 temperature response. This estimate is the effective radiative forcing time series that the average climate model would need to simulate the observed global mean surface temperature anomalies. We further infer the anthropogenic aerosols radiative forcing as a residual using the better-known greenhouse gas radiative forcing. This allows an independent estimate of anthropogenic aerosol radiative forcing, which suggests a cooling influence due to aerosols in the early part of the 20th century. The temporal kernels are also used to calculate decadal contributions from the dominant forcing agents to present day temperature, ocean heat content, and thermosteric sea level rise. The current global mean temperature anomaly is dominated by emissions in the past two decades, while current ocean heat content is more strongly affected by earlier decades.Comment: 18 pages, 4 figures, in revision in GR

The local content of all pure two-qubit states

The (non-)local content in the sense of Elitzur, Popescu, and Rohrlich (EPR2) [Phys. Lett. A 162, 25 (1992)] is a natural measure for the (non-)locality of quantum states. Its computation is in general difficult, even in low dimensions, and is one of the few open questions about pure two-qubit states. We present a complete solution to this long-lasting problem.Comment: 9 pages, 3 figure

One-dimensional Ising ferromagnet frustrated by long-range interactions at finite temperatures

We consider a one-dimensional lattice of Ising-type variables where the ferromagnetic exchange interaction J between neighboring sites is frustrated by a long-ranged anti-ferromagnetic interaction of strength g between the sites i and j, decaying as |i-j|^-alpha, with alpha>1. For alpha smaller than a certain threshold alpha_0, which is larger than 2 and depends on the ratio J/g, the ground state consists of an ordered sequence of segments with equal length and alternating magnetization. The width of the segments depends on both alpha and the ratio J/g. Our Monte Carlo study shows that the on-site magnetization vanishes at finite temperatures and finds no indication of any phase transition. Yet, the modulation present in the ground state is recovered at finite temperatures in the two-point correlation function, which oscillates in space with a characteristic spatial period: The latter depends on alpha and J/g and decreases smoothly from the ground-state value as the temperature is increased. Such an oscillation of the correlation function is exponentially damped over a characteristic spatial scale, the correlation length, which asymptotically diverges roughly as the inverse of the temperature as T=0 is approached. This suggests that the long-range interaction causes the Ising chain to fall into a universality class consistent with an underlying continuous symmetry. The e^(Delta/T)-temperature dependence of the correlation length and the uniform ferromagnetic ground state, characteristic of the g=0 discrete Ising symmetry, are recovered for alpha > alpha_0.Comment: 12 pages, 7 figure

The 5.25 & 5.7 μ\mum Astronomical Polycyclic Aromatic Hydrocarbon Emission Features

Astronomical mid-IR spectra show two minor PAH features at 5.25 and 5.7 $\mu$m (1905 and 1754 cm$^{\rm - 1}$) that hitherto have been little studied, but contain information about the astronomical PAH population that complements that of the major emission bands. Here we report a study involving both laboratory and theoretical analysis of the fundamentals of PAH spectroscopy that produce features in this region and use these to analyze the astronomical spectra. The ISO SWS spectra of fifteen objects showing these PAH features were considered for this study, of which four have sufficient S/N between 5 and 6 $\mu$m to allow for an in-depth analysis. All four astronomical spectra show similar peak positions and profiles. The 5.25 $\mu$m feature is peaked and asymmetric, while the 5.7 $\mu$m feature is broader and flatter. Detailed analysis of the laboratory spectra and quantum chemical calculations show that the astronomical 5.25 and 5.7 $\mu$m bands are a blend of combination, difference and overtone bands primarily involving CH stretching and CH in-plane and CH out-of-plane bending fundamental vibrations. The experimental and computational spectra show that, of all the hydrogen adjacency classes possible on PAHs, solo and duo hydrogens consistently produce prominent bands at the observed positions whereas quartet hydrogens do not. In all, this a study supports the picture that astronomical PAHs are large with compact, regular structures. From the coupling with primarily strong CH out-of-plane bending modes one might surmise that the 5.25 and 5.7 $\mu$m bands track the neutral PAH population. However, theory suggests the role of charge in these astronomical bands might also be important.Comment: Accepted ApJ, 40 pages in pre-print, 14 figures, two onlin

Mid-gut ACTH-secreting neuroendocrine tumor unmasked with (18)F-dihydroxyphenylalanine-positron emission tomography.

Ectopic ACTH Cushing's syndrome (EAS) is often caused by neuroendocrine tumors (NETs) of lungs, pancreas, thymus, and other less frequent locations. Localizing the source of ACTH can be challenging. A 64-year-old man presented with rapidly progressing fatigue, muscular weakness, and dyspnea. He was in poor condition and showed facial redness, proximal amyotrophy, and bruises. Laboratory disclosed hypokalemia, metabolic alkalosis, and markedly elevated ACTH and cortisol levels. Pituitary was normal on magnetic resonance imaging (MRI), and bilateral inferior petrosal sinus blood sampling with corticotropin-releasing hormone stimulation showed no significant central-to-periphery gradient of ACTH. Head and neck, thoracic and abdominal computerized tomography (CT), MRI, somatostatin receptor scintigraphy (SSRS), and (18)F-deoxyglucose-positron emission tomography (FDG-PET) failed to identify the primary tumor. (18)F-dihydroxyphenylalanine (F-DOPA)-PET/CT unveiled a 20-mm nodule in the jejunum and a metastatic lymph node. Segmental jejunum resection showed two adjacent NETs, measuring 2.0 and 0.5 cm with a peritoneal metastasis. The largest tumor expressed ACTH in 30% of cells. Following surgery, after a transient adrenal insufficiency, ACTH and cortisol levels returned to normal values and remain normal over a follow-up of 26 months. Small mid-gut NETs are difficult to localize on CT or MRI, and require metabolic imaging. Owing to low mitotic activity, NETs are generally poor candidates for FDG-PET, whereas SSRS shows poor sensitivity in EAS due to intrinsically low tumor concentration of type-2 somatostatin receptors (SST2) or to receptor down regulation by excess cortisol. However, F-DOPA-PET, which is related to amine precursor uptake by NETs, has been reported to have high positive predictive value for occult EAS despite low sensitivity, and constitutes a useful alternative to more conventional methods of tumor localization. LEARNING POINTS: Uncontrolled high cortisol levels in EAS can be lethal if untreated.Surgical excision is the keystone of NETs treatment, thus tumor localization is crucial.Most cases of EAS are caused by NETs, which are located mainly in the lungs. However, small gut NETs are elusive to conventional imaging and require metabolic imaging for detection.FDG-PET, based on tumor high metabolic rate, may not detect NETs that have low mitotic activity. SSRS may also fail, due to absent or low concentration of SST2, which may be down regulated by excess cortisol.F-DOPA-PET, based on amine-precursor uptake, can be a useful method to localize the occult source of ACTH in EAS when other methods have failed

Options to Accelerate Ozone Recovery: Ozone and Climate Benefits

The humankind or anthropogenic influence on ozone primarily originated from the chlorofluorocarbons and halons (chlorine and bromine). Representatives from governments have met periodically over the years to establish international regulations starting with the Montreal Protocol in 1987, which greatly limited the release of these ozone-depleting substances (DDSs). Two global models have been used to investigate the impact of hypothetical reductions in future emissions of ODSs on total column ozone. The investigations primarily focused on chlorine- and bromine-containing gases, but some computations also included nitrous oxide (N2O). The Montreal Protocol with ODS controls have been so successful that further regulations of chlorine- and bromine-containing gases could have only a fraction of the impact that regulations already in force have had. if all anthropogenic ODS emissions were halted beginning in 2011, ozone is calculated to be higher by about 1-2% during the period 2030-2100 compared to a case of no additional ODS restrictions. Chlorine- and bromine-containing gases and nitrous oxide are also greenhouse gases and lead to warming of the troposphere. Elimination of N 20 emissions would result in a reduction of radiative forcing of 0.23 W/sq m in 2100 than presently computed and destruction of the CFC bank would produce a reduction in radiative forcing of 0.005 W/sq m in 2100. This paper provides a quantitative way to consider future regulations of the CFC bank and N 20 emission

Plant viruses.

Clover viruses, 82ES38, 82AL47, 82MA19, 82BR19, 82BY29; 82BU5, 82HA9. Lupin virus, diseases. Barley yellow dwarf virus, 82AL46, 82AL51, 82B10, 82BA33, 82BR16, 82BR18, 82C29, 82E27, 82ES37, 82ES40, 82JE19, 82JE20, 82KA33, 82KA34, 82ABI3, 82MA18, 82MN22, 82MT34, 82NA32, 82WH28,82B8, 82MN17, 82E24, 82MT30, 82E25, 82MN18, 82MT31, 82B9, 82ABI2, 82BA31, 82C26, 82JE17, 82WH27, 82AL45, 82BR17, 82ES39, 82MA1, 82MA117, 82MT33

Superconducting Transition Temperature in Heterogeneous Ferromagnet-Superconductor Systems

We study the shift of the the superconducting transition temperature $T_c$ in ferromagnetic-superconducting bi-layers and in a superconducting film supplied a square array of ferromagnetic dots. We find that the transition temperature in these two cases change presumably in opposite direction and that its change is not too small. We extend these results to multilayer structures. We predict that rather small external magnetic field $\sim 10$ Oe can change the transition temperature of the bilayer by 10% .Comment: 9 pages, 2 figure

Status of the low emittance upgrade of the advanced light source

The Advanced Light Source is one of the earliest 3rd generation light sources. With an active upgrade program it has remained competitive over the years. The latest in a series of upgrades is a lattice upgrade project that was started in 2009. When it will be completed, the ALS will operate with a horizontal emittance of 2.2 nm and an effective emittance of 2.6 nm. Combined with the high current of 500 mA and the small vertical emittance the ALS already operates at, this upgrade will keep it competitive for years to come. This paper summarizes the status of the upgrade, including beam dynamics studies and lattice optimizations as well as the magnet design