Hyperinsulinism-hyperammonaemia syndrome: novel mutations in the GLUD1 gene and genotype-phenotype correlations

Background: Activating mutations in the GLUD1 gene (which encodes for the intra-mitochondrial enzyme glutamate dehydrogenase, GDH) cause the hyperinsulinism–hyperammonaemia (HI/HA) syndrome. Patients present with HA and leucine-sensitive hypoglycaemia. GDH is regulated by another intra-mitochondrial enzyme sirtuin 4 (SIRT4). Sirt4 knockout mice demonstrate activation of GDH with increased amino acid-stimulated insulin secretion. Objectives: To study the genotype–phenotype correlations in patients with GLUD1 mutations. To report the phenotype and functional analysis of a novel mutation (P436L) in the GLUD1 gene associated with the absence of HA. Patients and methods: Twenty patients with HI from 16 families had mutational analysis of the GLUD1 gene in view of HA (n=19) or leucine sensitivity (n=1). Patients negative for a GLUD1 mutation had sequence analysis of the SIRT4 gene. Functional analysis of the novel P436L GLUD1 mutation was performed. Results: Heterozygous missense mutations were detected in 15 patients with HI/HA, 2 of which are novel (N410D and D451V). In addition, a patient with a normal serum ammonia concentration (21 µmol/l) was heterozygous for a novel missense mutation P436L. Functional analysis of this mutation confirms that it is associated with a loss of GTP inhibition. Seizure disorder was common (43%) in our cohort of patients with a GLUD1 mutation. No mutations in the SIRT4 gene were identified. Conclusion: Patients with HI due to mutations in the GLUD1 gene may have normal serum ammonia concentrations. Hence, GLUD1 mutational analysis may be indicated in patients with leucine sensitivity; even in the absence of HA. A high frequency of epilepsy (43%) was observed in our patients with GLUD1 mutations

Diazoxide-responsive hyperinsulinemic hypoglycemia caused by HNF4A gene mutations

Objective: The phenotype associated with heterozygous HNF4A gene mutations has recently been extended to include diazoxide responsive neonatal hypoglycemia in addition to maturity-onset diabetes of the young (MODY). To date, mutation screening has been limited to patients with a family history consistent with MODY. In this study, we investigated the prevalence of HNF4A mutations in a large cohort of patients with diazoxide responsive hyperinsulinemic hypoglycemia (HH). Subjects and methods: We sequenced the ABCC8, KCNJ11, GCK, GLUD1, and/or HNF4A genes in 220 patients with HH responsive to diazoxide. The order of genetic testing was dependent upon the clinical phenotype. Results: A genetic diagnosis was possible for 59/220 (27%) patients. KATP channel mutations were most common (15%) followed by GLUD1 mutations causing hyperinsulinism with hyperammonemia (5.9%), and HNF4A mutations (5%). Seven of the 11 probands with a heterozygous HNF4A mutation did not have a parent affected with diabetes, and four de novo mutations were confirmed. These patients were diagnosed with HI within the first week of life (median age 1 day), and they had increased birth weight (median +2.4 SDS). The duration of diazoxide treatment ranged from 3 months to ongoing at 8 years. Conclusions: In this large series, HNF4A mutations are the third most common cause of diazoxide responsive HH. We recommend that HNF4A sequencing is considered in all patients with diazoxide responsive HH diagnosed in the first week of life irrespective of a family history of diabetes, once KATP channel mutations have been excluded

The Optical Alignment System of the ZEUS MicroVertex Detector

The laser alignment system of the ZEUS microvertex detector is described. The detector was installed in 2001 as part of an upgrade programme in preparation for the second phase of electron-proton physics at the HERA collider. The alignment system monitors the position of the vertex detector support structure with respect to the central tracking detector using semi-transparent amorphous-silicon sensors and diode lasers. The system is fully integrated into the general environmental monitoring of the ZEUS detector and data has been collected over a period of 5 years. The primary aim of defining periods of stability for track-based alignment has been achieved and the system is able to measure movements of the support structure to a precision around $10 \mu$m.Comment: 38 pages; 17 figure

Formation of aggregated nanoparticle spheres through femtosecond laser surface processing

A detailed structural and chemical analysis of a class of self-organized surface structures, termed aggregated nanoparticle spheres (AN-spheres), created using femtosecond laser surface processing (FLSP) on silicon, silicon carbide, and aluminum is reported in this paper. AN-spheres are spherical microstructures that are 20–100 μm in diameter and are composed entirely of nanoparticles produced during femtosecond laser ablation of material. AN-spheres have an onion-like layered morphology resulting from the build-up of nanoparticle layers over multiple passes of the laser beam. The material properties and chemical composition of the AN-spheres are presented in this paper based on scanning electron microscopy (SEM), focused ion beam (FIB) milling, transmission electron microscopy (TEM), and energy dispersive x-ray spectroscopy (EDX) analysis. There is a distinct difference in the density of nanoparticles between concentric rings of the onion-like morphology of the AN-sphere. Layers of high-density form when the laser sinters nanoparticles together and low-density layers form when nanoparticles redeposit while the laser ablates areas surrounding the AN-sphere. The dynamic nature of femtosecond laser ablation creates a variety of nanoparticles that make-up the AN-spheres including Si/C core-shell, nanoparticles that directly fragmented from the base material, nanoparticles with carbon shells that retarded oxidation, and amorphous, fully oxidized nanoparticles

The impact of classroom noise on reading comprehension of secondary school pupils

It has been known for many years that poor acoustic conditions in classrooms leading to high noise levels and poor speech intelligibility cause annoyance to pupils and teachers and affect the academic performance of pupils. Much of the previous research concerning the impact of noise and poor acoustics on pupils has involved children in primary schools, with fewer studies related to pupils of secondary school age. Furthermore, the majority of previous studies in schools have examined the impact of environmental noise, particularly aircraft noise, on children. The aim of the study described here was to examine the effects of typical levels of classroom noise on secondary school pupils, and to attempt to identify the threshold level at which adverse impacts might occur. A survey of acoustic conditions in secondary schools in England1 was accompanied by questionnaire surveys of pupils to ascertain levels of annoyance caused by noise, and their perceptions of its interference with their ability to hear and understand their teachers2 . In addition, students were tested in numeracy, mathematical reasoning, memory and reading comprehension in different levels of classroom noise. This paper describes the results of reading comprehension tests undertaken by nearly 1000 pupils aged between 11 and 16 years while they were exposed to typical classroom noise at different levels

Task design for audiographic conferencing: promoting beginner oral interaction in distance language learning

This paper presents the challenges involved in designing a full set of online tutorial materials for a beginners' Spanish course for distance language learners utilising an online audiographic conferencing VLE for synchronous oral interaction. Although much has been written about task design and task-based learning and teaching (TBLT) in language learning (Johnson, 2003; Klapper, 2003; Ellis, 2000; Nunan, 1989, among others), the shift to an audiographic Computer Mediated Communication (CMC) medium presents a number of challenges to task design which are only just beginning to be documented (Hampel 2003, Hampel & Baber 2003, Hampel & Hauck 2004). Here we will discuss what the challenges are for the design and implementation of activities suited to the development of oral skills in a foreign language in such an environment in the light of current theories of SLA (Skehan, 2003; Doughty & Long, 2003; Doughty, 2000; Long, 1996), task design, and CALL (Warschauer, 1997; Chapelle 1998) and how those challenges were met for the production of a full set of materials for a beginners' Spanish distance learning course at the Open University using a tool that had been deemed unsuitable for that level (Kötter, 2001). We will also present the findings of the developmental testing of a sample of these activities and recommend a model for tasks in an audiographic VLE to promote oral interaction at beginner level

Optimal Plastic Design for Partially Preassigned Strength Distribution

BRIEF NOTES 2iP 2,P 2iP | T T i £ tistically admissible stress field M(X) can only be optimal if at moment values M i (i = 1, 2, . . ., n) the rotations given by equations (l)-(3) result in a kinematically admissible displacement field (necessary condition). Example. For a clamped beam with three point loads, Since the slope of the moment diagram in the outer half of the beam is three times that in the inner half, equation The foregoing theorem admits an infinite number of solutions corresponding to 2.625 aP < x -3.25 aP. The moment diagrams for the limiting cases are shown in Remark. The proposed theorem is not related directly to Foulkes' theorem [2] and its extensions [6] because the latter preassign a specified strength distribution to given subsets of the structure. In the problem considered, the cost function is discontinuous but the subsets of the structure over which various regimes of the cost function apply are not preassigned. Hence the proposed extension of the Prager-Shield theory gives a more economical design than Foulkes' method

Combining best evidence: A novel method to calculate the alcohol-attributable fraction and its variance for injury mortality

<p>Abstract</p> <p>Background</p> <p>The alcohol-attributable fraction for injury mortality is defined as the proportion of fatal injury that would disappear if consumption went to zero. Estimating this fraction has previously been based on a simplistic view of drinking and associated risk. This paper develops a new way to calculate the alcohol-attributable fraction for injury based on different dimensions of drinking, mortality data, experimental data, survey research, new risk scenarios, and by incorporating different distributions of consumption within populations. For this analysis, the Canadian population in 2005 was used as the reference population.</p> <p>Methods</p> <p>Binge drinking and average daily consumption were modeled separately with respect to the calculation of the AAF. The acute consumption risk was calculated with a probability-based method that accounted for both the number of binge drinking occasions and the amount of alcohol consumed per occasion. The average daily consumption was computed based on the prevalence of daily drinking at various levels. These were both combined to get an overall estimate. 3 sensitivity analyses were performed using different alcohol consumption parameters to test the robustness of the model. Calculation of the variance to generate confidence limits around the point estimates was accomplished via Monte Carlo resampling methods on randomly generated AAFs that were based on the distribution and prevalence of drinking in the Canadian population.</p> <p>Results</p> <p>Overall, the AAFs decrease with age and are significantly lower for women than men across all ages. As binge drinking increases, the injury mortality AAF also increases. Motor vehicle collisions show the largest relative increases in AAF as alcohol consumption is increased, with over a 100% increase in AAF from the lowest to highest consumption category. Among non-motor vehicle collisions, the largest change in total AAF occurred both for homicide and other intentional injuries at about a 15% increase in the AAF from the lowest to the highest binge consumption scenarios.</p> <p>Conclusions</p> <p>This method combines the best available evidence to generate new alcohol-attributable fractions for alcohol-attributable injury mortality. Future research is needed to refine the risk function for non-motor vehicle injury types and to investigate potential interactions between binge drinking and average volume of alcohol consumption.</p