Hypergammaglobulinemia in the pediatric population as a marker for underlying autoimmune disease: a retrospective cohort study

Background: The significance of hypergammaglobulinemia as a marker of immune activation is unknown, as a differential diagnosis for hypergammaglobulinemia in children has not been adequately established. The goal of this study was to identify conditions associated with hypergammaglobulinemia in children, with the hypothesis that elevated immunoglobulin levels may precede or predict the development of autoimmune conditions. Methods: We reviewed the medical records for all children with IgG level ≥2000 mg/dL treated at a tertiary care children’s hospital from January 1, 2000 through December 31, 2009. We compared clinical and laboratory features of these patients, and developed an algorithm to predict the likelihood of underlying autoimmunity based on these characteristics. Results: After excluding children who had received IVIG, a total of 442 patients with hypergammaglobulinemia were identified. Of these, nearly half had autoimmune conditions, most frequently systemic lupus erythematosus and lupus-related disorders. Autoimmune gastrointestinal disorders such as inflammatory bowel disease were also common. Infectious diseases were the next largest category of diseases, followed with much less frequency by malignant, drug-related, and other conditions. In comparison with non-autoimmune conditions, patients with autoimmune disease had higher IgG levels, lower white blood cell counts, lower hemoglobin values, and lower C-reactive protein (CRP) levels. Multivariable logistic regression confirmed that CRP (P = 0.002), white blood cell count (P < 0.001), hemoglobin (P = 0.015), and female gender (P < 0.001) are independent risk factors for autoimmune disease in patients with high IgG levels. Conclusions: In a cohort of pediatric patients at a tertiary care children’s hospital, hypergammaglobulinemia was most commonly associated with autoimmune diseases. In female patients with hypergammaglobulinemia, the presence of leukopenia, anemia, and normal CRP was 95% predictive of underlying autoimmune disease

Crystal structure of Li_2B_(12)H_(12): a possible intermediate species in the decomposition of LiBH_4

The crystal structure of solvent-free Li_2B_(12)H_(12) has been determined by powder X-ray diffraction and confirmed by a combination of neutron vibrational spectroscopy and first-principles calculations. This compound is a possible intermediate in the dehydrogenation of LiBH_4, and its structural characterization is crucial for understanding the decomposition and regeneration of LiBH_4. Our results reveal that the structure of Li_2B_(12)H_(12) differs from other known alkali-metal (K, Rb, and Cs) derivatives

Advances in mechanisms of genetic instability related to hereditary neurological diseases

Substantial progress has been realized in the past several years in our understanding of the molecular mechanisms responsible for the expansions and deletions (genetic instabilities) of repeating tri-, tetra- and pentanucleotide repeating sequences associated with a number of hereditary neurological diseases. These instabilities occur by replication, recombination and repair processes, probably acting in concert, due to slippage of the DNA complementary strands relative to each other. The biophysical properties of the folded-back repeating sequence strands play a critical role in these instabilities. Non-B DNA structural elements (hairpins and slipped structures, DNA unwinding elements, tetraplexes, triplexes and sticky DNA) are described. The replication mechanisms are influenced by pausing of the replication fork, orientation of the repeat strands, location of the repeat sequences relative to replication origins and the flap endonuclease. Methyl-directed mismatch repair, nucleotide excision repair, and repair of damage caused by mutagens are discussed. Genetic recombination and double-strand break repair advances in Escherichia coli, yeast and mammalian models are reviewed. Furthermore, the newly discovered capacities of certain triplet repeat sequences to cause gross chromosomal rearrangements are discussed

Weather information network including graphical display

An apparatus for providing weather information onboard an aircraft includes a processor unit and a graphical user interface. The processor unit processes weather information after it is received onboard the aircraft from a ground-based source, and the graphical user interface provides a graphical presentation of the weather information to a user onboard the aircraft. Preferably, the graphical user interface includes one or more user-selectable options for graphically displaying at least one of convection information, turbulence information, icing information, weather satellite information, SIGMET information, significant weather prognosis information, and winds aloft information

Glenn Extreme Environments Rig (GEER) Independent Review

The Chief of the Space Science Project Office at Glenn Research Center (GRC) requested support from the NASA Engineering and Safety Center (NESC) to satisfy a request from the Science Mission Directorate (SMD) Associate Administrator and the Planetary Science Division Chief to obtain an independent review of the Glenn Extreme Environments Rig (GEER) and the operational controls in place for mitigating any hazard associated with its operation. This document contains the outcome of the NESC assessment

Shear Modes, Criticality and Extremal Black Holes

We consider a (2+1)-dimensional field theory, assumed to be holographically dual to the extremal Reissner-Nordstrom AdS(4) black hole background, and calculate the retarded correlators of charge (vector) current and energy-momentum (tensor) operators at finite momentum and frequency. We show that, similar to what was observed previously for the correlators of scalar and spinor operators, these correlators exhibit emergent scaling behavior at low frequency. We numerically compute the electromagnetic and gravitational quasinormal frequencies (in the shear channel) of the extremal Reissner-Nordstrom AdS(4) black hole corresponding to the spectrum of poles in the retarded correlators. The picture that emerges is quite simple: there is a branch cut along the negative imaginary frequency axis, and a series of isolated poles corresponding to damped excitations. All of these poles are always in the lower half complex frequency plane, indicating stability. We show that this analytic structure can be understood as the proper limit of finite temperature results as T is taken to zero holding the chemical potential fixed.Comment: 28 pages, 7 figures, added reference

Microstructural Transformations And Kinetics Of High-Temperature Heterogeneous Gasless Reactions By High-Speed X-Ray Phase-Contrast Imaging

Heterogeneous gasless reactive systems, including high-energy density metal-nonmetal compositions, have seen increasing study due to their various applications. However, owing to their high reaction temperature, short reaction time, and small scale of heterogeneity, investigation of their reaction mechanisms and kinetics is very difficult. In this study, microstructural changes and the kinetics of product layer growth in the W-Si system was investigated using a high-speed x-ray phase-contrast imaging technique. Using the Advanced Photon Source of Argonne National Laboratory, this method allowed direct imaging of irreversible reactions in the W-Si reactive system at frame rates up to 36 000 frames per second with 4-microsecond exposure and spatial resolution of 1micrometerser. Details of the Si melt and reactions between W and Si, that are unable to be viewed with visible-light imaging, were revealed. These include processes such as the initiation of nucleated melting and other physical phenomena that provide insight into the mixing of reactants and subsequent reaction. Through the use of this imaging technique and future optimization in the imaging process, a model for accurately identifying kinetics of chemical reactions, both spatially and temporally, is also proposed

A first order transition and parity violation in a color superconductor

In cold, dense quark matter, quarks of different flavor can form Cooper pairs which are anti-triplets under color and have total spin J=0. The transition to a phase where strange quarks condense with either up or down quarks is driven first order by the Coleman-Weinberg mechanism. At densities sufficiently high to (effectively) restore the axial U(1) symmetry, then relative to the ordinary vacuum, the condensation of up with down quarks (effectively) breaks parity spontaneously.Comment: 4 pages, ReVTeX, final versio

Evidence-based decision support for pediatric rheumatology reduces diagnostic errors.

BACKGROUND: The number of trained specialists world-wide is insufficient to serve all children with pediatric rheumatologic disorders, even in the countries with robust medical resources. We evaluated the potential of diagnostic decision support software (DDSS) to alleviate this shortage by assessing the ability of such software to improve the diagnostic accuracy of non-specialists. METHODS: Using vignettes of actual clinical cases, clinician testers generated a differential diagnosis before and after using diagnostic decision support software. The evaluation used the SimulConsult® DDSS tool, based on Bayesian pattern matching with temporal onset of each finding in each disease. The tool covered 5405 diseases (averaging 22 findings per disease). Rheumatology content in the database was developed using both primary references and textbooks. The frequency, timing, age of onset and age of disappearance of findings, as well as their incidence, treatability, and heritability were taken into account in order to guide diagnostic decision making. These capabilities allowed key information such as pertinent negatives and evolution over time to be used in the computations. Efficacy was measured by comparing whether the correct condition was included in the differential diagnosis generated by clinicians before using the software ( unaided ), versus after use of the DDSS ( aided ). RESULTS: The 26 clinicians demonstrated a significant reduction in diagnostic errors following introduction of the software, from 28% errors while unaided to 15% using decision support (p \u3c 0.0001). Improvement was greatest for emergency medicine physicians (p = 0.013) and clinicians in practice for less than 10 years (p = 0.012). This error reduction occurred despite the fact that testers employed an open book approach to generate their initial lists of potential diagnoses, spending an average of 8.6 min using printed and electronic sources of medical information before using the diagnostic software. CONCLUSIONS: These findings suggest that decision support can reduce diagnostic errors and improve use of relevant information by generalists. Such assistance could potentially help relieve the shortage of experts in pediatric rheumatology and similarly underserved specialties by improving generalists\u27 ability to evaluate and diagnose patients presenting with musculoskeletal complaints. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02205086

Neonatal hyperoxia promotes asthma-like features through IL-33–dependent ILC2 responses

Background Premature infants often require oxygen supplementation and, therefore, are exposed to oxidative stress. Following oxygen exposure, preterm infants frequently develop chronic lung disease and have a significantly increased risk of asthma. Objective We sought to identify the underlying mechanisms by which neonatal hyperoxia promotes asthma development. Methods Mice were exposed to neonatal hyperoxia followed by a period of room air recovery. A group of mice was also intranasally exposed to house dust mite antigen. Assessments were performed at various time points for evaluation of airway hyperresponsiveness, eosinophilia, mucus production, inflammatory gene expression, and TH and group 2 innate lymphoid cell (ILC2) responses. Sera from term- and preterm-born infants were also collected and levels of IL-33 and type 2 cytokines were measured. Results Neonatal hyperoxia induced asthma-like features including airway hyperresponsiveness, mucus hyperplasia, airway eosinophilia, and type 2 pulmonary inflammation. In addition, neonatal hyperoxia promoted allergic TH responses to house dust mite exposure. Elevated IL-33 levels and ILC2 responses were observed in the lungs most likely due to oxidative stress caused by neonatal hyperoxia. IL-33 receptor signaling and ILC2s were vital for the induction of asthma-like features following neonatal hyperoxia. Serum IL-33 levels correlated significantly with serum levels of IL-5 and IL-13 but not IL-4 in preterm infants. Conclusions These data demonstrate that an axis involving IL-33 and ILC2s is important for the development of asthma-like features following neonatal hyperoxia and suggest therapeutic potential for targeting IL-33, ILC2s, and oxidative stress to prevent and/or treat asthma development related to prematurity