Clinical spectrum of tuberculous optic neuropathy.

PURPOSE: Tuberculous optic neuropathy may follow infection with Mycobacterium tuberculosis or administration of the bacille Calmette-Guerin. However, this condition is not well described in the ophthalmic literature. METHODS: Ophthalmologists, identified through professional electronic networks or previous publications, collected standardized clinical data relating to 62 eyes of 49 patients who they had managed with tuberculous optic neuropathy. RESULTS: Tuberculous optic neuropathy was most commonly manifested as papillitis (51.6 %), neuroretinitis (14.5 %), and optic nerve tubercle (11.3 %). Uveitis was an additional ocular morbidity in 88.7 % of eyes. In 36.7 % of patients, extraocular tuberculosis was present. The majority of patients (69.4 %) had resided in and/or traveled to an endemic area. Although initial visual acuity was 20/50 or worse in 62.9 % of 62 eyes, 76.7 % of 60 eyes followed for a median of 12 months achieved visual acuities of 20/40 or better. Visual field defects were reported for 46.8 % of eyes, but these defects recovered in 63.2 % of 19 eyes with follow-up. CONCLUSION: Visual recovery from tuberculous optic neuropathy is common, if the diagnosis is recognized and appropriate treatment is instituted. A tuberculous etiology should be considered when evaluating optic neuropathy in persons from endemic areas.

Genome-wide meta-analysis identifies 11 new loci for anthropometric traits and provides insights into genetic architecture.

Approaches exploiting trait distribution extremes may be used to identify loci associated with common traits, but it is unknown whether these loci are generalizable to the broader population. In a genome-wide search for loci associated with the upper versus the lower 5th percentiles of body mass index, height and waist-to-hip ratio, as well as clinical classes of obesity, including up to 263,407 individuals of European ancestry, we identified 4 new loci (IGFBP4, H6PD, RSRC1 and PPP2R2A) influencing height detected in the distribution tails and 7 new loci (HNF4G, RPTOR, GNAT2, MRPS33P4, ADCY9, HS6ST3 and ZZZ3) for clinical classes of obesity. Further, we find a large overlap in genetic structure and the distribution of variants between traits based on extremes and the general population and little etiological heterogeneity between obesity subgroups.

FTO genetic variants, dietary intake and body mass index: insights from 177,330 individuals.

FTO is the strongest known genetic susceptibility locus for obesity. Experimental studies in animals suggest the potential roles of FTO in regulating food intake. The interactive relation among FTO variants, dietary intake and body mass index (BMI) is complex and results from previous often small-scale studies in humans are highly inconsistent. We performed large-scale analyses based on data from 177,330 adults (154 439 Whites, 5776 African Americans and 17 115 Asians) from 40 studies to examine: (i) the association between the FTO-rs9939609 variant (or a proxy single-nucleotide polymorphism) and total energy and macronutrient intake and (ii) the interaction between the FTO variant and dietary intake on BMI. The minor allele (A-allele) of the FTO-rs9939609 variant was associated with higher BMI in Whites (effect per allele = 0.34 [0.31, 0.37] kg/m(2), P = 1.9 × 10(-105)), and all participants (0.30 [0.30, 0.35] kg/m(2), P = 3.6 × 10(-107)). The BMI-increasing allele of the FTO variant showed a significant association with higher dietary protein intake (effect per allele = 0.08 [0.06, 0.10] %, P = 2.4 × 10(-16)), and relative weak associations with lower total energy intake (-6.4 [-10.1, -2.6] kcal/day, P = 0.001) and lower dietary carbohydrate intake (-0.07 [-0.11, -0.02] %, P = 0.004). The associations with protein (P = 7.5 × 10(-9)) and total energy (P = 0.002) were attenuated but remained significant after adjustment for BMI. We did not find significant interactions between the FTO variant and dietary intake of total energy, protein, carbohydrate or fat on BMI. Our findings suggest a positive association between the BMI-increasing allele of FTO variant and higher dietary protein intake and offer insight into potential link between FTO, dietary protein intake and adiposity.

Modules d'endo-permutation

Dans la th´eorie des repr´esentations modulaires des groupes finis, les modules d?endo-permutation occupent une place importante. En e_et, c?est le r?ole jou´e par ces modules dans l?analyse de la structure de certains modules simples pour des groupes finis p-nilpotents, qui a amen´e E. Dade `a en introduire le concept, en 1978. Quelques ann´ees plus tard, L. Puig a d´emontr´e que la source de n?importe quel module simple pour un groupe fini p-r´esoluble quelconque est un module d?endo-permutation. Plus r´ecemment, on s?est rendu compte que ces modules interviennent aussi dans l?analyse locale des cat´egories d´eriv´ees et dans l?´etude des syst`emes de fusion. La situation que l?on consid`ere est la suivante. On se donne un nombre premier p, un p-groupe fini P, un corps alg´ebriquement clos k de caract´eristique p et on veut d´eterminer tous les kP-modules d?endo-permutation couverts ind´ecomposables de type fini, c?est-`a-dire tous les kP-modules ind´ecomposables de type fini, tels que leur alg`ebre d?endomorphismes est un kP-module de permutation ayant un facteur direct trivial. On d´efinit une relation d?´equivalence sur l?ensemble de ces kP-modules et le produit tensoriel des modules induit une structure de groupe ab´elien sur l?ensemble des classes d?´equivalence. On appelle ce groupe, le groupe de Dade de P. Ainsi, classifier les modules d?endo-permutation couverts revient `a d´eterminer le groupe de Dade de P. Le groupe de Dade d?un p-groupe fini arbitraire est encore inconnu, bien qu?E. Dade, en 1978, ´etait d´ej`a parvenu `a la classification dans le cas o`u P est ab´elien. La premi`ere partie de ce travail de th`ese est consacr´ee au probl`eme de la classification dans le cas g´en´eral et r´esoud la question dans le cas de deux familles de p-groupes finis, `a savoir celle des p-groupes m´etacycliques, pour un nombre premier p impair, et celle des 2-groupes extrasp´eciaux, de la forme D8 _ · · · _ D8. Ces deux choix ont ´et´e motiv´es par le fait que ces groupes sont "presque" ab´eliens. De plus, certains r´esultats sur la structure du groupe de Dade d?un p-groupe fini quelconque rendent le groupe de Dade des groupes de ces deux familles plus simple `a ´etudier. Dans un deuxi`eme temps, nous nous sommes int´eress´es `a deux occurrences de ces modules dans la th´eorie de la repr´esentation des groupes finis, c?est-`a-dire `a deux raisons qui motivent leur ´etude. Ainsi, nous avons r´ealis´e des modules d?endo-permutation comme sources de modules simples. En particulier, il s?av`ere que, dans le cas d?un nombre premier p impair, tout module d?endo-permutation ind´ecomposable dont la classe est un ´el´ement de torsion dans le groupe de Dade est la source d?un module simple. Finalement, nous avons d´etermin´e, parmi tous les modules d?endo-permutation connus actuellement, lesquels poss`edent une r´esolution de permutation endo-scind´ee. Nous sommes arriv´es `a la conclusion que les seuls modules d?endo-permutation qui n?ont pas de r´esolution de permutation endo-scind´ee sont les modules "exceptionnels" apparaissant pour un 2-groupe de quaternions g´en´eralis´es.<br/><br/>In modular representation theory, endo-permutation modules occupy an important position. Indeed, the role that these modules play, in the analysis of the structure of some particular simple modules for finite p-nilpotent groups, induced E. Dade, in 1978, to give them their current name. A few years later, L. Puig proved that the source of any simple module for any finite psolvable group is an endo-permutation module. More recently, the occurrence of endo-permutation modules has also been noticed in the local analysis of splendid equivalences between derived categories and in the study of fusion systems. We consider the following situation. Given a prime number p, a finite pgroup P and an algebraically closed field k of characteristic p, we are looking for all finitely generated indecomposable capped endo-permutation kP-modules. That is, all finitely generated indecomposable kP-modules such that their endomorphism algebra is a permutation kP-module having a trivial direct summand. Then, we define an equivalence relation on the set of all isomorphism classes of such modules, and it turns out that the tensor product (over k) induces a structure of abelian group on this set. We call this group the Dade group of P. Hence, classifying all indecomposable finitely generated capped endo-permutation kPmodules is equivalent to determining the Dade group of P. At present, the Dade group of an arbitrary finite p-group is still unknown. However, E. Dade computed the Dade group of all finite abelian p-groups, in 1978 already. The first part of this doctoral thesis is concerned with the problem of the classification in the general case and solve it in the case of two families of finite p-groups, namely the metacyclic p-groups, for an odd prime number p, and the extraspecial 2-groups of the shape D8 _· · ·_D8. These two choices have been motivated by the fact that these groups are not far from being abelian. Moreover, some general results concerning the Dade group of arbitrary finite p-groups suggest that the Dade group of the groups belonging to these two families is easier to study. In the second part of this thesis, we have been looking at two particular occurrences of these modules in representation theory of finite groups which motivate the interest of their classification. Thus, we realised endo-permutation modules as sources of simple modules. In particular, it turns out that, in case p is an odd prime, any indecomposable module whose class in the Dade group is a torsion element is the source of some simple module. Finally, we considered all the modules we know at present and determined which ones have an endo-split permutation resolution. We could then conclude that all but the "exceptionnal" modules occurring in the generalized quaternion case have an endo-split permutation resolution.<br/><br/>"Module d?endo-permutation" n?est pas le nom d?une maladie exotique contagieuse (du moins pas `a ma connaissance), comme vous pourriez peut-?etre l?imaginer si vous faites partie des personnes qui croient que le titre de docteur n?est destin´e qu?aux m´edecins. Dans ce cas, il se peut que le sujet dont il est question ici vous cause quelques naus´ees et r´eveille de douloureux souvenirs d?´ecole, car un module d?endo-permutation est un objet math´ematique, alg´ebrique, plus pr´ecis´ement. Ce concept a ´et´e introduit il y a un quart de si`ecle, de l?autre c?ot´e de l?Atlantique, et il s?est r´ev´el´e su_samment int´eressant pour qu?aujourd?hui il ait franchi bien des fronti`eres, celles de l?alg`ebre y compris. Mais de quoi s?agit-il ? Si vous entendez le terme "endo-permutation" probablement pour la premi`ere fois, ce n?est certainement pas le cas pour celui de "module". Cependant, sa d´efinition dans le pr´esent contexte ne co¨ýncide avec aucune de celles figurant dans les dictionnaires ordinaires. Les personnes qui ont d´ej`a entendu parler de Frobenius, Burnside, Schur, ou encore Brauer, pourront vous dire qu?un module est une repr´esentation. "De quoi ?" vous demanderezvous. "Un spectacle de marionnettes, peut-?etre ?" Bien s?ur que non ! Un module d?endo-permutation est une repr´esentation particuli`ere de certains groupes finis, o`u un groupe n?est pas un groupe de rock, comme vous pouvez vous en douter, mais d´esigne un objet math´ematique connu par tous les ´etudiants en sciences au terme de leur premi`ere ann´ee universitaire (en th´eorie, du moins). La "popularit´e" de la notion de groupe, fini ou non, est due au fait que les groupes sont fr´equemment utilis´es, aussi bien dans le domaine abstrait des math´ematiques, que dans le monde r´eel des physiciens, chimistes et autres biologistes (pour ne citer qu?eux). "Mais comment peut-on utiliser concr`etement ces objets invisibles ?" vous demanderez-vous alors. Et bien, justement, en les consid´erant par l?interm´ediaire de leurs repr´esentations, c?est-`a-dire en leur associant des matrices, de fa¸con plus ou moins naturelle. Or, comme il y a "beaucoup trop" de matrices pour un groupe donn´e, elles sont classifi´ees selon certaines de leurs propri´et´es, ce qui permet de les r´epertorier dans diverses familles (celle des modules d?endo-permutation, par exemple). Un groupe est ainsi rendu "concret", car les donn´ees matricielles sont manipulables par tous les scienti- fiques (et leurs ordinateurs), qui peuvent alors les utiliser dans leurs recherches, afin de contribuer au progr`es de la science. En toute franchise, c?est bien loin de ces soucis terre-`a-terre que ce travail de th`ese sur la classification des modules d?endo-permutation a ´et´e accompli. En fait, quitte `a choquer certaines ?ames sensibles, sa r´ealisation est surtout due au caract`ere ´epicure de son auteur, qui, avouons-le, en a ´et´e pleinement satisfait !

Is the adiposity-associated FTO gene variant related to all-cause mortality independent of adiposity? Meta-analysis of data from 169,551 Caucasian adults.

Previously, a single nucleotide polymorphism (SNP), rs9939609, in the FTO gene showed a much stronger association with all-cause mortality than expected from its association with body mass index (BMI), body fat mass index (FMI) and waist circumference (WC). This finding implies that the SNP has strong pleiotropic effects on adiposity and adiposity-independent pathological pathways that leads to increased mortality. To investigate this further, we conducted a meta-analysis of similar data from 34 longitudinal studies including 169,551 adult Caucasians among whom 27,100 died during follow-up. Linear regression showed that the minor allele of the FTO SNP was associated with greater BMI (n = 169,551; 0.32 kg m(-2) ; 95% CI 0.28-0.32, P < 1 × 10(-32) ), WC (n = 152,631; 0.76 cm; 0.68-0.84, P < 1 × 10(-32) ) and FMI (n = 48,192; 0.17 kg m(-2) ; 0.13-0.22, P = 1.0 × 10(-13) ). Cox proportional hazard regression analyses for mortality showed that the hazards ratio (HR) for the minor allele of the FTO SNPs was 1.02 (1.00-1.04, P = 0.097), but the apparent excess risk was eliminated after adjustment for BMI and WC (HR: 1.00; 0.98-1.03, P = 0.662) and for FMI (HR: 1.00; 0.96-1.04, P = 0.932). In conclusion, this study does not support that the FTO SNP is associated with all-cause mortality independently of the adiposity phenotypes.

Safety profile of prasugrel and clopidogrel in patients with acute coronary syndromes in Switzerland.

OBJECTIVE: To assess safety up to 1 year of follow-up associated with prasugrel and clopidogrel use in a prospective cohort of patients with acute coronary syndromes (ACS). METHODS: Between 2009 and 2012, 2286 patients invasively managed for ACS were enrolled in the multicentre Swiss ACS Bleeding Cohort, among whom 2148 patients received either prasugrel or clopidogrel according to current guidelines. Patients with ST-elevation myocardial infarction (STEMI) preferentially received prasugrel, while those with non-STEMI, a history of stroke or transient ischaemic attack, age ≥75 years, or weight <60 kg received clopidogrel or reduced dose of prasugrel to comply with the prasugrel label. RESULTS: After adjustment using propensity scores, the primary end point of clinically relevant bleeding events (defined as the composite of Bleeding Academic Research Consortium, BARC, type 3, 4 or 5 bleeding) at 1 year, occurred at a similar rate in both patient groups (prasugrel/clopidogrel: 3.8%/5.5%). Stratified analyses in subgroups including patients with STEMI yielded a similar safety profile. After adjusting for baseline variables, no relevant differences in major adverse cardiovascular and cerebrovascular events were observed at 1 year (prasugrel/clopidogrel: cardiac death 2.6%/4.2%, myocardial infarction 2.7%/3.8%, revascularisation 5.9%/6.7%, stroke 1.0%/1.6%). Of note, this study was not designed to compare efficacy between prasugrel and clopidogrel. CONCLUSIONS: In this large prospective ACS cohort, patients treated with prasugrel according to current guidelines (ie, in patients without cerebrovascular disease, old age or underweight) had a similar safety profile compared with patients treated with clopidogrel. CLINICAL TRIAL REGISTRATION NUMBER: SPUM-ACS: NCT01000701; COMFORTABLE AMI: NCT00962416.

The REporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) Statement: Methods for Arriving at Consensus and Developing Reporting Guidelines.

OBJECTIVE: Routinely collected health data, collected for administrative and clinical purposes, without specific a priori research questions, are increasingly used for observational, comparative effectiveness, health services research, and clinical trials. The rapid evolution and availability of routinely collected data for research has brought to light specific issues not addressed by existing reporting guidelines. The aim of the present project was to determine the priorities of stakeholders in order to guide the development of the REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. METHODS: Two modified electronic Delphi surveys were sent to stakeholders. The first determined themes deemed important to include in the RECORD statement, and was analyzed using qualitative methods. The second determined quantitative prioritization of the themes based on categorization of manuscript headings. The surveys were followed by a meeting of RECORD working committee, and re-engagement with stakeholders via an online commentary period. RESULTS: The qualitative survey (76 responses of 123 surveys sent) generated 10 overarching themes and 13 themes derived from existing STROBE categories. Highest-rated overall items for inclusion were: Disease/exposure identification algorithms; Characteristics of the population included in databases; and Characteristics of the data. In the quantitative survey (71 responses of 135 sent), the importance assigned to each of the compiled themes varied depending on the manuscript section to which they were assigned. Following the working committee meeting, online ranking by stakeholders provided feedback and resulted in revision of the final checklist. CONCLUSIONS: The RECORD statement incorporated the suggestions provided by a large, diverse group of stakeholders to create a reporting checklist specific to observational research using routinely collected health data. Our findings point to unique aspects of studies conducted with routinely collected health data and the perceived need for better reporting of methodological issues.

Heavier smoking may lead to a relative increase in waist circumference: evidence for a causal relationship from a Mendelian randomisation meta-analysis. The CARTA consortium.

OBJECTIVES: To investigate, using a Mendelian randomisation approach, whether heavier smoking is associated with a range of regional adiposity phenotypes, in particular those related to abdominal adiposity. DESIGN: Mendelian randomisation meta-analyses using a genetic variant (rs16969968/rs1051730 in the CHRNA5-CHRNA3-CHRNB4 gene region) as a proxy for smoking heaviness, of the associations of smoking heaviness with a range of adiposity phenotypes. PARTICIPANTS: 148 731 current, former and never-smokers of European ancestry aged ≥16 years from 29 studies in the consortium for Causal Analysis Research in Tobacco and Alcohol (CARTA). PRIMARY OUTCOME MEASURES: Waist and hip circumferences, and waist-hip ratio. RESULTS: The data included up to 66 809 never-smokers, 43 009 former smokers and 38 913 current daily cigarette smokers. Among current smokers, for each extra minor allele, the geometric mean was lower for waist circumference by -0.40% (95% CI -0.57% to -0.22%), with effects on hip circumference, waist-hip ratio and body mass index (BMI) being -0.31% (95% CI -0.42% to -0.19), -0.08% (-0.19% to 0.03%) and -0.74% (-0.96% to -0.51%), respectively. In contrast, among never-smokers, these effects were higher by 0.23% (0.09% to 0.36%), 0.17% (0.08% to 0.26%), 0.07% (-0.01% to 0.15%) and 0.35% (0.18% to 0.52%), respectively. When adjusting the three central adiposity measures for BMI, the effects among current smokers changed direction and were higher by 0.14% (0.05% to 0.22%) for waist circumference, 0.02% (-0.05% to 0.08%) for hip circumference and 0.10% (0.02% to 0.19%) for waist-hip ratio, for each extra minor allele. CONCLUSIONS: For a given BMI, a gene variant associated with increased cigarette consumption was associated with increased waist circumference. Smoking in an effort to control weight may lead to accumulation of central adiposity.

Directional dominance on stature and cognition in diverse human populations.

Homozygosity has long been associated with rare, often devastating, Mendelian disorders, and Darwin was one of the first to recognize that inbreeding reduces evolutionary fitness. However, the effect of the more distant parental relatedness that is common in modern human populations is less well understood. Genomic data now allow us to investigate the effects of homozygosity on traits of public health importance by observing contiguous homozygous segments (runs of homozygosity), which are inferred to be homozygous along their complete length. Given the low levels of genome-wide homozygosity prevalent in most human populations, information is required on very large numbers of people to provide sufficient power. Here we use runs of homozygosity to study 16 health-related quantitative traits in 354,224 individuals from 102 cohorts, and find statistically significant associations between summed runs of homozygosity and four complex traits: height, forced expiratory lung volume in one second, general cognitive ability and educational attainment (P < 1 × 10(-300), 2.1 × 10(-6), 2.5 × 10(-10) and 1.8 × 10(-10), respectively). In each case, increased homozygosity was associated with decreased trait value, equivalent to the offspring of first cousins being 1.2 cm shorter and having 10 months' less education. Similar effect sizes were found across four continental groups and populations with different degrees of genome-wide homozygosity, providing evidence that homozygosity, rather than confounding, directly contributes to phenotypic variance. Contrary to earlier reports in substantially smaller samples, no evidence was seen of an influence of genome-wide homozygosity on blood pressure and low density lipoprotein cholesterol, or ten other cardio-metabolic traits. Since directional dominance is predicted for traits under directional evolutionary selection, this study provides evidence that increased stature and cognitive function have been positively selected in human evolution, whereas many important risk factors for late-onset complex diseases may not have been.