Comment on reversal of hypogonadotropic hypogonadism in a Chinese cohort.

The reversal of congenital hypogonadotropic hypogonadism (CHH) is a relatively recent phenomenon that has gained increasing attention over the past 10 years. Yet to date, only one prospective study has been conducted estimating that 10% (95% confidence interval [CI]: 2%-18%) of cases undergo reversal. [1] Other retrospective studies have reported rates in the range of 5%-8% [2],[3] and a recent study showed 44/308 (14%, 95% CI: 11%-19%) CHH patients underwent reversal. [4] Moreover, a time-to-event analysis in this large cohort revealed a lifetime reversal incidence of 22%. The article by Mao and colleagues presented in this issue is a meaningful contribution to our understanding of reversal as it examines the largest retrospective cohort to date. [5] Interestingly, they report the rate of reversal as 5% (95% CI: 3%-8%) in this Chinese cohort. It is difficult to reconcile the discrepancies in rates of reversibility and direct comparisons are hampered by the variable definitions employed. Using a novel definition for reversal (i.e, either endogenous testosterone (T) >270 ng dl−1 , serum T gradually increasing above 150 ng dl−1 with increased testicular volume, or normal spontaneous sperm production/normal erectile function/ejaculation), Mao and colleagues posit that testicular size and triptorelin-stimulated LH levels are reliable predictive factors for reversal. However, these cannot be considered as hard and fast rules for predicting reversal as the groups intersect - akin to the overlap observed between CHH patients and those with delayed puberty. Indeed, the fact that approximately half (44%, 95% CI: 25%-66%) of the reversal patients in the study by Mao et al.[5] were diagnosed between 17 and 19 years of age, underscores the challenge in differentiating CHH from extreme normal variants of puberty. This study further lends credence the recently reported observations that reversals may relapse. [4],[6] The notion that reversal may not be lasting highlights the vulnerability of the reproductive axis among CHH patients. While the mechanism(s) for relapse are unclear, it seems plausible that environmental, metabolic or psychiatric stressors could contribute. The factors that Mao and colleagues identify as significantly different in cases of reversal, were not informative for identifying those cases that relapsed back to a hypogonadal state. Notably, reversal has been reported in probands harboring mutations in genes underlying CHH. [1],[3],[4],[6] Unfortunately, comprehensive genetic screening on the Chinese cohort is not available. The reversal phenomenon is fascinating for its glimpse into the plasticity of the neuroendocrine control of reproduction. Future directions will almost certainly include investigation of specific genetic signatures and novel biomarkers for predicting reversal (and relapse). Yet CHH is a rare condition and to fully elucidate the biology of reversible CHH, it will be important to harmonize definitions of what constitutes a reversal, carefully phenotype patients and chart the natural history of their CHH. In this way, this unique human disease model may offer further insights into the control of human reproduction and provide opportunities to translate discoveries into enhanced approaches to improve the care and quality of life for these patients.

Adolescents et cigarettes électroniques [Adolescents and electronic cigarettes].

L'usage de cigarettes électroniques (vapotage) augmente chez les jeunes et les professionnels de la santé se sentent démunis. Ce court article donne quelques informations pratiques. L'usage (vapotage) de cigarettes électroniques (e-cigarettes) est un phénomène relativement récent qui est en train de prendre une ampleur inattendue, surtout chez les jeunes. Bien que les taux de prévalence soient extrêmement variables d'un pays à l'autre, ils sont en net augmentation: tant parmi ceux qui les ont seulement essayées que chez ceux qui les utilisent habituellement, les taux de prévalence ont doublé ou presque triplé en à peine une année. En outre, une proportion notable d'utilisateurs d'e-cigarettes (de 8 à 33% selon les études)n'avaient jamais fumé de cigarettes conventionnelles. Ce phénomène pourrait faire des e-cigarettes la porte d'entrée au tabagisme parmi les jeunes. Adolescents and electronic cigarettes: The use of electronic cigarettes (vaping) is increasing among young people and health professionals feel ill-prepared. This short article provides some practical information The use of electronic cigarettes (vaping) is increasing among young people and health professionals feel ill-prepared. This short article provides some practical information.

Integrative and systemic approaches for evaluating PPARβ/δ (PPARD) function.

The peroxisome proliferator-activated receptors (PPARs) are a group of nuclear receptors that function as transcription factors regulating the expression of genes involved in cellular differentiation, development, metabolism and also tumorigenesis. Three PPAR isotypes (α, β/δ and γ) have been identified, among which PPARβ/δ is the most difficult to functionally examine due to its tissue-specific diversity in cell fate determination, energy metabolism and housekeeping activities. PPARβ/δ acts both in a ligand-dependent and -independent manner. The specific type of regulation, activation or repression, is determined by many factors, among which the type of ligand, the presence/absence of PPARβ/δ-interacting corepressor or coactivator complexes and PPARβ/δ protein post-translational modifications play major roles. Recently, new global approaches to the study of nuclear receptors have made it possible to evaluate their molecular activity in a more systemic fashion, rather than deeply digging into a single pathway/function. This systemic approach is ideally suited for studying PPARβ/δ, due to its ubiquitous expression in various organs and its overlapping and tissue-specific transcriptomic signatures. The aim of the present review is to present in detail the diversity of PPARβ/δ function, focusing on the different information gained at the systemic level, and describing the global and unbiased approaches that combine a systems view with molecular understanding.

Searching electronic marketplaces

The main objective of this thesis was to analyze the usability of registers and indexes of electronic marketplaces. The work is focused on UDDI-based electronic marketplaces, which are standardized by the W3C. UDDI-registers are usable in intranets, extranets and in Internet. Using UDDI-registers Web-services can be searched in many ways, including alphabetical and domain specific searches. Humans and machines can use the features UDDI-registers. The thesis deals the design principles, architectures and specifications of UDDI-registers. In addition, the thesis includes the design and the specifications of an electronic marketplace developed for supporting electronic logistics services.

Software process improvement using an electronic process guide

Kasvava kiinnostus ohjelmistojen laatua kohtaan on herättänyt ohjelmistoprosesseihin ja niiden kehittämiseen kohdistuvaa huomiota viime vuosina. Ohjelmistoyritykset ympäri maailmaa ovat ottaneet käyttöön ohjelmistoprosessin kehittämismalleja, kuten CMM ja SPICE, pyrkiessään kohti parempilaatuisia ohjelmistotuotteita. Samalla on huomattu, että tehokas prosessien parantaminen ja suorittaminen tarvitsee tuekseen kuvauksen prosessista, jotta prosessin perusteellinen ymmärtäminen ja kommunikointi olisi mahdollista. Ohjelmistoprosesseja voidaan kuvata monilla eri tavoilla. Prosessiopas on prosessin esitysmuoto, jonka päätarkoituksena on helpottaa prosessin ymmärtämistä ja kommunikointia. Elektroninen prosessiopas on Web-teknologiaa hyödyntävä prosessiopas. Tässä työssä luodaan kehitysympäristö elektronisille prosessioppaille, joiden tarkoituksena on tukea ohjelmistoprosessin kehittämistä ja suorittamista. Ympäristö mahdollistaa ohjelmistoprosessinmallintamisen sekä yksilöllisten oppaiden luomisen ja muokkaamisen. Kehitysympäristöä käytetään mallintamaan tietoliikenneohjelmistoja valmistavan yrityksen ohjelmistoprosessia sekä luomaan elektronisia prosessioppaita tukemaan prosessin kehitystä ja suorittamista. Lopuksi pohditaan prosessioppaiden tarjoamaa tukea sekä mahdollisuuksia kohdeyrityksessä.

Electronic Data Interchange in Logistics Processes

Tämän diplomityön tarkoituksena oli tehdä selvitys EDI:in liittyvistä vaikutuksista, tarpeista ja eduista sekä valmistella Oracle Applications- toiminnanohjausjärjestelmän EDI Gateway- modulin ottamista tuotantokäyttöön. Tietoa tarvekartoitukseen saatiin keskustelujen avulla. Uusia kaupallisista lähtökohdista johdettuja, yritysten väliseen kaupankäyntiin ja internet-teknologian hyödyntämiseen kehitettyjä aloitteita käsiteltiin EDI-näkökulmasta tulevaisuutta varten. Ajankohtaisinta tietoa tätä diplomityötä varten löydettiin myös internetistä. Tämän jälkeen oli mahdollista toteuttaa sopivan laaja mutta rajattu EDI pilottiprojekti EDI-konseptin luomista varten. EDI:n vaikutuksiin ostossa keskityttiin tässä diplomityössä enemmän ja EDI:ä päätettiin soveltaa aluksi ostotilauksissa. EDI:n hyötyjä on vaikea mitata numeerisesti. Suurta määrää rahaa tai tuoteyksiköitä on käsiteltävä EDI-partnerin kanssa riittävän usein. EDI:n käyttöönottovaiheessa pääongelmat ovat sovelluksiin liittyviä tietotekniikkaongelmia. Selvityksistä ja EDI-projektista saatu tieto on mahdollista hyödyntää jatkokehityksessä. Lisätoimenpiteitä tarvitaan kokonaan toimivan järjestelmän luomiseksi.

Molecular profiling of CD8 T cells in autochthonous melanoma identifies Maf as driver of exhaustion.

T cells infiltrating neoplasms express surface molecules typical of chronically virus-stimulated T cells, often termed "exhausted" T cells. We compared the transcriptome of "exhausted" CD8 T cells infiltrating autochthonous melanomas to those of naïve and acutely stimulated CD8 T cells. Despite strong similarities between transcriptional signatures of tumor- and virus-induced exhausted CD8 T cells, notable differences appeared. Among transcriptional regulators, Nr4a2 and Maf were highly overexpressed in tumor-exhausted T cells and significantly upregulated in CD8 T cells from human melanoma metastases. Transduction of murine tumor-specific CD8 T cells to express Maf partially reproduced the transcriptional program associated with tumor-induced exhaustion. Upon adoptive transfer, the transduced cells showed normal homeostasis but failed to accumulate in tumor-bearing hosts and developed defective anti-tumor effector responses. We further identified TGFβ and IL-6 as main inducers of Maf expression in CD8 T cells and showed that Maf-deleted tumor-specific CD8 T cells were much more potent to restrain tumor growth in vivo. Therefore, the melanoma microenvironment contributes to skewing of CD8 T cell differentiation programs, in part by TGFβ/IL-6-mediated induction of Maf.

Electronic transport in low temperature nanocrystalline silicon thin-film transistors obtained by Hot-Wire CVD

Hydrogenated nanocrystalline silicon (nc-Si:H) obtained by hot-wire chemical vapour deposition (HWCVD) at low substrate temperature (150 °C) has been incorporated as the active layer in bottom-gate thin-film transistors (TFTs). These devices were electrically characterised by measuring in vacuum the output and transfer characteristics for different temperatures. The field-effect mobility showed a thermally activated behaviour which could be attributed to carrier trapping at the band tails, as in hydrogenated amorphous silicon (a-Si:H), and potential barriers for the electronic transport. Trapped charge at the interfaces of the columns, which are typical in nc-Si:H, would account for these barriers. By using the Levinson technique, the quality of the material at the column boundaries could be studied. Finally, these results were interpreted according to the particular microstructure of nc-Si:H.

Managing the Sick Child in the Era of Declining Malaria Transmission: Development of ALMANACH, an Electronic Algorithm for Appropriate Use of Antimicrobials.

OBJECTIVE: To review the available knowledge on epidemiology and diagnoses of acute infections in children aged 2 to 59 months in primary care setting and develop an electronic algorithm for the Integrated Management of Childhood Illness to reach optimal clinical outcome and rational use of medicines. METHODS: A structured literature review in Medline, Embase and the Cochrane Database of Systematic Review (CDRS) looked for available estimations of diseases prevalence in outpatients aged 2-59 months, and for available evidence on i) accuracy of clinical predictors, and ii) performance of point-of-care tests for targeted diseases. A new algorithm for the management of childhood illness (ALMANACH) was designed based on evidence retrieved and results of a study on etiologies of fever in Tanzanian children outpatients. FINDINGS: The major changes in ALMANACH compared to IMCI (2008 version) are the following: i) assessment of 10 danger signs, ii) classification of non-severe children into febrile and non-febrile illness, the latter receiving no antibiotics, iii) classification of pneumonia based on a respiratory rate threshold of 50 assessed twice for febrile children 12-59 months; iv) malaria rapid diagnostic test performed for all febrile children. In the absence of identified source of fever at the end of the assessment, v) urine dipstick performed for febrile children <2 years to consider urinary tract infection, vi) classification of 'possible typhoid' for febrile children >2 years with abdominal tenderness; and lastly vii) classification of 'likely viral infection' in case of negative results. CONCLUSION: This smartphone-run algorithm based on new evidence and two point-of-care tests should improve the quality of care of <5 year children and lead to more rational use of antimicrobials.

Prediction of multiple infections after severe burn trauma: a prospective cohort study.

OBJECTIVE: To develop predictive models for early triage of burn patients based on hypersusceptibility to repeated infections. BACKGROUND: Infection remains a major cause of mortality and morbidity after severe trauma, demanding new strategies to combat infections. Models for infection prediction are lacking. METHODS: Secondary analysis of 459 burn patients (≥16 years old) with 20% or more total body surface area burns recruited from 6 US burn centers. We compared blood transcriptomes with a 180-hour cutoff on the injury-to-transcriptome interval of 47 patients (≤1 infection episode) to those of 66 hypersusceptible patients [multiple (≥2) infection episodes (MIE)]. We used LASSO regression to select biomarkers and multivariate logistic regression to built models, accuracy of which were assessed by area under receiver operating characteristic curve (AUROC) and cross-validation. RESULTS: Three predictive models were developed using covariates of (1) clinical characteristics; (2) expression profiles of 14 genomic probes; (3) combining (1) and (2). The genomic and clinical models were highly predictive of MIE status [AUROCGenomic = 0.946 (95% CI: 0.906-0.986); AUROCClinical = 0.864 (CI: 0.794-0.933); AUROCGenomic/AUROCClinical P = 0.044]. Combined model has an increased AUROCCombined of 0.967 (CI: 0.940-0.993) compared with the individual models (AUROCCombined/AUROCClinical P = 0.0069). Hypersusceptible patients show early alterations in immune-related signaling pathways, epigenetic modulation, and chromatin remodeling. CONCLUSIONS: Early triage of burn patients more susceptible to infections can be made using clinical characteristics and/or genomic signatures. Genomic signature suggests new insights into the pathophysiology of hypersusceptibility to infection may lead to novel potential therapeutic or prophylactic targets.

CNDOL: A fast and reliable method for the calculation of electronic properties of very large systems. Applications to retinal binding pocket in rhodopsin and gas phase porphine.

Very large molecular systems can be calculated with the so called CNDOL approximate Hamiltonians that have been developed by avoiding oversimplifications and only using a priori parameters and formulas from the simpler NDO methods. A new diagonal monoelectronic term named CNDOL/21 shows great consistency and easier SCF convergence when used together with an appropriate function for charge repulsion energies that is derived from traditional formulas. It is possible to obtain a priori molecular orbitals and electron excitation properties after the configuration interaction of single excited determinants with reliability, maintaining interpretative possibilities even being a simplified Hamiltonian. Tests with some unequivocal gas phase maxima of simple molecules (benzene, furfural, acetaldehyde, hexyl alcohol, methyl amine, 2,5 dimethyl 2,4 hexadiene, and ethyl sulfide) ratify the general quality of this approach in comparison with other methods. The calculation of large systems as porphine in gas phase and a model of the complete retinal binding pocket in rhodopsin with 622 basis functions on 280 atoms at the quantum mechanical level show reliability leading to a resulting first allowed transition in 483 nm, very similar to the known experimental value of 500 nm of "dark state." In this very important case, our model gives a central role in this excitation to a charge transfer from the neighboring Glu(-) counterion to the retinaldehyde polyene chain. Tests with gas phase maxima of some important molecules corroborate the reliability of CNDOL/2 Hamiltonians.

MgO/Ag(001) interface structure and STM images from first principles

The interface of MgO/Ag(001) has been studied with density functional theory applied to slabs. We have found that regular MgO films show a small adhesion to the silver substrate, the binding can be increased in off-stoichiometric regimes, either by the presence of O vacancies at the oxide film or by a small excess of O atoms at the interface between the ceramic to the metal. By means of theoretical methods, the scanning tunneling microscopy signatures of these films is also analyzed in some detail. For defect free deposits containing 1 or 2 ML and at low voltages, tunnelling takes place from the surface Ag substrate, and at large positive voltages Mg atoms are imaged. If defects, oxygen vacancies, are present on the surface of the oxide they introduce much easier channels for tunnelling resulting in big protrusions and controlling the shape of the image, the extra O stored at the interface can also be detected for very thin films.

Comprehensive Molecular Portraits of Invasive Lobular Breast Cancer.

Invasive lobular carcinoma (ILC) is the second most prevalent histologic subtype of invasive breast cancer. Here, we comprehensively profiled 817 breast tumors, including 127 ILC, 490 ductal (IDC), and 88 mixed IDC/ILC. Besides E-cadherin loss, the best known ILC genetic hallmark, we identified mutations targeting PTEN, TBX3, and FOXA1 as ILC enriched features. PTEN loss associated with increased AKT phosphorylation, which was highest in ILC among all breast cancer subtypes. Spatially clustered FOXA1 mutations correlated with increased FOXA1 expression and activity. Conversely, GATA3 mutations and high expression characterized luminal A IDC, suggesting differential modulation of ER activity in ILC and IDC. Proliferation and immune-related signatures determined three ILC transcriptional subtypes associated with survival differences. Mixed IDC/ILC cases were molecularly classified as ILC-like and IDC-like revealing no true hybrid features. This multidimensional molecular atlas sheds new light on the genetic bases of ILC and provides potential clinical options.

The Electronic Structure of Co-Sputtered Zinc Indium Tin Oxide Thin Films

Zinc indium tin oxide (ZITO) transparent conductive oxide layers were deposited via radio frequency (RF) magnetron co-sputtering at room temperature. A series of samples with gradually varying zinc content was investigated. The samples were characterized with x-ray and ultraviolet photoemission spectroscopy (XPS, UPS) to determine the electronic structure of the surface. Valence and conduction bands maxima (VBM, CBM), and work function were determined. The experiments indicate that increasing Zn content results in films with a higher defect rate at the surface leading to the formation of a degenerately doped surface layer if the Zn content surpasses 50%. Furthermore, the experiments demonstrate that ZITO is susceptible to ultraviolet light induced work function reduction, similar to what was earlier observed on ITO and TiO2 films.