An intronic GAA repeat expansion in FGF14 causes the autosomal-dominant adult-onset ataxia SCA50/ATX-FGF14.

Adult-onset cerebellar ataxias are a group of neurodegenerative conditions that challenge both genetic discovery and molecular diagnosis. In this study, we identified an intronic (GAA) repeat expansion in fibroblast growth factor 14 (FGF14). Genetic analysis of 95 Australian individuals with adult-onset ataxia identified four (4.2%) with (GAA)>300 and a further nine individuals with (GAA)>250. PCR and long-read sequence analysis revealed these were pure (GAA) repeats. In comparison, no control subjects had (GAA)>300 and only 2/311 control individuals (0.6%) had a pure (GAA)>250. In a German validation cohort, 9/104 (8.7%) of affected individuals had (GAA)>335 and a further six had (GAA)>250, whereas 10/190 (5.3%) control subjects had (GAA)>250 but none were (GAA)>335. The combined data suggest (GAA)>335 are disease causing and fully penetrant (p = 6.0 × 10-8, OR = 72 [95% CI = 4.3-1,227]), while (GAA)>250 is likely pathogenic with reduced penetrance. Affected individuals had an adult-onset, slowly progressive cerebellar ataxia with variable features including vestibular impairment, hyper-reflexia, and autonomic dysfunction. A negative correlation between age at onset and repeat length was observed (R2 = 0.44, p = 0.00045, slope = -0.12) and identification of a shared haplotype in a minority of individuals suggests that the expansion can be inherited or generated de novo during meiotic division. This study demonstrates the power of genome sequencing and advanced bioinformatic tools to identify novel repeat expansions via model-free, genome-wide analysis and identifies SCA50/ATX-FGF14 as a frequent cause of adult-onset ataxia.

Neurosyphilis presenting as limbic encephalitis.

A man in his 50s presented with focal seizures and was found to have an inflammatory cerebrospinal fluid (CSF) with bilateral mesiotemporal lobe hyperintensity on magnetic resonance imaging (MRI) of the brain. Corticosteroid treatment was initiated for management of limbic encephalitis. Focal seizures, imaging abnormalities and inflammatory CSF persisted despite treatment and the patient was found to have neurosyphilis after developing neuropsychiatric symptoms. Syphilis is a sexually transmitted bacterial infection with multisystem involvement including neurological and psychiatric manifestations. Case reports have emerged of neurosyphilis presenting as limbic encephalitis with CSF pleocytosis and temporal lobe hyperintensity on MRI of the brain. Persistence of CSF or MRI abnormalities despite immunosuppressive therapy for limbic encephalitis should prompt investigation for alternate causes of chronic meningoencephalitis, which can occasionally include neurosyphilis.

Room-Temperature Thermoelectric Performance of n-Type Multiphase Pseudobinary Bi2Te3-Bi2S3 Compounds: Synergic Effects of Phonon Scattering and Energy Filtering.

Bismuth telluride-based alloys possess the highest efficiencies for the low-temperature-range (<500 K) applications among thermoelectric materials. Despite significant advances in the efficiency of p-type Bi2Te3-based materials through engineering the electronic band structure by convergence of multiple bands, the n-type pair still suffers from poor efficiency due to a lower number of electron pockets near the conduction band edge than the valence band. To overcome the persistent low efficiency of n-type Bi2Te3-based materials, we have fabricated multiphase pseudobinary Bi2Te3-Bi2S3 compounds to take advantages of phonon scattering and energy filtering at interfaces, enhancing the efficiency of these materials. The energy barrier generated at the interface of the secondary phase of Bi14Te13S8 in the Bi2Te3 matrix resulted in a higher Seebeck coefficient and consequently a higher power factor in multiphase compounds than the single-phase alloys. This effect was combined with low thermal conductivity achieved through phonon scattering at the interfaces of finely structured multiphase compounds and resulted in a relatively high thermoelectric figure of merit of ∼0.7 over the 300-550 K temperature range for the multiphase sample of n-type Bi2Te2.75S0.25, double the efficiency of single-phase Bi2Te3. Our results inform an alternative alloy design to enhance the performance of thermoelectric materials.

Enhancement of Diffusion, Densification and Solid-State Reactions in Dielectric Materials Due to Interfacial Interaction of Microwave Radiation: Theory and Experiment.

A detailed theoretical model and experimental study are presented that formulate and prove the existence of a robust ponderomotive force (PMF) near the interfaces in a granular dielectric material under microwave radiation. The model calculations show that the net direction of the PMF is pore angle-dependent. For most of the pore angles, the net force is towards the interface creating a mass transport that fills the interfacial pores and facilitates densification. For small ranges of angles, near 180o and 360o, PMF drives the ions in the reverse direction and depletes the pores. However, the net force for such ranges of angles is small. The PMF also enhances the diffusion of the mobile ionic species and, consequently, accelerates the solid-state reaction by increasing the collision probability. The proof-of-concept experiments show that a mixture of elemental powders can diffuse, react, and form dense materials when radiated by the microwave in just a few minutes. Such characteristics, together with field-induced decrystallization, offer a novel and simple approach for the synthesis of nanostructured compounds, which can have practical implications in ceramic technologies and thermoelectric materials.

Cytomegalovirus associated longitudinally extensive transverse myelitis and acute hepatitis in an immunocompetent adult.

Cytomegalovirus can cause severe disease in immunocompromised patients including encephalomyelitis, hepatitis, pneumonitis, colitis and retinitis. CMV induced myelitis and hepatitis are rare in immunocompetent patients. Following a thorough search on the literature using pubmed, there were only 10 well documented CMV-induced transverse myelitis cases reported worldwide. We report a healthy young male who developed longitudinal extensive transverse myelitis and acute hepatitis secondary to CMV infection. Our case is different from the other cases as our patient had concurrent acute hepatitis and received plasma exchange therapy (PLEX) in addition to pulsed steroids and antivirals. The patient recovered well and had an excellent outcome.

A Wearable Hydration Sensor with Conformal Nanowire Electrodes.

A wearable skin hydration sensor in the form of a capacitor is demonstrated based on skin impedance measurement. The capacitor consists of two interdigitated or parallel electrodes that are made of silver nanowires (AgNWs) in a polydimethylsiloxane (PDMS) matrix. The flexible and stretchable nature of the AgNW/PDMS electrode allows conformal contact to the skin. The hydration sensor is insensitive to the external humidity change and is calibrated against a commercial skin hydration system on an artificial skin over a wide hydration range. The hydration sensor is packaged into a flexible wristband, together with a network analyzer chip, a button cell battery, and an ultralow power microprocessor with Bluetooth. In addition, a chest patch consisting of a strain sensor, three electrocardiography electrodes, and a skin hydration sensor is developed for multimodal sensing. The wearable wristband and chest patch may be used for low-cost, wireless, and continuous monitoring of skin hydration and other health parameters.

Susac's syndrome: an immune mediated endotheliopathy laden with challenges and controversies.

Susac's syndrome is a microangiopathy of the retina, inner ear and brain manifesting as a triad of encephalopathy, hearing loss and branch retinal artery occlusion. The pathological mechanism is thought to be an immune-mediated small vessel vasculitis with some pathophysiological similarity to dermatomyositis. Awareness and early recognition of this syndrome is important as early treatment with immunosuppression can minimise cognitive, audiological and visual sequelae. We report a case of a 33-year-old woman who presented with the characteristic syndrome. She was treated with immunomodulatory therapy and remains well 2 years postpresentation with no new events.