Congenital myasthenic syndromes in adults: clinical features, diagnosis and long-term prognosis.

Congenital myasthenic syndromes (CMS) are clinically and genetically heterogeneous diseases caused by mutations affecting neuromuscular transmission. Even if the first symptoms mainly occur during childhood, adult neurologists must confront this challenging diagnosis and manage these patients throughout their adulthood. However, long-term follow-up data from large cohorts of CMS patients are lacking and the long-term prognosis of these patients is largely unknown. We report the clinical features, diagnostic difficulties, and long-term prognosis of a French nationwide cohort of 235 adult patients with genetically confirmed CMS followed in 23 specialized neuromuscular centres. Data were retrospectively analysed. Of the 235 patients, 123 were female (52.3%). The diagnosis was made in adulthood in 139 patients, 110 of whom presented their first symptoms before the age of 18. Mean follow-up time between first symptoms and last visit was 34 years (SD = 15.1). Pathogenic variants were found in 19 disease-related genes. CHRNE-low expressor variants were the most common (23.8%), followed by variants in DOK7 (18.7%) and RAPSN (14%). Genotypes were clustered into four groups according to the initial presentation: ocular group (CHRNE-LE, CHRND, FCCMS), distal group (SCCMS), limb-girdle group (RAPSN, COLQ, DOK7, GMPPB, GFPT1), and a variable-phenotype group (MUSK, AGRN). The phenotypical features of CMS did not change throughout life. Only four genotypes had a proportion of patients requiring intensive care unit (ICU) admission that exceeded 20%: RAPSN (54.8%), MUSK (50%), DOK7 (38.6%) and AGRN (25.0%). In RAPSN and MUSK patients most ICU admissions occurred before age 18 years and in DOK7 and AGRN patients at or after 18 years of age. Different patterns of disease course (stability, improvement and progressive worsening) may succeed one another in the same patient throughout life, particularly in AGRN, DOK7 and COLQ. At the last visit, 55% of SCCMS and 36.3% of DOK7 patients required ventilation; 36.3% of DOK7 patients, 25% of GMPPB patients and 20% of GFPT1 patients were wheelchair-bound; most of the patients who were both wheelchair-bound and ventilated were DOK7 patients. Six patients died in this cohort. The positive impact of therapy was striking, even in severely affected patients. In conclusion, even if motor and/or respiratory deterioration could occur in patients with initially moderate disease, particularly in DOK7, SCCMS and GFPT1 patients, the long-term prognosis for most CMS patients was favourable, with neither ventilation nor wheelchair needed at last visit. CHRNE patients did not worsen during adulthood and RAPSN patients, often severely affected in early childhood, subsequently improved.

Real-life effectiveness 1 year after switching to avalglucosidase alfa in late-onset Pompe disease patients worsening on alglucosidase alfa therapy: A French cohort study.

INTRODUCTION: Late-onset Pompe disease (LOPD) is characterized by a progressive myopathy resulting from a deficiency of acid α-glucosidase enzyme activity. Enzyme replacement therapy has been shown to be effective, but long-term treatment results vary. Avalglucosidase alfa demonstrated non-inferiority to alglucosidase alfa in a phase 3 study, allowing in France compassionate access for advanced LOPD patients unresponsive to alglucosidase alfa. METHODS: Data from the French Pompe registry were analyzed for patients who benefited from a switch to avalglucosidase alfa with at least 1 year of follow-up. Respiratory (forced vital capacity [FVC]) and motor functions (Six-Minute Walk Test [6MWT]) were assessed before and 1 year after switching. Individual changes in FVC and 6MWT were expressed as slopes and statistical analyses were performed to compare values. RESULTS: Twenty-nine patients were included (mean age 56 years, 11 years of prior treatment). The FVC and 6MWT values remained stable. The individual analyses showed a stabilization of motor worsening: -1 m/year on the 6MWT after the switch versus -63 m/year the year before the switch (i.e., a worsening of 33%/year before vs. an improvement of 3%/year later). Respiratory data were not statistically different. DISCUSSION: At the group level, gait parameters improved slightly with a stabilization of previous worsening, but respiratory parameters showed limited changes. At the individual level, results were discordant, with some patients with a good motor or respiratory response and some with further worsening. CONCLUSION: Switching to avalglucosidase alfa demonstrated varied responses in advanced LOPD patients with failing alglucosidase alfa therapy, with a general improvement in motor stabilization.

An Aqueous Analog MAC Machine.

Using ions in aqueous milieu for signal processing, like in biological circuits, may potentially lead to a bioinspired information processing platform. Studies, however, have focused on individual ionic diodes and transistors rather than circuits comprising many such devices. Here a 16 × 16 array of new ionic transistors is developed in an aqueous quinone solution. Each transistor features a concentric ring electrode pair with a disk electrode at the center. The electrochemistry of these electrodes in the solution provides the basis for the transistor operation. The ring pair electrochemically tunes the local electrolytic concentration to modulate the disk's Faradaic reaction rate. Thus, the disk current as a Faradaic reaction to the disk voltage is gated by the ring pair. The 16 × 16 array of these transistors performs analog multiply-accumulate (MAC) operations, a computing modality hotly pursued for low-power artificial neural networks. This exploits the transistor's operating regime where the disk current is a multiplication of the disk voltage and a weight parameter tuned by the ring pair gating. Such disk currents from multiple transistors are summated in a global reference electrode to complete a MAC task. This ionic circuit demonstrating analog computing is a step toward sophisticated aqueous ionics.

CMOS electrochemical pH localizer-imager.

pH controls a large repertoire of chemical and biochemical processes in water. Densely arrayed pH microenvironments would parallelize these processes, enabling their high-throughput studies and applications. However, pH localization, let alone its arrayed realization, remains challenging because of fast diffusion of protons in water. Here, we demonstrate arrayed localizations of picoliter-scale aqueous acids, using a 256-electrochemical cell array defined on and operated by a complementary metal oxide semiconductor (CMOS)-integrated circuit. Each cell, comprising a concentric pair of cathode and anode with their current injections controlled with a sub-nanoampere resolution by the CMOS electronics, creates a local pH environment, or a pH "voxel," via confined electrochemistry. The system also monitors the spatiotemporal pH profile across the array in real time for precision pH control. We highlight the utility of this CMOS pH localizer-imager for high-throughput tasks by parallelizing pH-gated molecular state encoding and pH-regulated enzymatic DNA elongation at any selected set of cells.

Glycogenin-1 deficiency mimicking limb-girdle muscular dystrophy.

Glycogen storage disease type XV (GSD XV) is a recently described muscle glycogenosis due to glycogenin-1 (GYG1) deficiency characterized by the presence of polyglucosan bodies on muscle biopsy (Polyglucosan body myopathy-2, PGBM2). Here we describe a 44 year-old man with limb-girdle muscle weakness mimicking a limb-girdle muscular dystrophy (LGMD), and early onset exertional myalgia. Neurologic examination revealed a waddling gait with hyperlordosis, bilateral asymmetric scapular winging, mild asymmetric deltoid and biceps brachii weakness, and pelvic-girdle weakness involving the gluteal muscles and, to a lesser extent, the quadriceps. Serum creatine kinase levels were slightly elevated. Electrophysiological examination showed a myopathic pattern. There was no cardiac or respiratory involvement. Whole-body muscle MRI revealed atrophy and fat replacement of the tongue, biceps brachii, pelvic girdle and erector spinae. A deltoid muscle biopsy showed the presence of PAS-positive inclusions that remained non-digested with alpha-amylase treatment. Electron microscopy studies confirmed the presence of polyglucosan bodies. A diagnostic gene panel designed by the Genetic Diagnosis Laboratory of Strasbourg University Hospital (France) for 210 muscular disorders genes disclosed two heterozygous, pathogenic GYG1 gene mutations (c.304G>C;p.(Asp102His) + c.164_165del). Considering the clinical heterogeneity found in the previously described 38 GYG-1 deficient patients, we suggest that GYG1 should be systematically included in targeted NGS gene panels for LGMDs, distal myopathies, and metabolic myopathies.

Newborn Screening for Severe Combined Immunodeficiency: Analytic and Clinical Performance of the T Cell Receptor Excision Circle Assay in France (DEPISTREC Study).

Severe combined immunodeficiency (SCID) is characterized by a major T cell deficiency. Infants with SCID are asymptomatic at birth but die from infections in the first year of life if not treated. Survival rates are better for early treatment. SCID therefore meets criteria for newborn screening (NBS). T cell receptor excision circle (TREC) quantification is a reliable marker of T cell deficiency and can be performed using Guthrie cards. The DEPISTREC project was designed to study the feasibility, clinical utility, and cost-effectiveness of generalized SCID screening in France. About 200,000 babies from all over the country were screened at birth with a commercial kit. We determined assay performance and proposed a cutoff for classification of results. Our findings suggest that, given clearly established validation rules and decision-making procedures, the TREC assay is a suitably specific and sensitive method for high-throughput SCID screening. Clinical Trials: NCT02244450.

Dynamics of self-reorganization explains passivation of silicate glasses.

Understanding the dissolution of silicate glasses and minerals from atomic to macroscopic levels is a challenge with major implications in geoscience and industry. One of the main uncertainties limiting the development of predictive models lies in the formation of an amorphous surface layer--called gel--that can in some circumstances control the reactivity of the buried interface. Here, we report experimental and simulation results deciphering the mechanisms by which the gel becomes passivating. The study conducted on a six-oxide borosilicate glass shows that gel reorganization involving high exchange rate of oxygen and low exchange rate of silicon is the key mechanism accounting for extremely low apparent water diffusivity (∼10-21 m2 s-1), which could be rate-limiting for the overall reaction. These findings could be used to improve kinetic models, and inspire the development of new molecular sieve materials with tailored properties as well as highly durable glass for application in extreme environments.

Electrolysis of Natural Waters Contaminated with Transition-Metal Ions: Identification of A Metastable FePb-Based Oxygen-Evolution Catalyst Operating in Weakly Acidic Solutions.

The possibility of efficient water electrooxidation sustained by continuous (re)generation of catalysts derived from the oxidative electrodeposition of transition-metal contaminants is examined herein for three natural water samples from Australia and China. The metal composition of the solutions has been determined by inductively coupled plasma optical emission spectrometry, and a range of strategies to produce water-splitting catalysts by means of in situ electrodeposition have been applied. The performance of the resulting electrocatalysts is below the state-of-the-art level owing to large amounts of impurities in the solutions and non-optimal concentrations of naturally available catalyst precursors. Nevertheless, these studies have identified the FePb-based system as a rare example of an electrocatalyst for water oxidation that forms in situ and maintains reasonable activity (≥4.5 mA cm-2 at an overpotential of 0.8 V) in weakly acidic solutions (pH 2.9).

Dipole-field-assisted charge extraction in metal-perovskite-metal back-contact solar cells.

Hybrid organic-inorganic halide perovskites are low-cost solution-processable solar cell materials with photovoltaic properties that rival those of crystalline silicon. The perovskite films are typically sandwiched between thin layers of hole and electron transport materials, which efficiently extract photogenerated charges. This affords high-energy conversion efficiencies but results in significant performance and fabrication challenges. Herein we present a simple charge transport layer-free perovskite solar cell, comprising only a perovskite layer with two interdigitated gold back-contacts. Charge extraction is achieved via self-assembled monolayers and their associated dipole fields at the metal-perovskite interface. Photovoltages of ~600 mV generated by self-assembled molecular monolayer modified perovskite solar cells are equivalent to the built-in potential generated by individual dipole layers. Efficient charge extraction results in photocurrents of up to 12.1 mA cm-2 under simulated sunlight, despite a large electrode spacing.Simplified device concepts may become important for the development of low cost photovoltaics. Lin et al. report solar cells based on interdigitated gold back-contacts and metal halide perovskites where charge extraction is assisted via a dipole field generated by self-assembled molecular monolayers.

Understanding iridium oxide nanoparticle surface sites by their interaction with catechol.

Iridium oxide (IrOx) is one of the best water splitting electrocatalysts, but its active site details are not well known. As with all heterogeneous catalysts, a strategy for counting the number of active sites is not clear, and understanding their nature and structure is remarkably difficult. In this work, we performed a combined study using optical spectroscopy, magnetic resonance and electrochemistry to characterize the interaction of IrOx nanoparticles (NPs) with a probe molecule, catechol. The catalyst is heterogeneous given that the substrate is in a different phase, but behaves as a homogeneous catalyst from the point of view of electrochemistry since it remains in colloidal suspension. We find two types of binding sites: centers A which bind catechol irreversibly making up 21% of the surface, and centers B which bind catechol reversibly making up 79% of the surface. UV-vis absorption spectroscopy shows that the A sites are responsible for the characteristic blue color of the NPs. Electrochemical experiments indicate that the B sites are catalytically active and we give the number of active sites per nanoparticle. We conclude by performing a survey of ligands used in solar cell architectures and show which ones bind well to the surface and which ones inhibit the catalytic activity when doing so, presenting quantitative guidelines for the correct handling of IrOx nanoparticles during their incorporation into multifunctional solar energy harvesting architectures. We suggest ligands binding on the surface oxygen atoms allow for large bound ligand densities with no detrimental effect on the catalytic activity.

Electrocatalytic CO2 Reduction to Formate at Low Overpotentials on Electrodeposited Pd Films: Stabilized Performance by Suppression of CO Formation.

Palladium nanoparticles are effective for catalytic CO2 reduction. However, CO, one of the most important products in the CO2 reduction sequence, has strong affinity for the Pd surface and poisons the catalytic sites rapidly. In this research, an electrodeposited Pd film exhibits high activity for CO2 reduction to formate with the suppression of CO formation at low overpotentials. The substrates, electrodeposition process and the post-treatment of the Pd films affect the CO2 reduction pathway significantly. The cyclic voltammetry deposition produces films that exhibit more porous morphologies and have higher current efficiencies for formate than those of films produced at constant potential. These films show stable CO2 reduction performance at low overpotentials and have high current efficiencies (≈50-60 % depending on the substrate) for formate formation at a potential of -0.4 V versus the reversible hydrogen electrode without any detectable CO formation. It seems that the Pd surface generated by the new electrodeposition process described here produces a nanostructure that can promote formate formation and suppress CO formation.

Structure and Chemical Durability of Lead Crystal Glass.

Silicate glasses containing lead, also called lead crystal glasses, are commonly used as food product containers, in particular for alcoholic beverages. Lead's health hazards require major attention, which can first be investigated through the understanding of Pb release mechanisms in solution. The behavior of a commercial crystal glass containing 10.6 mol % of PbO (28.3 wt %) was studied in a reference solution of 4% acetic acid at 22, 40, and 70 °C at early and advanced stages of reaction. High-resolution solid-state 17O and 29Si NMR was used to probe the local structure of the pristine and, for the first time, of the altered lead crystal glass. Inserted into the vitreous structure between the network formers as Si-O-Pb bonds, Pb does not form Pb-O-Pb clusters which are expected to be more easily leached. A part of K is located near Pb, forming mixed Si-O-(Pb,K) near the nonbridging oxygens. Pb is always released into the solution following a diffusion-controlled dissolution over various periods of time, at a rate between 1 and 2 orders of magnitude lower than the alkalis (K and Na). The preferential release of alkalis is followed by an in situ repolymerization of the silicate network. Pb is only depleted in the outermost part of the alteration layer. In the remaining part, it stays mainly surrounded by Si in a stable structural configuration similar to that of the pristine glass. A simple model is proposed to estimate the Pb concentration as a function of glass surface, solution volume, temperature, and contact time.

Origin and consequences of silicate glass passivation by surface layers.

Silicate glasses are durable materials, but are they sufficiently durable to confine highly radioactive wastes for hundreds of thousands years? Addressing this question requires a thorough understanding of the mechanisms underpinning aqueous corrosion of these materials. Here we show that in silica-saturated solution, a model glass of nuclear interest corrodes but at a rate that dramatically drops as a passivating layer forms. Water ingress into the glass, leading to the congruent release of mobile elements (B, Na and Ca), is followed by in situ repolymerization of the silicate network. This material is at equilibrium with pore and bulk solutions, and acts as a molecular sieve with a cutoff below 1 nm. The low corrosion rate resulting from the formation of this stable passivating layer enables the objective of durability to be met, while progress in the fundamental understanding of corrosion unlocks the potential for optimizing the design of nuclear glass-geological disposal.

Multiporphyrin arrays with π-π interchromophore interactions.

A recently reported synthetic method has been employed to prepare several arrays of free base and zinc porphyrins. In the arrays, the porphyrins are arranged around a central benzene ring. The lack of aryl rings in the linkages to the central benzene ring, coupled with the presence of only one meso-aryl substituent on each porphyrin, allows strong electronic interactions between the porphyrin macrocycles. In arrays containing two or six porphyrins, a variety of evidence indicates that the porphyrins exist as twist-stacked dimers reminiscent of the special pairs of bacteriochlorophylls found in some photosynthetic bacteria. These dimers feature van der Waals contact between the macrocycles, and demonstrate excitonic splitting due to π-π interactions. The excitonic effects split and blue-shift the Soret absorptions, and slightly broaden the Q-band absorptions and shift them to longer wavelengths. The interactions also lower the first oxidation potentials by ca. 100 mV, and the arrays show evidence for delocalization of the radical cation over both porphyrins in the dimer. The arrays demonstrate singlet-singlet energy transfer among the chromophores. Arrays of this type will be good models for some aspects of the interactions of photosynthetic pigments, including those of reaction center special pairs and possibly quantum coherence effects. They can also be useful in artificial photosynthetic constructs.

Boron-capped tris(glyoximato) cobalt clathrochelate as a precursor for the electrodeposition of nanoparticles catalyzing H2 evolution in water.

Electrochemical investigation of a boron-capped tris(glyoximato)cobalt clathrochelate complex in the presence of acid reveals that the catalytic activity toward hydrogen evolution results from an electrodeposition of cobalt-containing nanoparticles on the electrode surface at a modest cathodic potential. The deposited particles act as remarkably active catalysts for H(2) production in water at pH 7.

Force transmission in migrating cells.

During cell migration, forces generated by the actin cytoskeleton are transmitted through adhesion complexes to the substrate. To investigate the mechanism of force generation and transmission, we analyzed the relationship between actin network velocity and traction forces at the substrate in a model system of persistently migrating fish epidermal keratocytes. Front and lateral sides of the cell exhibited much stronger coupling between actin motion and traction forces than the trailing cell body. Further analysis of the traction-velocity relationship suggested that the force transmission mechanisms were different in different cell regions: at the front, traction was generated by a gripping of the actin network to the substrate, whereas at the sides and back, it was produced by the network's slipping over the substrate. Treatment with inhibitors of the actin-myosin system demonstrated that the cell body translocation could be powered by either of the two different processes, actomyosin contraction or actin assembly, with the former associated with significantly larger traction forces than the latter.

Actin-myosin viscoelastic flow in the keratocyte lamellipod.

The lamellipod, the locomotory region of migratory cells, is shaped by the balance of protrusion and contraction. The latter is the result of myosin-generated centripetal flow of the viscoelastic actin network. Recently, quantitative flow data was obtained, yet there is no detailed theory explaining the flow in a realistic geometry. We introduce models of viscoelastic actin mechanics and myosin transport and solve the model equations numerically for the flat, fan-shaped lamellipodial domain of keratocytes. The solutions demonstrate that in the rapidly crawling cell, myosin concentrates at the rear boundary and pulls the actin network inward, so the centripetal actin flow is very slow at the front, and faster at the rear and at the sides. The computed flow and respective traction forces compare well with the experimental data. We also calculate the graded protrusion at the cell boundary necessary to maintain the cell shape and make a number of other testable predictions. We discuss model implications for the cell shape, speed, and bi-stability.