Characterization of Human Disease Phenotypes Associated with Mutations in TREX1, RNASEH2A, RNASEH2B, RNASEH2C, SAMHD1, ADAR, and IFIH1

Aicardi-Goutieres syndrome is an inflammatory disease occurring due to mutations in any of TREX1, RNASEH2A, RNASEH2B, RNASEH2C, SAMHD1, ADAR or IFIH1. We report on 374 patients from 299 families with mutations in these seven genes. Most patients conformed to one of two fairly stereotyped clinical profiles; either exhibiting an in utero disease-onset (74 patients; 22.8% of all patients where data were available), or a post-natal presentation, usually within the first year of life (223 patients; 68.6%), characterized by a sub-acute encephalopathy and a loss of previously acquired skills. Other clinically distinct phenotypes were also observed; particularly, bilateral striatal necrosis (13 patients; 3.6%) and non-syndromic spastic paraparesis (12 patients; 3.4%). We recorded 69 deaths (19.3% of patients with follow-up data). Of 285 patients for whom data were available, 210 (73.7%) were profoundly disabled, with no useful motor, speech and intellectual function. Chilblains, glaucoma, hypothyroidism, cardiomyopathy, intracerebral vasculitis, peripheral neuropathy, bowel inflammation and systemic lupus erythematosus were seen frequently enough to be confirmed as real associations with the Aicardi-Goutieres syndrome phenotype. We observed a robust relationship between mutations in all seven genes with increased type I interferon activity in cerebrospinal fluid and serum, and the increased expression of interferon-stimulated gene transcripts in peripheral blood. We recorded a positive correlation between the level of cerebrospinal fluid interferon activity assayed within one year of disease presentation and the degree of subsequent disability. Interferon-stimulated gene transcripts remained high in most patients, indicating an ongoing disease process. On the basis of substantial morbidity and mortality, our data highlight the urgent need to define coherent treatment strategies for the phenotypes associated with mutations in the Aicardi-Goutieres syndrome-related genes. Our findings also make it clear that a window of therapeutic opportunity exists relevant to the majority of affected patients and indicate that the assessment of type I interferon activity might serve as a useful biomarker in future clinical trials

Clinical and Molecular Phenotype of Aicardi-Goutières Syndrome

Aicardi-Goutières syndrome (AGS) is a genetic encephalopathy whose clinical features mimic those of acquired in utero viral infection. AGS exhibits locus heterogeneity, with mutations identified in genes encoding the 3′→5′ exonuclease TREX1 and the three subunits of the RNASEH2 endonuclease complex. To define the molecular spectrum of AGS, we performed mutation screening in patients, from 127 pedigrees, with a clinical diagnosis of the disease. Biallelic mutations in TREX1, RNASEH2A, RNASEH2B, and RNASEH2C were observed in 31, 3, 47, and 18 families, respectively. In five families, we identified an RNASEH2A or RNASEH2B mutation on one allele only. In one child, the disease occurred because of a de novo heterozygous TREX1 mutation. In 22 families, no mutations were found. Null mutations were common in TREX1, although a specific missense mutation was observed frequently in patients from northern Europe. Almost all mutations in RNASEH2A, RNASEH2B, and RNASEH2C were missense. We identified an RNASEH2C founder mutation in 13 Pakistani families. We also collected clinical data from 123 mutation-positive patients. Two clinical presentations could be delineated: an early-onset neonatal form, highly reminiscent of congenital infection seen particularly with TREX1 mutations, and a later-onset presentation, sometimes occurring after several months of normal development and occasionally associated with remarkably preserved neurological function, most frequently due to RNASEH2B mutations. Mortality was correlated with genotype; 34.3% of patients with TREX1, RNASEH2A, and RNASEH2C mutations versus 8.0% RNASEH2B mutation–positive patients were known to have died (P=.001). Our analysis defines the phenotypic spectrum of AGS and suggests a coherent mutation-screening strategy in this heterogeneous disorder. Additionally, our data indicate that at least one further AGS-causing gene remains to be identified

Erratum to: The Intensive Care Global Study on Severe Acute Respiratory Infection (ICâGLOSSARI): a multicenter, multinational, 14-day inception cohort study (Intensive Care Medicine, (2016), 42, 5, (953), 10.1007/s00134-016-4317-4)

In both the original publication (DOI 10.1007/s00134-015-4206-2) and the first erratum (DOI 10.1007/s00134-016-4317-4), the members of the IC-GLOSSARI Investigators and the ESICM Trials Group were provided in such a way that they could not be indexed as collaborators on PubMed. The publisher apologizes for these errors and is pleased to list the members of the groups here: (Table presented.)

Sähkönlaadun ja energiankulutuksen tutkimus

Opinnäytetyössä tutkitaan sähkönlaadun ja energiankulutusta Raute Oyj:n rakentamissa vaneri- ja LVL-viilupalkkikoneissa. Opinnäytetyön tarkoituksena on selvittää esiintyykö Raute Oyj:n valmistamissa koneissa sähkönlaatua heikentäviä tekijöitä, kuten harmonisia yliaaltoja. Sähkönlaatua heikentävien tekijöiden lisäksi opinnäytetyössä selvitetään mahdollisuutta moottorikeskusten mitoituksessa käytettävän korjauskertoimen tarkentamiselle. Opinnäytetyön teoriaosassa esitellään sähkönlaatuun vaikuttavia tekijöitä, sekä niiden vaikutuksia sähköverkkoon ja verkonkäyttäjälle. Lisäksi teoriaosassa käydään läpi ratkaisuja, joilla esimerkiksi sähköverkossa esiintyvien yliaaltojen pitoisuutta voidaan vähentää tai poistaa kokonaan. Verkossa esiintyville häiriöille kuten harmonisille yliaalloille, taajuuden ja jännitteen vaihteluille on määritelty rajoituksia standardilla SFS-EN 50160, myös näitä rajoituksia ja niiden vaikutuksia sähkönlaatuun käydään läpi opinnäytetyön teoriaosassa. Sähkönlaatua ja energiankulutusta mitattiin kahdessa Raute Oyj:n koneessa, ja näiden mittaukseen käytettiin Fluken power quality analyzer mallia olevaa mittalaitetta. Mittaustuloksissa huomattiin sähkönlaadun olevan yleisesti hyvällä tasolla ja täyttävän standardissa SFS-EN 50160 sähkönlaadulle määritellyt raja-arvot. Tulosten perusteella huomattiin myös, että joissakin tapauksissa keskusten mitoituksessa käytettäviä korjauskertoimia pystyy tarkentamaan.The study researches the quality of electricity and the energy consumption on plywood and laminated veneer lumber (LVL) machines manufactured by Raute Plc. The Thesis aims to examine the potential existence of factors reducing the quality of electric, such as harmonic waves, on machines manufactured by Raute Plc. In addition to examine the electricity quality and consumption of energy, the thesis looks into the possibility of elaboration of motorcabin’s equalisation. The theory part of the Thesis presents factors that influence electric quality, as well as their influences on the electricity network and network’s users. Additionally, the theory part discusses solutions, which for instance reduce or eliminate harmonic waves in electric network. SFS-EN 50160 standard defines restrictions for disturbance in electric network such as harmonic waves, frequency and voltage variation, these restrictions are also presented in the theory part of the Thesis. In this study, electric quality and energy consumption were measured in two different machines manufactured by Raute Plc, and the measurements were conducted by Fluke power quality analyser measuring device. Electric quality was generally high according to the measurements, and it meets the electric quality standards defined in SFS-EN 50160. The measurements also indicated that in some cases the equalisation is possible to elaborate