Approccio globale alle mucopolisaccaridosi: applicazione di metodi altamente specifici per la diagnosi neonatale: risultati preliminari su campione di urina

Scopo dello studio Le Mucopolisaccaridosi (MPS) sono patologie multisistemiche ed invalidanti ad alto grado di mortalit\ue0 e morbidit\ue0, spesso diagnosticate in ritardo quando si sono gi\ue0 verificati danni irreversibili agli organi. Una diagnosi precoce ed accurata risulta quindi importante per la consulenza genetica alla famiglia e per ottimizzare le terapie che risultano pi\uf9 efficaci se attuate sin dalle prime settimane di vita del neonato, anche in assenza di un\u2019evidente sintomatologia. Obiettivo dello studio \ue8 quello di individuare marker affidabili, in grado di identificare diverse forme di MPS in una singola analisi. Campioni di sangue su spot (DBS) saranno analizzati attraverso una tecnica HPLC per la determinazione quantitativa e qualitativa dei disaccaridi che compongono i GAG, dopo il trattamento con enzimi specifici. Come controllo, i campioni di urine degli stessi soggetti verranno analizzati attraverso metodi standard: il saggio al colorante DMB e l\u2019elettroforesi su acetato di cellulosa. Vengono qui presentati i risultati della valutazione quantitativa e qualitativa dei GAG urinari. Metodi utilizzati Sono stati raccolti campioni di urina da 450 neonati sani a termine, dal 3\ub0 al 5\ub0 giorno di vita. La determinazione quantitativa dei GAG urinari totali \ue8 stata condotta mediante DMB test ed elettroforesi su acetato di cellulosa per identificare il pattern dei GAG escreti. Risultati La valutazione quantitativa dei GAG totali, con un valore medio di 227 \ub1 91 \ub5g GAG/mg di creatinina, ha messo in evidenza quantit\ue0 di GAG superiori (>50%) rispetto al valore medio di riferimento (114 \ub1 57 \ub5g GAG/mg di creatinina nella fascia di et\ue0 0-1 anno). Tutti i soggetti finora analizzati hanno mostrato all\u2019elettroforesi un pattern qualitativo normale rispetto ai patologici utilizzati come controllo. Conclusioni Lo studio si inserisce nell\u2019ambito di un progetto multicentrico triennale e fornir\ue0 un\u2019analisi di distribuzione dei valori normali dei GAG urinari nei primi giorni di vita, una valutazione dell\u2019affidabilit\ue0 del nuovo metodo per la determinazione dei disaccaridi su DBS e una stima della sua applicabilit\ue0. Ricerca in parte finanziata con fondi Progetto PRIN 201

A cohort study of reproductive and hormonal factors and renal cell cancer risk in women

We examined the association of reproductive and hormonal factors with renal cell cancer risk in a cohort study of 89 835 Canadian women. Compared with nulliparous women, parous women were at increased risk (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.02–3.09), and there was a significant gradient of risk with increasing levels of parity: relative to nulliparous women, women who had X5 pregnancies lasting 4 months or more had a 2.4-fold risk (HR 1⁄4 2.41, 95% CI 1⁄4 1.27–4.59, P for trend 0.01). Ever use of oral contraceptives was associated with a modest reduction in risk. No associations were observed for age at first live birth or use of hormone replacement therapy. The present study provides evidence that high parity may be associated with increased risk of renal cell cancer, and that oral contraceptive use may be associated with reduced risk

Delphi consensus on the current clinical and therapeutic knowledge on Anderson-Fabry disease

BACKGROUND: Management of Anderson-Fabry disease (AFD) is contentious, particularly regarding enzyme replacement therapy (ERT). We report results of a Delphi consensus panel on AFD management. METHODS: A survey to gauge consensus among AFD experts was distributed online and responses were analysed. Statements on: 1) diagnosis; 2) when starting ERT; 3) management of ERT infusion and adverse reactions; and 4) follow-up/monitoring response to therapy and progression of disease were included. Responses without consensus were discussed with an enlarged panel and modified to reach consensus. RESULTS: 15 experts responded to the survey. After plenary discussion among the enlarged panel, consensus was reached on most statements. Key points were the use of a target organ biopsy to show Gb3 deposits in symptomatic women with negative molecular analysis, the need for ERT in symptomatic women and in all patients with persistent signs and symptoms±organ damage. It was agreed to assess vital signs before ERT administration and use a 0.2μL filter on infusion to reduce the risk of adverse reactions, that serum should be drawn prior to the first infusion for anti-agalsidase antibody analysis to have a baseline value if a subsequent adverse reaction appears, and that pre-medication is required in those with prior infusion reactions. Holter ECG monitoring, cardiac and brain MRI, renal parameters, and abdominal ultrasound were considered important for the assessment of disease progression and response at ERT. CONCLUSIONS: This consensus supplies guidance to healthcare providers on best practice in the management of patients with AFD and indicates a need for more guidanc

Big issues for small feet : developmental, biomechanical and clinical narratives on children's footwear

The effects of footwear on the development of children's feet has been debated for many years and recent work from the developmental and biomechanical literature has challenged long-held views about footwear and the impact on foot development. This narrative review draws upon existing studies from developmental, biomechanical and clinical literature to explore the effects of footwear on the development of the foot. The emerging findings from this support the need for progress in [children's] footwear science and advance understanding of the interaction between the foot and shoe. Ensuring clear and credible messages inform practice requires a progressive evidence base but this remains big issue in children's footwear research

Large scale multifactorial likelihood quantitative analysis of BRCA1 and BRCA2 variants: An ENIGMA resource to support clinical variant classification

The multifactorial likelihood analysis method has demonstrated utility for quantitative assessment of variant pathogenicity for multiple cancer syndrome genes. Independent data types currently incorporated in the model for assessing BRCA1 and BRCA2 variants include clinically calibrated prior probability of pathogenicity based on variant location and bioinformatic prediction of variant effect, co-segregation, family cancer history profile, co-occurrence with a pathogenic variant in the same gene, breast tumor pathology, and case-control information. Research and clinical data for multifactorial likelihood analysis were collated for 1,395 BRCA1/2 predominantly intronic and missense variants, enabling classification based on posterior probability of pathogenicity for 734 variants: 447 variants were classified as (likely) benign, and 94 as (likely) pathogenic; and 248 classifications were new or considerably altered relative to ClinVar submissions. Classifications were compared with information not yet included in the likelihood model, and evidence strengths aligned to those recommended for ACMG/AMP classification codes. Altered mRNA splicing or function relative to known nonpathogenic variant controls were moderately to strongly predictive of variant pathogenicity. Variant absence in population datasets provided supporting evidence for variant pathogenicity. These findings have direct relevance for BRCA1 and BRCA2 variant evaluation, and justify the need for gene-specific calibration of evidence types used for variant classification

Effectiveness and Safety of rhIGF-1 Therapy in Children: The European Increlex® Growth Forum Database Experience.

BACKGROUND/AIMS: We report data from the EU Increlex® Growth Forum Database (IGFD) Registry, an ongoing, open-label, observational study monitoring clinical practice use of recombinant human insulin-like growth factor-1 (rhIGF-1) therapy in children. METHODS: Safety and effectiveness data on rhIGF-1 treatment of 195 enrolled children with growth failure were collected from December 2008 to September 2013. RESULTS: Mean ± SD (95% CI) height velocity during first year of rhIGF-1 treatment was 6.9 ± 2.2 cm/year (6.5; 7.2) (n = 144); in prepubertal patients naïve to treatment, this was 7.3 ± 2.0 cm/year (6.8; 7.7) (n = 81). Female sex, younger age at start of rhIGF-1 therapy, and lower baseline height SDS predicted first-year change in height SDS. The most frequent targeted treatment-emergent adverse events (% patients) were hypoglycemia (17.6%, predictors: young age, diagnosis of Laron syndrome, but not rhIGF-1 dose), lipohypertrophy (10.6%), tonsillar hypertrophy (7.4%), injection site reactions (6.4%), and headache (5.9%). Sixty-one serious adverse events (37 related to rhIGF-1 therapy) were reported in 31 patients (16.5%). CONCLUSION: Safety and effectiveness data on use of rhIGF-1 in a 'real-world' setting were similar to those from controlled randomized trials. Severe growth phenotype and early start of rhIGF-1 improved height response and predicted risk of hypoglycemia

Large scale multifactorial likelihood quantitative analysis of BRCA1 and BRCA2 variants: An ENIGMA resource to support clinical variant classification

Abstract The multifactorial likelihood analysis method has demonstrated utility for quantitative assessment of variant pathogenicity for multiple cancer syndrome genes. Independent data types currently incorporated in the model for assessing BRCA1 and BRCA2 variants include clinically calibrated prior probability of pathogenicity based on variant location and bioinformatic prediction of variant effect, co-segregation, family cancer history profile, co-occurrence with a pathogenic variant in the same gene, breast tumor pathology, and case-control information. Research and clinical data for multifactorial likelihood analysis were collated for 1395 BRCA1/2 predominantly intronic and missense variants, enabling classification based on posterior probability of pathogenicity for 734 variants: 447 variants were classified as (likely) benign, and 94 as (likely) pathogenic; 248 classifications were new or considerably altered relative to ClinVar submissions. Classifications were compared to information not yet included in the likelihood model, and evidence strengths aligned to those recommended for ACMG/AMP classification codes. Altered mRNA splicing or function relative to known non-pathogenic variant controls were moderately to strongly predictive of variant pathogenicity. Variant absence in population datasets provided supporting evidence for variant pathogenicity. These findings have direct relevance for BRCA1 and BRCA2 variant evaluation, and justify the need for gene-specific calibration of evidence types used for variant classification. This article is protected by copyright. All rights reserved.Peer reviewe

Ring chromosome 10 (p15q26) in a patient with unipolar affective disorder, multiple minor anomalies, and mental retardation

For several psychiatric diseases such as schizophrenia and autism, an involvement of genes in genesis of the illness has been suggested. Many studies have reported an association between chromosomal abnormalities and psychiatric disorders. Recently linkage studies have been conducted in families with mood disorders and although no gene has yet been identified, regions of interest of several chromosomes have been identified. We report on a patient with ring chromosome 10 (p15q26) presenting with mild dysmorphic features, moderate mental retardation, and an unipolar affective disorder. Extensive fluorescence in situ hybridization (FISH) experiments were performed to locate the breakpoints on ring chromosome 10. This study suggests the possibility of a correlation between a mood disorder and deletion on chromosome 10 q26