162 research outputs found
Abnormal hyperventilation in patients with hepatic cirrhosis: Role of enhanced chemosensitivity to carbon dioxide
BACKGROUND: Patients with hepatic cirrhosis frequently show idiopathic
hyperventilation at rest, despite no concomitant cardiopulmonary disease. The aim
of the study was to determine whether altered chemosensitivity either to hypoxia
or hypercapnia could underlie inappropriate hyperventilation in cirrhotic
patients. METHODS: We consecutively recruited 30 biopsy proven cirrhotic patients
equally distributed in the three Child's classes A, B and C (age 54±8years,
mean±SD). All patients underwent evaluation of chemosensitivity to hypoxia and to
hypercapnia and blood sampling for brain natriuretic peptide, norepinephrine and
progesterone, besides full clinical characterization. We also recruited 10 age-
and gender-matched healthy controls (age 55±7years). RESULTS: Overall, 18
patients (60%) showed an increased chemosensitivity to carbon dioxide (CO(2)),
while 8 patients (27%) showed enhanced chemosensitivity to hypoxia. Child's class
C patients had lower arterial partial pressure of CO(2) (PaCO(2)), higher rest
ventilation, increased chemosensitivity to hypercapnia, plasma level of
norepinephrine and serum progesterone levels when compared to class A patients
and controls (all p<0.05). Rest ventilation was positively related to pH (R=0.41,
p=0.023), chemosensitivity to hypercapnia (R=0.54, p=0.002), and progesterone
(R=0.53, p=0.016) and negatively to PaCO(2) (R=0.61, p<0.001), but not to
hemoglobin level and chemosensitivity to hypoxia. Chemosensitivity to hypercapnia
was positively related to PaCO(2) (R=0.74, p<0.001), serum progesterone (R=0.50,
p=0.016), and to plasma norepinephrine (R=0.57, p=0.004). CONCLUSIONS: Enhanced
chemosensitivity to hypercapnia was found in more decompensated cirrhotic
patients and was associated with sympathetic overactivity and elevated serum
progesterone, likely representing a key mechanism underlying the "unexplained"
hyperventilation observed in such patients
2P15-p16.1 microdeletions encompassing and proximal to BCL11A are associated with elevated HbF in addition to neurologic impairment
Elevated fetal hemoglobin (HbF) ameliorates the clinical severity of hemoglobinopathies such as β-thalassemia and sickle cell anemia. Currently, the only curative approach for individuals under chronic transfusion/chelation support therapy is allogeneic stem cell transplantation. However, recent analyses of heritable variations in HbF levels have provided a new therapeutic target for HbF reactivation: the transcriptional repressor BCL11A. Erythroid-specific BCL11A abrogation is now actively being sought as a therapeutic avenue, but the specific impact of such disruption in humans remains to be determined. Although single nucleotide polymorphisms in BCL11A erythroid regulatory elements have been reported, coding mutations are scarcer. It is thus of great interest that patients have recently been described with microdeletions encompassing BCL11A. These patients display neurodevelopmental abnormalities, but whether they show increased HbF has not been reported. We have examined the hematological phenotype, HbF levels, and erythroid BCL11A expression in 3 such patients. Haploinsufficiency of BCL11A induces only partial developmental g-globin silencing. Of greater interest is that a patient with a downstream deletion exhibits reduced BCL11A expression and increased HbF. Novel erythroid-specific regulatory elements in this region may be required for normal erythroid BCL11A expression, whereas loss of separate elements in the developing brain may explain the neurological phenotype
The calculation of the cardiac troponin T 99th percentile of the reference population is affected by age, gender, and population selection: A multicenter study in Italy.
Background: The aim of this study is to determine the 99th upper-reference limit (URL) for cardiac troponin
T (cTnT) in Italian apparently healthy subjects.
Methods: The reference population was selected from 5 cities: Bolzano (n = 290), Milano (CAMELIA-Study,
n = 287), Montignoso (MEHLP-Study, n = 306), Pisa (n = 182), and Reggio Calabria (MAREA-Study, n = 535).
Subjects having cardiac/systemic acute/chronic diseases were excluded. Participants to MEHLP project
underwent cardiac imaging investigation. High-sensitive cTnT was measured with Cobas-e411 (Roche
Diagnostics).
Results: We enrolled 1600 healthy subjects [54.6%males; age range 10–90 years; mean (SD): 36.4 (21.2) years],
including 34.6% aged b20 years, 54.5% between 20 and 64 years, and 10.9% over 65 years. In the youngest the
99th URL was 10.9 ng/L in males and 6.8 ng/L in females; in adults 23.2 ng/L and 10.2 ng/L; and in elderly
36.8 ng/L and 28.6 ng/L. After the exclusion of outliers the 99th URL values were significantly decreased
(P b 0.05) in particular those of the oldest (13.8 ng/L and 14 ng/L). MEHLP participants were divided in healthy
and asymptomatic, according to known cardiovascular risk factors (HDL, LDL, glucose, C-reactive protein): the
99th URL of cTnT values of these subgroups was significantly different (19.5 vs. 22.7, P b 0.05).
Conclusions: 99th URL of cTnT valueswas strongly affected by age, gender, selection of subjects and the statistical
evaluation of outliers
Novel mutations in the WFS1 gene are associated with Wolfram syndrome and systemic inflammation
Mutations in the WFS1 gene, encoding wolframin (WFS1), cause endoplasmic reticulum (ER) stress and are associated with a rare autosomal-recessive disorder known as Wolfram syndrome (WS). WS is clinically characterized by childhood-onset diabetes mellitus, optic atrophy, deafness, diabetes insipidus and neurological signs. We identified two novel WFS1 mutations in a patient with WS, namely, c.316-1G > A (in intron 3) and c.757A > T (in exon 7). Both mutations, located in the N-terminal region of the protein, were predicted to generate a truncated and inactive form of WFS1. We found that although the WFS1 protein was not expressed in peripheral blood mononuclear cells (PBMCs) of the proband, no constitutive ER stress activation could be detected in those cells. In contrast, WS proband's PBMCs produced very high levels of proinflammatory cytokines (i.e. TNF-α, IL-1β, and IL-6) in the absence of any stimulus. WFS1 silencing in PBMCs from control subjects by means of small RNA interference also induced a pronounced proinflammatory cytokine profile. The same cytokines were also significantly higher in sera from the WS patient as compared to matched healthy controls. Moreover, the chronic inflammatory state was associated with a dominance of proinflammatory T helper 17 (Th17)-type cells over regulatory T (Treg) lymphocytes in the WS PBMCs. The identification of a state of systemic chronic inflammation associated with WFS1 deficiency may pave the way to innovative and personalized therapeutic interventions in WS
State of the art of immunoassay methods for B-type natriuretic peptides: An update
The aim of this review article is to give an update on the state of the art of the immunoassay
methods for the measurement of B-type natriuretic peptide (BNP) and its related peptides.
Using chromatographic procedures, several studies reported an increasing number of
circulating peptides related to BNP in human plasma of patients with heart failure. These
peptides may have reduced or even no biological activity. Furthermore, other studies have
suggested that, using immunoassays that are considered specific for BNP, the precursor of the
peptide hormone, proBNP, constitutes a major portion of the peptide measured in plasma of
patients with heart failure. Because BNP immunoassay methods show large (up to 50%)
systematic differences in values, the use of identical decision values for all immunoassay
methods, as suggested by the most recent international guidelines, seems unreasonable. Since
proBNP significantly cross-reacts with all commercial immunoassay methods considered
specific for BNP, manufacturers should test and clearly declare the degree of cross-reactivity of
glycosylated and non-glycosylated proBNP in their BNP immunoassay methods. Clinicians
should take into account that there are large systematic differences between methods when
they compare results from different laboratories that use different BNP immunoassays. On the
other hand, clinical laboratories should take part in external quality assessment (EQA) programs
to evaluate the bias of their method in comparison to other BNP methods. Finally, the authors
believe that the development of more specific methods for the active peptide, BNP1–32, should
reduce the systematic differences between methods and result in better harmonization of
results
Mutation spectrum of MLL2 in a cohort of kabuki syndrome patients
ABSTRACT: BACKGROUND: Kabuki syndrome (Niikawa-Kuroki syndrome) is a rare, multiple congenital anomalies/mental retardation syndrome characterized by a peculiar face, short stature, skeletal, visceral and dermatoglyphic abnormalities, cardiac anomalies, and immunological defects. Recently mutations in the histone methyl transferase MLL2 gene have been identified as its underlying cause. METHODS: Genomic DNAs were extracted from 62 index patients clinically diagnosed as affected by Kabuki syndrome. Sanger sequencing was performed to analyze the whole coding region of the MLL2 gene including intron-exon junctions. The putative causal and possible functional effect of each nucleotide variant identified was estimated by in silico prediction tools. RESULTS: We identified 45 patients with MLL2 nucleotide variants. 38 out of the 42 variants were never described before. Consistently with previous reports, the majority are nonsense or frameshift mutations predicted to generate a truncated polypeptide. We also identified 3 indel, 7 missense and 3 splice site. CONCLUSIONS: This study emphasizes the relevance of mutational screening of the MLL2 gene among patients diagnosed with Kabuki syndrome. The identification of a large spectrum of MLL2 mutations possibly offers the opportunity to improve the actual knowledge on the clinical basis of this multiple congenital anomalies/mental retardation syndrome, design functional studies to understand the molecular mechanisms underlying this disease, establish genotype-phenotype correlations and improve clinical management
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