Duplications of the critical Rubinstein-Taybi deletion region on chromosome 16p13.3 cause a novel recognisable syndrome

Background The introduction of molecular karyotyping technologies facilitated the identification of specific genetic disorders associated with imbalances of certain genomic regions. A detailed phenotypic delineation of interstitial 16p13.3 duplications is hampered by the scarcity of such patients. Objectives To delineate the phenotypic spectrum associated with interstitial 16p13.3 duplications, and perform a genotype-phenotype analysis. Results The present report describes the genotypic and phenotypic delineation of nine submicroscopic interstitial 16p13.3 duplications. The critically duplicated region encompasses a single gene, CREBBP, which is mutated or deleted in Rubinstein-Taybi syndrome. In 10 out of the 12 hitherto described probands, the duplication arose de novo. Conclusions Interstitial 16p13.3 duplications have a recognizable phenotype, characterized by normal to moderately retarded mental development, normal growth, mild arthrogryposis, frequently small and proximally implanted thumbs and characteristic facial features. Occasionally, developmental defects of the heart, genitalia, palate or the eyes are observed. The frequent de novo occurrence of 16p13.3 duplications demonstrates the reduced reproductive fitness associated with this genotype. Inheritance of the duplication from a clinically normal parent in two cases indicates that the associated phenotype is incompletely penetrant

Le confessioni religiose tra libertà di vivere nella realtà dell'ordinamento statale e potere di creare norme giuridiche all'interno dello Stato. Il caso della Chiesa di Scientology.

L'A. si pone nella prospettiva di delineare il possibile significato della compresenza delle due distinte previsioni, l’una nell’art. 8, l’altra nell’art. 19 della Costituzione, a garanzia del fenomeno associativo religioso. La ricerca è stata redatta, fra l’altro, in considerazione della circostanza che, ad una prima sommaria lettura della Carta Costituzionale, il lettore potrebbe essere indotto a pensare che il fenomeno religioso, ed in particolare quello che si svolge in forma associata, goda di una maggiore preferenza, rispetto a quello che si esprime in forma individuale, per essere più volte disciplinato in Costituzione. Problema, questo, il quale non sembra abbia sinora ricevuto adeguato rilievo dalla dottrina ecclesiasticista che si è meritevolmente impegnata sul tema. Si è posto al riguardo l’interrogativo che nasce dalla presenza di due distinte previsioni costituzionali a garanzia del fenomeno associativo religioso: la prima contenuta nell’art. 8 il quale - com’è noto - regola con novità di linguaggio la posizione dei culti diversi dalla religione cattolica, garantisce alle confessioni religiose l’eguale libertà davanti alla legge, il diritto di organizzarsi secondo i propri statuti ed il potere di concludere intese con gli organi dello Stato; la seconda nell’art. 19 che riconosce la libertà di professare liberamente la propria fede religiosa in qualsiasi forma “individuale o associata”. In ordine ai numerosi problemi che la previsione costituzionale dell’art. 8 solleva, si è riflettuto soprattutto sul dubbio se la fattispecie in essa contemplata sia sostanzialmente ripetitiva e si risolva in un inutile duplicato di quanto disposto dall’art. 19 per la parte che riguarda tale aspetto, oppure se, con ciascuna di tali disposizioni, il legislatore costituzionale abbia voluto conferire uno specifico rilievo a due distinte sfere dell’esperienza giuridica con caratteristiche proprie, per struttura e sistemi di garanzie. L’analisi intrapresa ha interessato anche la ricostruzione della definizione giuridica di confessione religiosa, nonché l’accertamento del carattere confessionale della Chiesa di Scientology alla luce delle sentenze della giurisprudenza costituzionale e di legittimità

Genotype-phenotype correlation of 2q37 deletions including NPPC gene associated with skeletal malformations

Coordinated bone growth is controlled by numerous mechanisms which are only partially understood because of the involvement of many hormones and local regulators. The C-type Natriuretic Peptide (CNP), encoded by NPPC gene located on chromosome 2q37.1, is a molecule that regulates endochondral ossification of the cartilaginous growth plate and influences longitudinal bone growth. Two independent studies have described three patients with a Marfan-like phenotype presenting a de novo balanced translocation involving the same chromosomal region 2q37.1 and overexpression of NPPC. We report on two partially overlapping interstitial 2q37 deletions identified by array CGH. The two patients showed opposite phenotypes characterized by short stature and skeletal overgrowth, respectively. The patient with short stature presented a 2q37 deletion causing the loss of one copy of the NPPC gene and the truncation of the DIS3L2 gene with normal CNP plasma concentration. The deletion identified in the patient with a Marfan-like phenotype interrupted the DIS3L2 gene without involving the NPPC gene. In addition, a strongly elevated CNP plasma concentration was found in this patient. A possible role of NPPC as causative of the two opposite phenotypes is discussed in this study

Custom Array Comparative Genomic Hybridization: the Importance of DNA Quality, an Expert Eye, and Variant Validation.

The presence of false positive and false negative results in the Array Comparative Genomic Hybridization (aCGH) design is poorly addressed in literature reports. We took advantage of a custom aCGH recently carried out to analyze its design performance, the use of several Agilent aberrations detection algorithms, and the presence of false results. Our study provides a confirmation that the high density design does not generate more noise than standard designs and, might reach a good resolution. We noticed a not negligible presence of false negative and false positive results in the imbalances call performed by the Agilent software. The Aberration Detection Method 2 (ADM-2) algorithm with a threshold of 6 performed quite well, and the array design proved to be reliable, provided that some additional filters are applied, such as considering only intervals with average absolute log2ratio above 0.3. We also propose an additional filter that takes into account the proportion of probes with log2ratio exceeding suggestive values for gain or loss. In addition, the quality of samples was confirmed to be a crucial parameter. Finally, this work raises the importance of evaluating the samples profiles by eye and the necessity of validating the imbalances detected

Copy number variations in candidate genomic regions confirm genetic heterogeneity and parental bias in Hirschsprung disease

Background: Hirschsprung Disease (HSCR) is a congenital defect of the intestinal innervations characterized by complex inheritance. Many susceptibility genes including RET, the major HSCR gene, and several linked regions and associated loci have been shown to contribute to disease pathogenesis. Nonetheless, a proportion of patients still remains unexplained. Copy Number Variations (CNVs) have already been involved in HSCR, and for this reason we performed Comparative Genomic Hybridization (CGH), using a custom array with high density probes. Results: A total of 20 HSCR candidate regions/genes was tested in 55 sporadic patients and four patients with already known chromosomal aberrations. Among 83 calls, 12 variants were experimentally validated, three of which involving the HSCR crucial genes SEMA3A/3D, NRG1, and PHOX2B. Conversely RET involvement in HSCR does not seem to rely on the presence of CNVs while, interestingly, several gains and losses did co-occur with another RET defect, thus confirming that more than one predisposing event is necessary for HSCR to develop. New loci were also shown to be involved, such as ALDH1A2, already found to play a major role in the enteric nervous system. Finally, all the inherited CNVs were of maternal origin. Conclusions: Our results confirm a wide genetic heterogeneity in HSCR occurrence and support a role of candidate genes in expression regulation and cell signaling, thus contributing to depict further the molecular complexity of the genomic regions involved in the Enteric Nervous System development. The observed maternal transmission bias for HSCR associated CNVs supports the hypothesis that in females these variants might be more tolerated, requiring additional alterations to develop HSCR disease

Current and Emerging Radiotracers in Molecular Cardiovascular Imaging

Cardiovascular imaging has rapidly advanced over the past decades. Traditional imaging techniques such as echocardiography, computed tomography, and cardiovascular magnetic resonance are essential for assessing the structural and functional aspects of the cardiovascular system but often fall short in providing direct insights into disease activity. This gap is increasingly being bridged by molecular nuclear imaging techniques, including positron emission tomography and single-photon emission computed tomography, which enable the visualization of disease processes at the molecular and cellular levels. This review highlights the role of cardiovascular molecular imaging, emphasizing its current and potential applications in diagnosing and managing cardiovascular disease. With advancements in positron emission tomography scanners, novel radiotracers, and sophisticated imaging software, molecular imaging is set to play an essential role in precision medicine by enhancing our understanding of disease mechanisms, accelerating the development of targeted therapies, and facilitating personalized patient care.</p

Systematic review of cost-effectiveness of myocardial perfusion scintigraphy in patients with ischaemic heart disease

Coronary artery disease (CAD) is a major cause of death and disability. Several diagnostic tests, such as myocardial perfusion scintigraphy (MPS), are accurate for the detection of CAD, as well as having prognostic value for the prediction of cardiovascular events. Nevertheless, the diagnostic and prognostic value of these tests should be cost-effective and should lead to improved clinical outcome. We have reviewed the literature on the cost-effectiveness of MPS in different circumstances: (i) the diagnosis and management of CAD; (ii) comparison with exercise electrocardiography (ECG) and other imaging tests; (iii) as gatekeeper to invasive coronary angiography (ICA), (iv) the impact of appropriate use criteria; (v) acute chest pain, and (vi) screening of asymptomatic patients with type-2 diabetes. In total 57 reports were included. Although most non-invasive imaging tests are cost-effective compared with alternatives, the data conflict on which non-invasive strategy is the most cost-effective. Different definitions of cost-effectiveness further confound the subject. Computer simulations of clinical diagnosis and management are influenced by the assumptions made. For instance, diagnostic accuracy is often defined against an anatomical standard that is wrongly assumed to be perfect. Conflicting data arise most commonly from these incorrect or differing assumptions.</p

Haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril/valsartan

Aims: A novel tool for the evaluation of left ventricular (LV) systo-diastolic function through echo-derived haemodynamic forces (HDFs) has been recently proposed. The present study aimed to assess the predictive value of HDFs on (i) 6&nbsp;month treatment response to sacubitril/valsartan in heart failure with reduced ejection fraction (HFrEF) patients and (ii) cardiovascular events. Methods and results: Eighty-nine consecutive HFrEF patients [70% males, 65&nbsp;±&nbsp;9&nbsp;years, LV ejection fraction (LVEF) 27&nbsp;±&nbsp;7%] initiating sacubitril/valsartan underwent clinical, laboratory, ultrasound and cardiopulmonary exercise testing evaluations. Patients experiencing no adverse events and showing ≥50% reduction in plasma N-terminal pro-B-type natriuretic peptide and/or ≥10% LVEF increase over 6&nbsp;months were considered responders. Patients were followed up for the composite endpoint of HF-related hospitalisation, atrial fibrillation and cardiovascular death. Forty-five (51%) patients were responders. Among baseline variables, only HDF-derived whole cardiac cycle LV strength (wLVS) was higher in responders (4.4&nbsp;±&nbsp;1.3 vs. 3.6&nbsp;±&nbsp;1.2; p&nbsp;=&nbsp;0.01). wLVS was also the only independent predictor of sacubitril/valsartan response at multivariable logistic regression analysis [odds ratio 1.36; 95% confidence interval (CI) 1.10–1.67], with good accuracy at receiver operating characteristic (ROC) analysis [optimal cutpoint: ≥3.7%; area under the curve (AUC)&nbsp;=&nbsp;0.736]. During a 33&nbsp;month (23–41) median follow-up, a wLVS increase after 6&nbsp;months (ΔwLVS) showed a high discrimination ability at time-dependent ROC analysis (optimal cut-off: ≥0.5%; AUC&nbsp;=&nbsp;0.811), stratified prognosis (log-rank p&nbsp;&lt;&nbsp;0.0001) and remained an independent predictor for the composite endpoint (hazard ratio 0.76; 95% CI 0.61–0.95; p&nbsp;&lt;&nbsp;0.01), after adjusting for clinical and instrumental variables. Conclusions: HDF analysis predicts sacubitril/valsartan response and might optimise decision-making in HFrEF patients

The role of myocardial innervation imaging in different clinical scenarios: an expert document of the European Association of Cardiovascular Imaging and Cardiovascular Committee of the European Association of Nuclear Medicine

Cardiac sympathetic activity plays a key role in supporting cardiac function in both health and disease conditions, and nuclear cardiac imaging has always represented the only way for the non-invasive evaluation of the functional integrity of cardiac sympathetic terminals, mainly through the use of radiopharmaceuticals that are analogues of norepinephrine and, in particular, with the use of I-123-mIBG imaging. This technique demonstrates the presence of cardiac sympathetic dysfunction in different cardiac pathologies, linking the severity of sympathetic nervous system impairment to adverse patient's prognosis. This article will outline the state-of-the-art of cardiac I-123-mIBG imaging and define the value and clinical applications in the different fields of cardiovascular diseases.Cardiolog