A High-Quality Blue Whale Genome, Segmental Duplications, and Historical Demography

The blue whale, Balaenoptera musculus, is the largest animal known to have ever existed, making it an important case study in longevity and resistance to cancer. To further this and other blue whale-related research, we report a reference-quality, long-read-based genome assembly of this fascinating species. We assembled the genome from PacBio long reads and utilized Illumina/10×, optical maps, and Hi-C data for scaffolding, polishing, and manual curation. We also provided long read RNA-seq data to facilitate the annotation of the assembly by NCBI and Ensembl. Additionally, we annotated both haplotypes using TOGA and measured the genome size by flow cytometry. We then compared the blue whale genome with other cetaceans and artiodactyls, including vaquita (Phocoena sinus), the world's smallest cetacean, to investigate blue whale's unique biological traits. We found a dramatic amplification of several genes in the blue whale genome resulting from a recent burst in segmental duplications, though the possible connection between this amplification and giant body size requires further study. We also discovered sites in the insulin-like growth factor-1 gene correlated with body size in cetaceans. Finally, using our assembly to examine the heterozygosity and historical demography of Pacific and Atlantic blue whale populations, we found that the genomes of both populations are highly heterozygous and that their genetic isolation dates to the last interglacial period. Taken together, these results indicate how a high-quality, annotated blue whale genome will serve as an important resource for biology, evolution, and conservation research.

Preeclampsia and risk of maternal pulmonary hypertension at high altitude in Bolivia

Women with a history of preeclampsia (PE) have a greater risk of pulmonary arterial hypertension (PAH). In turn, pregnancy at high altitude is a risk factor for PE. However, whether women who develop PE during highland pregnancy are at risk of PAH before and after birth has not been investigated. We tested the hypothesis that during highland pregnancy, women who develop PE are at greater risk of PAH compared to women undergoing healthy highland pregnancies. The study was on 140 women in La Paz, Bolivia (3640m). Women undergoing healthy highland pregnancy were controls (C, n = 70; 29 ± 3.3 years old, mean±SD). Women diagnosed with PE were the experimental group (PE, n = 70, 31 ± 2 years old). Conventional (B- and M-mode, PW Doppler) and modern (pulsed wave tissue Doppler imaging) ultrasound were applied for cardiovascular íííassessment. Spirometry determined maternal lung function. Assessments occurred at 35 ± 4 weeks of pregnancy and 6 ± 0.3 weeks after birth. Relative to highland controls, highland PE women had enlarged right ventricular (RV) and right atrial chamber sizes, greater pulmonary artery dimensions and increased estimated RV contractility, pulmonary artery pressure and pulmonary vascular resistance. Highland PE women had lower values for peripheral oxygen saturation, forced expiratory flow and the bronchial permeability index. Differences remained 6 weeks after birth. Therefore, women who develop PE at high altitude are at greater risk of PAH before and long after birth. Hence, women with a history of PE at high altitude have an increased cardiovascular risk that transcends the systemic circulation to include the pulmonary vascular bed.

Datasets acquired with correlative microscopy method for delineation of prior austenite grain boundaries and characterization of prior austenite grain size in a low-alloy high-performance steel

Prior studies on martensitic steel microstructures have either delineated the prior austenite grain boundaries via chemical etching or reconstructed the prior austenite grains from crystallographic orientations measured with electron backscattered diffraction (EBSD). To appropriately validate the reconstruction algorithms, the EBSD data need to be collected on martensitic microstructures, where the prior austenite grain boundaries are delineated with techniques such as chemical etching that can serve as ground truth for comparison with the reconstructed prior austenite grains. In this article, the method of correlative microscopy is employed to collect scanning electron microscope (SEM) image and automated EBSD scan data from the same region of an appropriately etched steel specimen. The SEM images and automated EBSD scan data are presented for five different fields of view in the specimen. These datasets are analyzed and discussed in the accompanying article titled "Correlative microscopy for quantification of prior austenite grain size in AF9628 steel" [1].

NADH-linked mitochondrial respiration in the developing mouse brain is sex-, age- and tissue-dependent

Mitochondria play a major role in the brain. Apart from energy production, mitochondria regulate key factors in the activation of cell signaling pathways such as survival, proliferation, and differentiation. While all these processes occur during the physiological development of the brain, it is surprising that the mitochondrial functions and functioning in the brain during the postnatal development remain poorly explored. In this work, we collected samples of brainstem and cortex of mice at postnatal ages 3 (P3), 21 (P21), and at adulthood (3 months old) and evaluated the mitochondrial oxygen consumption after complex I activation. To do so, we used our oxygraph-2 K system (OROBOROS) that measures the mitochondrial bioenergetics in saponin-permeabilized tissue punches of 2  mg weight. Furthermore, as sex dimorphism in the brain occurs since very early stages of development, we performed experiments in brain samples of male and female mice. Accordingly, the mitochondrial oxygen consumption rate (OCR) was evaluated under activation of complex I (NADH-linked respiration - mitochondrial state 3), and during the inhibition of the complex V (ATP synthase) with oligomycin (mitochondrial state 4). In following, the respiratory control ratio (RCR - state 3/state4) was calculated as an index of mitochondrial oxidative-phosphorylation coupling. Our results show that the activity of the mitochondrial complex I in the brain increases along with the postnatal development in a sex- and tissue-dependent manner, with males showing higher activity than females, and with brainstem tissue showing higher activity than cortex. Our data may contribute to a better understanding of the sex-dependent maturation of the cortex and the cardiorespiratory network located in the brainstem.

Phylogenetic analysis of Histoplasma capsulatum var duboisii in baboons from archived formalin-fixed, paraffin embedded tissues

Histoplasma capsulatum var. duboisii (Hcd) infections have been well documented to cause chronic granulomatous disease, mainly involving the skin of baboons and humans in African countries primarily. This retrospective study classified the subspecies of Histoplasma and developed a phylogenetic tree utilizing DNA sequences extracted from formalin-fixed, paraffin embedded (FFPE) tissues from 9 baboons from a research colony in Texas histologically diagnosed with Hcd. Based on sequence analysis of ITS-2, Tub-1, and ARF, Hcd isolated from the archived samples closely aligns with the African clade and has 88% sequence homology with a sample isolated from an individual in Senegal.

Evaluation of septal insertion of atrioventricular valves in fetuses by postmortem 4.7 Tesla cardiac MRI: A feasibility study

PURPOSE

The purpose of this study was to compare non-invasive high-spatial-resolution postmortem cardiac magnetic resonance imaging (MRI) and autopsy findings for evaluating the septal insertion of atrioventricular valves in fetuses.

MATERIALS AND METHODS

Five fetal heart specimens including two normal hearts, one heart with complete atrioventricular septal defect (AVSD) and two hearts with linear insertion of atrioventricular valves (LIAVV; gestational age 17 to 34 weeks) were studied with cardiac MRI using a 4.7 T MRI scanner without sample preparation. Three (3D) and two-dimensional (2D) turbo-RARE (rapid imaging with refocused echoes) sequences in four-chamber and left-ventricular long-axis planes were obtained with a minimal isotropic/in-plane resolution of 156μm. Nonparametric tests were performed to compare the distance between insertions of medial leaflets of the atrioventricular valves and the inlet/outlet distance ratio between MRI and autopsy findings in normal, complete AVSD and with linear insertion of atrioventricular valves (LIAVV) fetal hearts.

RESULTS

Despite apparent differences between LIAVV/normal hearts, no significant differences were found between differential insertion of medial leaflets and inlet/outlet distance ratios with both techniques. Very good to excellent reliability between both techniques was found for differential insertion (ICC: 87.2%; 95% CI: -21.7%, 99.1%) (P=0.963) and inlet/outlet distance ratio (ICC 98.3%; 95%CI: 85.2%, 99.8%) (P=0.537) measurements.

CONCLUSION

Postmortem cardiac MRI could replace autopsy for assessing normal or abnormal septal insertion of atrioventricular valves in fetuses without requiring specific preparation of the heart.

MRI Features Can Predict 1p/19q Status in Intracranial Gliomas

BACKGROUND AND PURPOSE

The 2016 revision of the World Health Organization Classification of Tumors of the Central Nervous System mandates codeletion of chromosomes 1p and 19q for the diagnosis of oligodendroglioma. We studied whether conventional MR imaging features could predict 1p/19q status.

MATERIALS AND METHODS

Patients with previous 1p/19q testing were identified through pathology department records, typically performed on the basis of an oligodendroglial component on routine histology; 69 patients met the inclusion criteria. Preoperative imaging of patients with grade II or III gliomas was retrospectively assessed by 2 neuroradiologists, blinded to the 1p/19q status. Thirteen MR imaging features were first assessed in a small initial cohort (n = 10), after which the criteria were narrowed for the remaining patients as a validation cohort.

RESULTS

There was 85% agreement between radiologists for the overall prediction of 1p/19q status in the validation cohort, with an accuracy of 84%. The presence of >50% T2-FLAIR mismatch and calcification was found to be the most useful for predicting 1p/19q status. The >50% T2-FLAIR mismatch variable was demonstrated in 14 tumors and had 100% specificity for identifying a noncodeleted tumor (P = .001), with 97% interobserver correlation. Calcification was visualized in 7 tumors, 6 of which were 1p/19q codeleted (specificity, 97%; P = .006), with 100% interobserver correlation.

CONCLUSIONS

The presence of >50% T2-FLAIR mismatch is highly predictive of a noncodeleted tumor, while calcifications suggest a 1p/19q codeleted tumor. If formal 1p/19q testing is not possible, a combined MR imaging-histologic assessment may improve the diagnostic accuracy over histology alone.

DETERMINACIÓN DE GÉNEROS BACTERIANOS EN EL MAR DE LA PLAYA CANTOLAO – LA PUNTA – CALLAO

Los océanos albergan una gran diversidad biológica, hasta el momento relativamente poco explorada por el humano. Con el objetivo de ampliar los conocimientos en la biodiversidad bacteriana del mar peruano, se realizaron muestreos aleatorios en el mar de Playa Cantolao-La Punta-Callao (12º04´06´´ S 77º10´10´´O), en total se tomaron 5 muestras en frascos estériles a una profundidad de 3 m utilizando una vara de madera acondicionada a una jeringa de 20 ml. Para el aislamiento se utilizó el método de dispersión en placa en Agar Marino, se trabajó con diluciones sucesivas para obtener colonias aisladas. Para la identificación se realizaron pruebas bioquímicas que incluían determinación de citocromo oxidasa, motilidad, producción de H2S, producción de indol, metabolismo de glucosa, producción de pigmento, luminiscencia, catalasa y desarrollo en anaerobiosis; además de las coloraciones Gram y de espora. Los esquemas propuestos por Das S et al. (2007), Oliver J (1982) y el Bergey´s Manual 2da y 7ma edición fueron utilizados para la determinación de géneros. Se logró el aislamiento de 20 cepas bacterianas. Los géneros encontrados fueron: Moraxella, Bacillus, Acinetobacter, Vibrio, Aeromonas, Photobacterium, Alteromonas, Alcaligenes, Streptococcus y Chromobacterium. 

UNA DINÁMICA EXPERIMENTAL EDUCATIVA E INTERACTIVA EN EL MUSEO DE HISTORIA NATURAL “VERA ALLEMAN HAEGHEBAERT ”: LÍNEA DE TIEMPO

El Día Internacional de los Museos se celebra cada año el 18 de mayo, fecha para la cual el Museo de Historia Natural “Vera Alleman Haeghebaert”, de la Universidad Ricardo Palma organiza diversas actividades, desde conferencias para el alumnado hasta dinámicas de rigor social que involucren la difusión del conocimiento a diferentes niveles educativos. Es así que se crea la dinámica denominada “Línea de Tiempo”, con una visión educativa apoyada en el conocimiento científico y transformada en una actividad con opción a variaciones según el grado académico de las personas participantes, y que otorga accesibilidad a información sobre la historia de nuestro planeta. Recibiendo cada participante un número de imágenes de especies deflora y fauna extinta, este deberá clasificarlo en el periodo geológico correcto luego de haber recibido la explicación correspondiente en la visita al museo, reforzando así lo expuesto, creando identidad con los fósiles peruanos incluidos en la dinámica y dando a conocer la importancia de la protección de los yacimientos paleontológicos que nos permiten tener este conocimiento.

[Postoperative radiation therapy in lung carcinom]

Locally advanced non-small-cell lung carcinoma (NSCLC) is a very heterogeous disease, the role of postoperative radiation therapy (PORT) in pN2 patients with completly resected NSCLC remains controversial. Although an improvment in local control has been described in several studies, the effect on survival has been contradictory or inconclusive. Retrospective evaluation suggest a positive effect of PORT in high risk patients with pN2 disease: RI-resected NSCLC, bulky and multilevel N2. However further evaluation of PORT in prospectively randomized studies in completely resected pN2 NSCLC is needed.

Molecular findings and clinical data in a cohort of 150 patients with anophthalmia/microphthalmia

Anophthalmia and microphthalmia (AM) are the most severe malformations of the eye, corresponding respectively to reduced size or absent ocular globe. Wide genetic heterogeneity has been reported and different genes have been demonstrated to be causative of syndromic and non-syndromic forms of AM. We screened seven AM genes [GDF6 (growth differentiation factor 6), FOXE3 (forkhead box E3), OTX2 (orthodenticle protein homolog 2), PAX6 (paired box 6), RAX (retina and anterior neural fold homeobox), SOX2 (SRY sex determining region Y-box 2), and VSX2 (visual system homeobox 2 gene)] in a cohort of 150 patients with isolated or syndromic AM. The causative genetic defect was identified in 21% of the patients (32/150). Point mutations were identified by direct sequencing of these genes in 25 patients (13 in SOX2, 4 in RAX, 3 in OTX2, 2 in FOXE3, 1 in VSX2, 1 in PAX6, and 1 in GDF6). In addition eight gene deletions (five SOX2, two OTX2 and one RAX) were identified using a semi-quantitative multiplex polymerase chain reaction (PCR) [quantitative multiplex PCR amplification of short fluorescent fragments (QMPSF)]. The causative genetic defect was identified in 21% of the patients. This result contributes to our knowledge of the molecular basis of AM, and will facilitate accurate genetic counselling.

Three-dimensional helical computed tomography in prenatal diagnosis of fetal skeletal dysplasia

OBJECTIVES

(1) To study the use and diagnostic value, as a complement to ultrasound, of helical computed tomography (helical CT) to differentiate normal fetuses from cases of skeletal dysplasia; (2) to define the most relevant indications for helical CT; and (3) to evaluate its diagnostic performance with respect to radiological criteria considered discriminatory.

METHODS

This was a retrospective study from 2005 to 2008 in 67 pregnant women who underwent helical CT after 26 weeks of gestation for suspected fetal skeletal dysplasia due to fetal shortened long bones on ultrasound (≤ 10(th) percentile), either alone or associated with other bone abnormalities. The results were compared with pediatric examinations in 41 cases and with fetal autopsy findings after elective termination of pregnancy in the others.

RESULTS

Helical CT had a sensitivity of 82%, specificity of 91% and positive and negative predictive values of 90% and 83%, respectively, for diagnosis of fetal skeletal dysplasia. An etiological diagnosis that had not been suspected at ultrasound was specified in 15% of cases and diagnoses suspected at ultrasound were confirmed in 24% and discounted in 43% of cases. The prevalence of skeletal dysplasia was increased in cases of micromelia < 3(rd) percentile or if there was a combination of bone signs. Helical CT showed 69% sensitivity in identifying individual predefined pathological bone signs which were confirmed on fetal autopsy findings.

CONCLUSION

Helical CT is a key examination, in combination with ultrasound, in the diagnosis of fetal skeletal dysplasia from 26 weeks of gestation. It should be reserved for cases with severe micromelia below the 3(rd) percentile and for those with micromelia ≤ 10(th) percentile associated with another bone sign. A checklist of discriminatory signs is proposed.

Epilepsy and primary cerebral tumours

Although the association of epilepsy with cerebral tumours is well recognized, the reported incidence of seizures and relationship to tumour pathology varies significantly. This study assessed retrospectively the incidence of seizures, relationship to tumour pathology, natural history of epilepsy and prognostic significance of presentation with a seizure in 120 consecutive adults with histologically proven primary cerebral hemisphere tumours including meningiomas. 52% had a seizure and most were at presentation. Seizures were more common with anaplastic astrocytoma (AA) (18 23 ) than glioblastoma multiforme (21 56 ) (p = 0.001) and seizure occurrence was associated with cortical invasion. 52% of meningioma patients had a seizure. Seizures recurred in 34%, more frequently with glioma (19 of 46) than meningioma (1 of 15) (p < 0.05). Patients with AA presenting with a seizure had a longer survival (28 months) than patients without seizure (8 months) (p = 0.05 one sided). In conclusion, seizures are a common complication of cerebral tumours, usually at presentation and correlate with tumour pathology. A seizure at presentation in AA correlates with longer survival.

Rapidly progressive Whipple's disease of the central nervous system

We describe a patient with rapidly progressive Whipple's disease confined to the central nervous system (CNS). The diagnosis was made pre-mortem following stereotactic and open brain biopsis and confirmed at autopsy. Despite appropriate antibiotic treatment, the disease ran a fulminant course to death after nine weeks.

[Prenatal diagnosis of cleft lip with or without cleft palate: retrospective study and review]

OBJECTIVES

To evaluate the management of prenatally diagnosed cleft lip with or without cleft palate and the immediate postnatal outcome.

MATERIAL AND METHODS

Retrospective study of all cases of cleft lip with or without cleft palate referred to our fetal medicine unit, between January 2005 and January 2011. The anatomical type of cleft, associated malformations, and the postnatal outcome were reviewed.

RESULTS

Forty-three cases of fetal cleft lip with or without cleft palate were reviewed. The mean gestational age at diagnosis was 24 weeks ± 4. The postnatal distribution of clefts was: 30 cleft lip and palate (70%) and 13 cleft lip (30%). The prenatal diagnosis of the cleft type was exact in 27 cases (62.8%). Nine cases had associated anomalies (21%), detected prenatally in three cases (37.5%). There was no karyotypical abnormality. Six pregnancies were terminated (14%). The immediate postnatal outcome was comparable with unselected newborns.

CONCLUSION

The prenatal diagnosis of cleft lip with or without cleft palate is correct, with two thirds of exact diagnoses. Large clefts palate are the best detected. Associated malformations cannot always be diagnosed by prenatal ultrasound, but have to be searched for because they modify the fetal outcome.

Intragenic rearrangements in LARGE and POMGNT1 genes in severe dystroglycanopathies

Dystroglycanopathies are a heterogeneous group of muscular dystrophies with autosomal recessive inheritance characterized by abnormal glycosylation of alpha-dystroglycan. The most severe phenotypes are Walker-Warburg Syndrome (WWS) and muscle-eye-brain disease (MEB) presenting with lissencephaly type II (LIS II) and in which muscular dystrophy is associated with mental retardation and eye abnormalities. To date, six distinct genes, POMT1, POMT2, POMGNT1, FKTN, FKRP, LARGE and recently in one case DPM3, have been shown to be involved in dystroglycanopathies. Genomic sequencing alone is still frequently used for diagnosis purpose, not allowing detection of intragenic rearrangements at the heterozygous state contrarily to RNA analysis, quantitative PCR and CGH array analysis. These latter methods enabled us to identify four new intragenic rearrangements in the LARGE gene in three fetuses with WWS, born to two unrelated families: deletion of exons 9-10 and duplication of introns 1-4 for the first family and deletion of exons 4 and 7 for the second one; and a deletion of the last six exons of the POMGNT1 gene in two unrelated MEB patients. Genomic dosage studies using emerging tools such as CGH array should be included in routine molecular analysis of dystroglycanopathies, not only for the screening of the LARGE gene in which this kind of mutation seems to be more frequent than point mutations, but also for the other involved genes, especially in severe clinical cases.

[Genetic testing in the context of the revision of the French law on bioethics]

This article focuses on six questions raised by genetic testing in human: (1) the use of genetic tests, (2) information given to relatives of patients affected with genetic disorders, (3) prenatal and preimplantatory diagnosis for late onset genetic diseases and the use of pangenomic tests in prenatal diagnosis, (4) direct-to-consumer genetic testing, (5) population screening in the age of genomic medicine and (6) incidental findings when genetic testing are used.

412 OVARIAN RESPONSE IN ALPACAS (VICUGNA PACOS) TO SUPERSTIMULATORY TREATMENT WITH FOLLICLE-STIMULATING HORMONE AND EQUINE CHORIONIC GONADOTROPIN

The objective of this study was to evaluate the ovarian response in alpacas to superstimulatory treatment with FSH and eCG. Alpacas females (n = 49) were examined daily by transrectal ultrasonography using a 7.5-MHz linear-array transducer (Aloka SSD500, Tokyo, Japan) to determine ovarian follicular dynamics. Alpacas (n =41) were selected when a growing follicle ≥7 mm in diameter was detected and were given an i.m. injection of 4 μg of buserelin (Conceptal®, Intervet, Millsboro, MD, USA) on Day 0 (i.e. beginning of treatment). On Day 2, alpacas were assigned to 1 of the following 2 treatments: (1) the FSH group (n = 21), which received a total dose of 200 mg NIH-FSH-P1 of pFSH (Folltropin®-V, Bioniche Animal Health Inc., Belleville, Ontario, Canada) in decreasing dosages of 52, 48, 40, 32, and 28 mg divided in twice-daily i.m. injections for 5 days; and (2) the eCG group (n = 20), which received a single dose of 750 IU of eCG (Folligon®, Intervet, Millsboro, MD, USA). Animals received an i.m. dose of 0.150 mg of triapost (PGF; Iliren, Intervet, Millsboro, MD, USA) on Day 6. On Day 7, ovaries of all alpacas were examined by transrectal ultrasonography, followed by mating and embryo collection on Day 14. Data were analyzed by ANOVA. The mean number of follicles <7 mm in diameter was 5.8 ± 1.0 and 3.2 ± 0.9 for those treated with FSH and eCG, respectively (NS). The number of follicles 7 to 13 mm in diameter was 5.8 ± 1.5 and 9.7 ± 1.2 for the FSH and eCG groups, respectively (P < 0.05). The number of follicles >13 mm in diameter was 0.3 ± 0.4 and 1.0 ± 0.3 for the FSH and eCG groups, respectively (NS). The mean (± SD) follicle diameter was 8.3 ± 0.3 and 9.0 ± 0.2 for the FSH and eCG groups, respectively (NS). The mean (± SD) number of CL was 6.0 ± 1.9 and 8.7 ± 2.3 for the FSH and eCG groups, respectively (NS). Only 82.9% of animals (34/41) were flushed and embryos were recovered in 18 animals (52.9%), with 2.7 ± 0.4 and 2.7 ± 0.7 embryos in the FSH and eCG groups, respectively (NS). Large unovulated follicles (diameter >13 mm) were observed in 34.1% of animals (14/41) on Day 14 and most of them (71.4%) were in the group treated with eCG (10/14; P < 0.05). In conclusion, the use of eCG resulted in a higher number of preovulatory follicles (7-13 mm in diameter) than FSH. However, the percentage of animals with large unovulated follicles was also higher in the eCG-treated group, resulting in no differences in the number of CL counted or embryos obtained per treatment.

Lissencéphalies : aspects cliniques et génétiques

The term lissencephaly covers a group of rare malformations sharing the common feature of anomalies in the appearance of brain convolutions (characterised by simplification or absence of folding) associated with abnormal organisation of the cortical layers as a result of neuronal migration defects during embryogenesis. Children with lissencephaly have feeding and swallowing problems, muscle tone anomalies (early hypotonia and subsequently limb hypertonia), seizures (in particular, infantile spasms) and severe psychomotor retardation. Multiple forms of lissencephaly have been described and their current classification is based on the associated malformations and underlying aetiology. Two large groups can be distinguished: classical lissencephaly (and its variants) and cobblestone lissencephaly. In classical lissencephaly (or type I), the cortex appears thickened, with four more or less disorganised layers rather than six normal layers. In the variants of classical lissencephaly, extra-cortical anomalies are also present (total or subtotal agenesis of the corpus callosum and/or cerebellar hypoplasia). The classical lissencephalies and the variant forms can be further divided into several subgroups. Four forms can be distinguished on the basis of their genetic aetiology: anomalies in the LIS1 gene (isolated lissencephaly and Miller-Dieker syndrome), anomalies in the TUBA3 and DCX genes, and lissencephalies caused by mutations in the ARX gene (XLAG syndrome, X-linked lissencephaly with agenesis of the corpus callosum). The incidence of all forms of type I lissencephaly is around 1 in 100,000 births. In addition to these four entities, isolated lissencephalies without a known genetic defect, lissencephalies with severe microcephaly (microlissencephaly) and lissencephalies associated with polymalformative syndromes are also included in the group of classical lissencephalies. Cobblestone lissencephaly (formally referred to as type II) is present in three entities: the Walker-Warburg, Fukuyama and MEB (Muscle-Eye-Brain) syndromes. It is characterised by global disorganisation of cerebral organogenesis with an uneven cortical surface (with a pebbled or cobblestone appearance). Microscopic examination reveals total disorganisation of the cortex and the absence of any distinguishable layers. Management is symptomatic only (swallowing problems require adapted feeding to prevent food aspiration, articular and respiratory physiotherapy to prevent orthopaedic problems resulting from hyptonia and treatment of gastrooesophageal reflux). The epilepsy is often resistant to treatment. The encephalopathy associated with lissencephaly is often very severe and affected children are completely dependent on the carer.

Molecular heterogeneity in fetal forms of type II lissencephaly

Type II lissencephaly (type II LIS) is a group of autosomal recessive congenital muscular dystrophies (CMD) associated with defects in alpha-DG O-glycosylation, which comprises Walker-Warburg syndrome, Fukuyama cerebral and muscular dystrophy, or muscle-eye-brain disease. The most severe forms of these diseases often have a fetal presentation and lead to a pregnancy termination. We report here the first molecular study on fetal type II LIS in a series of 47 fetuses from 41 unrelated families. Sequencing of the different genes known to be involved in alpha-DG O-glycosylation allowed the molecular diagnosis in 22 families: involvement of POMT1 was demonstrated in 32% of cases, whereas POMGNT1 and POMT2 were incriminated in 15% and in 7% of cases, respectively. We found 30 different mutations in these three genes, 25 were described herein for the first time, 15 in POMT1, and five in POMT2 and POMGNT1. Despite sequencing of FKRP, FCMD, and LARGE, no definitive molecular diagnosis could be made for the other half of our cases. Preliminary results concerning genotype-phenotype correlations show that the choice of the first gene sequenced should depend on the clinical severity of the type II LIS; POMT1 and POMT2 for severest clinical picture and POMGNT1 for milder disease. The other genes, FKRP, FCMD, and LARGE, seem not to be implicated in the fetal form of CMD.

Detection of an Alu insertion in the POMT1 gene from three French Walker Warburg syndrome families

Walker Warburg syndrome (WWS) is the most severe of a group of multiple congenital disorders known as lissencephaly type II ( LIS Type II) associated with congenital muscular dystrophy and eye abnormalities. The POMT1 gene is the most frequently affected found in 20% of patients with WWS. We describe five fetuses with WWS in three non-related families carrying a same mutation in the POMT1 gene. All fetuses presented with tetra ventricular hydrocephaly, and arachnoidal neuroglial ectopia and cortical dysplasia characteristic of LIS type II. We performed sequencing of the POMT1 gene on fetal DNA. The five fetuses were found to share an insertion of an inversed Alu repeated DNA element within exon 3 of the POMT1 gene, all at the heterozygous state except one at the homozygous state. This mutation was associated with a common transition c.2203 C > T (p.Arg735Cys) in exon 20 on the same allele and similar intragenic haplotype, suggesting that the three families could be related or indicating a possible founder effect in France. Insertions of Alu sequences, which are rarely found in coding regions, have occasionally been reported to cause other genetic diseases. However, this is the first report of a retrotransposon insertion in the POMT1 gene associated with WWS.

Treatment of rectosigmoid endometriosis by laparoscopically assisted vaginal rectosigmoidectomy

OBJECTIVE

To describe the use of mechanical anastomoses in cases of laparoscopically assisted vaginal rectosigmoidectomy for the treatment of rectosigmoid endometriosis.

METHODS

Pilot study evaluating eight patients with rectosigmoid endometriosis referred for surgical treatment. All patients were submitted to laparoscopically assisted vaginal segmental resection of the rectosigmoid with anastomoses performed using linear and circular staplers.

RESULTS

The average length of the surgical procedure was 177.5 min and average duration of hospitalization was 4.13 days. There were no intra-operative complications and integrity of the anastomoses was confirmed in all patients. One patient reported partial improvement of symptoms and 7 patients presented complete clinical remission 12 months following surgery.

CONCLUSION

Laparoscopically assisted vaginal segmental resection of the sigmoid infiltrated by endometriosis is a feasible surgical procedure. The technique combines transvaginal access with mechanical intestinal anastomoses performed using linear and circular staplers, and achieves good results with low morbidity.