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Schwartz CE, Aylsworth AS, Allanson J, Battaglia A, Carey JC, Curry CJ, Davies KE, Eichler EE, Graham JM, Hall B, Hall JG, Holmes LB, Hoyme HE, Hunter A, Innis J, Johnson J, Keppler-Noreuil KM, Leroy JG, Moore C, Nelson DL, Neri G, Opitz JM, Picketts D, Raymond FL, Shalev SA, Stevenson RE, Stumpel CTRM, Sutherland G, Viskochil DH, Weaver DD, Zackai EH. Personal journeys to and in human genetics and dysmorphology. Am J Med Genet A 2024; 194:e63514. [PMID: 38329159 DOI: 10.1002/ajmg.a.63514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/29/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
Genetics has become a critical component of medicine over the past five to six decades. Alongside genetics, a relatively new discipline, dysmorphology, has also begun to play an important role in providing critically important diagnoses to individuals and families. Both have become indispensable to unraveling rare diseases. Almost every medical specialty relies on individuals experienced in these specialties to provide diagnoses for patients who present themselves to other doctors. Additionally, both specialties have become reliant on molecular geneticists to identify genes associated with human disorders. Many of the medical geneticists, dysmorphologists, and molecular geneticists traveled a circuitous route before arriving at the position they occupied. The purpose of collecting the memoirs contained in this article was to convey to the reader that many of the individuals who contributed to the advancement of genetics and dysmorphology since the late 1960s/early 1970s traveled along a journey based on many chances taken, replying to the necessities they faced along the way before finding full enjoyment in the practice of medical and human genetics or dysmorphology. Additionally, and of equal importance, all exhibited an ability to evolve with their field of expertise as human genetics became human genomics with the development of novel technologies.
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Affiliation(s)
- Charles E Schwartz
- Senior Research Scientist Emeritus, Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Arthur S Aylsworth
- Emeritus Professor of Pediatrics and Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Judith Allanson
- Professor of Paediatrics, University of Ottawa, Ottawa, Canada
- Clinical Geneticist, Children's Hospital of Eastern Ontario (Retired), Ottawa, Canada
| | - Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Cynthia J Curry
- Professor of Pediatrics, Emerita, UCSF, Adjunct Professor of Pediatrics, Stanford, Medical Director Genetic Medicine, Community Regional Medical Center, Fresno, California, USA
| | - Kay E Davies
- Department of Physiology, Anatomy and Genetics, MDUK Oxford Neuromuscular Centre, Oxford, UK
| | - Evan E Eichler
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, Washington, USA
| | - John M Graham
- Professor Emeritus, Division of Medical Genetics, Department of Pediatrics, Cedars-Sinai Medical Center, and David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Bryan Hall
- Emeritus, Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA
| | - Judith G Hall
- University of British Columbia and Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics and Medical Genetics, British Columbia Children's Hospital, Vancouver, Canada
| | - Lewis B Holmes
- Emeritus Chief, Medical Genetics and Metabolism Unit, Mass General for Children; Professor of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - H Eugene Hoyme
- Medical Director, Sanford Children's Genomic Medicine Consortium, Senior Advisor, Sanford Imagenetics, Sanford Health, Emeritus Professor and Past Chair, Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
- Adjunct Professor and Medical Director, Genetic Counseling Graduate Program, Augustana University, Sioux Falls, South Dakota, USA
- Extraordinary Professor of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alasdair Hunter
- Emeritus Clinical Geneticist, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jeffrey Innis
- Staff Physician, Pediatric Genetics, Golisano Children's Hospital of Southwest Florida, Fort Myers, Florida, USA
- Professor Emeritus of Human Genetics, Pediatrics and Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - John Johnson
- Emeritus Clinical Geneticist, Department of Medical Genetics, Shodair Hospital, Helena, Montana, USA
| | - Kim M Keppler-Noreuil
- Professor of Pediatrics Division of Genetics & Metabolism, Program Director, Medical Genetics & Genomics Residency Training Program, Co-Director of the UW NORD Center of Excellence for Rare Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jules G Leroy
- Professor Emeritus, Ghent University School of Medicine, Ghent, Belgium
| | - Cynthia Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control, Atlanta, Georgia, USA
| | - David L Nelson
- Department of Molecular and Human Genetics, Jan and Dan Duncan Neurological Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Giovanni Neri
- Institute of Genomic Medicine, Catholic University School of Medicine, Rome, Italy
| | - John M Opitz
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Picketts
- Senior Scientist, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Professor, Departments of Medicine, Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - F Lucy Raymond
- Department of Medical Genetics, University of Cambridge, Cambridge, England
| | - Stavit Allon Shalev
- The Genetics Institute, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Connie T R M Stumpel
- Emeritus Professor of Clinical Genetics, Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Grant Sutherland
- Emeritus Geneticist, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Emeritus Professor, University of Adelaide, Adelaide, South Australia, Australia
| | - David H Viskochil
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David D Weaver
- Professor Emeritus of Medical and Molecular Genetics, Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Medeiros LH, de Barros SP, Fidelis da Silva LV, Bueno PM, Garcia-Usó M, Trindade-Suedam IK. Bite Force, Masticatory Performance, and Nutritional Status of Adult Individuals With Treacher Collins Syndrome. Cleft Palate Craniofac J 2024; 61:566-573. [PMID: 36544279 DOI: 10.1177/10556656221132376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To characterize the stomatognathic system of individuals with Treacher Collins syndrome (TCS) by assessing bite force (BF) and masticatory performance (MP) and to evaluate the nutritional status (NS) of this population through anthropometric measurements. DESIGN Cross-sectional study. SETTING A public tertiary care hospital. PATIENTS Forty-one individuals were divided into 2 groups: (1) Control (CON): 20 control adults with class I skeletal pattern and (2) TCS: 21 adults with TCS. INTERVENTIONS BF measurement was assessed using a gnathodynamometer (IDDK Kratos). MP assessment was done using Image J-NIH software, by calculating the particles size of food submitted to standard chewing cycles ). NS was assessed based on body mass index (BMI). MAIN OUTCOME MEASURES Based on the craniofacial dysmorphology, it is our hypothesis that this population present a dysfunctional masticatory system, which can negatively impact NS. RESULTS Means BF values for the TCS were significantly reduced when compared with the CON group and corresponded to 170.9 ± 109.4N and 431.6 ± 134.1N (right molar [RM]) and 171.2 ± 93.9N and 427.4 ± 147.8N (left molar [LM]), respectively (P < .05). Although no significant differences were observed, the mean particle size of the TCS was greater when compared with the CON group and corresponded to 1.58 ± 1.93 mm2 and 0.66 ± 0.52 mm2, respectively. Although statistically similar mean values of BMIs were observed on both groups (CON = 23.4 ± 4.7/TCS = 23.4 ± 6.1), underweight and overweight individuals were found in 48% of the individuals with TCS and in 15% of the CON group participants. CONCLUSION Individuals with TCS showed a significant BF reduction, but no differences were observed in MP and NS when compared with the control individuals.
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Affiliation(s)
- Laís Hollara Medeiros
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Suely Prieto de Barros
- Department of Clinical Nutrition, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Leide Vilma Fidelis da Silva
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Patricia Martins Bueno
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Michele Garcia-Usó
- Department of Biological Sciences, Dental School of Ourinhos, UNIFIO, Ourinhos, São Paulo, Brazil
| | - Ivy Kiemle Trindade-Suedam
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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Carrer A, Romaniello MG, Calderara ML, Mariani M, Biondi A, Selicorni A. Application of the Face2Gene tool in an Italian dysmorphological pediatric clinic: Retrospective validation and future perspectives. Am J Med Genet A 2024; 194:e63459. [PMID: 37927205 DOI: 10.1002/ajmg.a.63459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
Neurodevelopmental disorders exhibit recurrent facial features that can suggest the genetic diagnosis at a glance, but recognizing subtle dysmorphisms is a specialized skill that requires very long training. Face2Gene (FDNA Inc) is an innovative computer-aided phenotyping tool that analyses patient's portraits and suggests 30 candidate syndromes with similar morphology in a prioritized list. We hypothesized that the software could support even expert physicians in the diagnostic workup of genetic conditions. In this study, we assessed the performance of Face2Gene in an Italian dysmorphological pediatrics clinic. We uploaded two-dimensional face pictures of 145 children affected by genetic conditions with typical phenotypic traits. All diagnoses were previously confirmed by cytogenetic or molecular tests. Overall, the software's differential included the correct syndrome in most cases (98%). We evaluated the efficiency of the algorithm even considering the rareness of the genetic conditions. All "common" diagnoses were correctly identified, most of them with high diagnostic accuracy (93% in top-3 matches). Finally, the performance for the most common pediatric syndromes was calculated. Face2Gene performed well even for ultra-rare genetic conditions (75% within top-3 matches and 83% within top-10 matches). Expert geneticists maybe do not need computer support to recognize common syndromes, but our results prove that the tool can be useful not only for general pediatricians but also in dysmorphological clinics for ultra-rare genetic conditions.
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Affiliation(s)
- Alessia Carrer
- Department of Health Sciences, University of Milan, Milan, Italy
- Mariani Foundation Center for Fragile Child, Pediatric Unit ASST Lariana, Como, Italy
| | - Maria Giovanna Romaniello
- Mariani Foundation Center for Fragile Child, Pediatric Unit ASST Lariana, Como, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Letizia Calderara
- Mariani Foundation Center for Fragile Child, Pediatric Unit ASST Lariana, Como, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Milena Mariani
- Mariani Foundation Center for Fragile Child, Pediatric Unit ASST Lariana, Como, Italy
| | - Andrea Biondi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Paediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Angelo Selicorni
- Mariani Foundation Center for Fragile Child, Pediatric Unit ASST Lariana, Como, Italy
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Darouich S, Darouich S, Gtari D, Bellamine H. CLPB Deficiency Associated Neonatal Cavitating Leukoencephalopathy: A Potential Pathomechanism Underlying Neurologic Disorder. Pediatr Dev Pathol 2024; 27:198-204. [PMID: 37903135 DOI: 10.1177/10935266231204785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Caseinolytic peptidase B homolog (CLPB) is a mitochondrial protein which is highly expressed in brain. Its deficiency may be associated with severe neonatal encephalopathy. This report describes a case of fatal neonatal encephalopathy associated with biallelic stop-gain mutation in CLPB (NM_001258392.3:c.1159C>T/p.Arg387*). Neurologic disorder encompasses pre- and post-natal features including polyhydramnios, intrauterine growth restriction, respiratory insufficiency, lethargy, excessive startle reflex, generalized hypertonia, and epileptic seizures. Brain macroscopic examination demonstrates frontal severe periventricular cystic leukoencephalopathy, along with mild ex-vacuo tri-ventricular dilatation. The most striking immunohistopathologic features are striato-thalamic neurodegeneration and deep white matter loss associated with strong reactive astrogliosis. This report supports that CLPB deficiency should be considered among the neurometabolic disorders associated with severe prenatal-onset neurologic impairment that may result from cystic leukoencephalopathy.
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Affiliation(s)
- Sihem Darouich
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - Samia Darouich
- Institut Supérieur des Sciences Humaines de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - Dorsaf Gtari
- Département d'Anatomie et Cytologie pathologiques, Hôpital Menzel Bourguiba, Menzel Bourguiba, Tunisia
| | - Houda Bellamine
- Département d'Anatomie et Cytologie pathologiques, Hôpital Menzel Bourguiba, Menzel Bourguiba, Tunisia
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Varagur K, Zubovic E, Skolnick GB, Buss J, Snyder-Warwick A, Reinisch J, Patel KB. Porous Polyethylene Versus Autologous Costochondral Reconstruction for Microtia: Incidence and Analysis of Secondary Procedures. Cleft Palate Craniofac J 2024; 61:365-372. [PMID: 36217745 DOI: 10.1177/10556656221132034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine the frequency of autologous and alloplastic ear reconstructions for patients with microtia in the United States, and describe post-index procedure rates associated with each method. DESIGN Retrospective cohort study. SETTING Claims data from 500 + hospitals from IBM® MarketScan® Commercial and Multi-State Medicaid databases. PATIENTS/PARTICIPANTS A total of 649 patients aged 1 to 17 years with International Classification of Diseases, ninth/tenth revision (ICD-9/10) diagnoses for microtia, congenital absence of the ear, or hemifacial microsomia. INTERVENTIONS Alloplastic or autologous ear reconstruction between 2006 and 2018. MAIN OUTCOME MEASURE Post-index procedures performed within 1 year following the index repair, analyzed across the study period and separately for each half of the study period (2006-2012, 2012-2018). RESULTS A total of 486 (75%) qualifying patients received autologous and 163 (25%) received alloplastic reconstruction. Secondary procedure rates were significantly higher in the autologous group at 90 days (P = .034), 180 days (P < .001), and at 365 days (P < .001). Alloplastic reconstruction accounted for 23.2% of reconstructions in the first half of the study period compared with 26.7% in the second half (P = .319). One-year secondary procedure rates in the autologous group were not significantly different between both halves of the study period (69.7% vs 67.1%, P = .558), but were significantly lower in the second half for the alloplastic group (44.9% vs 20.2%, P = .001). CONCLUSIONS In these databases, autologous reconstruction is more common than alloplastic reconstruction. Autologous reconstruction is staged, with most undergoing a secondary procedure between 3 months and 1 year postoperatively. Secondary procedure rates decreased over time in patients undergoing alloplastic reconstruction.
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Affiliation(s)
- Kaamya Varagur
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Ema Zubovic
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Joanna Buss
- Institute of Clinical and Translational Sciences, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA
| | - Alison Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - John Reinisch
- Division of Plastic Surgery, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
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Chu TW, Shannon P, Parks T. Skeletal Growth Arrest Lines in Fetal Remains: Histopathology and Correlative Placental Pathology. Pediatr Dev Pathol 2024; 27:23-31. [PMID: 37818682 DOI: 10.1177/10935266231195750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Skeletal growth arrest lines (GAL) are transverse lines of metaphyseal radiodensity accompanying episodic severe physiological stress. They are poorly described in fetal remains. MATERIALS AND METHODS We searched our autopsy practice for instances of fetal GAL in post mortem radiology, and correlated them with long bone histology and placental pathology. We describe the appearance, distribution, and pathology of GAL in a cohort of fetal autopsies, and compare the placental pathology accompanying GAL to the placental pathology of asymmetrical growth restriction (AGR) in the same time period. RESULTS In 2108 consecutive fetal post mortems, we found 20 cases with GAL. About 16 were in singletons with AGR. In these 16, the distribution of placental pathologies was similar to a contemporaneous cohort of 113 cases with AGR. Of the remaining 4, two twins out of 9 sets of monochorionic twins with AGR demonstrated GAL. One case of GAL had symmetrical growth restriction with cytomegalovirus infection, and one case had no AGR and an old, unexplained retroplacental hemorrhage. On histology, GAL are characterized by a region of mineralized chondroid, which is variably incorporated into irregular trabecular bone. DISCUSSION GALs accompany a variety of placental pathologies and twin-twin transfusion, suggesting episodic disease progression.
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Affiliation(s)
- Tsz Wing Chu
- Mount Sinai Hospital, Department of Pathology and Laboratory Medicine, Toronto, ON, Canada
| | - Patrick Shannon
- Mount Sinai Hospital, Department of Pathology and Laboratory Medicine, Toronto, ON, Canada
| | - Tony Parks
- Mount Sinai Hospital, Department of Pathology and Laboratory Medicine, Toronto, ON, Canada
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Said AM, Zubovic E, Pfeifauf KD, Skolnick GB, Agboada J, Acayo-Laker P, Naidoo SD, Politi MC, Smyth M, Patel KB. Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis. Cleft Palate Craniofac J 2024; 61:138-143. [PMID: 36128842 DOI: 10.1177/10556656221128413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To describe the process of developing a craniosynostosis decision aid. We conducted a mixed-methods exploratory study between August 2019 and March 2020 to develop a decision aid about surgical treatment for single suture craniosynostosis. A single tertiary care academic children's hospital. The decision aid development team consisted of surgeons, research fellows, a clinical nurse practitioner, clinical researchers with expertise in decision science, and a university-affiliated design school. Qualitative interviews (N = 5) were performed with families, clinicians (N = 2), and a helmeting orthotist to provide feedback on decision aid content, format, and usability. After cycles of revisions and iterations, 3 related decision aids were designed and approved by the marketing arm of our institution. Distinct booklets were created to enable focused discussion of treatment options for the 3 major types of single suture craniosynostosis (sagittal, metopic, unicoronal). Three decision aids representing the 3 most common forms of single suture craniosynostosis were developed. Clinicians found the decision aids could help facilitate discussions about families' treatment preferences, goals, and concerns. We developed a customizable decision aid for single suture craniosynostosis treatment options. This tool lays the foundation for shared decision-making by assessing family preferences and providing clear, concise, and credible information regarding surgical treatment. Future research can evaluate this tool's impact on patient-clinician discussions about families' goals and preferences for treatment.
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Affiliation(s)
- Abdullah M Said
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Ema Zubovic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Kristin D Pfeifauf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Jude Agboada
- Graphic Design, Lindquist College of Arts & Humanities, Weber State University, Ogden, UT, USA
| | - Penina Acayo-Laker
- Communication Design, Sam Fox School of Design & Visual Arts, Washington University in St. Louis, St. Louis, MO, USA
| | - Sybill D Naidoo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Matthew Smyth
- Department of Neurosurgery, Johns Hopkins University Division of Pediatric Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
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Hennocq Q, Bongibault T, Marlin S, Amiel J, Attie-Bitach T, Baujat G, Boutaud L, Carpentier G, Corre P, Denoyelle F, Djate Delbrah F, Douillet M, Galliani E, Kamolvisit W, Lyonnet S, Milea D, Pingault V, Porntaveetus T, Touzet-Roumazeille S, Willems M, Picard A, Rio M, Garcelon N, Khonsari RH. AI-based diagnosis in mandibulofacial dysostosis with microcephaly using external ear shapes. Front Pediatr 2023; 11:1171277. [PMID: 37664547 PMCID: PMC10469912 DOI: 10.3389/fped.2023.1171277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Mandibulo-Facial Dysostosis with Microcephaly (MFDM) is a rare disease with a broad spectrum of symptoms, characterized by zygomatic and mandibular hypoplasia, microcephaly, and ear abnormalities. Here, we aimed at describing the external ear phenotype of MFDM patients, and train an Artificial Intelligence (AI)-based model to differentiate MFDM ears from non-syndromic control ears (binary classification), and from ears of the main differential diagnoses of this condition (multi-class classification): Treacher Collins (TC), Nager (NAFD) and CHARGE syndromes. Methods The training set contained 1,592 ear photographs, corresponding to 550 patients. We extracted 48 patients completely independent of the training set, with only one photograph per ear per patient. After a CNN-(Convolutional Neural Network) based ear detection, the images were automatically landmarked. Generalized Procrustes Analysis was then performed, along with a dimension reduction using PCA (Principal Component Analysis). The principal components were used as inputs in an eXtreme Gradient Boosting (XGBoost) model, optimized using a 5-fold cross-validation. Finally, the model was tested on an independent validation set. Results We trained the model on 1,592 ear photographs, corresponding to 1,296 control ears, 105 MFDM, 33 NAFD, 70 TC and 88 CHARGE syndrome ears. The model detected MFDM with an accuracy of 0.969 [0.838-0.999] (p < 0.001) and an AUC (Area Under the Curve) of 0.975 within controls (binary classification). Balanced accuracies were 0.811 [0.648-0.920] (p = 0.002) in a first multiclass design (MFDM vs. controls and differential diagnoses) and 0.813 [0.544-0.960] (p = 0.003) in a second multiclass design (MFDM vs. differential diagnoses). Conclusion This is the first AI-based syndrome detection model in dysmorphology based on the external ear, opening promising clinical applications both for local care and referral, and for expert centers.
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Affiliation(s)
- Quentin Hennocq
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
- Laboratoire ‘Forme et Croissance du Crâne’, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Thomas Bongibault
- Imagine Institute, INSERM UMR1163, Paris, France
- Laboratoire ‘Forme et Croissance du Crâne’, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Sandrine Marlin
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Jeanne Amiel
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Tania Attie-Bitach
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Geneviève Baujat
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Lucile Boutaud
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Georges Carpentier
- CHU Lille, Inserm, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008-Controlled Drug Delivery Systems and Biomaterial, Université de Lille, Lille, France
| | - Pierre Corre
- Department of Oral and Maxillofacial Surgery, INSERM U1229—Regenerative Medicine and Skeleton RMeS, Nantes, France
- Department of Oral and Maxillofacial Surgery, Nantes University, CHU Nantes, Nantes, France
| | - Françoise Denoyelle
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | | | | | - Eva Galliani
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Wuttichart Kamolvisit
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Stanislas Lyonnet
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Dan Milea
- Duke-NUS Medical School Singapore, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Véronique Pingault
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Thantrira Porntaveetus
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sandrine Touzet-Roumazeille
- CHU Lille, Inserm, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008-Controlled Drug Delivery Systems and Biomaterial, Université de Lille, Lille, France
| | - Marjolaine Willems
- Département de Génétique Clinique, CHRU de Montpellier, Hôpital Arnaud de Villeneuve, Institute for Neurosciences of Montpellier, INSERM, Univ Montpellier, Montpellier, France
| | - Arnaud Picard
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Marlène Rio
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | | | - Roman H. Khonsari
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
- Laboratoire ‘Forme et Croissance du Crâne’, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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9
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Ozturk T, Soylu S, Coban G, Turker G. Mandibular Radiomorphometric Characteristics of Individuals with Bilateral or Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2023:10556656231178504. [PMID: 37229644 DOI: 10.1177/10556656231178504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE This study aimed to investigate and compare the mandibular radiomorphometric characteristics of patients with unilateral or bilateral cleft lip and palate (CLP) with those of individuals without CLP and to determine whether there was a difference. DESIGN Retrospective cohort study. SETTING Orthodontic Department in Faculty of Dentistry. PATIENTS AND INTERVENTIONS Mandibular cortical bone thickness was measured on high-quality panoramic radiographs taken from 46 patients with unilateral or bilateral CLP aged 13-15 years and 21 control patients. MAIN OUTCOME MEASURES Three radiomorphometric indices [antegonial index (AI), mental index (MI), and panoramic mandibular index (PMI)] were measured bilaterally. AutoCAD software was used for MI, PMI, and AI measurements. RESULTS Left MI values were significantly lower in individuals with unilateral cleft lip and palate (UCLP; 0.029 ± 0.04) than in individuals with bilateral cleft lip and palate (BCLP; 0.033 ± 0.07). In addition, right MI values of individuals with right UCLP (0.26 ± 0.06) were significantly lower than those of individuals with left UCLP (0.34 ± 0.06) or BCLP (0.32 ± 0.08). No difference was observed between individuals with BCLP and left UCLP. These values did not differ between groups. CONCLUSIONS Antegonial index and PMI values did not differ between individuals with different types of CLP or when compared with control patients. In patients with UCLP, cortical bone thickness was found to be reduced on the cleft side compared to the intact side. Patients with UCLP with a right-sided cleft had a more substantial decrease in cortical bone thickness.
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Affiliation(s)
- Taner Ozturk
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Türkiye
| | - Sertan Soylu
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Türkiye
| | - Gokhan Coban
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Türkiye
| | - Gokhan Turker
- Department of Orthodontics, Faculty of Dentistry, Mersin University, Mersin, Türkiye
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10
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Kishinchand R, Boyce M, Vyas H, Sewell L, Mohi A, Brengartner L, Miller R, Gorr MW, Wold LE, Cray J. In Utero Exposure to Maternal Electronic Nicotine Delivery System use Demonstrate Alterations to Craniofacial Development. Cleft Palate Craniofac J 2023:10556656231163400. [PMID: 36916055 DOI: 10.1177/10556656231163400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE Develop a model for the study of Electronic Nicotine Device (ENDS) exposure on craniofacial development. DESIGN Experimental preclinical design followed as pregnant murine dams were randomized and exposed to filtered air exposure, carrier exposure consisting of 50% volume of propylene glycol and vegetable glycine (ENDS Carrier) respectively, or carrier exposure with 20 mg/ml of nicotine added to the liquid vaporizer (ENDS carrier with nicotine). SETTING Preclinical murine model exposure using the SciReq exposure system. PARTICIPANTS C57BL6 adult 8 week old female pregnant mice and exposed in utero litters. INTERVENTIONS Exposure to control filtered air, ENDS carrier or ENDS carrier with nicotine added throughout gestation at 1 puff/minute, 4 h/day, five days a week. MAIN OUTCOME MEASURES Cephalometric measures of post-natal day 15 pups born as exposed litters. RESULTS Data suggests alterations to several facial morphology parameters in the developing offspring, suggesting electronic nicotine device systems may alter facial growth if used during pregnancy. CONCLUSIONS Future research should concentrate on varied formulations and exposure regimens of ENDS to determine timing windows of exposures and ENDS formulations that may be harmful to craniofacial development.
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Affiliation(s)
- Rajiv Kishinchand
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Mark Boyce
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Heema Vyas
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Leslie Sewell
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Amr Mohi
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Lexie Brengartner
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Roy Miller
- School of Nursing, 2647The Ohio State University, Columbus, OH 43210, USA
| | - Matthew W Gorr
- School of Nursing, 2647The Ohio State University, Columbus, OH 43210, USA.,Department of Physiology and Cell Biology, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Loren E Wold
- School of Nursing, 2647The Ohio State University, Columbus, OH 43210, USA.,Department of Physiology and Cell Biology, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - James Cray
- Department of Biomedical Education and Anatomy, 12305The Ohio State University College of Medicine, Columbus, OH 43210, USA.,Division of Biosciences, College of Dentistry, 2647The Ohio State University, Columbus, OH 43210, USA
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11
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Solomon BD, Adam MP, Fong CT, Girisha KM, Hall JG, Hurst AC, Krawitz PM, Moosa S, Phadke SR, Tekendo-Ngongang C, Wenger TL. Perspectives on the future of dysmorphology. Am J Med Genet A 2023; 191:659-671. [PMID: 36484420 PMCID: PMC9928773 DOI: 10.1002/ajmg.a.63060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/30/2022] [Accepted: 11/12/2022] [Indexed: 12/13/2022]
Abstract
The field of clinical genetics and genomics continues to evolve. In the past few decades, milestones like the initial sequencing of the human genome, dramatic changes in sequencing technologies, and the introduction of artificial intelligence, have upended the field and offered fascinating new insights. Though difficult to predict the precise paths the field will follow, rapid change may continue to be inevitable. Within genetics, the practice of dysmorphology, as defined by pioneering geneticist David W. Smith in the 1960s as "the study of, or general subject of abnormal development of tissue form" has also been affected by technological advances as well as more general trends in biomedicine. To address possibilities, potential, and perils regarding the future of dysmorphology, a group of clinical geneticists, representing different career stages, areas of focus, and geographic regions, have contributed to this piece by providing insights about how the practice of dysmorphology will develop over the next several decades.
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Affiliation(s)
- Benjamin D. Solomon
- Medical Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland, United States of America
| | - Margaret P. Adam
- Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
| | - Chin-To Fong
- Department of Genetics, University of Rochester, Rochester, New York, United States of America
| | - Katta M. Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Judith G. Hall
- University of British Columbia and Children’s and Women’s Health Centre of British Columbia, Canada
- Department of Pediatrics and Medical Genetics, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Anna C.E. Hurst
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Peter M. Krawitz
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Shahida Moosa
- Division of Molecular Biology and Human Genetics, Stellenbosch University
- Medical Genetics, Tygerberg Hospital, Tygerberg, South Africa
| | - Shubha R. Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Cedrik Tekendo-Ngongang
- Medical Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland, United States of America
| | - Tara L. Wenger
- Division of Genetic Medicine, University of Washington, Seattle, Washington, United States of America
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12
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Darouich S, Bellamine H, Khamassi I. Severe Ciliopathy-Like Phenotype in an Infant With a Novel MPDU1 Missense Variant. Pediatr Dev Pathol 2023; 26:161-165. [PMID: 36755425 DOI: 10.1177/10935266231151773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Congenital disorders of glycosylation (CDG) are associated with ciliary dysfunction due to altered glycosylation of ciliary glycoproteins. We describe a severe ciliopathy-like phenotype in a female infant associated with a novel homozygous missense variant NM_004870.4(MPDU1):c.503G>A/p.Gly168Glu. Our findings, based on the co-segregation of the variant with the phenotype and in-silico analysis, implicate this MPDU1 missense variant in this disorder. Matched phenotype includes symmetric growth restriction, facial dysmorphism, ichthyosis, hepatomegaly with severe duct plate malformation, renal cortical tubular and glomerular cysts, moderate cerebral tetraventricular dilatation, and severe pontocerebellar hypoplasia. According to this observation, CDG should be included in the workup of infantile ciliopathy-like disorder.
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Affiliation(s)
- Sihem Darouich
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie.,Unité de Pathologie Fœtale et Placentaire, CHU Habib Bougatfa, Bizerte, Tunisie
| | - Houda Bellamine
- Département de Cytologie et Anatomie Pathologiques, Hôpital Menzel Bourguiba, Menzel Bourguiba, Tunisie
| | - Ichrak Khamassi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisie.,Département de Néonatologie et Pédiatrie, CHU Habib Bougatfa, Bizerte, Tunisie
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13
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Hennocq Q, Bongibault T, Bizière M, Delassus O, Douillet M, Cormier-Daire V, Amiel J, Lyonnet S, Marlin S, Rio M, Picard A, Khonsari RH, Garcelon N. An automatic facial landmarking for children with rare diseases. Am J Med Genet A 2023; 191:1210-1221. [PMID: 36714960 DOI: 10.1002/ajmg.a.63126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/31/2023]
Abstract
Two to three thousand syndromes modify facial features: their screening requires the eye of an expert in dysmorphology. A widely used tool in shape characterization is geometric morphometrics based on landmarks, which are precise and reproducible anatomical points. Landmark positioning is user dependent and time consuming. Many automatic landmarking tools are currently available but do not work for children, because they have mainly been trained using photographic databases of healthy adults. Here, we developed a method for building an automatic landmarking pipeline for frontal and lateral facial photographs as well as photographs of external ears. We evaluated the algorithm on patients diagnosed with Treacher Collins (TC) syndrome as it is the most frequent mandibulofacial dysostosis in humans and is clinically recognizable although highly variable in severity. We extracted photographs from the photographic database of the maxillofacial surgery and plastic surgery department of Hôpital Necker-Enfants Malades in Paris, France with the diagnosis of TC syndrome. The control group was built from children admitted for craniofacial trauma or skin lesions. After testing two methods of object detection by bounding boxes, a Haar Cascade-based tool and a Faster Region-based Convolutional Neural Network (Faster R-CNN)-based tool, we evaluated three different automatic annotation algorithms: the patch-based active appearance model (AAM), the holistic AAM, and the constrained local model (CLM). The final error corresponding to the distance between the points placed by automatic annotation and those placed by manual annotation was reported. We included, respectively, 1664, 2044, and 1375 manually annotated frontal, profile, and ear photographs. Object recognition was optimized with the Faster R-CNN-based detector. The best annotation model was the patch-based AAM (p < 0.001 for frontal faces, p = 0.082 for profile faces and p < 0.001 for ears). This automatic annotation model resulted in the same classification performance as manually annotated data. Pretraining on public photographs did not improve the performance of the model. We defined a pipeline to create automatic annotation models adapted to faces with congenital anomalies, an essential prerequisite for research in dysmorphology.
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Affiliation(s)
- Quentin Hennocq
- Imagine Institute, INSERM UMR 1163, Paris, France.,Département de chirurgie maxillo-faciale et chirurgie plastique pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
| | | | | | | | | | - Valérie Cormier-Daire
- Fédération de médecine génomique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Jeanne Amiel
- Fédération de médecine génomique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Stanislas Lyonnet
- Fédération de médecine génomique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Sandrine Marlin
- Fédération de médecine génomique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Marlène Rio
- Fédération de médecine génomique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Arnaud Picard
- Département de chirurgie maxillo-faciale et chirurgie plastique pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Roman Hossein Khonsari
- Département de chirurgie maxillo-faciale et chirurgie plastique pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
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14
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Wright T, Law C, Wright B, Wright B. Does Father Christmas Have a Distinctive Facial Phenotype? Vision (Basel) 2022; 6. [PMID: 36548933 DOI: 10.3390/vision6040071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
We investigated whether Father Christmas has a distinguishable facial phenotype by performing a cross-sectional cohort study examining the facial feature vectors of all publicly available photographs obtained from a google image search of individuals meeting our eligibility criteria presenting as Father Christmas compared with other adult and elderly bearded men. Facial feature vectors were determined using the open-source OpenFace facial recognition system and assessed by support vector machines (SVM). SVM classifiers were trained to distinguish between the facial feature vectors from our groups. Accuracy, precision, and recall results were calculated and the area under the curve (AUC) of the receiver operating characteristic (ROC) were reported for each classifier. SVM classifiers were able to distinguish the face of Father Christmas from other adult men with a high degree of accuracy and could discriminate Father Christmas from elderly bearded men but with lower accuracy. Father Christmas appears to have a distinct facial phenotype when compared to adult men and elderly bearded men. This will be reassuring to children who may be keen to recognise him but raises some interesting questions about the careful use of two-dimensional facial analysis, particularly when employed to explore the relationships between genotype and facial phenotype in a clinical dysmorphology setting.
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15
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Bandoli G, Coles C, Kable J, Jones KL, Delker E, Wertelecki W, Yevtushok L, Zymak-Zakutnya N, Granovska I, Plotka L, Chambers C. Alcohol-related dysmorphic features as predictors of neurodevelopmental delay in infants and preschool-aged children: Results from a birth cohort in Ukraine. Alcohol Clin Exp Res 2022; 46:2236-2244. [PMID: 36308058 PMCID: PMC10187054 DOI: 10.1111/acer.14966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cardinal and non-cardinal dysmorphic features are associated with prenatal alcohol exposure (PAE); however, their association with neurodevelopment is less clear. The objective of this study was to determine whether alcohol-related dysmorphic features predict neurodevelopmental delay in infants and toddlers. METHODS We analyzed a prospective pregnancy cohort in western Ukraine enrolled between 2008 and 2014. A dysmorphology examination comprising body size and three cardinal and 14 non-cardinal dysmorphic features was performed at approximately 6 to 12 months of age. PAE was self-reported and operationalized as absolute ounces of alcohol per day around the time of conception. Neurodevelopment was assessed at 6 to 12 months with the Bayley Scales of Infant Development-II (BSID-II), and at 3.5 to 4.5 years of age with the Differential Ability Scales-II, the Child Behavior Checklist, and multiple measures that were used to create an executive functioning factor score. We performed logistic regression to predict children's neurodevelopment from dysmorphic features, growth measures, sex, and PAE. RESULTS From an analytic sample of 582 unique children, 566 had BSID-II scores in infancy, and 289 completed the preschool battery. Models with all cardinal and non-cardinal dysmorphic features, growth measures, sex, and PAE performed better than models with subsets of those inputs. In general, models had poor performance classifying delays in infancy (area under the curve (AUC) <0.7) and acceptable performance on preschool-aged outcomes (AUC ~0.75). When the sample was limited to children with moderate-to-high PAE, predictive ability improved on preschool-aged outcomes (AUC 0.76 to 0.89). Sensitivity was relatively low for all models (12% to 63%), although other metrics of performance were higher. CONCLUSION Predictive analysis based on dysmorphic features and measures of growth performed modestly in this sample. As these features are more reliably measured than neurodevelopment at an earlier age, the inclusion of dysmorphic features and measures of growth in predictive models should be further explored and validated in different settings and populations.
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Affiliation(s)
| | | | | | | | - Erin Delker
- Department of Pediatrics, University of California San Diego
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California San Diego
- OMNI-Net Ukraine Birth Defects Program
| | - Lyubov Yevtushok
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
- Lviv National Medical University, Lviv, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net Ukraine Birth Defects Program
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Iryna Granovska
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Larysa Plotka
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
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16
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Biesecker LG, Adam MP, Chung BH, Kosaki K, Menke LA, White SM, Carey JC, Hennekam RC. Elements of morphology: Standard terminology for the trunk and limbs. Am J Med Genet A 2022; 188:3191-3228. [PMID: 36062894 PMCID: PMC9582996 DOI: 10.1002/ajmg.a.62965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/19/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023]
Abstract
An international group of clinicians working in the field of dysmorphology has initiated the standardization of terms used to describe human morphology. The goals are to standardize these terms and reach consensus regarding their definitions. In this way, we will increase the utility of descriptions of the human phenotype and facilitate reliable comparisons of findings among patients. Additional discussions with other workers in dysmorphology and related fields, such as developmental biology and molecular genetics, will become more precise. Here we introduce the anatomy of the trunk and limbs and define and illustrate the terms that describe the major characteristics of these body regions.
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Affiliation(s)
- Leslie G. Biesecker
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Margaret P. Adam
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Brian H.Y. Chung
- Department of Pediatrics and Adolescent Medicine, LKS Faculty of Medicine, University of Hong Kong, and Hong Kong Genome Institute, Hong Kong Special Administrative Region, China
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, 108-8345, Japan
| | - Leonie A. Menke
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Susan M. White
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Victoria, and Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - John C. Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah Health, Salt Lake City, Utah, USA
| | - Raoul C.M. Hennekam
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
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17
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Ozbaran NB, Ozyasar SC, Dogan N, Kafali HY, Isik E, Satar A, Kose S, Atik T, Cogulu O. Evaluation of social cognition, autistic traits, and dysmorphology in comorbid specific learning disorder and attention-deficit/hyperactivity disorder. Clin Child Psychol Psychiatry 2022; 27:991-1005. [PMID: 35658687 DOI: 10.1177/13591045221095428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research on areas such as social cognition, autistic traits, and minor physical anomalies in comorbid Specific Learning Disorder (SLD) and attention-deficit/hyperactivity disorder (ADHD) is limited. In this study, we compared these areas in children aged between 8 and 14 with comorbid SLD and ADHD and their typically developed peers. Emotion recognition and social cognition were evaluated by Faces Test, Reading the Mind in the Eyes Test, Comprehension Test, and Difficulties in Emotion Regulation Scale. Autism Spectrum Screening Questionnaire and Social Responsiveness Scale were used for screening of autism spectrum disorder in children. Furthermore, autistic traits in parents were measured by Autism-Spectrum Quotient. The MPAs of all the subjects were determined by pediatric geneticists. We detected that children with comorbid SLD and ADHD performed worse than controls in all social cognition tests and maternal AQ score had a strong correlation with the Faces Test, DERS, and SRS scores. Also, the total ASSQ score in the comorbid SLD and ADHD group was significantly higher than controls. Finally, MPAs were significantly more frequent in the comorbid SLD and ADHD group. Impairment in social cognition and evaluation of autistic traits and dysmorphology in children with comorbid SLD and ADHD may provide useful information on neurodevelopmental disorders.
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Affiliation(s)
- Nazli Burcu Ozbaran
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, 60521Ege University, Izmir, Turkey
| | - Senay Celenay Ozyasar
- Department of Child and Adolescent Psychiatry, 233010Adiyaman Education and Research Hospital, Adiyaman, Turkey
| | - Nurhak Dogan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, 60521Ege University, Izmir, Turkey
| | - Helin Yilmaz Kafali
- Department of Child and Adolescent Psychiatry, 536164Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Esra Isik
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, 60521Ege University, Izmir, Turkey
| | - Aysegul Satar
- Department of Child and Adolescent Psychiatry, Ardahan State Hospital, Ardahan, Turkey
| | - Sezen Kose
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, 60521Ege University, Izmir, Turkey
| | - Tahir Atik
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, 60521Ege University, Izmir, Turkey
| | - Ozgur Cogulu
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, 60521Ege University, Izmir, Turkey
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18
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Arslan AB, Zamani AG, Yıldırım MS. Novel Findings, Mini-Review and Dysmorphological Characterization of 16p13.11 Microduplication syndrome. Int J Dev Neurosci 2022; 82:289-294. [PMID: 35470466 DOI: 10.1002/jdn.10188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 11/07/2022] Open
Abstract
The short arm of chromosome 16 and especially the region 16p13.11 is a chromosome region where many structural variants, especially deletions and duplications, can be observed. While deletions of this region are clinically well defined, duplications are rare, and so far, there is no established clinical consensus in regard with its clinical picture, and especially the dysmorphic perspective of the disease is far from being clear. A 5-year-and-2-month-old patient who presented with epilepsy, autism and late speech onset complaints, was evaluated in our genetics department. On physical examination unilateral preauricular skin tag and upslanting palpebral fissures were noted. Microarray analysis was performed and reported as ([hg19]: 16p13.11 (14.897.804-16.730.375) x3). The literature review revealed only a few reports about the syndrome, but some dysmorphological findings appear to recur in different reports, which enables a possible characterization. Dysmorphic findings were discussed.
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Affiliation(s)
- Ahmet Burak Arslan
- Medical Genetics Department, Necmettin Erbakan University Hospital, Konya, Turkey
| | - Ayşe Gül Zamani
- Medical Genetics Department, Necmettin Erbakan University Hospital, Konya, Turkey
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19
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Bruce MK, Tao W, Beiriger J, Christensen C, Pfaff MJ, Whitaker R, Goldstein JA. 3D Photography to Quantify the Severity of Metopic Craniosynostosis. Cleft Palate Craniofac J 2022:10556656221087071. [PMID: 35306870 PMCID: PMC9489814 DOI: 10.1177/10556656221087071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aims to determine the utility of 3D photography for evaluating the severity of metopic craniosynostosis (MCS) using a validated, supervised machine learning (ML) algorithm. This single-center retrospective cohort study included patients who were evaluated at our tertiary care center for MCS from 2016 to 2020 and underwent both head CT and 3D photography within a 2-month period. The analysis method builds on our previously established ML algorithm for evaluating MCS severity using skull shape from CT scans. In this study, we regress the model to analyze 3D photographs and correlate the severity scores from both imaging modalities. 14 patients met inclusion criteria, 64.3% male (n = 9). The mean age in years at 3D photography and CT imaging was 0.97 and 0.94, respectively. Ten patient images were obtained preoperatively, and 4 patients did not require surgery. The severity prediction of the ML algorithm correlates closely when comparing the 3D photographs to CT bone data (Spearman correlation coefficient [SCC] r = 0.75; Pearson correlation coefficient [PCC] r = 0.82). The results of this study show that 3D photography is a valid alternative to CT for evaluation of head shape in MCS. Its use will provide an objective, quantifiable means of assessing outcomes in a rigorous manner while decreasing radiation exposure in this patient population.
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Affiliation(s)
- Madeleine K Bruce
- Department of Plastic Surgery, 6619UPMC Children's Hospital, Pittsburgh, PA, United States
| | - Wenzheng Tao
- School of Computing, University of Utah, Salt Lake City, UT, United States
| | - Justin Beiriger
- Department of Plastic Surgery, 6619UPMC Children's Hospital, Pittsburgh, PA, United States
| | | | - Miles J Pfaff
- Department of Plastic Surgery, 6619UPMC Children's Hospital, Pittsburgh, PA, United States
| | - Ross Whitaker
- School of Computing, University of Utah, Salt Lake City, UT, United States
| | - Jesse A Goldstein
- Department of Plastic Surgery, 6619UPMC Children's Hospital, Pittsburgh, PA, United States
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20
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Forsyth R, Parisi MA, Altintas B, Malicdan MC, Vilboux T, Knoll J, Brooks BP, Zein WM, Gahl WA, Toro C, Gunay-Aygun M. Systematic analysis of physical examination characteristics of 94 individuals with Joubert syndrome: Keys to suspecting the diagnosis. Am J Med Genet C Semin Med Genet 2022; 190:121-130. [PMID: 35312150 PMCID: PMC9117497 DOI: 10.1002/ajmg.c.31966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 11/12/2022]
Abstract
Joubert syndrome (JS) is a neurodevelopmental disorder characterized by hypotonia and developmental delay, as well as the obligatory molar tooth sign on brain imaging. Since hypotonia and developmental delay are nonspecific features, there must be a high level of clinical suspicion of JS so that the diagnostic brain imaging and/or molecular testing for the >38 genes associated with JS is/are obtained. The goal of this study was to analyze clinical photographs of a cohort of patients with JS to define a list of physical examination features that should prompt investigation for JS. Analysis of photographs from 94 individuals with JS revealed that there is a recognizable pattern of facial features in JS that changes over time as individuals age. Macrocephaly, head tilting even when looking straight ahead, eye movement abnormalities (oculomotor apraxia, nystagmus, strabismus), and ptosis are common in those with JS. Distinctive features in younger children include triangular-shaped open mouth with tongue protrusion; in older children and adults, mandibular prognathia and prominent nasal bridge are common.
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Affiliation(s)
- RaeLynn Forsyth
- Department of Pediatrics and McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Melissa A Parisi
- Intellectual & Developmental Disabilities Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Burak Altintas
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - May Christine Malicdan
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Thierry Vilboux
- Inova Functional Laboratory, Inova Health System, Fairfax, Virginia, USA
- Section of Human Biochemical Genetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jasmine Knoll
- Division of Genetics and Genomics, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian P Brooks
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Wadih M Zein
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - William A Gahl
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
- Section of Human Biochemical Genetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Camilo Toro
- Undiagnosed Disease Network, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Meral Gunay-Aygun
- Department of Pediatrics and McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Section of Human Biochemical Genetics, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
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21
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Starosta RT, Granadillo JL, Patel KR, Finegold MJ, Stoll J, Kulkarni S. Intrahepatic Cholestasis, Refractory Epilepsy, Skeletal Dysplasia, Endocrine Failure, and Dysmorphic Features in a Child With a Monoallelic 2q24-32.2 Deletion Encompassing ABCB11. Pediatr Dev Pathol 2022; 25:174-179. [PMID: 34428094 DOI: 10.1177/10935266211036084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a newborn who presented with multiple limb and facial anomalies, endocrine disorders, and progressively worsening low-GGT cholestasis. A liver biopsy revealed hepatocellular cholestasis with giant cell transformation. Immunohistochemical staining revealed complete absence of BSEP protein compared to control liver. A large 2q24-32.2 deletion leading to loss of 78 OMIM genes. Multiple structural anomalies, epilepsy and endocrine anomalies have been described with hemizygous loss of these genes. This deletion also resulted in complete heterozygous deletion of ABCB11, which encodes the bile salt export pump (BSEP). Genetic analysis did not reveal any pathogenic variants, deletions, or duplications in the other ABCB11 allele. A heterozygous variant in NR1H4, which causes the autosomal recessive progressive familial intrahepatic cholestasis type 5, was also detected. The possible explanations for the PFIC type 2 phenotype in heterozygous loss of ABCB11 include genetic modifiers or di-genic disease with a compound ABCB11 deletion and an NR1H4 missense variant; or undetected pathogenic variants in the other ABCB11 or NR1H4 alleles.
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Affiliation(s)
- Rodrigo Tzovenos Starosta
- Division of Genetics and Genomic Medicine, Department of Pediatrics, 7548Washington University in Saint Louis, Saint Louis Children's Hospital, Washington University in Saint Louis, Saint Louis, Missouri.,Department of Pediatrics, 7548Washington University in Saint Louis, Washington University in Saint Louis, St. Louis Children's Hospital, Saint Louis, Missouri
| | - Jorge Luis Granadillo
- Division of Genetics and Genomic Medicine, Department of Pediatrics, 7548Washington University in Saint Louis, Saint Louis Children's Hospital, Washington University in Saint Louis, Saint Louis, Missouri
| | - Kalyani R Patel
- Department of Pathology and Immunology, Texas Children's Hospital, Houston, Texas
| | | | - Janis Stoll
- Department of Pediatrics, 7548Washington University in Saint Louis, Washington University in Saint Louis, St. Louis Children's Hospital, Saint Louis, Missouri
| | - Sakil Kulkarni
- Department of Pediatrics, 7548Washington University in Saint Louis, Washington University in Saint Louis, St. Louis Children's Hospital, Saint Louis, Missouri
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22
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Pors J, Philipp T, Terry J. Placental Expression of the Forelimb Patterning Transcription Factor MEIS2 in Trisomy 15. Fetal Pediatr Pathol 2021; 40:597-604. [PMID: 32138576 DOI: 10.1080/15513815.2020.1732509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BackgroundObservations of first trimester human trisomy 15 (T15) embryos have identified meromelic changes in the upper limbs. These changes are similar to those observed in animal studies investigating the effects of overexpression of Meis2, a signaling transcription factor expressed during forelimb development. Although it would be exceedingly difficult to assess MEIS2 expression in the human embryonic arm, MEIS2 has been reported as consistently expressed in first trimester placental villus stroma. Methods: This study addresses whether gene dosage effect might underlie meromelia in T15 by comparing MEIS2 expression in placentas from T15 and euploid spontaneous abortions employing manual and automated assessment of MEIS2 immunohistochemical scoring. Results: Average MEIS2 expression is increased in T15 first trimester placental tissue compared to euploid controls but that the difference is marginal. Manual and automated scoring showed moderately strong correlation. Conclusion: Extrapolation of these results suggests MEIS2 overexpression may not be required for meromelia in T15.
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Affiliation(s)
- Jennifer Pors
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom Philipp
- Department of Gynecology and Obstetrics, Danube Hospital, Vienna, Austria
| | - Jefferson Terry
- Pathology, BC Children's Hospital, Vancouver, British Columbia, Canada
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23
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Ruschkowski B, Nasr A, Oltean I, Lawrence S, El Demellawy D. Examining the Relationship Between Gastroschisis and Placental Fetal Vascular Malperfusion. Pediatr Dev Pathol 2021; 24:531-541. [PMID: 34284667 PMCID: PMC8652372 DOI: 10.1177/10935266211029629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Gastroschisis is a congenital malformation characterized by intestinal herniation through an abdominal wall defect. Despite its unknown pathogenesis, known risk factors include maternal smoking, alcohol use, and young maternal age. Previous work has shown that gastroschisis is associated with placental delayed villous maturation, and the goal of this study was to assess for additional associated placental pathologies that may help clarify the pathogenesis of gastroschisis. METHODS We conducted a retrospective slide review of 29 placentas of neonates with gastroschisis. Additionally, we reviewed pathology reports from one control group of 30 placentas with other congenital malformations. Gross and histological data were collected based on a standardized rubric. RESULTS Gastroschisis was associated with increased placental fetal vascular malperfusion (FVM) in 62% of cases (versus 0% of controls, p < 0.0001). It was also associated with increased placental villous maldevelopment in 76% of cases (versus 3% of controls, p < 0.0001). CONCLUSION Our study demonstrates an association between gastroschisis and FVM. While FVM could be the consequence of vascular disruption due to the ventral location of gastroschisis, it could also reflect estrogen-induced thrombosis in early pregnancy. Further research is needed to separate these possibilities and determine the cause of the placental FVM observed in gastroschisis.
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Affiliation(s)
| | - Ahmed Nasr
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Department of Pediatric Surgery, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Irina Oltean
- Department of Pediatric Surgery, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sarah Lawrence
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Department of Pediatrics, Neonatology Division, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Dina El Demellawy
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada,Dina El Demellawy, Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, Ontario K1H 8L1, Canada.
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24
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Pyle LC. The discipline of dysmorphology and the beauty of art. Am J Med Genet C Semin Med Genet 2021; 187:141-143. [PMID: 33991442 DOI: 10.1002/ajmg.c.31914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
A physician learns to appreciate art by first learning the human form through dysmorphology, and via the art collection of physician Dr. Albert C. Barnes and the Barnes Museum (Philadelphia, PA).
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Affiliation(s)
- Louise C Pyle
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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25
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Battaglia A, Carey JC. Reflections on observing faces in art. Am J Med Genet C Semin Med Genet 2021; 187:144-147. [PMID: 33982855 DOI: 10.1002/ajmg.c.31912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Abstract
The experience of art provides the visitor of a museum or gallery with the opportunity to contemplate and share the human condition both from the physical and psychological point of view. Because of the accessibility and the number of museums throughout Europe, classical European art as both sculpture and painting, affords the viewer the opportunity to experience life from one part of the world over centuries of history. These museums occasionally exhibit pieces showing a person with a human disorder and physical differences. On viewing such artwork, practitioners of health care, especially dysmorphologists, usually find themselves observing such pieces within the context of their practice. In this essay, the coauthors reflect on paintings and sculptures which remind us of our patients with similar physical and medical conditions. Various works of art also provide the opportunity to observe and view the human face from many vantage points and times in history. Several paintings are cited to illustrate the central themes of the Commentary: the human circumstance of disease and differences and the skill of observing and describing the human face.
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Affiliation(s)
- Agatino Battaglia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, Utah, USA
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26
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Innes AM, Lynch DC. Fifty years of recognizable patterns of human malformation: Insights and opportunities. Am J Med Genet A 2021; 185:2653-2669. [PMID: 33951288 DOI: 10.1002/ajmg.a.62240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
Now in its 7th edition, Smith's Recognizable Patterns of Human Malformation was first published in 1970. This 1st edition comprised 135 "dysmorphic syndromes of multiple primary defects" and 12 "single syndromic malformations resulting in secondary defects." Of the former, other than a few chromosomal and environmental disorders, most were heritable conditions of then unknown etiology. In 2021, the majority of these conditions are now "solved," a notable exception is Hallermann-Streiff syndrome. The "solved" conditions were typically clinically delineated decades prior to understanding the underlying etiology, which rarely required recent technologies such as exome sequencing (ES) to elucidate. The 7th edition includes nearly 300 syndromes, sequences, and associations. An increasing number of conditions first appearing in the latest editions are sporadic, with many solved using either array CGH or ES. We have reviewed all syndromes that have appeared in "Smith's" with a focus on inheritance, heterogeneity, and year and method of etiologic discovery. Several themes emerge. Genetic heterogeneity and pleiotropy of genes are frequent. Several of the currently "unresolved" syndromes are clinically diverse such as Dubowitz syndrome. Multiple recurrent constellations of embryonic malformations, with VACTERL association as a paradigm, are increasingly likely to have a shared pathogenesis requiring further study.
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Affiliation(s)
- A Micheil Innes
- Department of Medical Genetics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle C Lynch
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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27
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Sanchez-Lara PA, Grand K, Haanpää MK, Curry CJ, Wang R, Ezgü F, Rose CM, D'Cunha Burkardt D, Conway RL, Relan A, Carey JC. Thinking outside "The Box": Case-based didactics for medical education and the instructional legacy of Dr John M. Graham, Jr. Am J Med Genet A 2021; 185:2636-2645. [PMID: 33913595 DOI: 10.1002/ajmg.a.62202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/23/2022]
Abstract
The increasing demand for advanced genomic services has finally come to the attention of healthcare systems and stakeholders who are now eager to find creative solutions to increase the pool of genomic literate providers. Training in genetics and dysmorphology has historically been conducted as a self-driven practice in pattern recognition, ideally within a formal or informal apprenticeship supervised by a master diagnostician. In recent times, case-based learning, framed by flipped classroom pedagogy have become the preferred teaching methods for complex medical topics such as genetics and genomics. To illuminate this perspective, our article was written in honor of the teaching style and pedagogy of Dr John M. Graham Jr and his lifelong commitment to medical education and mentoring.
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Affiliation(s)
- Pedro A Sanchez-Lara
- Division of Medical Genetics, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Katheryn Grand
- Division of Medical Genetics, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maria K Haanpää
- Department of Genomics and Clinical Genetics, Turku University Hospital, Turku, Finland.,Department of Medicine, Stanford University, School of Medicine, Stanford, California, USA
| | - Cynthia J Curry
- Genetic Medicine, Department of Pediatrics, University of California San Francisco, Fresno, California, USA
| | - Raymond Wang
- Division of Metabolic Disorders, CHOC, Children's Hospital Orange County, Orange, California, USA.,Department of Pediatrics, University of California-Irvine School of Medicine, Orange, California, USA
| | - Fatih Ezgü
- Faculty of Medicine, Department and Laboratory of Pediatric Metabolic Disorders, Gazi University, Ankara, Turkey
| | - Catherine M Rose
- Victorian Clinical Genetic Service, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Deepika D'Cunha Burkardt
- Medical Genomics and Metabolic Genetics Branch, National Human genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert L Conway
- Department of Pediatric Neurosciences, Spectrum Health/Helen DeVos Children's Hospital Medical Genetics, Grand Rapids, Michigan, USA
| | - Anju Relan
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - John C Carey
- Department of Pediatrics, Division of Medical genetics, The University of Utah, Salt Lake City, Utah, USA
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28
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Hootnick DR, Levinsohn EM. Embryology of the lower limb demonstrates that congenital absent fibula is a radiologic misnomer. Anat Rec (Hoboken) 2021; 305:8-17. [PMID: 33773063 DOI: 10.1002/ar.24628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/09/2021] [Accepted: 02/26/2021] [Indexed: 11/11/2022]
Abstract
The congenitally shortened limb (CSL) with fibular deficiency or absence has historically been graded by plain radiography, while associated cartilaginous and arterial soft tissue anomalies have been comparatively neglected. Consistent pathological evidence of remnant cartilaginous bodies in place of the fibula presupposes earlier existence of a preformed cartilaginous template of the fibula. In complete fibular radiographic absences, often associated with midline metatarsal deficiencies, the two usual nutrient arteries to the fibula fail to form, as they normally would have, around the (16-18 mm stage) sixth embryonic week. The histopathology of fallow persisting fibular anlagen, in association with missing arteries and retained primitive arteries, suggests the anlage is a dystrophic, but otherwise normally prefigured, cartilaginous scaffold of the fibula. Thus, the widely employed term absent fibula, which has been grounded in plain radiography, is a misnomer. Additionally, since the metatarsals missing in congenitally shortened limb are midline, the related term, fibular hemimelia, is similarly inaccurate. A new taxonomy, based on embryological principles rather than radiographic appearance alone, will promote limb dystrophism as a more accurate term combining arrested embryonic vascular development and congenitally shortened limb of the lower extremity.
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Affiliation(s)
- David R Hootnick
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA.,Department of Cellular and Developmental Biology, SUNY Upstate Medical University, Syracuse, New York, USA.,Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York, USA
| | - E Mark Levinsohn
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA.,Department of Radiology, Crouse Irving Memorial Hospital, Syracuse, New York, USA
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29
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Mahmoud R, Leonenko A, Butler MG, Flodman P, Gold JA, Miller JL, Roof E, Dykens E, Driscoll DJ, Kimonis V. Influence of molecular classes and growth hormone treatment on growth and dysmorphology in Prader-Willi syndrome: A multicenter study. Clin Genet 2021; 100:29-39. [PMID: 33615449 DOI: 10.1111/cge.13947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/16/2022]
Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder with three molecular classes but clinical ascertainment is based on distinctive features. The prevalence of dysmorphic features was studied in 355 PWS participants (61% deletion, 36% maternal disomy [UPD], and 3% imprinting defects) from the National Institute of Health PWS Rare Diseases Clinical Research Network. The effect of growth hormone (GH) treatment on growth and dysmorphic features was compared. Among participants, upslanting palpebral fissures were seen in 23%; strabismus in 42%; abnormal dentition in 32%; small hands in 63% and small feet in 70%; hypopigmentation in 30%; striae in 32% and skin picking in 26%. Compared to those with UPD, participants with deletions were found to be heavier (p = 0.002), had smaller head circumference (HC) (p = 0.009), higher incidence of a flat occiput (p = 0.005); low-anterior hairline (p = 0.04); abnormal dentition (p = 0.009); abdominal striae (p = 0.045), nail abnormalities (p = 0.050), and fair-haired (p < 0.001). Participants in both genetic groups receiving GH were taller (p = 0.005), had larger HCs (p = 0.005), and longer hands (p = 0.049). This study suggested that PWS genetic subtypes and GH treatment can influence growth and dysmorphic features that may impact clinical diagnosis of PWS, such as stature, head shape and appearance of the eyes, nose, and genitalia.
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Affiliation(s)
- Ranim Mahmoud
- Department of Pediatrics, University of California, Irvine, CA, Children's Hospital of Orange County, Orange, California.,Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Anna Leonenko
- Department of Pediatrics, University of California, Irvine, CA, Children's Hospital of Orange County, Orange, California
| | - Merlin G Butler
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Pamela Flodman
- Department of Pediatrics, University of California, Irvine, CA, Children's Hospital of Orange County, Orange, California
| | - June-Anne Gold
- Department of Pediatrics, University of California, Irvine, CA, Children's Hospital of Orange County, Orange, California.,Department of Pediatrics, Loma Linda University Medical School, Loma Linda, California.,Childrens Hospital of Orange County, Orange, California
| | - Jennifer L Miller
- Department of Pediatrics, University of Florida, College of Medicine, Gainesville, Florida
| | - Elizabeth Roof
- Vanderbilt Kennedy Center for Research on Human Development, Vanderbilt University, Nashville, Tennessee
| | - Elisabeth Dykens
- Vanderbilt Kennedy Center for Research on Human Development, Vanderbilt University, Nashville, Tennessee
| | - Daniel J Driscoll
- Department of Pediatrics, University of Florida, College of Medicine, Gainesville, Florida
| | - Virginia Kimonis
- Department of Pediatrics, University of California, Irvine, CA, Children's Hospital of Orange County, Orange, California.,Childrens Hospital of Orange County, Orange, California
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Marwaha A, Chitayat D, Meyn MS, Mendoza-Londono R, Chad L. The point-of-care use of a facial phenotyping tool in the genetics clinic: Enhancing diagnosis and education with machine learning. Am J Med Genet A 2021; 185:1151-1158. [PMID: 33554457 DOI: 10.1002/ajmg.a.62092] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/13/2020] [Accepted: 01/09/2021] [Indexed: 12/17/2022]
Abstract
Computer-assisted pattern recognition platforms, such as Face2Gene® (F2G), can facilitate the diagnosis of children with rare genetic syndromes by comparing a patient's features to known genetic diagnoses. Our work designed, implemented, and evaluated an innovative model of care in clinical genetics in a heterogeneous and multicultural patient population that utilized this facial phenotyping software at the point-of-care. We assessed the performance of F2G by comparing the suggested diagnoses to the patient's confirmed molecular diagnosis. Providers' overall experiences with the technology and trainees' educational experiences were assessed with questionnaires. We achieved an overall diagnostic yield of 57%. This increased to 82% when cases diagnosed with syndromes not recognized by F2G were removed. The mean rank of a confirmed diagnosis in the top 10 was 2.3 (CI 1.5-3.2) and the mean gestalt score 37.6%. The most commonly suggested diagnoses were Noonan syndrome, mucopolysaccharidosis, and 22q11.2 deletion syndrome. Our qualitative assessment revealed that clinicians and trainees saw value using the tool in practice. Overall, this work helped to implement an innovative patient care delivery model in clinical genetics that utilizes a facial phenotyping tool at the point-of-care. Our data suggest that F2G has utility in the genetics clinic as a clinical decision support tool in diverse populations, with a majority of patients having their eventual diagnosis listed in the top 10 suggested syndromes based on a photograph alone. It shows promise for further integration into clinical care and medical education, and we advocate for its continued use, adoption and refinement along with transparent and accountable industrial partnerships.
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Affiliation(s)
- Ashish Marwaha
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada.,The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - M Stephen Meyn
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada.,Center for Human Genomics and Precision Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Roberto Mendoza-Londono
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada
| | - Lauren Chad
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada.,Department of Bioethics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Kanuri B, Fong V, Ponny SR, Weerasekera R, Pulakanti K, Patel KS, Tyshynsky R, Patel SB. Generation and validation of a conditional knockout mouse model for desmosterolosis. J Lipid Res 2021; 62:100028. [PMID: 33524375 PMCID: PMC7933790 DOI: 10.1016/j.jlr.2021.100028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 12/28/2020] [Accepted: 01/21/2021] [Indexed: 11/28/2022] Open
Abstract
The enzyme 3β-hydroxysterol-Δ24 reductase (DHCR24, EC 1.3.1.72) catalyzes the conversion of desmosterol to cholesterol and is obligatory for post-squalene cholesterol synthesis. Genetic loss of this enzyme results in desmosterolosis (MIM #602398), a rare disease that presents with multiple congenital anomalies, features of which overlap with subjects with the Smith-Lemli-Opitz syndrome (another post-squalene cholesterol disorder). Global knockout (KO) of Dhcr24 in mice recapitulates the biochemical phenotype, but pups die within 24 h from a lethal dermopathy, limiting its utility as a disease model. Here, we report a conditional KO mouse model (Dhcr24flx/flx) and validate it by generating a liver-specific KO (Dhcr24flx/flx,Alb-Cre). Dhcr24flx/flx,Alb-Cre mice showed normal growth and fertility, while accumulating significantly elevated levels of desmosterol in plasma and liver. Of interest, despite the loss of cholesterol synthesis in the liver, hepatic architecture, gene expression of sterol synthesis genes, and lipoprotein secretion appeared unchanged. The increased desmosterol content in bile and stool indicated a possible compensatory role of hepatobiliary secretion in maintaining sterol homeostasis. This mouse model should now allow for the study of the effects of postnatal loss of DHCR24, as well as role of tissue-specific loss of this enzyme during development and adulthood.
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Affiliation(s)
- Babunageswararao Kanuri
- Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati, Cincinnati, OH, USA
| | - Vincent Fong
- Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati, Cincinnati, OH, USA
| | - Sithara Raju Ponny
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Kriya S Patel
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Roman Tyshynsky
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Shailendra B Patel
- Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati, Cincinnati, OH, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA.
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Tandon D, Skolnick GB, Naidoo SD, Grames LM, Cradock MM, Smyth MD, Patel KB. Morphologic Severity of Craniosynostosis: Implications for Speech and Neurodevelopment. Cleft Palate Craniofac J 2021; 58:1361-1369. [PMID: 33467909 DOI: 10.1177/1055665620984643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Single-suture craniosynostosis (SSC) can be associated with neurodevelopmental deficits. We examined the correlation between morphologic severity and incidence of speech-language or psychological concerns. METHODS In 62 patients (33 sagittal, 17 metopic, and 12 unicoronal), morphologic severity was determined via preoperative computed tomography (CT). Severity metrics for sagittal, metopic, and unicoronal synostosis were adjusted cephalic index (aCI), interfrontal angle (IFA), and anterior cranial fossa area ratio (ACFR), respectively. Speech-language and psychological concerns were assessed at age ≥4.5 years and defined as recommendation for therapy or monitoring. RESULTS Mean assessment age was 5.7 years; 32% had a speech-language concern and 44% had a psychological concern; 44% had neither. Sagittal: Mean aCI of those with a speech-language concern (0.62) and those without (0.62) were equivalent (P = .580), as were mean aCI of those with a psychological concern (0.62) and those without (0.62; P = .572). Metopic: Mean IFA with (117.9) and without (125.2) a speech-language concern were equivalent (P = .326), as were mean IFA with (120.2) and without (123.2) a psychological concern (P = .711). Unicoronal: Mean ACFR with (0.65) and without (0.69) a psychological concern (P = .423) were equivalent. However, mean ACFR with (0.74) and without (0.63) a speech-language concern were not (P = .022*). Bivariate rank correlation showed significant association between morphologic severity and speech-language score only for unicoronal synostosis (ρ = .722; P = .008*). CONCLUSION A significant portion of patients with SSC had speech-language or psychological concerns. We found no correlation between morphologic severity and incidence of speech-language or psychological concerns for patients with sagittal or metopic synostosis. Morphological severity did correlate with speech concerns in patients with unicoronal synostosis.
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Affiliation(s)
- Damini Tandon
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, MO, USA
| | - Sybill D Naidoo
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, MO, USA
| | - Lynn Marty Grames
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, MO, USA
| | | | - Matthew D Smyth
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, MO, USA
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Tonello C, Paula RG, Paula IP, Nunes RB, Kokitsu-Nakata NM, Alonso N. Eyeball Preservation With Purse-String Conjunctival Closure for Melting Corneal Ulcer in Rare Facial Cleft. Cleft Palate Craniofac J 2020; 58:1195-1200. [PMID: 33349028 DOI: 10.1177/1055665620980632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rare facial clefts are characterized by facial involvement that is not restricted to the lip, palate, and alveolus as in traditional cleft lip and palate. The craniofacial skeleton and the orbital structures are frequently affected in these conditions. Exposure of the eyeball, when not early treated, puts the function and the preservation of the eye at risk. We report the case of a 2-month-old boy admitted to our service with an extensive oral-ocular cleft and exposure of the eyeball with melting corneal ulcer treated with a conjunctival closure with a purse-string suture.
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Affiliation(s)
- Cristiano Tonello
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Raul G Paula
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Isabella P Paula
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Rodrigo B Nunes
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Nancy M Kokitsu-Nakata
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
| | - Nivaldo Alonso
- Hospital for Rehabilitation of Craniofacial Anomalies and Hospital of Clinics of Medicine Faculty, University of São Paulo, São Paulo, Brazil
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Kanuri B, Fong V, Ponny SR, Tallman KA, Rao SR, Porter N, Fliesler SJ, Patel SB. Generation and validation of a conditional knockout mouse model for the study of the Smith-Lemli-Opitz syndrome. J Lipid Res 2020; 62:100002. [PMID: 33410752 PMCID: PMC7890206 DOI: 10.1194/jlr.ra120001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022] Open
Abstract
Smith-Lemli-Opitz Syndrome (SLOS) is a developmental disorder (OMIM #270400) caused by autosomal recessive mutations in the Dhcr7 gene, which encodes the enzyme 3β-hydroxysterol-Δ7 reductase. SLOS patients present clinically with dysmorphology and neurological, behavioral, and cognitive defects, with characteristically elevated levels of 7-dehydrocholesterol (7-DHC) in all bodily tissues and fluids. Previous mouse models of SLOS have been hampered by postnatal lethality when Dhcr7 is knocked out globally, while a hypomorphic mouse model showed improvement in the biochemical phenotype with aging and did not manifest most other characteristic features of SLOS. We report the generation of a conditional knockout of Dhcr7 (Dhcr7flx/flx), validated by generating a mouse with a liver-specific deletion (Dhcr7L-KO). Phenotypic characterization of liver-specific knockout mice revealed no significant changes in viability, fertility, growth curves, liver architecture, hepatic triglyceride secretion, or parameters of systemic glucose homeostasis. Furthermore, qPCR and RNA-Seq analyses of livers revealed no perturbations in pathways responsible for cholesterol synthesis, either in male or in female Dhcr7L-KO mice, suggesting that hepatic disruption of postsqualene cholesterol synthesis leads to minimal impact on sterol metabolism in the liver. This validated conditional Dhcr7 knockout model may now allow us to systematically explore the pathophysiology of SLOS, by allowing for temporal, cell and tissue-specific loss of DHCR7.
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Affiliation(s)
- Babunageswararao Kanuri
- Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati, Cincinnati, OH, USA
| | - Vincent Fong
- Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati, Cincinnati, OH, USA
| | - Sithara Raju Ponny
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Keri A Tallman
- Department of Chemistry and Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, USA
| | - Sriganesh Ramachandra Rao
- Departments of Ophthalmology and Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-State University of New York, Buffalo, NY, USA
| | - Ned Porter
- Department of Chemistry and Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, USA
| | - Steven J Fliesler
- Departments of Ophthalmology and Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-State University of New York, Buffalo, NY, USA; Graduate Program in Neuroscience, University at Buffalo- State University of New York, Buffalo, NY, USA; Research Service, VA Western New York Healthcare System, Buffalo, NY, USA
| | - Shailendra B Patel
- Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati, Cincinnati, OH, USA.
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35
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Remy F, Godio-Raboutet Y, Captier G, Bonnaure P, Burgart P, Guyot L, Thollon L. The Hypoplasic Mandible: What Makes it Different From the Healthy Child? Cleft Palate Craniofac J 2020; 58:966-973. [PMID: 33167677 DOI: 10.1177/1055665620972301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the morphology of the hypoplasic mandible and its evolution during the growth period to better understand how it differs from the pediatric healthy mandible. METHOD Three-dimensional mandibular models of hypoplasic and healthy children aged from 39 gestational weeks to 7 years old were analyzed with a morphometric method including data clustering. Morphological distinctions between pathological and healthy mandibles were highlighted. Bilateral and unilateral mandibular hypoplasia were distinguished. RESULTS The study sample was composed of 31 hypoplasic children and as many sex- and age-matched healthy children. Morphological distinctions between pathological and healthy mandibles were highlighted only from the first year of life. In bilateral hypoplasia, the overall mandibular dimensions were reduced while there was only a ramus asymmetry in unilateral mandibular hypoplasia (mean ± SD of the difference between the Grp03c and Grp03b subgroups: 6.80 ± 6.37 - P value = 1.64e-3 for the height of the left ramus versus 0.18 ± 4.18 - P value = .82 for the height of the right ramus). Supervised classification trees were built to identify the pathology and discriminate unilateral from bilateral mandibular hypoplasia (prediction rates = 81% and 84%, respectively). CONCLUSIONS Based on a morphometric analysis, we demonstrated that mandibular hypoplasia significantly impacts the mandibular morphology only from the first year of life, with a distinction between bilateral and unilateral hypoplasia.
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Affiliation(s)
- Floriane Remy
- Aix-Marseille Univ, yUniv Gustave Eiffel, LBA, Marseille, France.,YooMed, Montpellier, France
| | | | - Guillaume Captier
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Montpellier, France
| | | | | | - Laurent Guyot
- Department of Oral-Maxillofacial, Plastic and Reconstructive Surgery, A.P.-H.M., North University Hospital, Marseille, France.,Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Lionel Thollon
- Aix-Marseille Univ, yUniv Gustave Eiffel, LBA, Marseille, France
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36
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Stilwell PA, Elbakry M. A foot toe remember. Arch Dis Child 2020; 105:1107. [PMID: 31296596 DOI: 10.1136/archdischild-2019-317377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2019] [Indexed: 11/04/2022]
Affiliation(s)
| | - Mariam Elbakry
- Neonatal Department, Northwick Park Hospital, London, UK
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37
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Özcabı B, Vatansever M, Güven A. Hypogonadism: Is It Always Hypogonadotropic in an Adolescent With a Cleft Palate? A Surprising Case of Klinefelter Syndrome. Cleft Palate Craniofac J 2020; 58:787-790. [PMID: 33107323 DOI: 10.1177/1055665620967601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pituitary hormone deficiencies may occur in children with midline defects; in these cases, hypogonadism is usually hypogonadotropic. Herein, we report a boy at the age of 13.8 years with mild mental retardation, previously operated for complete cleft palate (isolated) and presented with hypoglycemia due to isolated secondary adrenal insufficiency, who further had a decrease in testicular size with increased follicle-stimulating hormone level (hypergonadotropic hypogonadism) and diagnosed with Klinefelter syndrome. Klinefelter syndrome in childhood is rarely diagnosed and cases are observed in a wide spectrum. Although some regional duplications of the X chromosome also show midline defects such as spina bifida-neural tube defects, mental retardation, hypopituitarism (mostly growth hormone deficiency); coexistence of Klinefelter syndrome and isolated secondary adrenal deficiency/midline defect in our case may also be coincidental. However, to our knowledge, this is the first case in literature with this association in a patient with a 47, XXY karyotype.
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Affiliation(s)
- Bahar Özcabı
- HSU, Division of Pediatric Endocrinology, Department of Pediatrics, 147023Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.,Department of Pediatrics, Yeni Yuzyil Medical School, Istanbul, Turkey
| | - Meriç Vatansever
- HSU, Division of Pediatric Endocrinology, Department of Pediatrics, 147023Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ayla Güven
- HSU, Division of Pediatric Endocrinology, Department of Pediatrics, 147023Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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Halabi A, Khan U, Maazoun K, Kamal NM. Abdominal mystery in a neonate. Arch Dis Child Educ Pract Ed 2020; 105:227-229. [PMID: 31302593 DOI: 10.1136/archdischild-2018-316161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/15/2018] [Indexed: 11/03/2022]
Affiliation(s)
| | - Ubaidullah Khan
- Pediatrics, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Kais Maazoun
- Pediatric Surgery, CHU Monastir, Monastir, Tunisia
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Mégarbané A, Hana S, El-Hayek S, Gambarini A, Al-Ali MT, Delague V. Developmental delay, intellectual disability, short stature, subglottic stenosis, hearing impairment, onychodysplasia of the index fingers, and distinctive facial features: A newly reported autosomal recessive syndrome. Am J Med Genet A 2020; 182:1865-1872. [PMID: 32618096 DOI: 10.1002/ajmg.a.61730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 11/06/2022]
Abstract
We report on a multiply consanguineous Syrian family where two siblings, a boy and a girl, presented with a compilation of symptoms including developmental delay, severe intellectual disability, absent speech, hearing impairment, short stature, subglottic stenosis, increased length of the palpebral fissures, onychodysplasia of index fingers, scoliosis, genu valgum, and malpositioned toes. Two other individuals from the extended family with similar clinical features are also described. Array-CGH did not reveal any pathological copy number variation. Exome sequencing failed to find any causal variants. Differential diagnoses and the possibility that we might be reporting a hitherto unknown syndrome are discussed.
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Affiliation(s)
- André Mégarbané
- Institut Jérôme Lejeune, Paris, France.,Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Abstract
Gastroschisis is a congenital abnormality characterized by visceral herniation through an abdominal wall defect. While the cause of gastroschisis is unknown, it has been linked to risk factors including young maternal age, smoking, and alcohol use during pregnancy. To date, the only established placental correlate is amniocyte vacuolization. Based on our clinical experience, we hypothesized that delayed villous maturation (DVM) is also associated with gastroschisis. We conducted a retrospective slide review of 23 placentas of neonates with gastroschisis. Additionally, we selected 2 control groups of placentas: 1 with a previous diagnosis of DVM and 1 with normal villous morphology. All placentas were randomized and reviewed by 2 perinatal pathologists, who were blinded to the group; DVM and amniocyte vacuolization were assessed. Gastroschisis was associated with increased placental DVM in 65.2% of cases (vs 13.6% of controls; P = .0007) and increased amniocyte vacuolization in 52.2% of cases (vs 9.1% of controls; P = .003) compared to the control group. Based on the normal and DVM groups, kappa agreement between current slide review and initial pathology diagnosis was 0.419, indicating moderate agreement. Our study shows that gastroschisis is associated with placental DVM. This association may be due to (1) a common upstream factor contributing to both gastroschisis and DVM or (2) DVM may be a consequence of the altered placental and amniotic environment in the context of gastroschisis.
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Affiliation(s)
| | | | - Dina El Demellawy
- Department of Pathology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - David Grynspan
- Department of Pathology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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41
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Jezela-Stanek A, Ciara E, Jurkiewicz D, Kucharczyk M, Jędrzejowska M, Chrzanowska KH, Krajewska-Walasek M, Żemojtel T. The phenotype-driven computational analysis yields clinical diagnosis for patients with atypical manifestations of known intellectual disability syndromes. Mol Genet Genomic Med 2020; 8:e1263. [PMID: 32337850 PMCID: PMC7507388 DOI: 10.1002/mgg3.1263] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Due to extensive clinical and genetic heterogeneity of intellectual disability (ID) syndromes, the process of diagnosis is very challenging even for expert clinicians. Despite recent advancements in molecular diagnostics methodologies, a significant fraction of ID patients remains without a clinical diagnosis. METHODS, RESULTS, AND CONCLUSIONS Here, in a prospective study on a cohort of 21 families (trios) with a child presenting with ID of unknown etiology, we executed phenotype-driven bioinformatic analysis method, PhenIX, utilizing targeted next-generation sequencing (NGS) data and Human Phenotype Ontology (HPO)-encoded phenotype data. This approach resulted in clinical diagnosis for eight individuals presenting with atypical manifestations of Rubinstein-Taybi syndrome 2 (MIM 613684), Spastic Paraplegia 50 (MIM 612936), Wiedemann-Steiner syndrome (MIM 605130), Cornelia de Lange syndrome 2 (MIM 300590), Cerebral creatine deficiency syndrome 1 (MIM 300352), Glass Syndrome (MIM 612313), Mental retardation, autosomal dominant 31 (MIM 616158), and Bosch-Boonstra-Schaaf optic atrophy syndrome (MIM 615722).
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Affiliation(s)
- Aleksandra Jezela-Stanek
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.,Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Elżbieta Ciara
- Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dorota Jurkiewicz
- Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Marzena Kucharczyk
- Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Maria Jędrzejowska
- Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland.,Mossakowski Medical Research Centre, Neuromuscular Unit, Polish Academy of Sciences, Warsaw, Poland
| | - Krystyna H Chrzanowska
- Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Tomasz Żemojtel
- Genomics Platform, Berlin Institute of Health, Berlin, Germany.,Institute of Bioorganic Chemistry, Polish Academy of Sciences, Poznan, Poland
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Kumps C, Campos-Xavier B, Hilhorst-Hofstee Y, Marcelis C, Kraenzlin M, Fleischer N, Unger S, Superti-Furga A. The Connective Tissue Disorder Associated with Recessive Variants in the SLC39A13 Zinc Transporter Gene (Spondylo-Dysplastic Ehlers-Danlos Syndrome Type 3): Insights from Four Novel Patients and Follow-Up on Two Original Cases. Genes (Basel) 2020; 11:genes11040420. [PMID: 32295219 PMCID: PMC7231014 DOI: 10.3390/genes11040420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 01/04/2023] Open
Abstract
Recessive loss-of-function variants in SLC39A13, a putative zinc transporter gene, were first associated with a connective tissue disorder that is now called “Ehlers–Danlos syndrome, spondylodysplastic form type 3” (SCD-EDS, OMIM 612350) in 2008. Nine individuals have been described. We describe here four additional affected individuals from three consanguineous families and the follow up of two of the original cases. In our series, cardinal findings included thin and finely wrinkled skin of the hands and feet, characteristic facial features with downslanting palpebral fissures, mild hypertelorism, prominent eyes with a paucity of periorbital fat, blueish sclerae, microdontia, or oligodontia, and—in contrast to most types of Ehlers–Danlos syndrome—significant short stature of childhood onset. Mild radiographic changes were observed, among which platyspondyly is a useful diagnostic feature. Two of our patients developed severe keratoconus, and two suffered from cerebrovascular accidents in their twenties, suggesting that there may be a vascular component to this condition. All patients tested had a significantly reduced ratio of the two collagen-derived crosslink derivates, pyridinoline-to-deoxypyridinoline, in urine, suggesting that this simple test is diagnostically useful. Additionally, analysis of the facial features of affected individuals by DeepGestalt technology confirmed their specificity and may be sufficient to suggest the diagnosis directly. Given that the clinical presentation in childhood consists mainly of short stature and characteristic facial features, the differential diagnosis is not necessarily that of a connective tissue disorder and therefore, we propose that SLC39A13 is included in gene panels designed to address dysmorphism and short stature. This approach may result in more efficient diagnosis.
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Affiliation(s)
- Camille Kumps
- Division of Genetic Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland; (C.K.); (B.C.-X.); (S.U.)
| | - Belinda Campos-Xavier
- Division of Genetic Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland; (C.K.); (B.C.-X.); (S.U.)
| | - Yvonne Hilhorst-Hofstee
- Department of Clinical Genetics, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands;
| | - Carlo Marcelis
- Department of Human Genetics, Radboud University Nijmegen Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Marius Kraenzlin
- Clinic for Endocrinology, Diabetes & Metabolism, University Hospital Basel, 4031 Basel, Switzerland;
| | | | - Sheila Unger
- Division of Genetic Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland; (C.K.); (B.C.-X.); (S.U.)
| | - Andrea Superti-Furga
- Division of Genetic Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland; (C.K.); (B.C.-X.); (S.U.)
- Correspondence:
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Abstract
Genetic and genomic testing technologies have expanded beyond levels of diagnostic capability that were unimaginable even a few years ago. While this has significantly benefited clinicians in their care of patients and families, it has also altered how geneticists evaluate patients. One immediate example is the role of the dysmorphologic physical exam in the patient evaluation. While some have suggested that it is no longer necessary, we argue that the dysmorphologic physical exam is still essential, albeit in a different role.
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Hootnick DR. Congenital fibular dystrophisms conform to embryonic arterial dysgenesis. Anat Rec (Hoboken) 2020; 303:2792-2800. [PMID: 31872958 DOI: 10.1002/ar.24348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 01/09/2023]
Abstract
The congenital short limb (CSL) with fibular deficiency has traditionally been graded by plain radiography. The most popular orthopedic classification sorts the fibular dysmorphologies into three radiographic groupings: IA (thinned), IB (proximally truncated), or II (absent). In contrast, the soft tissues have been relatively neglected. Since bone formation of the fibula progresses from the anlage, a scaffolding cartilage mold intermediate, cartilage transformation to bone is dependent upon timely embryonic arterial invasion. Absences of the requisite arteries predicate specific skeletal dysmorphologies. The usual arterial supply of the fibula is comprised primarily of the anterior tibialis artery (ATA), which uniquely supplies the proximal portion of the fibula, and also joins the peroneal artery (PA) in supplying the mid to distal fibular shaft. Combinations of the two nutrient arteries allow four potential variations of fibular vascular supply, among which the ATA and PA conjoin to supply the normal fibula and variably supply the three dysmorphic fibular models. The IA and IB deformities conform, respectively, to the absences of the PA and the ATA. Combined ATA and PA absences present in the radiographically "absent" fibula. Thus, each of the four fibular (dys)morphologies conforms to a specific embryonic pattern of arterial development. The term "dystrophism" most accurately characterizes such malformed long bones.
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Affiliation(s)
- David R Hootnick
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York.,Department of Cell and Developmental Biology, SUNY Upstate Medical University, Syracuse, New York.,Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York
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45
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Roessler HI, Shields K, Grange DK, Knoers NVAM, van Haaften G, Hammond P, van Haelst MM. Three-dimensional facial morphology in Cantú syndrome. Am J Med Genet A 2020; 182:1041-1052. [PMID: 32100467 PMCID: PMC7217184 DOI: 10.1002/ajmg.a.61517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 12/21/2022]
Abstract
Cantú syndrome (CS) was first described in 1982, and is caused by pathogenic variants in ABCC9 and KCNJ8 encoding regulatory and pore forming subunits of ATP-sensitive potassium (KATP ) channels, respectively. It is characterized by congenital hypertrichosis, osteochondrodysplasia, extensive cardiovascular abnormalities and distinctive facial anomalies including a broad nasal bridge, long philtrum, epicanthal folds, and prominent lips. Many genetic syndromes, such as CS, involve facial anomalies that serve as a significant clue in the initial identification of the respective disorder before clinical or molecular diagnosis are undertaken. However, an overwhelming number of CS patients receive misdiagnoses based on an evaluation of coarse facial features. By analyzing three-dimensional images of CS faces, we quantified facial dysmorphology in a cohort of both male and female CS patients with confirmed ABCC9 variants. Morphometric analysis of different regions of the face revealed gender-specific significant differences in face shape. Moreover, we show that 3D facial photographs can distinguish between CS and other genetic disorders with specific facial dysmorphologies that have been mistaken for CS-associated anomalies in the past, hence assisting in an earlier clinical and molecular diagnosis. This optimizes genetic counseling and reduces stress for patients and parents by avoiding unnecessary misdiagnosis.
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Affiliation(s)
- Helen I Roessler
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kathleen Shields
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dorothy K Grange
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.,Center for the Investigation of Membrane Excitability Diseases (CIMED), St. Louis, Missouri, USA
| | - Nine V A M Knoers
- Deptartment of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Gijs van Haaften
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter Hammond
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Mieke M van Haelst
- Department of Clinical Genetics, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Genetics, VU Medical Center, VU University Amsterdam, Amsterdam, The Netherlands
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Faily S, Perveen R, Chandler K, Clayton-Smith J. Oral-Facial-Digital Syndrome Type 1: Further Clinical and Molecular Delineation in 2 New Families. Cleft Palate Craniofac J 2020; 57:606-615. [PMID: 32064904 DOI: 10.1177/1055665620902880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Oral-facial-digital syndrome type 1 (OFD1) [OMIM 311200] is a rare genetic disorder associated with congenital anomalies of the oral cavity, face, and digits. This condition is associated with mutations in the OFD1 gene. Our objective was to recruit patients with the OFD1 clinical phenotype without genetic confirmation, aiming to identify genetic variants in the OFD1 gene. DESIGN Three patients from 2 unrelated families were recruited into our study. We employed a variety of genomic techniques on these patients, including candidate gene analysis, array comparative genomic hybridization, whole-exome sequencing, and whole-genome sequencing. RESULTS We investigated 3 affected patients from 2 unrelated families with a clinical diagnosis of OFD1. We discovered a novel pathogenic dominant missense mutation c.635G>C (p.Arg212Pro) in the OFD1 gene in one family. A novel frameshift, loss-of-function mutation c.306delA (p.Glu103LysfsTer42) was detected in the affected patient in the second family. CONCLUSIONS These new genetic variants will add to the spectrum of known OFD1 mutations associated with the OFD1 disorder. Our study also confirms the variable phenotypic presentation of OFD1 and its well-recognized association with central nervous system malformations and renal anomalies. Molecular diagnostic confirmation achieved in these families will have positive implications for their medical management.
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Affiliation(s)
- Sara Faily
- Manchester Centre for Genomic Medicine, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Rahat Perveen
- Manchester Centre for Genomic Medicine, University of Manchester, St Mary's Hospital, Manchester, United Kingdom
| | - Kate Chandler
- Manchester Centre for Genomic Medicine, University of Manchester, St Mary's Hospital, Manchester, United Kingdom.,Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Jill Clayton-Smith
- Manchester Centre for Genomic Medicine, University of Manchester, St Mary's Hospital, Manchester, United Kingdom.,Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
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Mégarbané A, Deepthi A, Obeid M, T Al-Ali M, Gambarini A, El-Hayek S. Homozygous deletion of exons 2-7 within TGFB3 gene in a child with severe Loeys-Dietz syndrome and Marfan-like features. Am J Med Genet A 2020; 182:1230-1235. [PMID: 32022420 DOI: 10.1002/ajmg.a.61508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 01/16/2023]
Abstract
We describe a patient with palatal abnormalities-cleft palate and bifid uvula; distinctive facial features-long and triangular face, large ears and nose, thin lips and dental crowding; musculoskeletal abnormalities-severe scoliosis, joint laxity, long digits, flat feet, decreased muscle mass, and diminished muscle strength; and cardiac features-a dilatated ascending aorta at the level of Valsalva sinuses and a patent foramen ovale. Sequence analysis and deletion/duplication testing for a panel of genes involved in connective tissue disorders revealed the presence of a novel homozygous deletion of exons 2-7 in TGFB3 gene. Heterozygous pathogenic mutations in TGFB3 have been associated with Loeys-Dietz syndrome 5 (LDS5) and Arrhythmogenic Right Ventricular Dysplasia type 1. Here, we report the first case of a homozygous TGFB3 variant associated with a severe LDS5 and Marfan-like presentation.
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Affiliation(s)
| | - Asha Deepthi
- Centre for Arab Genomic Studies, Dubai, United Arab Emirates
| | - Marc Obeid
- American University of Science and Technology, Faculty of Health Sciences, Lebanon
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Santos G, Ickow I, Job J, Brooker JE, Dvoracek LA, Rigby E, Shah N, Chen W, Branstetter B, Schuster LA. Cone-Beam Computed Tomography Incidental Findings in Individuals With Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 57:404-411. [PMID: 31964169 DOI: 10.1177/1055665619897469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The use of cone-beam computed tomography (CBCT) is well-established in clinical practice. This study seeks to categorize and quantify the incidental finding (IF) rate on CBCT in patients with cleft lip and palate (CLP) prior to orthodontic or surgical treatment. METHODS This is systematic retrospective review of head and neck CBCTs in patients with nonsyndromic CLP taken between 2012 and 2019 at a single tertiary referral center. All assessments were performed independently by 4 observers (a head and neck radiologist and 3 orthodontists, including 2 fellowship-trained cleft-craniofacial orthodontists ). The images were divided into 9 anatomical areas and screened using serial axial slices and 3D reconstructions. The absolute number of IFs was reported for each area and statistical analysis was performed. RESULTS Incidental findings were found in 106 (95.5%) of the 111 patients. The most common sites were the maxilla (87.4%, principally dental anomalies), paranasal sinuses (46.8%, principally inflammatory opacification), and inner ear cavities (18.9%, principally inflammatory opacification). Eleven patients had skull malformations. Thirty-three patients had IFs in 1 anatomical area, 49 patients in 2 anatomical areas, 19 patients in 3 areas, and 5 patients presented with IFs in 4 of the 9 anatomical areas. DISCUSSION In patients with CLP, IFs on CBCT exam were present in the majority of cases. Most patients with IFs had them in multiple anatomical areas of the head and neck. The maxillary dental-alveolar complex was the most common area. Inflammatory changes in the inner ear cavities and paranasal sinuses were also common; however, cervical spine and skull abnormalities were also identified. Clinicians caring for patients with CLP should be aware of IFs, which may warrant further investigation and treatment.
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Affiliation(s)
| | - Ilana Ickow
- Department of Plastic and Reconstructive Surgery, The John Hopkins University School of Medicine, Baltimore, MD
| | - Joici Job
- Department of Radiology, Ohio State University, Columbus, OH, USA
| | - Jack E Brooker
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lucas A Dvoracek
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erick Rigby
- Law Office of Erick Rigby, Washington, PA, USA
| | - Nilesh Shah
- School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wendy Chen
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Barton Branstetter
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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49
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Scheuerle AE, Kwon P, Joing M. Defect evaluation by infant photographs in a multicenter pharmaceutical clinical trial. Birth Defects Res 2020; 112:118-121. [PMID: 31746564 DOI: 10.1002/bdr2.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/24/2019] [Accepted: 11/03/2019] [Indexed: 11/07/2022]
Abstract
OBJECT The NT-04 clinical trial of investigational medication NT100 had a limited, though geographically diverse, study population. To enhance potential birth defect identification, photographic dysmorphology exam of infants was performed along with review of prenatal and postnatal medical records. METHODS Standardized photographic views were developed: full body (prone and supine), face, both profiles, dorsal and ventral hands and feet, genitalia, and birthmarks/skin lesions. Professional photographers were identified and trained. Photos were taken in the first month of life at the subject's home and uploaded to a secure electronic online photo viewer. The evaluating geneticist accessed the photos electronically and submitted an evaluation. RESULTS Forty subjects had 39 evaluable outcomes (55 babies). Twelve photographers were recruited, 10 of whom worked with multiple subjects. Photographic dysmorphology evaluation was done on 38 pregnancy outcomes. Only one baby had missing photos due to an apparent protocol error. Four babies were photographed with diaper on. CONCLUSIONS The standardized photographs worked well. Advantages include: a single clinician evaluating all infants, the photographs could be reviewed repeatedly as needed, and minor malformations were more uniformly identified. Difficulties were: identifying local photographers and supplying training and training materials. There was no protocol for retaking or obtaining new photos and the study consent form did not include permission to publish the photographs. This was a successful pilot study of infant photographic assessment to detect congenital anomalies in a clinical trial.
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Affiliation(s)
- Angela E Scheuerle
- Department of Pediatrics, Division of Genetics and Metabolism, UT Southwestern Medical Center, Dallas, Texas
| | - Paul Kwon
- Nora Therapeutics, Inc., Palo Alto, California
| | - Mark Joing
- Nora Therapeutics, Inc., Palo Alto, California
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50
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Oldzej J, Manazir J, Gold JA, Mahmoud R, Osann K, Flodman P, Cassidy SB, Kimonis VE. Molecular subtype and growth hormone effects on dysmorphology in Prader-Willi syndrome. Am J Med Genet A 2019; 182:169-175. [PMID: 31782896 DOI: 10.1002/ajmg.a.61408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/28/2019] [Accepted: 10/18/2019] [Indexed: 12/27/2022]
Abstract
Prader-Willi syndrome (PWS) affects 1/15,000-1/30,000 live births and is characterized by lack of expression of paternally inherited genes on 15q11.2-15q13 caused by paternal deletions, maternal uniparental disomy (UPD), or imprinting defects. Affected individuals have distinct physical features, and growth hormone (GH) deficiency occurs in some individuals with PWS. The aim of this study is to test the hypotheses that (a) individuals with deletions and UPD have different physical and dysmorphic features, (b) individuals treated with GH have different physical and dysmorphic features than those not treated, and (c) GH treatment effects are different for individuals with UPD in comparison to those with deletions. Study participants included 30 individuals with deletions or UPD, who did or did not have GH treatment. Participants' molecular abnormalities were determined by molecular and cytogenetic analysis. Clinical data were obtained by a single dysmorphologist. Individuals with deletions were found to be heavier (p = .001), taller (p = .031), with smaller head circumferences (p = .042) and were more likely to have fair skin and hair than their family members (p = .031, .049, respectively) compared to UPD patients. Females with deletions more commonly had hypoplastic labia minora (p = .009) and clitoris (.030) in comparison to those with UPD. Individuals who received GH in both deletion and UPD groups were taller (p = .004), had larger hands (p = .011) and feet (p = .006) and a trend for a larger head circumference (p = .103). Interestingly, the GH-treated group also had a lower rate of strabismus (esotropia [p = .017] and exotropia [p = .039]). This study showed statistically significant correlations between phenotype and molecular subtypes and also between phenotype and GH treatment.
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Affiliation(s)
- Jeannine Oldzej
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California
| | - Javeria Manazir
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California
| | - June-Anne Gold
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California.,Division of Biochemical and Clinical Genetics, Children's Hospital of Orange County, Orange, California.,Division of Genetics and Metabolism, Department of Pediatrics, Loma Linda University Medical School, Loma Linda, California
| | - Ranim Mahmoud
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California.,Genetics Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Kathryn Osann
- Department of Medicine, University of California, Irvine, California
| | - Pamela Flodman
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California
| | - Suzanne B Cassidy
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California.,Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco, California
| | - Virginia E Kimonis
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California.,Division of Biochemical and Clinical Genetics, Children's Hospital of Orange County, Orange, California
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