A Case Report of Occult Breast Cancer Detected by Diagnostic Laparoscopy for Suspected Ovarian Cancer

Diagnostic laparoscopy is useful in the management of gynecological cancers; however, it can occasionally result in the detection of other malignancies. Occult breast cancer (OBC) is metastatic breast cancer without a recognized primary breast lesion. We report a rare case of OBC that was detected laparoscopically. A 64-year-old female presented to our hospital with back pain. Magnetic resonance imaging (MRI) revealed a 50 mm multicystic tumor with an internal nodule in the right ovary. Positron emission tomography/computed tomography showed abnormal accumulation in multiple lymph nodes, moderate accumulation in the ovarian tumor nodule, and no accumulation in the breasts. Ovarian cancer was suspected, and a diagnostic laparoscopy was performed. Laparoscopically, a cystic tumor in the right ovary and 10 mm nodule in the right round ligament were observed and partially resected. Immunohistopathologically, the nodules of the round ligament exhibited features consistent with those of breast cancer, but the ovarian tumor was a seromucinous borderline tumor. MRI revealed no breast lesions. Therefore, the malignancy was diagnosed as an OBC.

Genotype-Phenotype Correlations in Thirty Japanese Patients with Congenital Hypothyroidism Attributable to TG Defects

CONTEXT

Thyroglobulin (Tg), encoded by TG, is essential for thyroid hormone synthesis. TG defects result in congenital hypothyroidism (CH). Most reported patients were born before the introduction of newborn screening (NBS).

OBJECTIVE

We aimed to clarify the phenotypic features of patients with TG defects diagnosed and treated since the neonatal period.

SUBJECTS AND METHODS

We screened 1061 patients with CH for thirteen CH-related genes and identified thirty patients with TG defects. One patient was diagnosed due to hypothyroidism-related symptoms and the rest were diagnosed via NBS. Patients were divided into two groups according to their genotypes, and clinical characteristics were compared. We evaluated the functionality of the seven missense variants using HEK293 cells.

RESULTS

Twenty-seven rare TG variants were detected, including fifteen nonsense, three frameshift, two splice-site, and seven missense variants. Patients were divided into two groups: thirteen patients with biallelic truncating variants and seventeen patients with monoallelic/biallelic missense variants. Patients with missense variants were more likely to develop thyroid enlargement with TSH stimulation than patients with biallelic truncating variants. Patients with biallelic truncating variants invariably required full hormone replacement, whereas patients with missense variants required variable doses of levothyroxine. Loss of function of the seven missense variants was confirmed in vitro.

CONCLUSION

To our knowledge, this is the largest investigation on the clinical presentation of TG defects diagnosed in the neonatal period. Patients with missense variants showed relatively mild hypothyroidism with compensative goiter. Patients with only truncating variants showed minimal or no compensative goiter and required full hormone replacement.

Relationship between Birth Order and Postnatal Growth until 4 Years of Age: The Japan Environment and Children’s Study

Later-borns tend to be shorter than first-borns in childhood and adulthood. However, large-scale prospective studies examining growth during infancy according to birth order are limited. We aimed to investigate the relationship between birth order and growth during the first 4 years of life in a Japanese prospective birth cohort study. A total of 26,249 full-term singleton births were targeted. General linear and multivariable logistic regression models were performed and adjusted for birth weight, parents’ heights, maternal age at delivery, gestational weight gain, maternal smoking and alcohol drinking status during pregnancy, household income, breastfeeding status, and Study Areas. The multivariate adjusted mean length Z-scores in “first-borns having no sibling”, “first-borns having siblings”, “second-borns”, and “third-borns or more” were −0.026, −0.013, 0.136, and 0.120 at birth and −0.324, −0.330, −0.466, and −0.569 at 10 months, respectively. Results similar to those at 10 months were observed at 1.5, 3, and 4 years. The adjusted odds ratios (95% confidence intervals) of short stature at 4 years in “first-borns having siblings”, “second-borns”, and “third-borns or more” were 1.08 (0.84–1.39), 1.36 (1.13–1.62), and 1.50 (1.20–1.88), respectively, versus “first-borns having no sibling”. Birth order was significantly associated with postnatal growth and may be a factor predisposing to short stature in early childhood.

Successful resection of growing teratoma syndrome in the abdominal wall with reconstruction using tensor fascia lata muscle flap: A case report and literature review

While cancer cure is the primary goal, fertility preservation is also a cornerstone of the underlying principle of treatment for ovarian germ cell tumors. Growing teratoma syndrome (GTS) presents with growth of mature teratomas during or after chemotherapy. We report a case of successful treatment of GTS in the anterior abdominal wall involving reconstruction. A 23-year-old woman with a suspected right ovarian mature teratoma with torsion underwent emergency laparoscopically assisted extracorporeal ovarian cystectomy. Histopathological findings revealed a grade 1 immature teratoma. After two months, postoperative α-fetoprotein (AFP) levels increased, and disseminated lesions developed not only in the pelvic cavity but also in the abdominal wound where the tumor had been extracted using an extracorporeal technique at the time of primary surgery. The patient underwent laparoscopic right salpingo-oophorectomy, excision of multiple peritoneal nodules, and biopsy of abdominal wall mass. The left rectus abdominis muscle tumor could not be removed. All of these nodules were diagnosed as metastatic immature teratomas. Although the patient received three cycles of chemotherapy, the residual tumor in the abdominal wall grew remarkably despite post-chemotherapy normalization of AFP levels. Both rectus abdominis muscles involving the residual tumors were removed and reconstructed using a left tensor fascia lata muscle flap. Histopathologically, the residual tumors were identified as mature teratomas with no immature elements, resulting in GTS. The patient got pregnant without the need of fertility treatment and gave birth uneventfully by cesarean section. Thus, reconstruction with a tensor fascia lata muscle flap facilitated complete removal of GTS while preserving fertility.

An infant with a heterozygous variant of<i> ABCG5</i> presented with hypercholesterolemia only during breastfeeding

Sitosterolemia (OMIM #210250) is a rare lipid disorder caused by variants in genes encoding adenosine triphosphate (ATP)-binding cassette subfamily G Member 5 (ABCG5) or 8 (ABCG8), which play roles in the intestinal and biliary excretion of cholesterol and plant sterols, such as sitosterol and campesterol. Although considered an autosomal recessive disorder, recent reports have shown that a heterozygous ABCG5 variant can also cause mild symptoms. Here, we report the case of an infant with a heterozygous variant of ABCG5. A 6-mo-old breast-fed Japanese male infant was found to have elevated serum total cholesterol and low-density lipoprotein-cholesterol (LDL-C) levels of 528 mg/dL and 449 mg/dL, respectively, upon examination for growth disturbances. As weaning progressed, the cholesterol levels normalized. Genetic analysis revealed that the patient and his mother had the heterozygous variant c.1166G>A (p.Arg389His) in ABCG5. Compared to his father, who did not have the ABCG5 variant, the patient and his mother had mild elevations of serum sitosterol and campesterol. Serum sitosterol and campesterol levels were 9.6 and 12 μg/mL for the patient, 4.9 and 9.3 μg/mL for his mother, and 2.1 and 3.4 μg/mL for his father, respectively. Therefore, heterozygous variants of ABCG5 may lead to transient hypercholesterolemia during breastfeeding.

Hematocolpos due to lower vaginal agenesis in an adolescent girl

Background

Hematocolpos due to imperforate hymen is an important differential diagnosis of abdominal pain in early adolescent stage. However, hematocolpos due to lower vaginal agenesis must be considered because the management differs.

Case Presentation

A healthy 11-year-old girl presented with a 2-day left lower abdominal pain history. Her breast development had begun, but she had not reached menarche. Computed tomography showed high absorptive value liquid filling the upper vaginal to uterine cavity, a pale highly absorptive fluid component suggestive of hemorrhagic ascites in the abdominal cavity on both sides of the uterus, and normal bilateral ovaries. Magnetic resonance imaging diagnosed hematocolpos due to lower vaginal agenesis. The blood clot was aspirated with a transabdominal ultrasound-guided transvaginal puncture.

Conclusion

History-taking, imaging tests, and appropriate collaboration with obstetrician/gynecologist with awareness of secondary sexual characteristics were crucial in this case.

Giant retroperitoneal dedifferentiated liposarcoma mimicking ovarian cancer: A case report

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Clinical features of the dedifferentiated subtype of LPS that has a diameter of >30 cm remains unknown.

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Surgical resection entails a high risk due to the size and anatomical location and difficulty in preoperative diagnosis.

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CT is the most useful imaging method for evaluating tumor location, size, origin, and relationship to adjacent organs.

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Retroperitoneal LPS should be considered in the case of a giant intra-abdominal tumor with a fatty component.

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Surgical resection is the mainstay of treatment for retroperitoneal LPS.

Retroperitoneal liposarcoma is a rare tumor, and its dedifferentiated subtype and a larger diameter are associated with a poor prognosis. However, there are few reports of retroperitoneal liposarcomas, both with a dedifferentiated subtype and a diameter of >30 cm. We report a case of a giant retroperitoneal liposarcoma with a dedifferentiated subtype. A 78-year-old woman presented to our hospital with abdominal distension and loss of appetite. Computed tomography and magnetic resonance imaging findings revealed a 35-cm-diameter solid tumor in the peritoneal cavity. CA125 (64.8 U/mL) and HE4 (229.0 pmol/L) were elevated preoperatively raising suspicion for ovarian malignancy. However, intraoperative findings revealed that the tumor originated in the retroperitoneal cavity. Reductive surgery for the tumor and partial resection of the sigmoid colon and left ureter were performed, and pathological examination confirmed a retroperitoneal dedifferentiated liposarcoma. Although her symptoms improved postoperatively, she died 11 months after surgery due to disease progression.

Successful nedaplatin desensitization therapy in a patient with platinum-sensitive recurrent ovarian cancer: A case report and literature review

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Platinum-based chemotherapy is the cornerstone of treatment for ovarian cancer.

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Hypersensitivity reaction (HSR) is a serious adverse reaction of anticancer drugs with anaphylactic features.

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HSR to platinum agents could lead to interruption of effective treatments for ovarian cancer, resulting in poor prognosis.

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We presented a case of successful nedaplatin desensitization therapy with a history of HSR to carboplatin and nedaplatin.

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The nedaplatin desensitization regimen could be an alternative for the patients with platinum sensitive ovarian cancer.

Desensitization protocols of platinum-based agents are recommended for patients with a history of hypersensitivity reaction (HSR). Herein, we report the first case of a successful desensitization therapy with nedaplatin after HSR to carboplatin and nedaplatin for platinum-sensitive recurrent ovarian cancer. A 53 year-old woman was diagnosed with stage IIIC serous carcinoma of the ovary and underwent primary debulking surgery followed by an adjuvant chemotherapy. The tumor relapsed 4 times in 10 years after the initial treatment, and platinum-based chemotherapy was performed on each occasion. HSR to carboplatin without and with desensitization protocol occurred during the 9th cycle of treatment and 2nd cycle of retreatment, respectively. Additionally, HSR to nedaplatin occurred during the 16th cycle of nedaplatin treatment. A four-step desensitization protocol with nedaplatin was conducted without occurrence of any severe adverse event. Nedaplatin desensitization regimen could be a new alternation for HSR to platinum-based agents.

The iodide transporter Slc26a7 impacts thyroid function more strongly than Slc26a4 in mice

SLC26A4 is a known iodide transporter, and is localized at the apical membrane of thyrocytes. Previously, we reported that SLC26A7 is also involved in iodide transport and that Slc26a7 is a novel causative gene for congenital hypothyroidism. However, its detailed role in vivo remains to be elucidated. We generated mice that were deficient in Slc26a7 and Slc26a4 to delineate differences and associations in their roles in iodide transport. Slc26a7^-/- mice showed goitrous congenital hypothyroidism and mild growth failure on a normal diet. Slc26a7^-/- mice with a low iodine environment showed marked growth failure. In contrast, Slc26a4^-/- mice showed no growth failure and hypothyroidism in the same low iodine environment. Double-deficient mice showed more severe growth failure than Slc26a7^-/- mice. RNA-seq analysis revealed that the number of differentially expressed genes (DEGs) in Slc26a7^-/- mice was significantly higher than that in Slc26a4^-/- mice. These indicate that SLC26A7 is more strongly involved in iodide transport and the maintenance of thyroid function than SLC26A4.

Partial nephrogenic diabetes insipidus with a novel arginine vasopressin receptor 2 gene variant

X-linked nephrogenic diabetes insipidus (NDI) is caused by variations in arginine vasopressin receptor 2 (AVPR2). Some patients show partial resistance to arginine vasopressin (AVP). A 19-month-old Japanese boy presented with polydipsia since infancy. His mother had a history of polydipsia during pregnancy, and his maternal granduncle also had polydipsia. Intermediate urine osmolality and markedly high plasma AVP levels were observed in the water deprivation test. Subsequent pitressin administration caused no further elevation in urine osmolality. We diagnosed the patient with partial NDI, initiated therapy with hydrochlorothiazide, and placed him on a low-sodium diet. Although his urine volume decreased by 20-30% after the initiation of therapy, progressive hydronephrosis and growth retardation developed 2 years later. We investigated his genetic background by multiplex targeted sequencing of genes associated with inherited renal diseases, including AVPR2 and aquaporin-2 (AQP2). We identified a hemizygous missense variant in AVPR2 NM_000054:c.371A>G,p.(Tyr124Cys) in the boy and a heterozygous variant in the mother at the same locus. Distinguishing partial NDI from primary polydipsia is difficult because of its mild symptoms. Markedly elevated plasma AVP levels with intermediate urine osmolality may suggest partial NDI, and genetic analysis can be useful for such patients.

An infant case of pseudohypoaldosteronism type1A caused by a novel NR3C2 variant

Pseudohypoaldosteronism type1A (PHA1A) is the renal form of pseudohypoaldosteronism with autosomal dominant inheritance. PHA1A is caused by haploinsufficiency of the mineralocorticoid receptor, which is encoded by NR3C2. We encountered an infant who was diagnosed with PHA1A due to hyponatremia, hyperkalemia, and poor weight gain in the neonatal period. She carried a novel heterozygous mutation (NM_000901.5: c.1757 + 1 G > C) in the splice donor site of IVS-2 in NR3C2.

Regional Difference in Myelination in Monocarboxylate Transporter 8 Deficiency: Case Reports and Literature Review of Cases in Japan

Background: Monocarboxylate transporter 8 (MCT8) is a thyroid hormone transmembrane transporter protein. MCT8 deficiency induces severe X-linked psychomotor retardation. Previous reports have documented delayed myelination in the central white matter (WM) in these patients; however, the regional pattern of myelination has not been fully elucidated. Here, we describe the regional evaluation of myelination in four patients with MCT8 deficiency. We also reviewed the myelination status of previously reported Japanese patients with MCT8 deficiency based on magnetic resonance imaging (MRI).

Case Reports: Four patients were genetically diagnosed with MCT8 deficiency at the age of 4–9 months. In infancy, MRI signal of myelination was observed mainly in the cerebellar WM, posterior limb of internal capsule, and the optic radiation. There was progression of myelination with increase in age.

Discussion: We identified 36 patients with MCT8 deficiency from 25 families reported from Japan. The available MRI images were obtained at the age of <2 years in 13 patients, between 2 and 4 years in six patients, between 4 and 6 years in three patients, and at ≥6 years in eight patients. Cerebellar WM, posterior limb of internal capsule, and optic radiation showed MRI signal of myelination by the age of 2 years, followed by centrum semiovale and corpus callosum by the age of 4 years. Most regions except for deep anterior WM showed MRI signal of myelination at the age of 6 years.

Conclusion: The sequential pattern of myelination in patients with MCT8 deficiency was largely similar to that in normal children; however, delayed myelination of the deep anterior WM was a remarkable finding. Further studies are required to characterize the imaging features of patients with MCT8 deficiency.

Peripheral nerves are involved in hypomyelinating leukodystrophy-3 caused by a homozygous AIMP1 variant

INTRODUCTION

Aminoacyl-tRNA synthetase-interacting multifunctional protein 1 (AIMP1) is a non-catalytic component of the multi-tRNA synthetase complex that catalyzes the ligation of amino acids to their correct tRNAs. Bi-allelic truncating variants in the AIMP1 gene have been associated with hypomyelinating leukodystrophy-3 (HLD3; MIM 260600), which is characterized by hypomyelination, microcephaly, seizures and decreased life expectancy. Although peripheral nerve involvement has been assumed for HLD3, no compelling evidence is available to date.

CASE REPORT

The case was a first-born Filipino male. He showed profound developmental delay, failure to thrive, and spasticity in his limbs. At three months of age he developed refractory epilepsy. Serial magnetic resonance imaging (MRIs) showed profound myelination delay and progressive cerebral atrophy. He showed abnormal nerve conduction studies. Genetic testing revealed a homozygous pathogenic variant in the AIMP1 gene (NM_004757.3: c.115C > T: p.Gln39*). The parents were heterozygous for the same variant.

CONCLUSION

Here, we report a patient with a homozygous nonsense AIMP1 variant showing peripheral neuropathy as well as HLD3. Our case suggests that AIMP1 plays a pivotal role in the peripheral nerve as well as the central nervous system.

Clinical and genetic investigation of 136 Japanese patients with congenital hypothyroidism

Objectives Congenital hypothyroidism (CH) is the most common congenital endocrine disorder. Recent advances in genetic testing have revealed its causative mutations in some CH patients. However, the underlying etiology remains unknown in most patients. This study aimed to perform clinical and genetic investigation in Japanese CH patients to uncover genotype-phenotype correlations. Methods We enrolled 136 Japanese patients with transient or permanent CH between April 2015 and March 2017, and performed next-generation sequencing of 19 genes implicated in CH. Results We identified potentially pathogenic bi-allelic variants in DUOX2, TSHR, and TPO in 19, 5, and 1 patient, respectively (autosomal recessive), and a potentially pathogenic mono-allelic variant in NKX2-1 (autosomal dominant) in 1 patient. Molecular genetic diagnosis was highly suggested in 26 patients (19%) from 23 families. We also detected a potentially pathogenic mono-allelic variant in five recessive genes (DUOX2, TSHR, TG, DUOXA2, and TPO) in 31 unrelated patients (23%), although the pathogenicity of these variants remains inconclusive. Patients with bi-allelic DUOX2 variants showed a more severe clinical presentation in infancy than those with bi-allelic TSHR variants. However, this trend reversed beyond infancy. There were no statistical differences in initial thyroid stimulating hormone, free thyroxine, thyroglobulin, and levothyroxine dose as of March 2017 between patients with bi-allelic and mono-allelic DUOX2 variants. Conclusions The prevalence of potentially-pathogenic variants in Japanese CH patients was similar to that found by previous reports. Our study demonstrates a genotype-phenotype correlation in Japanese CH patients.

Spin Current as a Probe of the Z_{2}-Vortex Topological Transition in the Classical Heisenberg Antiferromagnet on the Triangular Lattice

We have theoretically investigated transport properties of the classical Heisenberg antiferromagnet on the triangular lattice, in which a binding-unbinding topological transition of Z_{2} vortices is predicted to occur at a finite temperature T_{v}. It is shown by means of the hybrid Monte Carlo and spin-dynamics simulations that the longitudinal spin-current conductivity exhibits a divergence at T_{v}, while the thermal conductivity only shows a monotonic temperature dependence with no clear anomaly at T_{v}. The significant enhancement of the spin-current conductivity is found to be due to the rapid growth of the spin-current-relaxation time toward T_{v}, which can be understood as a manifestation of the topological nature of the free Z_{2} vortex whose lifetime gets longer toward T_{v}. The result suggests that the spin-current measurement is a promising probe to detect the Z_{2}-vortex topological transition, which has remained elusive in experiments.

Determination of Zearalenone in Cereal Grains, Animal Feed, and Feed Ingredients Using Immunoaffinity Column Chromatography and Liquid Chromatography: Interlaboratory Study

A method using immunoaffinity column chromatography (IAC) and liquid chromatography (LC) for determination of zearalenone in cereal grains, animal feed, and feed ingredients was collaboratively studied. The test portion is extracted by shaking with acetonitrilewater (90 + 10, v/v) and sodium chloride. The extract is diluted and applied to an immunoaffinity column, the column is washed with water or phosphatebuffered saline or methanolwater (30 + 70, v/v), and zearalenone is eluted with methanol. The eluate is evaporated, the residue is dissolved in mobile phase and analyzed by reversed-phase LC with fluorescence detection. The presence of zearalenone can be confirmed using an alternate excitation wavelength or diode array detection. Twenty samples were sent to 13 collaborators (8 in Europe, 2 in the United States, one in Japan, one in Uruguay, and one in Canada). Eighteen samples of naturally contaminated corn, barley, wheat, dried distillers grains, swine feed, and dairy feed were analyzed as blind duplicates, along with blank corn and wheat samples. The analyses were done in 2 sample sets with inclusion of a spiked wheat control sample (0.1 mg/kg) in each set. Spiked samples recoveries were 89116, and for the 18 naturally contaminated samples, RSDr values (within-laboratory repeatability) ranged from 6.67 to 12.1, RSDR values (among-laboratory reproducibility) ranged from 12.5 to 19.7, and HorRat values ranged from 0.61 to 0.90.

Transition from Leigh syndrome to MELAS syndrome in a patient with heteroplasmic MT-ND3 m.10158T>C

An m.10158T>C mutation in MT-ND3, encoding a subunit of respiratory complex I, causes early-onset Leigh syndrome (LS), mitochondrial encephalomyopathy with lactic acid and stroke-like episodes (MELAS) syndrome, and LS and MELAS overlapping syndrome, presumably dependent on the ratio of heteroplasmy. Herein, we report a 4-year-old girl with heteroplasmic m.10158T>C mutation, showing an evolving age-dependent phenotype from LS to MELAS syndromes. She showed mild developmental delay during infancy, which was associated with magnetic resonance imaging lesions in the brain stem and basal ganglia. At the age of 4 years, she developed rapid neurological deterioration and intractable seizures, which was associated with recurrent multiple cerebral lesions as well as basal ganglia lesions. Her cerebral lesions were located predominantly in white matter and appeared at multiple areas simultaneously, unique characteristics that are distinct from typical MELAS. Two patients with LS-MELAS overlapping syndrome with m.10158T>C have been previously reported, however, this is the first patient with m.10158T>C showing significant age-dependent changes in clinical features and neuro-images, implying an age-dependent role of complex I in the developing brain.

Congenital goitrous hypothyroidism is caused by dysfunction of the iodide transporter SLC26A7

Iodide transport and storage in the thyroid follicles is crucial for thyroid hormone synthesis. Pendrin, the iodide exporter that transports iodide to thyroid follicles, is responsible for Pendred syndrome, a disorder characterized by congenital hypothyroidism and hearing loss. However, thyroid hormone levels are basically normal in patients with Pendred syndrome, indicating the presence of another unknown iodide transporter. Here, we show that SLC26A7 is a novel iodide transporter in the thyroid. We observe that SLC26A7 is specifically expressed in normal thyroid tissues and demonstrate its function in iodide transport. Using whole-exome sequencing, we also find a homozygous nonsense mutation in SLC26A7 (c.1498 C > T; p.Gln500Ter) in two siblings with congenital goitrous hypothyroidism. The mutated SLC26A7 protein shows an abnormal cytoplasmic localisation and lacks the iodide transport function. These results reveal that SLC26A7 functions as a novel iodide transporter in the thyroid and its dysfunction affects thyroid hormonogenesis in humans and causes congenital goitrous hypothyroidism.

Individual Clinically Diagnosed with CHARGE Syndrome but with a Mutation in KMT2D, a Gene Associated with Kabuki Syndrome: A Case Report

We report a Japanese female patient presenting with classic features of CHARGE syndrome, including choanal atresia, growth and development retardation, ear malformations, genital anomalies, multiple endocrine deficiency, and unilateral facial nerve palsy. She was clinically diagnosed with typical CHARGE syndrome, but genetic analysis using the TruSight One Sequence Panel revealed a germline heterozygous mutation in KMT2D with no pathogenic CHD7 alterations associated with CHARGE syndrome. Kabuki syndrome is a rare multisystem disorder characterized by five cardinal manifestations including typical facial features, skeletal anomalies, dermatoglyphic abnormalities, mild to moderate intellectual disability, and postnatal growth deficiency. Germline mutations in KMT2D underlie the molecular pathogenesis of 52–76% of patients with Kabuki syndrome. This is an instructive case that clearly represents a phenotypic overlap between Kabuki syndrome and CHARGE syndrome. It suggests the importance of considering the possibility of a diagnosis of Kabuki syndrome even if patients present with typical symptoms and meet diagnostic criteria of CHARGE syndrome. The case also emphasizes the impact of non-biased exhaustive genetic analysis by next-generation sequencing in the genetic diagnosis of rare congenital disorders with atypical manifestations.

Combined genetic analyses can achieve efficient diagnostic yields for subjects with Alagille syndrome and incomplete Alagille syndrome

AIM

We evaluated combined genetic analyses with targeted next-generation sequencing (NGS), multiplex ligation probe amplification (MLPA) of Jagged1 (JAG1) genes and microarray comparative genomic hybridisation (CGH) in subjects with Alagille syndrome, incomplete clinical features of Alagille syndrome and biliary atresia.

METHODS

Subjects recruited from April 2013 to December 2015 underwent a targeted NGS analysis, including JAG1 and Notch homolog 2 (NOTCH2). If no mutations were detected in JAG1 or NOTCH2, or if copy number variations were suggested by the NGS analysis, we performed an MLPA analysis of JAG1. We also performed a microarray CGH analysis with whole-exon deletion detected by the MLPA analysis.

RESULTS

We analysed 30 subjects with Alagille syndrome, nine with incomplete Alagille syndrome and 17 with biliary atresia and detected pathogenic mutations in JAG1 or NOTCH2 in 24/30 subjects with Alagille syndrome and in 4/9 subjects with incomplete Alagille syndrome. No pathogenic mutations were detected in subjects with biliary atresia. The frequency of JAG1 mutations was as follows: single nucleotide variants (51.9%), small insertion or deletion (29.6%) and gross deletion (18.5%).

CONCLUSION

Combined genetic analyses achieved efficient diagnostic yields for subjects with Alagille syndrome and incomplete Alagille syndrome.

Molecular genetic and clinical delineation of 22 patients with congenital hypogonadotropic hypogonadism

BACKGROUND

Congenital hypogonadotropic hypogonadism (CHH) is classified as Kallmann syndrome (KS) with anosmia/hyposmia or normosmic (n)CHH. Here, we investigated the genetic causes and phenotype-genotype correlations in Japanese patients with CHH.

METHODS

We enrolled 22 Japanese patients with CHH from 21 families (18 patients with KS and 4 with nCHH) and analyzed 27 genes implicated in CHH by next-generation and Sanger sequencing.

RESULTS

We detected 12 potentially pathogenic mutations in 11 families, with three having a mutation in ANOS1 (X-linked recessive); three and four having a mutation in FGFR1 and CHD7, respectively (autosomal dominant); and one having two TACR3 mutations (autosomal recessive). Among four patients with KS carrying a CHD7 mutation, one had perceptive deafness and two had a cleft lip/palate.

CONCLUSIONS

The frequency of CHH genes in the Japanese was compatible with previous reports, except that CHD7 mutations might be more common. Furthermore, partial phenotype-genotype correlations were demonstrated in our cohort.

Development and inter-laboratory study of a method for quantifying ochratoxin A in pet foods

An analytical method for quantifying ochratoxin A (OTA) in pet foods using high-performance liquid chromatography was developed, and an inter-laboratory study was conducted. OTA was extracted from samples with aqueous acetonitrile. The extract was purified by an immunoaffinity column, OCHRAKING, and analysed by high performance liquid chromatography with fluorescence detection. The limits of quantification by this method were 2 µg/kg for dry and semidry pet food and 1 µg/kg for wet type pet food. The calibration curve showed linearity in the range of 0.5-50 ng/ml (equivalent to 1-100 µg/kg for wet type pet food). The mean recoveries of OTA spiked at 1-5 µg/kg were in the range of 83.0-106% and relative standard deviations of the in-house method validation were 2.6-6.8%. The mean recoveries, repeatability, reproducibility and the Horwitz ratios for OTA from the inter-laboratory validation study were 75.6-83.1%, 3.5-6.1%, 5.0-15.0% and 0.23-0.68, respectively.

A combination of genetic and biochemical analyses for the diagnosis of PI3K-AKT-mTOR pathway-associated megalencephaly

Background

Constitutive activation of the PI3K-AKT-mTOR pathway (mTOR pathway) underlies megalencephaly in many patients. Yet, prevalence of the involvement of the PI3K-AKT-mTOR pathway in patients with megalencephaly remains to be elucidated, and molecular diagnosis is challenging. Here, we have successfully established a combination of genetic and biochemical methods for diagnosis of mTOR pathway-associated megalencephaly, and have attempted to delineate the clinical characteristics of the disorder.

Methods

Thirteen patients with an increased head circumference and neurological symptoms participated in the study. To evaluate the activation of the mTOR pathway, we performed western blot analysis to determine the expression levels of phosphorylated S6 ribosomal protein (phospho-S6 protein) in lymphoblastoid cell lines from 12 patients. Multiplex targeted sequencing analysis for 15 genes involved in the mTOR pathway was performed on 12 patients, and whole-exome sequencing was performed on one additional patient. Clinical features and MRI findings were also investigated.

Results

We identified pathogenic mutations in six (AKT3, 1 patient; PIK3R2, 2 patients; PTEN, 3 patients) of the 13 patients. Increased expression of phospho-S6 protein was demonstrated in all five mutation-positive patients in whom western blotting was performed, as well as in three mutation-negative patients. Developmental delay, dysmorphic facial features were observed in almost all patients. Syndactyly/polydactyly and capillary malformations were not observed, even in patients with AKT3 or PIK3R2 mutations. There were no common phenotypes or MRI findings among these patients.

Conclusions

A combination of genetic and biochemical methods successfully identified mTOR pathway involvement in nine of 13 (approximately 70%) patients with megalencephaly, indicating a major contribution of the pathway to the pathogenesis of megalencephaly. Our combined approach could be useful to identify patients who are suitable for future clinical trials using an mTOR inhibitor.

Molecular Genetic Dissection and Neonatal/Infantile Intrahepatic Cholestasis Using Targeted Next-Generation Sequencing

OBJECTIVES

To ascertain a molecular genetic diagnosis for subjects with neonatal/infantile intrahepatic cholestasis (NIIC) by the use of next-generation sequencing (NGS) and to perform a genotype-phenotype correlation.

STUDY DESIGN

We recruited Japanese subjects with NIIC who had no definitive molecular genetic diagnosis. We developed a diagnostic custom panel of 18 genes, and the amplicon library was sequenced via NGS. We then compared clinical data between the molecular genetically confirmed subjects with NIIC.

RESULTS

We analyzed 109 patients with NIIC ("genetic cholestasis," 31 subjects; "unknown with complications" such as prematurity, 46 subjects; "unknown without complications," 32 subjects), and a molecular genetic diagnosis was made for 28 subjects (26%). The rate of positive molecular genetic diagnosis in each category was 22 of 31 (71%) for the "genetic cholestasis" group, 2 of 46 (4.3%) for the "unknown with complications" group, and 4 of 32 (12.5%) for the "unknown without complications" group. The grouping of the molecular diagnoses in the group with genetic cholestasis was as follows: 12 with Alagille syndrome, 5 with neonatal Dubin-Johnson syndrome, 5 with neonatal intrahepatic cholestasis caused by citrin deficiency, and 6 with progressive familial intrahepatic cholestasis or benign recurrent intrahepatic cholestasis with low gamma-glutamyl transpeptidase levels. Several clinical datasets, including age of onset, direct bilirubin, and aminotransferases, were significantly different between the disorders confirmed using molecular genetic diagnosis.

CONCLUSION

Targeted NGS can be used for molecular genetic diagnosis in subjects with NIIC. Clinical diagnosis should be accordingly redefined in the view of molecular genetic findings.

Establishment of a Host-vector System in Lactobacillus helveticus with β-Galactosidase Activity as a Selection Marker

A host-vector system was established in Lactobacillus helveticus with beta-galactosidase activity as a selection marker. Plasmid pBG10 was constructed by joining the beta-galactosidase gene from L. bulgaricus, the promoter region of the erythromycin resistance gene from pAM beta 1, the replication region of pBR329, and the replication region of the L. helveticus cryptic plasmid pLJ1. L. helveticus SBT2195 (Lac- mutant), transformed with pBG10, was selected on skim milk plates. The structural gene of alpha-amylase (1536 bp) from Bacillus licheniformis, inserted downstream of the promoter region of the erythromycin resistance gene of pBG10, was expressed in L. helveticus SBT2195. Plasmid pBG10 is a food-grade and expression vector in L. helveticus.

Incubation of saccharin craving and within-session changes in responding for a cue previously associated with saccharin

Time-dependent increases in cue-induced sucrose seeking after forced abstinence have been described in rats with a history of sucrose self-administration, suggesting sucrose craving "incubates". In the present study, we examined whether the incubation of craving generalizes to the artificial sweetener, saccharin. Thirty-one male Long-Evans rats lever pressed for 0.3% saccharin solution 1h/day for 10 days. On either Day 1 or 30 of forced abstinence, rats responded for 1h for presentation of a tone+light cue previously presented with every saccharin delivery during self-administration training. Rats responded more during this cue-reactivity test session following 30 vs. 1 day of forced abstinence ("incubation of craving"). This result is the first demonstration of the "incubation of saccharin craving" and suggests that a post-ingestive caloric consequence of self-administration is not a necessary condition for the development of incubation of sucrose craving. We also examined the time course (within-session decreases) of active-lever responding during the 1-h cue-reactivity test session. Rats in the Day 30 group responded more than rats in the Day 1 group from the beginning of the test session. In addition, within-session decreases in responding were shallower in slope in the Day 30 than the Day 1 group. These results indicate that "incubation of saccharin craving" enhances the persistence of seeking behavior.

Orbital order and Hund's rule frustration in Kondo lattices

We analyze a microscopic origin of the Kondo effect-assisted orbital order in heavy-fermion materials. By studying the periodic two-orbital Anderson model with two local electrons, we show that frustration of Hund's rule coupling due to the Kondo effect leads to an incommensurate spiral orbital and magnetic order, which exists only inside the Kondo screened (heavy-electron) phase. This spiral state can be observed in neutron and resonant x-ray scattering measurements in U- and Pr-based heavy-fermion compounds, and realized in cold atomic gases, e.g., fermionic 173Yb.

Expansion of donor-reactive host T cells in primary graft failure after allogeneic hematopoietic SCT following reduced-intensity conditioning

Graft rejection remains a major obstacle in allogeneic hematopoietic SCT following reduced-intensity conditioning (RIC-SCT), particularly after cord blood transplantation (CBT). In a murine MHC-mismatched model of RIC-SCT, primary graft rejection was associated with activation and expansion of donor-reactive host T cells in peripheral blood and BM early after SCT. Donor-derived dendritic cells are at least partly involved in host T-cell activation. We then evaluated if such an expansion of host T cells could be associated with graft rejection after RIC-CBT. Expansion of residual host lymphocytes was observed in 4/7 patients with graft rejection at 3 weeks after CBT, but in none of the 17 patients who achieved engraftment. These results suggest the crucial role of residual host T cells after RIC-SCT in graft rejection and expansion of host T cells could be a marker of graft rejection. Development of more efficient T cell-suppressive conditioning regimens may be necessary in the context of RIC-SCT.

Inhomogeneous superconducting States of mesoscopic thin-walled cylinders in external magnetic fields

We theoretically investigate the appearance of spatially modulated superconducting states in mesoscopic superconducting thin-wall cylinders in a magnetic field at low temperatures. Quantization of the electron motion around the circumference of the cylinder leads to a discontinuous evolution of the spatial modulation of the superconducting order parameter along the transition line T(c)(H). We show that this discontinuity leads to the nonmonotonic behavior of the specific heat jump at the onset of superconductivity as a function of temperature and field. We argue that this geometry provides an excellent opportunity to directly and unambiguously detect distinctive signatures of the Fulde-Ferrell-Larkin-Ovchinnikov modulation of the superconducting order.

The function of platelet-derived growth factor in the differentiation of mouse tongue striated muscle

OBJECTIVE

To determine the function of platelet-derived growth factor (PDGF) in the final differentiation phase of tongue striated muscle cells.

MATERIALS AND METHODS

We analyzed the expressions of PDGF-A, -B, platelet-derived growth factor receptor (PDGFR)-α, and PDGFR-β in mouse tongues between embryonic days (E) 11 and 15. Furthermore, we examined the effects of human recombinant PDGF-AB and the peptide antagonist for PDGFRs using an organ culture system of mouse embryonic tongue. Mouse tongues at E12 were cultured in BGJb medium containing human recombinant PDGF-AB for 4 days or the peptide antagonist for PDGF receptors for 8 days.

RESULTS

PDGF-A, -B, PDGFR-α, and -β were expressed in the differentiating muscle cells between E11 and 15. The human recombinant PDGF-AB induced increases in the mRNA expressions of myogenin and muscle creatine kinase (MCK) and the number of fast myosin heavy chain (fMHC)-positive cells, markers for the differentiation of muscle cells. On the other hand, the peptide antagonist for PDGFRs induced suppressions in the mRNA expressions of myogenin and MCK, and the number of fMHC-positive cells. Both the PDGF-AB and the antagonist failed to affect the expressions of cell proliferation markers.

CONCLUSION

These results suggest that PDGF functions as a positive regulator in the final differentiation phase of tongue muscle cells in mouse embryos.

Copper damascene using low dielectric constant fluorinated amorphous carbon interlayer

We have developed a new interconnect technique using a low-k (εt,=2.5) organic interlayer (fluorinated amorphous carbon: a-C:F) and a low-resistivity metal line (copper). The new technique attains a duction in both the capacitance of the interlayer and the resistance of the metal line. We found that a-C:F on Cu reduces reflection to 10% for Kr-F line lithography. However, a-C:F cannot act as a protection layer for oxidation even at 200°C in atmospheric ambient annealing. Cu diffusion into a-C:F is about 100 nm at the annealing temperature of 450°C. The resistivity of the Cu line is 2.3–2.4 μΩ · cm for the 0.5-μm line width. Although the leakage current of the a-C:F ILD is one order higher than that of the SiO2 ILD, electrical isolation is acceptable at < 20 V when annealing is carried out at 350°C in a vacuum.

Specific Lysogenicity in Streptomyces azureus

Slope (or plate) cultures of thiostrepton-producing Streptomyces azureus (ATCC 14921) often showed spontaneously developing plaques. Plaques increased in number during serial subcultures. The production of aerial mycelia and sporulating aerial hyphae was interrupted by the overlapping plaques, whereas the growth of substrate mycelia continued in the plaques. These abnormal (eroded) cultures were easily restored to their normal conditions once they were passed through liquid cultures under shaking conditions. A few phage particles were found in the plaques, together with some headless tails and numerous tail tips which formed a hexagonal crystal or a large crystal mass when viewed in an electron microscope. No lytic phenomenon and no phage production were found in the liquid cultures, although all mycelia and spores harbored phage-producing abilities. It was also found that the propagation of phages was successful in solid culture, but not in liquid culture. The whole phage was named SAt2, which belongs to group B of Bradley's morphological classification. From these results, it is considered that S. azureus is lysogenic with temperate phage SAt2, of which virulent mutants are able to infect the aerial mycelia and sporulating hyphae of their lysogenic host.

Dermatophyte infections in Cairo, Egypt

In this study, we examined dermatophyte infections in patients referred to the Department of Dermatology, EL-Houd El-Marsoud Hospital, Cairo, during March 2004 to June 2005. Of 506 patients enrolled in this investigation, 403 (79.6%) were clinically diagnosed as having dermatophytoses (age range 6-70 years; males 240; females 163). Species identification determined by observation of their macroscopic and microscopic characteristics was complemented with sequencing of the internal transcribed spacer ITS1-5.8S-ITS2 rDNA region. The most common dermatophyte infection diagnosed was tinea capitis (76.4%), followed by tinea corporis (22.3%) and tinea unguium (1.2%). The most frequently isolated dermatophyte species was Trichophyton violaceum, which accounted for most (71.1%) of all the recovered dermatophytes, followed by Microsporum canis (21.09%), Trichophyton rubrum (6.2%), and Microsporum boullardii (0.49%); both Epidermophyton floccosum and Trichophyton tonsurans were each only rarely isolated (0.24%).

Development of advanced-type multi-functional electronic personal dosemeter

An advanced-type small, light, multi-functional electronic personal dosemeter has been developed using silicon semiconductor radiation detectors for dose management of workers at nuclear power plants and accelerator facilities. This dosemeter is 62 x 82 x 27 mm(3) in size and approximately 130 g in weight, which is capable of measuring personal gamma ray and neutron dose equivalents, Hp(10), simultaneously. The neutron dose equivalent can be obtained using two types of silicon semiconductors: a slow-neutron sensor (<1 MeV) and a fast-neutron sensor (>1 MeV). The slow neutron sensor is a 10 x 10 mm(2) p-type silicon on which a natural boron layer is deposited around an aluminium electrode. The fast neutron sensor is also a 10 x 10 mm(2) p-type silicon crystal on which an amorphous silicon hydride is deposited. The neutron energy response corresponding to the fluence-to-dose-equivalent conversion coefficient given by ICRP Publication 74 has been evaluated using a monoenergetic neutron source from 250 keV to 15 MeV at the Fast Neutron Laboratory of Tohoku University. As the result, the Hp(10) response to neutrons in the energy range of 250 keV and 4.4 MeV within +/-50% difference has been obtained.

Development of a neutron personal dose equivalent detector

A new neutron-measuring instrument that is intended to measure a neutron personal dose equivalent, H(p)(10) was developed. This instrument is composed of two parts: (1) a conventional moderator-based neutron dose equivalent meter and (2) a neutron shield made of borated polyethylene, which covers a backward hemisphere to adjust the angular dependence. The whole design was determined on the basis of MCNP calculations so as to have response characteristics that would generally match both the energy and angular dependencies of H(p)(10). This new instrument will be a great help in assessing the reference values of neutron H(p)(10) during field testing of personal neutron dosemeters in workplaces and also in interpreting their readings.

Development of torsade de pointes caused by exacerbation of QT prolongation during clipping of cerebral artery aneurysm in a patient with subarachnoid haemorrhage

We report the case of a 79-yr-old woman with subarachnoid haemorrhage (SAH) in whom torsade de pointes (TdP) caused by worsening the QT prolongation occurred during clipping of cerebral artery aneurysm. This patient shows a potential risk of occurrence of life-threatening tachyarrhythmia, TdP by prolonging the QT interval during surgery in patients with SAH even with no additional factors that predispose to TdP. Therefore, a proper monitoring of the QT interval is necessary as a predictor of TdP. When ventricular tachyarrhythmia occurs, recognition of TdP is important because antiarrhythmic drug therapy for TdP is different from that for ventricular tachyarrhythmias that is not TdP.