Early neurological signs in infants identified through neonatal screening for SMA: do they predict outcome?

Neonatal screening for SMA has allowed the identification of infants who may present with early clinical signs. Our aim was to establish whether the presence and the severity of early clinical signs have an effect on the development of motor milestones. Infants identified through newborn screening were prospectively assessed using a structured neonatal neurological examination and an additional module developed for the assessment of floppy infants. As part of the follow-up, all infants were assessed using the HINE-2 to establish developmental milestones. Only infants with at least 24 months of follow-up were included. Normal early neurological examination (n = 11) was associated with independent walking before the age of 18 months while infants with early clinical signs of SMA (n = 4) did not achieve ambulation (duration follow-up 33.2 months). Paucisymptomatic patients (n = 3) achieved ambulation, one before the age of 18 months and the other 2 between 22 and 24 months.  Conclusion: Our findings suggest that early clinical signs may contribute to predict motor milestones development. What is Known: • There is increasing evidence of heterogeneity among the SMA newborns identified via NBS. • The proposed nosology describes a clinically silent disease, an intermediate category ('paucisymptomatic') and 'symptomatic SMA'. What is New: • The presence of minimal clinical signs at birth does not prevent the possibility to achieve independent walking but this may occur with some delay. • The combination of genotype at SMN locus and clinical evaluation may better predict the possibility to achieve milestones.

De Novo DNM1L Mutation in a Patient with Encephalopathy, Cardiomyopathy and Fatal Non-Epileptic Paroxysmal Refractory Vomiting.

Mitochondrial fission and fusion are vital dynamic processes for mitochondrial quality control and for the maintenance of cellular respiration; they also play an important role in the formation and maintenance of cells with high energy demand including cardiomyocytes and neurons. The DNM1L (dynamin-1 like) gene encodes for the DRP1 protein, an evolutionary conserved member of the dynamin family that is responsible for the fission of mitochondria; it is ubiquitous but highly expressed in the developing neonatal heart. De novo heterozygous pathogenic variants in the DNM1L gene have been previously reported to be associated with neonatal or infantile-onset encephalopathy characterized by hypotonia, developmental delay and refractory epilepsy. However, cardiac involvement has been previously reported only in one case. Next-Generation Sequencing (NGS) was used to genetically assess a baby girl characterized by developmental delay with spastic-dystonic, tetraparesis and hypertrophic cardiomyopathy of the left ventricle. Histochemical analysis and spectrophotometric determination of electron transport chain were performed to characterize the muscle biopsy; moreover, the morphology of mitochondria and peroxisomes was evaluated in cultured fibroblasts as well. Herein, we expand the phenotype of DNM1L-related disorder, describing the case of a girl with a heterozygous mutation in DNM1L and affected by progressive infantile encephalopathy, with cardiomyopathy and fatal paroxysmal vomiting correlated with bulbar transitory abnormal T2 hyperintensities and diffusion-weighted imaging (DWI) restriction areas, but without epilepsy. In patients with DNM1L mutations, careful evaluation for cardiac involvement is recommended.

Type I spinal muscular atrophy patients treated with nusinersen: 4-year follow-up of motor, respiratory and bulbar function.

BACKGROUND: We report the 4-year follow-up in type I patients treated with nusinersen and the changes in motor, respiratory and bulbar function in relation to subtype, age and SMN2 copy number. METHODS: The study included SMA 1 patients with at least one assessment after 12, 24 and 48 months from the first dose of nusinersen. The assessments used were Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) and the Hammersmith Infant Neurological Examination (HINE-II). RESULTS: Forty-eight patients, with ages ranging from 7 days to 12 years (mean 3.3 years, SD 3.6 years) were included in the study. The CHOP INTEND and HINE-II scores significantly increased between baseline and 48 months (p < 0.001). When age at starting treatment subgroups (<210 days, <2 years, 2-4 years, 5-11 years, ≥12 years) were considered, the CHOP INTEND increased significantly in patients younger than 4 years at treatment, while the HINE-2 increased significantly in patients younger than 2 years at treatment. In a mixed-model analysis, age, nutritional and respiratory status were predictive of changes on both scales while SMN2 copy number and decimal classification were not. CONCLUSIONS: Our results confirm the safety profile previously reported and support the durability of the efficacy of nusinersen at 4 years with an overall stability or mild improvement and no evidence of deterioration over a long period of time.

Assessing Prevalence and Characteristics of Oro-bulbar Involvement in Children and Adults with SMA Type 2 and 3 Using a Multimodal Approach.

Bulbar and jaw muscles are impaired in patients with Spinal Muscular Atrophy (SMA) but the assessment of their severity and progression are limited by the lack of age-appropriate and disease-specific measures. We investigated mastication and swallowing in children and adults with SMA, sitters and walkers. In a 2-year multicentre cross-sectional prospective study, lip and tongue strength (Iowa Oral Performance Instrument), chewing and swallowing (Test of Masticating and Swallowing Solids), active mouth opening (aMMO) were compared to age-appropriate normative data. The perceived burden of oro-bulbar involvement (SMA-Health Index) was recorded. 78 patients were included, 45 children (median age 7.4 years),22 adults (median age 26.8 years) on nusinersen and 11 untreated (median age 32.7 years). Forty-three percent children had reduced mouth opening, 50% had prolonged total time to eat. These issues were more prominent in sitters than in walkers (p = 0.019, p = 0.014). Sixty-six percent needed increased swallows for bolus clearance. Nusinersen treated adults had median aMMO, tongue strength and total time at TOMASS values within normal range (z score: -1.40, -1.22, -1.32, respectively) whereas untreated adults had reduced aMMO (z score: -2.68) and tongue strength (z score: -2.20). Only a minority of children (2/17) and treated adults (5/21) reported burden in swallowing or mastication compared to all untreated adults (5/5). After 16 months, mastication and swallowing were stable in treated children and adults, whether sitters or walkers. The reported multimodal approach to assess oro-bulbar functions demonstrate that swallowing and mastication are impaired in SMA despite patients' perception. These results suggest a trend towards stabilization of oro-bulbar function in patients on long-term treatment with nusinersen.

Atomically Precise Platinum Carbonyl Nanoclusters: Synthesis, Total Structure, and Electrochemical Investigation of [Pt27(CO)31]4- Displaying a Defective Structure.

The molecular Pt nanocluster [Pt27(CO)31]4- (14-) was obtained by thermal decomposition of [Pt15(CO)30]2- in tetrahydrofuran under a H2 atmosphere. The reaction of 14- with increasing amounts of HBF4·Et2O afforded the previously reported [Pt26(CO)32]2- (32-) and [Pt26(CO)32]- (3-). The new nanocluster 14- was characterized by IR and UV-visible spectroscopy, single-crystal X-ray diffraction, direct-current superconducting quantum interference device magnetometry, cyclic voltammetry, IR spectroelectrochemistry (IR SEC), and electrochemical impedance spectroscopy. The cluster displays a cubic-close-packed Pt27 framework generated by the overlapping of four ABCA layers, composed of 3, 7, 11, and 6 atoms, respectively, that encapsulates a fully interstitial Pt4 tetrahedron. One Pt atom is missing within layer 3, and this defect (vacancy) generates local deformations within layers 2 and 3. These local deformations tend to repair the defect (missing atom) and increase the number of Pt-Pt bonding contacts, minimizing the total energy. The cluster 14- is perfectly diamagnetic and displays a rich electrochemical behavior. Indeed, six different oxidation states have been characterized by IR SEC, unraveling the series of 1n- (n = 3-8) isostructural nanoclusters. Computational studies have been carried out to further support the interpretation of the experimental data.

Neurological assessment of newborns with spinal muscular atrophy identified through neonatal screening.

The possibility to identify patients with spinal muscular atrophy through neonatal screenings has highlighted the need for clinical assessments that may systematically evaluate the possible presence of early neurological signs. The aim of this study was to use the Hammersmith Neonatal Neurological Examination (HNNE) and a module specifically designed for floppy infants to assess the possible variability of neurological findings in infants identified through neonatal screening. The infants included in this study were identified as part of a pilot study exploring neonatal screening in two Italian regions. A neurological examination was performed using the HNNE and an additional module developed for the assessment of floppy infants. Seventeen infants were identified through the screening. One patient had 1 SMN2 copy, 9 had 2 copies, 3 had 3, and 4 had more than 3 copies. Nine of the 17 infants (53%) had completely normal results on both scales, 3 had minimal signs, and the other 5 had more obvious clinical signs. The number of SMN2 copies was related to the presence of abnormal neurological signs (p = 0.036) but two SMN2 copies were associated with variable clinical signs as they were found in some infants with respectively normal examination or obvious severe early signs. CONCLUSIONS: Our results suggest that the combination of both scales increases the possibility to detect neonatal neurological signs and to define different early patterns of involvement also identifying paucisymptomatic patients. WHAT IS KNOWN: • The use of new therapeutic options in presymptomatic SMA patients leads to a dramatic reduction of the onset and severity of the diesease. • The already existing tools commonly used in Type I SMA (HINE and CHOP-intend) may not be suitable to identify minor neurological signs in the neonatal period. WHAT IS NEW: • Combining the HNNE and the floppy infant module, we were able to identify early neurological signs in SMA infants identified through newborn screening and may help to predict the individual therapeutic outcome of these patients. • Iinfants with 2 SMN2 copies identified through the screening had a more variable neonatal examination compared to those with three or more copies, in agreement with similar findings in older infants.

Body mass index in type 2 spinal muscular atrophy: a longitudinal study.

The aim of this retrospective study was to review body mass index (BMI) in a large cohort of Italian pediatric type 2 spinal muscular atrophy (SMA) patients, aged between 0 and 20 years and to establish possible differences in relation to a number of variables such as ventilation, motor function, and survival motor neuron 2 gene copies. Cross-sectional data were collected from 102 patients for a total of 344 visits. Standard growth charts for height and weight were used as reference, with age adjusted BMI calculated using the Center for Disease and Prevention Children's BMI Tool. In the 344 visits, weight ranged between 3.90 and 83 kg, and the BMI between 8.4 and 31.6 with a BMI/age z-scores < - 2SD present in 28% and BMI/age z-scores > + 2SD in 9% of the measurements. The BMI/age z-scores were relatively stable < 5 years of age with an increasing number of patients < - 2SD after the age of 5, and a wider range of BMI/age z-scores after the age of 13. A difference on the BMI/age z-scores was found among the different age subgroups (< 5, 5-12, ≥ 13 years). A multivariate analysis in 58 patients with longitudinal assessments showed that baseline BMI/age z-scores and gender were significantly contributing to the changes while other variables were not. CONCLUSION: Our results confirm that careful surveillance of weight and BMI/age z-scores is needed in type 2 SMA. Further studies, including assessments of chewing and swallowing and of lean/fat body mass, will help to better understand the possible mechanisms underlying weight issues. WHAT IS KNOWN: • Feeding difficulties have been reported in a few studies and were invariably found in patients with type 1 SMA. • Type 2 SMA patients often have low BMI with a relevant number of patients requiring tube feeding. WHAT IS NEW: • Reduction in BMI/age z-score overtime appeared to depend on baseline BMI/age z-score and gender. • Patients with a low BMI/age z-score were at higher risk of developing further reduction.

Heterometallic Ni-Pt Chini-Type Carbonyl Clusters: An Example of Molecular Random Alloy Clusters.

The direct reactions of homometallic [Ni6(CO)12]2- and [Pt6(CO)12]2- Chini carbonyl clusters result in heterometallic Ni-Pt Chini-type clusters of the general formula [Pt6-xNix(CO)12]2- (x = 0-6). Their molecular structures have been determined by single-crystal X-ray diffraction (SC-XRD), showing a common octahedral (staggered, D3d) structure analogous to that of [Ni6(CO)12]2-, whereas [Pt6(CO)12]2- displays a trigonal-prismatic (eclipsed, D3h) structure. This structural change after replacing one single Pt with Ni may be classified as an alloying effect, and it has been theoretically investigated by DFT methods. Spectroscopic (IR and 195Pt and 13C NMR) and ESI-MS studies indicate that mixtures of [Pt6-xNix(CO)12]2- (x = 0-6) clusters are actually present in solution, whose compositions may be varied in an almost continuous way. Thus, they may be viewed as random alloy clusters whose overall compositions depend on the stoichiometry of the reagents.

Atomically Precise Ni-Pd Alloy Carbonyl Nanoclusters: Synthesis, Total Structure, Electrochemistry, Spectroelectrochemistry, and Electrochemical Impedance Spectroscopy.

The molecular nanocluster [Ni36-xPd5+x(CO)46]6- (x = 0.41) (16-) was obtained from the reaction of [NMe3(CH2Ph)]2[Ni6(CO)12] with 0.8 molar equivalent of [Pd(CH3CN)4][BF4]2 in tetrahydrofuran (thf). In contrast, [Ni37-xPd7+x(CO)48]6- (x = 0.69) (26-) and [HNi37-xPd7+x(CO)48]5- (x = 0.53) (35-) were obtained from the reactions of [NBu4]2[Ni6(CO)12] with 0.9-1.0 molar equivalent of [Pd(CH3CN)4][BF4]2 in thf. After workup, 35- was extracted in acetone, whereas 26- was soluble in CH3CN. The total structures of 16-, 26-, and 35- were determined with atomic precision by single-crystal X-ray diffraction. Their metal cores adopted cubic close packed structures and displayed both substitutional and compositional disorder, in light of the fact that some positions could be occupied by either Ni or Pd. The redox behavior of these new Ni-Pd molecular alloy nanoclusters was investigated by cyclic voltammetry and in situ infrared spectroelectrochemistry. All three compounds 16-, 26-, and 35- displayed several reversible redox processes and behaved as electron sinks and molecular nanocapacitors. Moreover, to gain insight into the factors that affect the current-potential profiles, cyclic voltammograms were recorded at both Pt and glassy carbon working electrodes and electrochemical impedance spectroscopy experiments performed for the first time on molecular carbonyl nanoclusters.

Polymerization Isomerism in Co-M (M = Cu, Ag, Au) Carbonyl Clusters: Synthesis, Structures and Computational Investigation.

The reaction of [Co(CO)4]- (1) with M(I) compounds (M = Cu, Ag, Au) was reinvestigated unraveling an unprecedented case of polymerization isomerism. Thus, as previously reported, the trinuclear clusters [M{Co(CO)4}2]- (M = Cu, 2; Ag, 3; Au, 4) were obtained by reacting 1 with M(I) in a 2:1 molar ratio. Their molecular structures were corroborated by single-crystal X-ray diffraction (SC-XRD) on isomorphous [NEt4][M{Co(CO)4}2] salts. [NEt4](3)represented the first structural characterization of 3. More interestingly, changing the crystallization conditions of solutions of 3, the hexanuclear cluster [Ag2{Co(CO)4}4]2- (5) was obtained in the solid state instead of 3. Its molecular structure was determined by SC-XRD as Na2(5)·C4H6O2, [PPN]2(5)·C5H12 (PPN = N(PPh3)2]+), [NBu4]2(5) and [NMe4]2(5) salts. 5 may be viewed as a dimer of 3 and, thus, it represents a rare case of polymerization isomerism (that is, two compounds having the same elemental composition but different molecular weights) in cluster chemistry. The phenomenon was further studied in solution by IR and ESI-MS measurements and theoretically investigated by computational methods. Both experimental evidence and density functional theory (DFT) calculations clearly pointed out that the dimerization process occurs in the solid state only in the case of Ag, whereas Cu and Au related species exist only as monomers.

Nusinersen in type 1 spinal muscular atrophy: Twelve-month real-world data.

OBJECTIVE: The aim of the study was to report 12-month changes after treatment with nusinersen in a cohort of 85 type I spinal muscular atrophy patients of ages ranging from 2 months to 15 years and 11 months. METHODS: All patients were assessed using the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) and the Hammersmith Infant Neurological Examination-Section 2 (HINE-2). RESULTS: Two of the 85 patients had 1 SMN2 copy, 61 had 2 copies, and 18 had 3 copies. In 4 patients the SMN2 copy number was not available. At baseline, the mean CHOP INTEND scores ranged between 0 and 52 (mean = 15.66, standard deviation [SD] = ±13.48), and the mean HINE-2 score was between 0 and 5 (mean = 0.69, SD = ±1.23). There was a difference between baseline and the 12-month scores on both the CHOP INTEND and the HINE-2 for the whole group (p < 0.001), the subgroups with 2 SMN2 copies (p < 0.001), and those with 3 SMN2 copies (p < 0.001). The difference was found not only in patients younger than 210 days at baseline (p < 0.001) but also in those younger than 5 years on the CHOP INTEND and younger than 2 years on the HINE-2. INTERPRETATION: Our results, expanding the age range and the severity of type I patients treated with nusinersen over 1 year, provide additional data on the range of efficacy of the drug that will be helpful in making an informed decision on whether to start treatment in patients of different ages and severity. ANN NEUROL 2019;86:443-451.

Synthesis, Structural Characterization, and DFT Investigations of [MxM'5-xFe4(CO)16]3- (M, M' = Cu, Ag, Au; M ≠ M') 2-D Molecular Alloy Clusters.

Miscellaneous 2-D molecular alloy clusters of the type [MxM'5-xFe4(CO)16]3- (M, M' = Cu, Ag, Au; M ≠ M') have been prepared through the reactions of [Cu3Fe3(CO)12]3-, [Ag4Fe4(CO)16]4- or [M5Fe4(CO)16]3- (M = Cu, Ag) with M'(I) salts (M' = Cu, Ag, Au). Their formation involves a combination of oxidation, condensation, and substitution reactions. The total structures of several [MxM'5-xFe4(CO)16]3- clusters with different compositions have been determined by means of single crystal X-ray diffraction (SC-XRD) and their nature in solution elucidated by electron spray ionization mass spectrometry (ESI-MS) and IR and UV-visible spectroscopy. Substitutional and compositional disorder is present in the solid state structures, and ESI-MS analyses point out that mixtures of isostructural clusters differing by a few M/M' coinage metals are present. SC-XRD studies indicate some site preferences of the coinage metals within the metal cores of these clusters, with Au preferentially in corner sites and Cu in the central site. DFT studies give theoretical support to the experimental structural evidence. The site preference is mainly dictated by the strength of the Fe-M bonds that decreases in the order Fe-Au > Fe-Ag > Fe-Cu, and the preferred structure is the one that maximizes the number of stronger Fe-M interactions. Overall, the molecular nature of these clusters allows their structures to be fully revealed with atomic precision, resulting in the elucidation of the bonding parameters that determine the distribution of the different metals within their metal cores.

Thermal Growth of Au-Fe Heterometallic Carbonyl Clusters Containing N-Heterocyclic Carbene and Phosphine Ligands.

The thermal reactions of [NEt4][Fe(CO)4(AuNHC)] [NHC = IMes ([NEt4][1]) or IPr ([NEt4][2]); IMes = C3N2H2(C6H2Me3)2; IPr = C3N2H2(C6H3iPr2)2], Fe(CO)4(AuNHC)2 [NHC = IMes (3) or IPr (4)], Fe(CO)4(AuIMes)(AuIPr) (5), and Fe(CO)4(AuNHC)(AuPPh3) [NHC = IMes (6) or IPr (7)] were investigated in different solvents [CH2Cl2, CH3CN, dimethylformamide, and dimethyl sulfoxide (dmso)] and at different temperatures (50-160 °C) in an attempt to obtain higher-nuclearity clusters. 1 and 2 completely decomposed in refluxing CH2Cl2, resulting in [Fe2(CO)8(AuNHC)]- [NHC = IMes (10) or IPr (11)]. Traces of [Fe3(CO)10(CCH3)]- (12) were obtained as a side product. Conversely, 6 decomposed in refluxing CH3CN, affording the new cluster [Au3{Fe(CO)4}2(PPh3)2]- (15). The relative stability of the two isomers found in the solid state structure of 15 was computationally investigated. 4 was very stable, and only after prolonged heating above 150 °C in dmso was limited decomposition observed, affording small amounts of [Fe3S(CO)9]2- (9), [HFe(CO)4]- (16), and [Au16S{Fe(CO)4}4(IPr)4]n+ (17). A dicationic nature for 17 was proposed on the basis of density functional theory calculations. All of the other reactions examined led to species that were previously reported. The molecular structures of the new clusters 11, 12, 15, and 17 were determined by single-crystal X-ray diffraction as their [NEt4][11]·1.5toluene, [Au(IMes)2][15]·0.67CH2Cl2, [NEt4][12], and [17][BF4]n·solvent salts, respectively.

The acute impact of an ultramarathon on right heart: A 12-lead ECG study.

BACKGROUND: Some concerns exist about possible detrimental effects on cardiac function of ultra-endurance competitions. The aim of this study was to evaluate the acute effects of an ultramarathon by comparing pre- and post-race 12-lead ECG features. METHODS: A total of 301 competitive athletes (mean age: 48 ± 9 years) running a 50-km ultramarathon were analyzed. Twelve-lead ECG was collected the day before the race and immediately at the finish line. According to the Italian law, athletes could have participated only after undergoing pre-participation screening that ruled out the presence of an underlying heart disease. RESULTS: After the race a significant increase in P-wave voltage (P < .001) and P-wave duration (P < .001) was found as compared to pre-race data with a higher percentage of athletes fulfilling the ECG criteria for right atrial enlargement (RAE; from 3% to 17%, P < .001). The presence of RAE post-race significantly correlated with age, hours of training/week, and years of training and inversely with time at the finish line and the final position in the ranking. T-wave and R-wave amplitude (P < .001) and QTc-interval duration (P < .001) significantly increased after the race. No significant differences in terms of supraventricular or ventricular arrhythmias were found. CONCLUSIONS: A sizeable proportion of athletes running a 50-km ultramarathon demonstrated post-race ECG signs of right heart overload but no arrhythmias. This finding supports the hypothesis that ultra-endurance races may induce transient right heart overload.

Polymerization Isomerism in [{MFe(CO)4} n] n- (M = Cu, Ag, Au; n = 3, 4) Molecular Clusters Supported by Metallophilic Interactions.

Triangular clusters [{MFe(CO)4}3]3- (M = Cu, 4; Ag, 5; Au, 6) were selectively obtained by heating Fe(CO)4(MIMes)2 (M = Cu, 1; Ag, 2; Au, 3; IMes = C3N2H2(C6H2Me3)2). 1-3 were synthesized by reacting Na2[Fe(CO)4]·2thf with 2 equiv of M(IMes)Cl. As previously described, the direct reactions of Na2[Fe(CO)4]·2thf with one equivalent of M(I) salts resulted in the triangular cluster [{CuFe(CO)4}3]3- for Cu, whereas the square clusters [{MFe(CO)4}4]4- were formed for Ag and Au. Thus, depending on the synthetic protocol adopted, both the triangular [{MFe(CO)4}3]3- and square [{MFe(CO)4}4]4- polymerization isomers can be selectively obtained, at least for Ag and Au. Polymerization isomerism, that is two compounds having the same elemental compositions but different molecular weights, was investigated in [{MFe(CO)4} n] n- ( n = 3, 4; M = Cu, Ag, Au) by means of structural and theoretical methods and the role of metallophilic interactions was computationally studied by means of the atoms-in-molecules (AIM) approach.

Normal and abnormal QT interval duration and its changes in preadolescents and adolescents practicing sport.

AIMS: Twelve-lead electrocardiogram (ECG) is an established tool in the evaluation of athletes, providing information about life-threatening cardiovascular diseases, such as long QT syndrome. However, the interpretation of ECG is sometimes challenging in children, particularly for the repolarization phase. The aim of this prospective, longitudinal study was to determinate the distribution of QT interval in children practicing sport and to evaluate changes in QT duration overtime. METHODS AND RESULTS: A population of 1473 preadolescents practising sport (12.0 ± 1.8 years, 7-15 years) was analysed. Each athlete was evaluated at baseline, mid-term, and end of the study (mean follow-up: 3 ± 1 years). QT interval was corrected with Bazett (B) and Fridericia (F) formulae. At baseline QT interval corrected with the Bazett formula (QTcB) was 412 ± 25 ms and QT interval corrected with the Fridericia formula (QTcF) 387 ± 21 ms, with no changes during follow-up. Ten children (0.68%) had an abnormal QTc. In those with QTcB and QTcF ≥480 ms, QTc duration persisted abnormal during the follow-up and they were disqualified. Conversely, children with 460 ms < (QTcB) <480 ms had a normal QTc interval at the end of the study. These children had also a normal QTcF. Mean difference in the calculation of QT between the two formulae was 25 ± 11 ms (P < 0.0001). For resting heart rate (HR) ≥82 b.p.m., QTcF was independent from HR contrary to QTcB. CONCLUSION: Normal QTc interval does not change over time in preadolescents. A minority of them has a QTc ≥480 ms; in these subjects, QTc interval remains prolonged. The use of Bazett and Fridericia correction formulae is not interchangeable and the Fridericia correction should be preferred in preadolescents with a resting HR ≥82 b.p.m.

Clinical and neuroimaging features of autosomal recessive spastic paraplegia 35 (SPG35): case reports, new mutations, and brief literature review.

Spastic paraplegia 35 (SPG35) is a recessive condition characterized by childhood onset, progressive course, complicated by dystonia, dysarthria, cognitive impairment, and epilepsy. Mutations in the FA2H gene have been described in several families, leading to the proposal of a single entity, named fatty acid hydrolase-associated neurodegeneration (FAHN). Several reports have described a polymorphic radiological picture with white matter lesions of various degrees and a distinct form of neurodegeneration with brain iron accumulation. While we reviewed the pertinent literature, we also report three new patients with SPG35, highlighting the possible absence of white matter lesions even after a long neuroimaging follow-up. Three-dimensional modeling of the mutated proteins was helpful to elucidate the role of the site of mutations and the correlation with the residual enzyme activity as determined in cultured skin fibroblasts.

Synthesis of [Pt12(CO)20(dppm)2]2- and [Pt18(CO)30(dppm)3]2- Heteroleptic Chini-type Platinum Clusters by the Oxidative Oligomerization of [Pt6(CO)12(dppm)]2.

The reactions of [Pt6(CO)12]2- with CH(PPh2)2 (dppm), CH2═C(PPh2)2 (P^P), and Fe(C5H4PPh2)2 (dppf) proceed via nonredox substitution and result in the heteroleptic Chini-type clusters [Pt6(CO)10(dppm)]2-, [Pt6(CO)10(P^P)]2-, and [Pt6(CO)10(dppf)]2-, respectively. Conversely, the reactions of [Pt6(CO)12]2- with Ph2P(CH2)4PPh2 (dppb) and Ph2PC≡CPPh2 (dppa) can be described as redox fragmentation that afford the neutral complexes Pt(dppb)2, Pt2(CO)2(dppa)3, and Pt8(CO)6(PPh2)2(C≡CPPh2)2(dppa)2. The oxidation of [Pt6(CO)10(dppm)]2- results in its oligomerization to yield the larger heteroleptic Chini-type clusters [Pt12(CO)20(dppm)2]2-, [Pt18(CO)30(dppm)3]2-, and [Pt24(CO)40(dppm)4]2- (for the latter there is only IR spectroscopic evidence). All the clusters were characterized by means of IR and 31P NMR spectroscopies and electrospray ionization mass spectrometry. Moreover, the crystal structures of [NEt4]2[Pt6(CO)10(dppm)]·CH3CN, [NEt4]2[Pt12(CO)20(dppm)2]·2CH3CN·2dmf, [NEt4]2[Pt12(CO)20(dppm)2]·4dmf, [NEt4]2[Pt6(CO)10(dppf)]·2CH3CN, Pt2(CO)2(dppa)3·0.5CH3CN, Pt8(CO)6(PPh2)2(C≡CPPh2)2(dppa)2·2thf, and Pt(dppb)2 were determined by single-crystal diffraction (dmf = dimethylformamide; thf = tetrahydrofuran).

Fast Progression of Cerebellar Atrophy in PLA2G6-Associated Infantile Neuronal Axonal Dystrophy.

Infantile neuronal axonal dystrophy (INAD) is characterized by progressive cerebellar atrophy. MRI has been recommended as a marker of disease progression in cerebellar diseases. We performed a longitudinal brain volumetry study in a couple of bicorial twins with PLA2G6-positive INAD. Brain volumetry was calculated with FreeSurfer software on 3T T1-weighted images acquired at age 28 (t 0) and 36 months (t 1) in patient 1 and at age 22 (t 0) and 31 months (t 1) in patient 2. Data at t 0 were compared to those obtained in 18 control children aged 14-44 months with normal MRI. At t 0, both patients showed markedly lower cerebellar volume compared to controls. At t 1, both patients exhibited a remarkable decrease of cerebellar volume (-25.8% in patient 1; -16.5% in patient 2) and of frontal (-6.8% in patient 1 and -3.3% in patient 2) and occipital (-9.8% in patient 1 and -9.1% in patient 2) cortical GM volume. Our MRI morphometry study indicates that INAD is characterized by a remarkably fast progression of cerebellar atrophy and mild atrophy of the frontal and occipital cortex presumably secondary to deafferentation in the cortical-pons-cerebellum-rubro-thalamus-cortical circuit and visual pathways.

Recurrent drop attacks in early childhood as presenting symptom of benign hereditary chorea caused by TITF1 gene mutations.

Drop attacks are sudden, spontaneous falls without loss of consciousness, followed by rapid recovery. Causes in children include severe epilepsies, movement disorders, cataplexy, and psychiatric disorders. We describe two children (a 3-year-old female and a 12-year-old male) with mild neuromotor delay and sudden falls appearing upon starting to walk. Extensive clinical and laboratory investigation was unremarkable. Twenty to 22 months after the onset of falls, both children developed subtle choreiform movements, affecting all four limbs, leading to frequent falls, at times causing traumatic injury. A heterozygous mutation of the TITF1/NKX2-1 gene (14q13) was detected in both patients, allowing the diagnosis of benign hereditary chorea (BHC). Treatment with levodopa attenuated abnormal movements and led to disappearance of drop attacks. A diagnosis of BHC should be considered in young children with recurrent and unexplained drop attacks, especially if associated with neuromotor delay, even in the absence of choreiform movements.