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1.
Handb Clin Neurol ; 202: 265-278, 2024.
Article in English | MEDLINE | ID: mdl-39111913

ABSTRACT

X-linked adrenoleukodystrophy (ALD) is a peroxisomal disorder that leads to progressive neurodegeneration in brain and spinal cord. The most devastating phenotype of childhood cerebral ALD can be halted by allogeneic hematopoietic stem cell transplantation but the procedure remains cumbersome and limited by engraftment problems and graft versus host disease. This is particularly difficult for boys with more advanced brain lesions and neurologic impairment. Fortunately, newborn screening has led to regular monitoring and increased detection of cerebral ALD in early symptomatic or asymptomatic stages. Adults with ALD can also develop cerebral ALD but here implementation of HSCT is more challenging due to vulnerabilities not seen in childhood cerebral ALD. More recently the hematopoietic stem cell approach has given rise to a first ex vivo lentiviral gene therapy for this rare disorder. Over 60 boys with cerebral ALD have received ex vivo lentiviral gene therapy worldwide. While the approach is effective in halting progression of early-stage inflammatory demyelination in brain and prevents engraft problems and graft versus host disease, there have also been cases of myelodysplastic syndrome emerging. In September of 2022, the FDA granted accelerated approval of ex vivo lentiviral gene therapy to slow the progression of neurologic dysfunction in boys 4-17years of age with early, active cerebral ALD. We describe the history of these developments, outline the pathophysiology of the disorder and the corresponding rationale of hematopoietic stem cell therapy as well as current developments in the field.


Subject(s)
Adrenoleukodystrophy , Genetic Therapy , Hematopoietic Stem Cell Transplantation , Humans , Adrenoleukodystrophy/therapy , Adrenoleukodystrophy/genetics , Genetic Therapy/methods , Hematopoietic Stem Cell Transplantation/methods , Male
2.
Nat Biotechnol ; 2024 Jul 22.
Article in English | MEDLINE | ID: mdl-39039307

ABSTRACT

Genome editing technologies based on DNA-dependent polymerases (DDPs) could offer several benefits compared with other types of editors to install diverse edits. Here, we develop click editing, a genome writing platform that couples the advantageous properties of DDPs with RNA-programmable nickases to permit the installation of a range of edits, including substitutions, insertions and deletions. Click editors (CEs) leverage the 'click'-like bioconjugation ability of HUH endonucleases with single-stranded DNA substrates to covalently tether 'click DNA' (clkDNA) templates encoding user-specifiable edits at targeted genomic loci. Through iterative optimization of the modular components of CEs and their clkDNAs, we demonstrate the ability to install precise genome edits with minimal indels in diverse immortalized human cell types and primary fibroblasts with precise editing efficiencies of up to ~30%. Editing efficiency can be improved by rapidly screening clkDNA oligonucleotides with various modifications, including repair-evading substitutions. Click editing is a precise and versatile genome editing approach for diverse biological applications.

3.
Eur J Cardiothorac Surg ; 66(1)2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38991832

ABSTRACT

OBJECTIVES: To report experience with a Relay® stent-graft custom-made platform in treating different aortic arch pathology in 2 high-volume aortic centres. METHODS: A retrospective analysis of all patients treated between July 2016 and July 2023 with custom-made Relay® stent-graft (custom-made device). Underlying aortic arch pathology was an aneurysm, penetrating aortic ulcer, and dissection. Three custom-made device designs were used: proximal scallop, fenestrations, and inner branches. The endpoints were technical success, perioperative stroke, death, and reintervention rate. RESULTS: Thirty-five patients (89% males) with a mean age of 70 ± 11 years were treated.Indication for treatment was penetrating aortic ulcer in 14 patients (40%), aneurysm in 11 patients (31%) and aortic dissection in 10 patients (29%). The technical success rate was 100%. Twenty-eight patients (80%) had proximal sealing in zone 0, and 7 (20%) had proximal sealing in zone 1. Nine patients (25.6%) had proximal scallops, 9 (25.6%) had 1 big fenestration and 17 (48.8%) had a branched device; 1 with single branch, 15 with double branches and 1 with triple branches. Thirty patients (86%) had previous or simultaneous left subclavian artery revascularization. No patient died during 30 days. Two patients (5.7%) had stroke postoperatively; both recovered without disabling deficits. The mean follow-up was 35 ± 26 months. Six patients (17.1%) died during follow-up. One patient required reinforcement of the bridging stent in the left common carotid artery and one additional vascular plugging of the left subclavian artery. Three patients received distal extension. CONCLUSIONS: The Relay® stent-graft custom-made platform showed a good performance in our study with a high technical success rate, low perioperative stroke and mortality, and low reintervention rates during the follow-up.


Subject(s)
Aorta, Thoracic , Blood Vessel Prosthesis Implantation , Blood Vessel Prosthesis , Prosthesis Design , Stents , Humans , Male , Aged , Female , Retrospective Studies , Aorta, Thoracic/surgery , Aorta, Thoracic/diagnostic imaging , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/methods , Middle Aged , Treatment Outcome , Aged, 80 and over , Endovascular Procedures/methods , Endovascular Procedures/instrumentation , Aortic Diseases/surgery
4.
J Clin Med ; 13(12)2024 Jun 19.
Article in English | MEDLINE | ID: mdl-38930123

ABSTRACT

Background/Objective: With the rapid advancement in surgical technologies, new workflows for mandibular reconstruction are constantly being evaluated. Cutting guides are extensively employed for defining osteotomy planes but are prone to errors during fabrication and positioning. A virtually defined osteotomy plane and drilling holes in robotic surgery minimize potential sources of error and yield highly accurate outcomes. Methods: Ten mandibular replicas were evaluated after cutting-guided saw osteotomy and robot-guided laser osteotomy following reconstruction with patient-specific implants. The descriptive data analysis summarizes the mean, standard deviation (SD), median, minimum, maximum, and root mean square (RMS) values of the surface comparison for 3D printed models regarding trueness and precision. Results: The saw group had a median trueness RMS value of 2.0 mm (SD ± 1.7) and a precision of 1.6 mm (SD ± 1.4). The laser group had a median trueness RMS value of 1.2 mm (SD ± 1.1) and an equal precision of 1.6 mm (SD ± 1.4). These results indicate that robot-guided laser osteotomies have a comparable accuracy to cutting-guided saw osteotomies, even though there was a lack of statistical significance. Conclusions: Despite the limited sample size, this digital high-tech procedure has been shown to be potentially equivalent to the conventional osteotomy method. Robotic surgery and laser osteotomy offers enormous advantages, as they enable the seamless integration of precise virtual preoperative planning and exact execution in the human body, eliminating the need for surgical guides in the future.

5.
J Neuromuscul Dis ; 11(4): 735-747, 2024.
Article in English | MEDLINE | ID: mdl-38788085

ABSTRACT

Motor neuron diseases and peripheral neuropathies are heterogeneous groups of neurodegenerative disorders that manifest with distinct symptoms due to progressive dysfunction or loss of specific neuronal subpopulations during different stages of development. A few monogenic, neurodegenerative diseases associated with primary metabolic disruptions of sphingolipid biosynthesis have been recently discovered. Sphingolipids are a subclass of lipids that form critical building blocks of all cellular and subcellular organelle membranes including the membrane components of the nervous system cells. They are especially abundant within the lipid portion of myelin. In this review, we will focus on our current understanding of disease phenotypes in three monogenic, neuromuscular diseases associated with pathogenic variants in components of serine palmitoyltransferase, the first step in sphingolipid biosynthesis. These include hereditary sensory and autonomic neuropathy type 1 (HSAN1), a sensory predominant peripheral neuropathy, and two neurodegenerative disorders: juvenile amyotrophic lateral sclerosis affecting the upper and lower motor neurons with sparing of sensory neurons, and a complicated form of hereditary spastic paraplegia with selective involvement of the upper motor neurons and more broad CNS neurodegeneration. We will also review our current understanding of disease pathomechanisms, therapeutic approaches, and the unanswered questions to explore in future studies.


Subject(s)
Neurodegenerative Diseases , Neurodevelopmental Disorders , Serine C-Palmitoyltransferase , Humans , Amyotrophic Lateral Sclerosis/genetics , Amyotrophic Lateral Sclerosis/metabolism , Hereditary Sensory and Autonomic Neuropathies/genetics , Hereditary Sensory and Autonomic Neuropathies/metabolism , Hereditary Sensory and Autonomic Neuropathies/physiopathology , Neurodegenerative Diseases/metabolism , Serine C-Palmitoyltransferase/metabolism , Serine C-Palmitoyltransferase/genetics , Spastic Paraplegia, Hereditary/genetics , Spastic Paraplegia, Hereditary/metabolism , Sphingolipids/metabolism
6.
Int J Technol Assess Health Care ; 40(1): e30, 2024 May 02.
Article in English | MEDLINE | ID: mdl-38695141

ABSTRACT

OBJECTIVES: While patient input to health technology assessment (HTA) has traditionally been of a qualitative nature, there is increasing interest to integrate quantitative evidence from patient preference studies into HTA decision making. Preference data can be used to generate disease-specific health utility data. We generated a health utility score for patients with chronic obstructive pulmonary disease (COPD) and consider its use within HTAs. METHODS: Based on qualitative research, six symptoms were identified as important to COPD patients: shortness of breath, exacerbations, chronic cough, mucus secretion, sleep disturbance, and urinary incontinence. We employed a discrete choice experiment (DCE) and the random parameter logistic regression technique to estimate utility scores for all COPD health states. The relationship between patients' COPD health utility scores, self-perceived COPD severity, and EQ-5D-3L utility scores was analyzed, with data stratified according to disease severity and comorbidity subgroups. RESULTS: The COPD health utility score had face validity, with utility scores negatively correlated with patients' self-perceived COPD severity. The correlation between the COPD health utility scores and EQ-5D-3L values was only moderate. While patient EQ-5D-3L scores were impacted by comorbidities, the COPD health utility score was less impacted by comorbid conditions. CONCLUSIONS: Our COPD utility measure, derived from a DCE, provides a patient-centered health utility score and is more sensitive to the COPD health of the individual and less sensitive to other comorbidities. This disease-specific instrument should be considered alongside generic health-related quality of life instruments when valuing new COPD therapies in submissions to licensing and reimbursement agencies.


Subject(s)
Patient Preference , Pulmonary Disease, Chronic Obstructive , Quality of Life , Severity of Illness Index , Technology Assessment, Biomedical , Humans , Female , Male , Middle Aged , Aged , Choice Behavior , Comorbidity , Health Status
8.
Clin Exp Med ; 24(1): 82, 2024 Apr 23.
Article in English | MEDLINE | ID: mdl-38653874

ABSTRACT

PURPOSE: Vascularized lymph node transfer (VLNT) entails the autologous relocation of lymph nodes to a lymphedematous region of the body, whereas lymphaticovenous anastomosis (LVA) creates a direct bypass between the lymphatic and venous system. Both techniques are meant to lastingly bolster the local lymphatic drainage capacity. This study compared safety and effectiveness of VLNT and LVA in patients with chronic breast cancer related lymphedema (BCRL). METHODS: A retrospective cohort study was conducted using data from our encrypted database composed of patients with chronic BCRL who were treated with either VLNT or LVA and had a minimum follow-up of two years. Patient-specific variables analyzed included pre- and postoperative arm circumferences, lymphedema stages and postoperative complications. RESULTS: A total of 105 patients met the inclusion criteria, of which 96 patients demonstrated a complete follow-up period of two years. The VLNT group displayed larger preoperative circumferential measurements, evident in both in the isolated examination of the affected arm, as well as when adjusted for the contralateral unaffected arm. Significant reduction in arm volume was achieved by both groups. However, VLNT demonstrated superior relative reduction rates than LVA, neutralizing any significant arm size disparities after 24 months. Surgery duration was slightly longer for VLNT than LVA. Postoperative complications, predominantly minor, were exclusively observed in the VLNT group. CONCLUSIONS: Both VLNT and LVA offer significant improvement for patients suffering from chronic BCRL. VLNT shows an even greater potential for improvement in more severe cases of BCRL, but involves a higher risk for (mostly minor) complications.


Subject(s)
Breast Cancer Lymphedema , Microsurgery , Quality of Life , Humans , Female , Middle Aged , Retrospective Studies , Breast Cancer Lymphedema/surgery , Microsurgery/methods , Aged , Adult , Anastomosis, Surgical , Lymph Nodes/pathology , Lymph Nodes/surgery , Treatment Outcome , Breast Neoplasms/surgery , Breast Neoplasms/complications , Postoperative Complications , Lymphedema/surgery , Lymphedema/etiology
9.
J Child Neurol ; 39(5-6): 161-170, 2024 May.
Article in English | MEDLINE | ID: mdl-38659405

ABSTRACT

GM2 gangliosidoses (GM2) are a group of rare lysosomal storage disorders in which accumulation of GM2 gangliosides results in progressive central nervous system damage. The infantile GM2 phenotype is characterized by delays in milestones by 6 months of age, followed by rapid loss of motor, cognitive, and visual function. Advancements in early diagnosis and pharmacotherapies provide promise for improved outcomes. However, the lack of feasible and clinically meaningful clinical outcome assessments for GM2 poses a challenge to characterizing GM2 natural history and selecting clinical trial endpoints. The purpose of this study was to develop a remotely administered infantile GM2 rating scale to measure health-related function in children with infantile GM2. A 2-phase mixed methods design was employed. In phase 1 of the study, 8 families of children with Infantile GM2 completed a natural history survey and a 1:1 semistructured interview to provide caregiver perspectives on the impacts of GM2 on health-related function. In phase 2 of the study, 8 expert clinicians provided feedback via surveys and participated in videoconference-hosted focus groups to refine scale administration and scoring procedures. These methods guided the development of 16 scale items to assess function in 5 health-related function domains: vision, hand and arm use, communication, gross motor, and feeding. This study used caregiver perspectives and expert clinician feedback to develop a remotely administered clinical outcome assessment of clinically meaningful health-related function in children with infantile GM2. Future studies will further evaluate the feasibility, reliability, and validity of the Infantile GM2 Clinical Rating Scale.


Subject(s)
Gangliosidoses, GM2 , Humans , Male , Female , Gangliosidoses, GM2/diagnosis , Infant , Child, Preschool , Severity of Illness Index
10.
Eur J Cardiothorac Surg ; 65(3)2024 Mar 01.
Article in English | MEDLINE | ID: mdl-38430465

ABSTRACT

OBJECTIVES: The aim of this study was to report on mid-term outcomes after endovascular aortic repair (EVAR) in patients with Marfan (MFS) or Loeys-Dietz (LDS) syndrome. METHODS: We analysed data from 2 European centres of patients with MFS and LDS undergoing EVAR. Patients were analysed based on (i) timing of the procedure (planned versus emergency procedure) and (ii) the nature of the landing zone (safe versus non-safe). The primary end-point was freedom from reintervention. Secondary end-points were freedom from stroke, bleeding and death. RESULTS: A population of 419 patients with MFS (n = 352) or LDS (n = 67) was analysed for the purpose of this study. Thirty-nine patients (9%) underwent EVAR. Indications for thoracic endovascular aortic repair or EVAR were aortic dissection in 13 (33%) patients, aortic aneurysm in 22 (57%) patients and others (intercostal patch aneurysm, penetrating atherosclerotic ulcer, pseudoaneurysm, kinking of frozen elephant trunk (FET)) in 4 (10%) patients. Thoracic endovascular repair was performed in 34 patients, and abdominal endovascular aortic repair was performed in 5 patients. Mean age at 1st thoracic endovascular aortic repair/EVAR was 48.5 ± 15.4 years. Mean follow-up after 1st thoracic endovascular aortic repair/EVAR was 5.9 ± 4.4 years. There was no statistically significant difference in the rate of reinterventions between patients with non-safe landing zone and the patients with safe proximal landing zone (P = 0.609). Furthermore, there was no increased probability for reintervention after planned endovascular intervention compared to emergency procedures (P = 0.916). Mean time to reintervention, either open surgical or endovascular, after planned endovascular intervention was in median 3.9 years (95% confidence interval 2.0-5.9 years) and 2.0 years (95% confidence interval -1.1 to 5.1 years) (P = 0.23) after emergency procedures. CONCLUSIONS: EVAR in patients with MFS and LDS and a safe landing zone is feasible and safe. Endovascular treatment is a viable option when employed by a multi-disciplinary aortic team even if the landing zone is in native tissue.


Subject(s)
Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Loeys-Dietz Syndrome , Marfan Syndrome , Humans , Adult , Middle Aged , Loeys-Dietz Syndrome/surgery , Loeys-Dietz Syndrome/complications , Endovascular Aneurysm Repair , Marfan Syndrome/complications , Marfan Syndrome/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Treatment Outcome , Retrospective Studies , Aortic Aneurysm, Thoracic/surgery , Postoperative Complications/epidemiology , Postoperative Complications/surgery
12.
Orphanet J Rare Dis ; 19(1): 79, 2024 Feb 20.
Article in English | MEDLINE | ID: mdl-38378692

ABSTRACT

BACKGROUND: TBL1XR1 encodes a F-box-like/WD40 repeat-containing protein that plays a role in transcription mediated by nuclear receptors and is a known genetic cause of neurodevelopmental disease of childhood (OMIM# 608628). Yet the developmental trajectory and progression of neurologic symptoms over time remains poorly understood. METHODS: We developed and distributed a survey to two closed Facebook groups devoted to families of patients with TBL1XR1-related disorder. The survey consisted of 14 subsections focused upon the developmental trajectories of cognitive, behavioral, motor, and other neurological abnormalities. Data were collected and managed using REDCap electronic data capture tools. RESULTS: Caregivers of 41 patients with a TBL1XR1-related disorder completed the cross-sectional survey. All reported variants affecting a single amino acid, including missense mutations and in-frame deletions, were found in the WD40 repeat regions of Tbl1xr1. These are domains considered important for protein-protein interactions that may plausibly underlie disease pathology. The majority of patients were diagnosed with a neurologic condition before they received their genetic diagnosis. Language appeared most significantly affected with only a minority of the cohort achieving more advanced milestones in this domain. CONCLUSION: TBL1XR1-related disorder encompasses a spectrum of clinical presentations, marked by early developmental delay ranging in severity, with a subset of patients experiencing developmental regression in later childhood.


Subject(s)
Neurodevelopmental Disorders , Humans , Cross-Sectional Studies , Mutation, Missense/genetics , Receptors, Cytoplasmic and Nuclear/genetics , Repressor Proteins/genetics
13.
Nature ; 626(7998): 341-346, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38297117

ABSTRACT

The Middle to Upper Palaeolithic transition in Europe is associated with the regional disappearance of Neanderthals and the spread of Homo sapiens. Late Neanderthals persisted in western Europe several millennia after the occurrence of H. sapiens in eastern Europe1. Local hybridization between the two groups occurred2, but not on all occasions3. Archaeological evidence also indicates the presence of several technocomplexes during this transition, complicating our understanding and the association of behavioural adaptations with specific hominin groups4. One such technocomplex for which the makers are unknown is the Lincombian-Ranisian-Jerzmanowician (LRJ), which has been described in northwestern and central Europe5-8. Here we present the morphological and proteomic taxonomic identification, mitochondrial DNA analysis and direct radiocarbon dating of human remains directly associated with an LRJ assemblage at the site Ilsenhöhle in Ranis (Germany). These human remains are among the earliest directly dated Upper Palaeolithic H. sapiens remains in Eurasia. We show that early H. sapiens associated with the LRJ were present in central and northwestern Europe long before the extinction of late Neanderthals in southwestern Europe. Our results strengthen the notion of a patchwork of distinct human populations and technocomplexes present in Europe during this transitional period.


Subject(s)
Human Migration , Animals , Humans , Body Remains/metabolism , DNA, Ancient/analysis , DNA, Mitochondrial/analysis , DNA, Mitochondrial/genetics , Europe , Extinction, Biological , Fossils , Germany , History, Ancient , Neanderthals/classification , Neanderthals/genetics , Neanderthals/metabolism , Proteomics , Radiometric Dating , Human Migration/history , Time Factors
14.
Eur J Cardiothorac Surg ; 65(1)2024 Jan 02.
Article in English | MEDLINE | ID: mdl-38244577

ABSTRACT

OBJECTIVES: There is an ongoing debate regarding whether patients benefit more from root replacement compared to a reconstruction of the sinuses of Valsalva in acute type A aortic dissection (aTAAD). In those with known or suspected connective tissue disorders, root replacement is considered appropriate. However, there are currently no diameter-based guidelines regarding the best approach in patients with minimally to moderately dilated root and no connective tissue disorders. METHODS: From January 2005 to December 2022, a two-centre registry of aTAAD was created. Patients were included based on their age (≤60 years), the absence of root entry and dilatation >50 mm and the absence of syndromic hereditable aortic disease. Patients were divided into 2 groups based on the proximal procedure, root reconstruction and root replacement. Propensity score pair matching was performed based on preoperative characteristics. RESULTS: Cumulative incidence of reintervention at 10 years was slightly higher after root reconstruction 13% vs 3.9% in the matched group (P = 0.040). Survival at 10 years was not affected by the procedure independently of the matching 72.1% vs 71.4% (P = 0.2). Uni- and multivariate Cox regressions showed that a root diameter of >40 mm was associated with a hazard ratio of 7.7 (95% confidence interval 2.6-23) and 5.4 (7-17), respectively, for reoperation for aneurysm and pseudoaneurysm. CONCLUSIONS: Rate of reoperation due to proximal pseudoaneurysm and aneurysm could be significantly reduced with a lower threshold of 40 mm to replace the aortic root in aTAAD than in elective cases.


Subject(s)
Aneurysm, False , Aortic Aneurysm, Thoracic , Aortic Diseases , Aortic Dissection , Blood Vessel Prosthesis Implantation , Humans , Middle Aged , Aneurysm, False/surgery , Treatment Outcome , Aortic Dissection/epidemiology , Aortic Dissection/surgery , Aorta/surgery , Aortic Diseases/surgery , Retrospective Studies , Aortic Aneurysm, Thoracic/epidemiology , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/etiology , Reoperation , Blood Vessel Prosthesis Implantation/methods
15.
Clin Microbiol Infect ; 30(3): 353-359, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38000535

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate antibiotic prescribing of medium-to-high prescribing primary care physicians being followed up after the completion of a Swiss national intervention trial of antibiotic prescription audit and feedback in the first SARS-CoV-2 pandemic year. METHODS: We used health insurer based claims data to calculate monthly antibiotic prescription rates per 100 consultations (primary endpoint) and applying interrupted time series (ITS) analysis methods, we estimated the immediate (step change) and sustained effects (slope) of the SARS-CoV-2 epidemic in 2020 on antibiotic prescribing compared to the pre-pandemic trial period from 2017-2019. RESULTS: We analysed data of 2945 of 3426 physicians (86.0%) from the trial with over 4 million consultations annually, who were in 2020 still in practice. Consultations dropped by 43% during the first pandemic year compared with 2017. Median monthly antibiotic prescription rates per 100 consultations in 2017 were 8.44 (Interquartile range [IQ] 6.32-11.50) and 8.35 (6.34-11.74) in the intervention and control groups, respectively, and increased to 15.63 (10.69-23.81) and 16.31 (10.65-24.72) per 100 consultations in 2020. ITS-derived incidence rate ratios for overall antibiotic prescriptions were 2.32 (95% CI 2.07-2.59) for the immediate pandemic effect, and 0.96 (0.95-0.98) for the sustained effect (change in slope in 2020 compared with 2017-2019). DISCUSSION: The SARS-CoV-2 pandemic had a major impact on antibiotic prescription patterns in primary care in Switzerland. For future viral pandemics, intervention plans with timely activation steps to minimize unjustified antibiotic consumption in primary care should be prepared.


Subject(s)
COVID-19 , Physicians, Primary Care , Humans , Pandemics , Switzerland/epidemiology , Anti-Bacterial Agents/therapeutic use , COVID-19/epidemiology , SARS-CoV-2 , Primary Health Care , Practice Patterns, Physicians'
16.
Ann Clin Transl Neurol ; 11(1): 207-224, 2024 01.
Article in English | MEDLINE | ID: mdl-38009419

ABSTRACT

OBJECTIVE: Late-onset GM2 gangliosidosis (LOGG) subtypes late-onset Tay-Sachs (LOTS) and Sandhoff disease (LOSD) are ultra-rare neurodegenerative lysosomal storage disorders presenting with weakness, ataxia, and neuropsychiatric symptoms. Previous studies considered LOTS and LOSD clinically indistinguishable; recent studies have challenged this. We performed a scoping review to ascertain whether imaging and clinical features may differentiate these diseases. METHODS: We examined MEDLINE/non-MEDLINE databases up to May 2022. Articles reporting brain imaging findings in genetically/enzymatically confirmed LOGG, symptom onset at age ≥ 10 years (or evaluated at least once ≥18 years) were included, yielding 170 LOGG patients (LOTS = 127, LOSD = 43) across 68 papers. We compared LOTS versus LOSD and performed regression analyses. Results were corrected for multiple comparisons. RESULTS: Age of onset was lower in LOTS versus LOSD (17.9 ± 8.2 vs. 23.9 ± 14.4 years, p = 0.017), although disease duration was similar (p = 0.34). LOTS more commonly had psychosis/bipolar symptoms (35.0% vs. 9.30%, p = 0.011) but less frequent swallowing problems (4.10% vs. 18.60%, p = 0.041). Cerebellar atrophy was more common in LOTS (89.0%) versus LOSD (60.5%), p < 0.0001, with more severe atrophy in LOTS (p = 0.0005). Brainstem atrophy was documented only in LOTS (14.2%). Independent predictors of LOTS versus LOSD (odds ratio [95% confidence interval]) included the presence of psychosis/bipolar symptoms (4.95 [1.59-19.52], p = 0.011), no swallowing symptoms (0.16 [0.036-0.64], p = 0.011), and cerebellar atrophy (5.81 [2.10-17.08], p = 0.0009). Lower age of onset (0.96 [0.93-1.00], p = 0.075) and tremor (2.50 [0.94-7.43], p = 0.078) were marginally statistically significant but felt relevant to include in the model. INTERPRETATION: These data suggest significant differences in symptomatology, disease course, and imaging findings between LOTS and LOSD.


Subject(s)
Gangliosidoses, GM2 , Neurodegenerative Diseases , Psychotic Disorders , Humans , Child , Disease Progression , Atrophy , Gangliosidoses, GM2/diagnostic imaging
17.
Pediatr Pulmonol ; 59(1): 169-180, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37905693

ABSTRACT

OBJECTIVE: Childhood cancer survivors are at risk for pulmonary morbidity due to exposure to lung-toxic treatments, including specific chemotherapeutics, radiotherapy, and surgery. Longitudinal data on lung function and its change over time are scarce. We investigated lung function trajectories in survivors over time and the association with lung-toxic treatments. METHODS: This retrospective, multicenter cohort study included Swiss survivors diagnosed between 1990 and 2013 and exposed to lung-toxic chemotherapeutics or thoracic radiotherapy. Pulmonary function tests (PFTs), including forced expiration volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity,  and diffusion capacity of the lung for carbon monoxide, were obtained from hospital charts. We calculated z-scores and percentage predicted, described lung function over time, and determined risk factors for change in FEV1 and FVC using multivariable linear regression. RESULTS: We included 790 PFTs from 183 survivors, with a median age of 12 years at diagnosis and 5.5 years of follow-up. Most common diagnosis was lymphoma (55%). Half (49%) of survivors had at least one abnormal pulmonary function parameter, mainly restrictive (22%). Trajectories of FEV1 and FVC started at z-scores of -1.5 at diagnosis and remained low throughout follow-up. Survivors treated with thoracic surgery started particularly low, with an FEV1 of -1.08 z-scores (-2.02 to -0.15) and an FVC of -1.42 z-scores (-2.27 to -0.57) compared to those without surgery. CONCLUSION: Reduced pulmonary function was frequent but mainly of mild to moderate severity. Nevertheless, more research and long-term surveillance of this vulnerable population is needed.


Subject(s)
Cancer Survivors , Neoplasms , Humans , Child , Cohort Studies , Retrospective Studies , Switzerland/epidemiology , Lung , Vital Capacity , Forced Expiratory Volume
18.
Dalton Trans ; 53(1): 74-81, 2023 Dec 19.
Article in English | MEDLINE | ID: mdl-38032271

ABSTRACT

The germanium-centred Lewis superacid Ge(pinF)2 (1) was isolated as acetonitrile mono-adduct 1·MeCN and thoroughly characterized by NMR spectroscopy, X-ray crystallography and quantum chemical calculations. Ion abstraction and NMR experiments revealed the hard as well as soft Lewis superacidic nature of 1·MeCN. The title compound readily activates hydrosilanes such as Et3SiH, which is not feasible for its harder silicon homologue 2·MeCN, and even reacts with Et3SiF. The strongly coordinating acetonitrile could be abstracted by B(C6F5), giving the donor-free Ge(pinF)2 (1) and Si(pinF)2 (2) which are Lewis superacids. Unlike 1·MeCN, the donor-free 1 efficiently catalyses hydrosilylation of α-methylstyrene by Et3SiH. For this process, an inverse temperature dependence was observed, i.e. a complete conversion was achieved rapidly when the reaction was cooled to -35 °C, but the reaction stopped at elevated temperatures. Mechanistic investigations, including stoichiometric experiments and quantum chemical calculations, outlined the formation of germylene Ge(pinF) (3), which acts as the active catalyst. The germylene is formed by reductive elimination of the silylated pinacol from the hydrogermane intermediate, which is obtained by the initial reaction of 1 with Et3SiH. The inverse temperature dependence of the catalytic reaction could be explained by low entropy associated with the complexation of two cooperating germylenes and the substrates. With this example we introduce an in situ generated Lewis acidic germylene complex for catalytic hydrosilylation of olefins and again exemplify the great potential of main-group-element-based complexes in catalysis.

19.
Front Robot AI ; 10: 1253049, 2023.
Article in English | MEDLINE | ID: mdl-38023585

ABSTRACT

The term "world model" (WM) has surfaced several times in robotics, for instance, in the context of mobile manipulation, navigation and mapping, and deep reinforcement learning. Despite its frequent use, the term does not appear to have a concise definition that is consistently used across domains and research fields. In this review article, we bootstrap a terminology for WMs, describe important design dimensions found in robotic WMs, and use them to analyze the literature on WMs in robotics, which spans four decades. Throughout, we motivate the need for WMs by using principles from software engineering, including "Design for use," "Do not repeat yourself," and "Low coupling, high cohesion." Concrete design guidelines are proposed for the future development and implementation of WMs. Finally, we highlight similarities and differences between the use of the term "world model" in robotic mobile manipulation and deep reinforcement learning.

20.
Sci Rep ; 13(1): 18345, 2023 10 26.
Article in English | MEDLINE | ID: mdl-37884544

ABSTRACT

High-throughput proteomic analysis of archaeological skeletal remains provides information about past fauna community compositions and species dispersals in time and space. Archaeological skeletal remains are a finite resource, however, and therefore it becomes relevant to optimize methods of skeletal proteome extraction. Ancient proteins in bone specimens can be highly degraded and consequently, extraction methods for well-preserved or modern bone might be unsuitable for the processing of highly degraded skeletal proteomes. In this study, we compared six proteomic extraction methods on Late Pleistocene remains with variable levels of proteome preservation. We tested the accuracy of species identification, protein sequence coverage, deamidation, and the number of post-translational modifications per method. We find striking differences in obtained proteome complexity and sequence coverage, highlighting that simple acid-insoluble proteome extraction methods perform better in highly degraded contexts. For well-preserved specimens, the approach using EDTA demineralization and protease-mix proteolysis yielded a higher number of identified peptides. The protocols presented here allowed protein extraction from ancient bone with a minimum number of working steps and equipment and yielded protein extracts within three working days. We expect further development along this route to benefit large-scale screening applications of relevance to archaeological and human evolution research.


Subject(s)
Proteome , Proteomics , Humans , Proteome/analysis , Proteomics/methods , Body Remains , Peptides , Amino Acid Sequence
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