The laminar organization of cell types in macaque cortex and its relationship to neuronal oscillations.

The canonical microcircuit (CMC) has been hypothesized to be the fundamental unit of information processing in cortex. Each CMC unit is thought to be an interconnected column of neurons with specific connections between excitatory and inhibitory neurons across layers. Recently, we identified a conserved spectrolaminar motif of oscillatory activity across the primate cortex that may be the physiological consequence of the CMC. The spectrolaminar motif consists of local field potential (LFP) gamma-band power (40-150 Hz) peaking in superficial layers 2 and 3 and alpha/beta-band power (8-30 Hz) peaking in deep layers 5 and 6. Here, we investigate whether specific conserved cell types may produce the spectrolaminar motif. We collected laminar histological and electrophysiological data in 11 distinct cortical areas spanning the visual hierarchy: V1, V2, V3, V4, TEO, MT, MST, LIP, 8A/FEF, PMD, and LPFC (area 46), and anatomical data in DP and 7A. We stained representative slices for the three main inhibitory subtypes, Parvalbumin (PV), Calbindin (CB), and Calretinin (CR) positive neurons, as well as pyramidal cells marked with Neurogranin (NRGN). We found a conserved laminar structure of PV, CB, CR, and pyramidal cells. We also found a consistent relationship between the laminar distribution of inhibitory subtypes with power in the local field potential. PV interneuron density positively correlated with gamma (40-150 Hz) power. CR and CB density negatively correlated with alpha (8-12 Hz) and beta (13-30 Hz) oscillations. The conserved, layer-specific pattern of inhibition and excitation across layers is therefore likely the anatomical substrate of the spectrolaminar motif. Significance Statement: Neuronal oscillations emerge as an interplay between excitatory and inhibitory neurons and underlie cognitive functions and conscious states. These oscillations have distinct expression patterns across cortical layers. Does cellular anatomy enable these oscillations to emerge in specific cortical layers? We present a comprehensive analysis of the laminar distribution of the three main inhibitory cell types in primate cortex (Parvalbumin, Calbindin, and Calretinin positive) and excitatory pyramidal cells. We found a canonical relationship between the laminar anatomy and electrophysiology in 11 distinct primate areas spanning from primary visual to prefrontal cortex. The laminar anatomy explained the expression patterns of neuronal oscillations in different frequencies. Our work provides insight into the cortex-wide cellular mechanisms that generate neuronal oscillations in primates.

Neural Spike Train Synchronisation Indices: Definitions, Interpretations and Applications.

A comparison of previously defined spike train syncrhonization indices is undertaken within a stochastic point process framework. The second order cumulant density (covariance density) is shown to be common to all the indices. Simulation studies were used to investigate the sampling variability of a single index based on the second order cumulant. The simulations used a paired motoneurone model and a paired regular spiking cortical neurone model. The sampling variability of spike trains generated under identical conditions from the paired motoneurone model varied from 50% { 160% of the estimated value. On theoretical grounds, and on the basis of simulated data a rate dependence is present in all synchronization indices. The application of coherence and pooled coherence estimates to the issue of synchronization indices is considered. This alternative frequency domain approach allows an arbitrary number of spike train pairs to be evaluated for statistically significant differences, and combined into a single population measure. The pooled coherence framework allows pooled time domain measures to be derived, application of this to the simulated data is illustrated. Data from the cortical neurone model is generated over a wide range of firing rates (1 - 250 spikes/sec). The pooled coherence framework correctly characterizes the sampling variability as not significant over this wide operating range. The broader applicability of this approach to multi electrode array data is briefly discussed.

Cutaneous hyperpigmentation and familial gastrointestinal stromal tumour associated with KIT mutation.

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours arising in the gastrointestinal tract. Early detection, before metastasis occurs, is important as complete surgical excision achieves cure. Approximately 85% of GISTs are associated with mutations in the KIT gene, and although the majority of GISTs are sporadic, familial GISTs have been identified. Several families with multiple GIST tumours have also been described with various cutaneous findings including hyperpigmentation, multiple lentigines, vitiligo and urticaria pigmentosa. We discuss a 6-year-old boy who presented with an unusual pattern of hyperpigmentation in association with a family history of GIST. A causative KIT mutation was identified in DNA from the pigmented skin and from the resected GIST, and the patient was referred to the Paediatric Gastroenterology department for GIST screening. The term 'GIST cutaneous hyperpigmentation disease' has been suggested previously for the association of familial GIST with cutaneous hyperpigmentation caused by a germline KIT mutation.

African-Caribbean Cancer Consortium Scientific and Training Conference 2017.

The sixth International African-Caribbean Cancer Consortium (AC3) Conference was held 6-9 October 2017 in Miami, Florida, U.S.A. The conference was open to all researchers, trainees, clinical and public health professionals, and community members, and served as an international hub for the United States, the Caribbean, and Africa. Sessions included AC3 collaboration meetings, cancer surveillance and research skills training workshops, and a community cancer prevention conference.

Cortical specialisation to social stimuli from the first days to the second year of life: A rural Gambian cohort.

Brain and nervous system development in human infants during the first 1000days (conception to two years of age) is critical, and compromised development during this time (such as from under nutrition or poverty) can have life-long effects on physical growth and cognitive function. Cortical mapping of cognitive function during infancy is poorly understood in resource-poor settings due to the lack of transportable and low-cost neuroimaging methods. Having established a signature cortical response to social versus non-social visual and auditory stimuli in infants from 4 to 6 months of age in the UK, here we apply this functional Near Infrared Spectroscopy (fNIRS) paradigm to investigate social responses in infants from the first postnatal days to the second year of life in two contrasting environments: rural Gambian and urban UK. Results reveal robust, localized, socially selective brain responses from 9 to 24 months of life to both the visual and auditory stimuli. In contrast at 0-2 months of age infants exhibit non-social auditory selectivity, an effect that persists until 4-8 months when we observe a transition to greater social stimulus selectivity. These findings reveal a robust developmental curve of cortical specialisation over the first two years of life.

Vein imaging laser reduces bruising in bruise-prone botulinum toxin injected patients.

BACKGROUND: Injection-related bruising is a common complication of many injectable treatments including facial injections of botulinum toxin (BTX) for aesthetic use. OBJECTIVE: We have investigated the use of a vein imaging laser (VIL) to observe otherwise non-visible subcutaneous blood vessels in 40 patients who had a history of bruising with past BTX injections to the face during the previous 12 months. METHODS: Over a 4-month period 40 patients, who previously had developed bruising after injectable BTX to the face, were treated with further BTX to the same areas as previously, but using a VIL during the injections. Patients were evaluated for their severity of bruising. RESULTS: 40 patients out of 2400 patients had experienced bruising with a severity score total of 92 (mean per patient 2.3) with BTX injections before VIL use. On injection using the VIL 6 of the 40 patients had bruising with severity score total of 7 (mean 1.16). CONCLUSION: The use of a VIL significantly reduced the frequency and severity of bruising associated with BTX injections.

Using fNIRS to Study Working Memory of Infants in Rural Africa.

A pilot study was conducted to assess the feasibility of using fNIRS as an alternative to behavioral assessments of cognitive development with infants in rural Africa. We report preliminary results of a study looking at working memory in 12-16-month-olds and discuss the benefits and shortcomings for the potential future use of fNIRS to investigate the effects of nutritional insults and interventions in global health studies.

Prevalence of founder mutations in the BRCA1 and BRCA2 genes among unaffected women from the Bahamas.

Population-based testing for BRCA1/2 mutations detects a high proportion of carriers not identified by cancer family history-based testing. We sought to determine whether population-based testing is an effective approach to genetic testing in the Bahamas, where 23% of women with breast cancer carry one of seven founder mutations in the BRCA1 or BRCA2 gene. We determined the prevalence of founder BRCA mutations in 1847 Bahamian women without a personal history of breast or ovarian cancer, unselected for age or family history. We found that 2.8% (20/705) of unaffected women with a family history of breast/ovarian cancer and 0.09% (1/1089) of unaffected women without a family history carry a BRCA mutation. A total of 38% of unaffected women with a known mutation in the family were found to carry the familial mutation. We previously suggested that all Bahamian women with breast or ovarian cancer be offered genetic testing. These current data suggest that additionally all unaffected Bahamian women with a family history of breast/ovarian cancer should be offered genetic testing for the founder BRCA mutations.

Medial prefrontal cortex circuit function during retrieval and extinction of associative learning under anesthesia.

Associative learning is encoded under anesthesia and involves the medial prefrontal cortex (mPFC). Neuronal activity in mPFC increases in response to a conditioned stimulus (CS+) previously paired with an unconditioned stimulus (US) but not during presentation of an unpaired stimulus (CS-) in anesthetized animals. Studies in conscious animals have shown dissociable roles for different mPFC subregions in mediating various memory processes, with the prelimbic (PL) and infralimbic (IL) cortex involved in the retrieval and extinction of conditioned responding, respectively. Therefore PL and IL may also play different roles in mediating the retrieval and extinction of discrimination learning under anesthesia. Here we used in vivo electrophysiology to examine unit and local field potential (LFP) activity in PL and IL before and after auditory discrimination learning and during later retrieval and extinction testing in anesthetized rats. Animals received repeated presentations of two distinct sounds, one of which was paired with footshock (US). In separate control experiments animals received footshocks without sounds. After discrimination learning the paired (CS+) and unpaired (CS-) sounds were repeatedly presented alone. We found increased unit firing and LFP power in PL and, to a lesser extent, IL after discrimination learning but not after footshocks alone. After discrimination learning, unit firing and LFP power increased in PL and IL in response to presentation of the first CS+, compared to the first CS-. However, PL and IL activity increased during the last CS- presentation, such that activity during presentation of the last CS+ and CS- did not differ. These results confirm previous findings and extend them by showing that increased PL and IL activity result from encoding of the CS+/US association rather than US presentation. They also suggest that extinction may occur under anesthesia and might be represented at the neural level in PL and IL.

Knowledge and attitudes toward HPV and the HPV vaccines in the Bahamas / Conocimientos y actitudes hacia el VPH y las vacunas contra VPH en las Bahamas

OBJECTIVE: High-risk types of human papillomavirus (HPV) are a necessary, albeit not sufficient, cause for cervical cancer development. In The Bahamas, cervical cancer is one of the leading causes of cancer despite screening and educational efforts. As a vaccine programme is being considered, awareness of HPV-related conditions and its vaccine need to be measured. METHODS: This study design was cross-sectional and carried out at three clinical sites and one community in Nassau, Bahamas. All participants were over the age of 18 years and were invited to answer a (self-administered) questionnaire regarding knowledge and attitudes toward HPV and its vaccines. RESULTS: Of399 participants, 75% were female and 23% male. About 41% had a high school education and 55.4% had some tertiary college education. Forty-six per cent had heard of HPV and 35% heard of the vaccine. The mean number of correct answers about HPV was 2.93 ± 3.17 of 10 questions, while for the vaccine, it was 1.37 ± 1.58 of five questions. Multivariable logistic regression indicated that some college education was associated with more HPV and HPV vaccine knowledge. Seventy-three per cent needed reassurance of the vaccine's safety and efficacy. Sixty-five per cent would vaccinate their daughters and 68% would vaccinate their sons if the vaccine was safe and effective. CONCLUSION: More public education is needed to increase awareness of cervical cancer and HPV-related diseases. Reassurance with respect to vaccine safety and efficacy also needs to be addressed. Since the majority would vaccinate their children, there is the potential for a national vaccination programme to succeed.

OBJETIVO: Los tipos de alto riesgo del virus del papiloma humano (VPH) son una medida necesaria, aunque no constituyen causa suficiente para el desarrollo de cáncer cervical. En las Bahamas, el cáncer de cuello uterino es una de las principales causas de cáncer a pesar de los esfuerzos realizados en términos de pesquizaje y educación. En un momento en que se está considerando la posibilidad de un programa de vacunación, es necesario evaluar el nivel de conciencia con respecto a las condiciones relacionadas con el VPH y su vacuna. MÉTODOS: Se trata de un estudio con un diseño transversal, llevado a cabo en tres clínicas y en una comunidad, en Nassau, Bahamas. Todos los participantes eran mayores de 18 años y fueron invitados a responder un cuestionario autoadministrado sobre conocimientos y actitudes hacia el VPH y sus vacunas. RESULTADOS: De 399 participantes, el 75% eran hembras y el 23% eran varones. Aproximadamente el 41% tenía educación secundaria y el 55,4% tenía algún nivel de educación terciaria. El cuarenta y seis por ciento había oído del VPH, y el 35% había oído hablar de la vacuna. El número promedio de respuestas correctas sobre el VPH fue 2.93 ± 3.17 de 10 preguntas, mientras que para la vacuna, fue 1.37 ± 1.58 de cinco preguntas. La regresión logística multivariable indicó cierta asociación de la educación universitaria con más conocimientos sobre el VPHy la vacuna del VPH. Setenta y tres por ciento necesitaban garantías de seguridad y eficacia en relación con la vacuna. El sesenta y cinco por ciento vacunaría a sus hijas, y el 68% vacunaría a sus hijos varones, si la vacuna fuese segura y efectiva. CONCLUSIÓN: Se requiere más educación pública para aumentar la conciencia sobre el cáncer de cuello uterino y las enfermedades relacionadas con el VPH. Asimismo hay que abordar el problema de las garantías respecto a la eficacia y seguridad de la vacuna. Puesto que la mayoría vacunaría a sus hijos e hijas, existe la posibilidad de que un programa nacional de vacunación tenga éxito.

Microstructure and point defects in CdTe nanowires for photovoltaic applications.

Defects in Au-catalysed CdTe nanowires vapour-liquid-solid-grown on polycrystalline underlayers have been critically evaluated. Their low-temperature photoluminescence spectra were dominated by excitonic emission with rarely observed above-gap emission also being recorded. While acceptor bound exciton lines due to monovalent metallic impurities (Ag, Cu or Na) were seen, only deeper, donor-acceptor-pair emission could be attributed to the Au contamination that is expected from the catalyst. Annealing under nitrogen acted to enhance the single crystal-like PL emission, whilst oxidizing and reducing anneals of the type that is used in solar cell device processing caused it to degrade. The incidence of stacking faults, polytypes and twins was related only to the growth axes of the wires (<111> 50%, <112> 30% and <110> 20%), and was not influenced by annealing. The potential electrical activity of the point and extended defects, and the suitability of these nanowire materials (including processing steps) for solar cell applications, is discussed. Overall they have a quality that is superior to that of thin polycrystalline films, although questions remain about recombination due to Au.

Basolateral amygdala activity during the retrieval of associative learning under anesthesia.

Associative learning can occur under anesthesia and its neural correlates have begun to be elucidated. During discrimination learning under anesthesia in rats, lateral amygdala excitability increases in response to a conditioned stimulus (CS+) previously paired with electrical stimulation of the paw but not to another stimulus presented alone (CS-). Similarly, medial prefrontal cortex activity increases selectively during CS+ presentation after discrimination learning but this occurs only in neurons receiving input from the basolateral amygdala (BLA), the main source of amygdaloid projections to this region. However, BLA activity during discrimination learning under anesthesia has not been investigated. Here we used in vivo electrophysiology to examine BLA activity before and after associative learning and during later memory retrieval in anesthetized rats. We examined extracellular unit and local field potential (LFP) activity using an auditory discrimination learning paradigm. Rats were repeatedly presented with two distinct sounds, one of which was paired with electrical stimulation of the paw. One hour later, the paired sound (CS+) was presented alone along with the sound not paired with electrical stimulation (CS-). We found increased unit firing late (1 h) but not early (5 min) after learning. LFP power was increased both early and late after learning. In control experiments we also found increased unit and LFP activity late after electrical stimulation alone. After discrimination learning, unit firing increased in response to CS+, but not CS-, presentation. LFP power also showed a modest increase during CS+, compared to CS-, presentation. These findings suggest that discrimination learning under anesthesia can occur at the neural level in BLA. The potential relevance of these results is discussed in relation to previous studies examining neural activity during fear learning and memory processing in conscious animals.

Knowledge and Attitudes toward HPV and the HPV Vaccines in The Bahamas.

OBJECTIVE: High-risk types of human papillomavirus (HPV) are a necessary, albeit not sufficient, cause for cervical cancer development. In The Bahamas, cervical cancer is one of the leading causes of cancer despite screening and educational efforts. As a vaccine programme is being considered, awareness of HPV-related conditions and its vaccine needs to be measured. METHODS: This study design was cross-sectional and carried out at three clinical sites and one community in Nassau, Bahamas. All participants were over the age of 18 years and were invited to answer a (self-administered) questionnaire regarding knowledge and attitudes toward HPV and its vaccines. RESULTS: Of 399 participants, 75% were female and 23% male. About 41% had a high school education and 55.4% had some tertiary college education. Forty-six per cent had heard of HPV and 35% heard of the vaccine. The mean number of correct answers about HPV was 2.93 ± 3.17 of 10 questions, while for the vaccine, it was 1.37 ± 1.58 of five questions. Multivariable logistic regression indicated that some college education was associated with more HPV and HPV vaccine knowledge. Seventy-three per cent needed reassurance of the vaccine's safety and efficacy. Sixty-five per cent would vaccinate their daughters and 68% would vaccinate their sons if the vaccine was safe and effective. CONCLUSION: More public education is needed to increase awareness of cervical cancer and HPV-related diseases. Reassurance with respect to vaccine safety and efficacy also needs to be addressed. Since the majority would vaccinate their children, there is the potential for a national vaccination programme to succeed.

Genetic testing and screening of individuals at risk of NF2.

Genetic testing and management of the at-risk individual for neurofibromatosis type 2 (NF2) is complicated by the well-documented risk of mosaicism that causes a milder later onset more asymmetrical disease course. Risks of NF2 were derived from genetic testing of over 1000 individuals through the Manchester NF2-testing service. Individuals are at risk of NF2 or have 'potential' NF2 if they have features of the disease that fall short of diagnostic criteria or are the first-degree relative of someone with NF2 or suspected NF2. The present protocol devised for the Nationally Commissioned Group (NCG) NF2 service in England addresses the risks, genetic testing and screening protocol for individuals at risk of NF2. Screening with cranial magnetic resonance imaging is advised until the risk of NF2 falls below a pragmatic threshold of 1%. Multiple case scenarios are shown to illustrate how to use the protocol.

The current and future role of the dietetic support worker.

BACKGROUND: The role of the dietetic support worker (DSW) was developed to provide cost-effective support to dietetic services in the National Health Service (NHS). However, there is little evidence about how the role is perceived or the impact of the introduction of Agenda for Change in 2004 (a guide to pay terms and conditions for NHS staff) on role definition. The present study aimed to gather evidence from DSWs and dietitians on the current role of the DSW to help inform the future development of the role. METHODS: A questionnaire survey was conducted on DSWs and dietitians in 10 trusts in the East of England. Issues included qualifications, experience, training, satisfaction with Agenda for Change, supervision and responsibility. Themes were further explored by semi-structured telephone interviews conducted on a subsample. RESULTS: Eighteen out of 24 DSWs and 62 out of 98 dietitians responded to the questionnaire. The role of the DSW is highly valued by dietitians. Over three-quarters of DSWs and over 90% of dietitians agree that the employment of DSWs improved the working lives of dietitians. Only 50% of DSWs were happy with their Agenda for Change banding, although this did not adversely affect their job satisfaction. Both groups saw the role of the DSW becoming more specialised, despite concerns about access to appropriate training and the lack of a structured career pathway. CONCLUSIONS: This study identified issues relating to the future development of the role of the DSW from the viewpoint of DSWs and dietetic assistants.

A periodogram-based test for weak stationarity and consistency between sections in time series.

In one approach to spectral estimation, a sample record is broken into a number of disjoint sections, or data is collected over a number of discrete trials. Spectral parameters are formed by averaging periodograms across these discrete sections or trials. A key assumption in this approach is that of weak stationarity. This paper describes a simple test that checks if periodogram ordinates are consistent across sections as a means of assessing weak stationarity. The test is called the Periodogram Coefficient of Variation (PCOV) test, and is a frequency domain test based on a technique of spectral analysis. Application of the test is illustrated to both simulated and experimental data (EMG, physiological tremor, EEG). An additional role for the test as a useful tool in exploratory analysis of time series is highlighted.

Reduction of common motoneuronal drive on the affected side during walking in hemiplegic stroke patients.

OBJECTIVE: The objective of this study was to use motor unit coupling in the time and frequency domains to obtain evidence of changes in motoneuronal drive during walking in subjects with stroke. METHODS: Paired tibialis anterior (TA) EMG activity was sampled during the swing phase of treadmill walking in eight subjects with unilateral stroke. RESULTS: On the unaffected side, short-term synchronization was evident from the presence of a narrow central peak in cumulant densities and from the presence of significant coherence between these signals in the 10-25 Hz band. Such indicators of short-term synchrony were either absent or very small on the affected side. Instead, pronounced 10 Hz coupling was observed. CONCLUSIONS: It is suggested that reduced corticospinal drive to the spinal motoneurones is responsible for the reduced short-term synchrony and coherence in the 10-25 Hz frequency band on the affected side in hemiplegic patients during walking. SIGNIFICANCE: This is of importance for understanding the mechanisms responsible for reduced gait ability and development of new strategies for gait restoration.

Early life programming of hemispheric lateralization and synchronization in the adult medial prefrontal cortex.

Neonatal maternal separation (MS) in the rat increases the vulnerability to stressors later in life. In contrast, brief handling (H) in early life confers resilience to stressors in adulthood. Early life programming of stress reactivity may involve the medial prefrontal cortex (mPFC), a region which modulates various stress responses. Moreover, hemispheric specialization in mPFC may mediate adaptive coping responses to stress. In the present study, neuronal activity was examined simultaneously in left and right mPFC in adult rats previously subjected to MS, H or animal facility rearing (AFR). In vivo electrophysiology, under isoflurane anesthesia, was used to conduct acute recordings of unit and local field potential (LFP) activity in response to systemic administration of N-methyl-beta-carboline-3-carboxamide (FG-7142), a benzodiazepine receptor partial inverse agonist which mimics various stress responses. MS decreased basal unit activity selectively in right mPFC. Basal LFP activity was reduced with MS in left and right mPFC, compared to AFR and H, respectively. Hemispheric synchronization of basal LFP activity was also attenuated by MS at lower frequencies. FG-7142 elicited lateralized effects on mPFC activity with different early rearing conditions. Activity in left mPFC was greater with AFR and MS (AFR>MS), whereas activity was predominantly greater with H in right mPFC. Finally, compared to AFR, MS reduced and H enhanced hemispheric synchronization of LFP activity with FG-7142 treatment in a dose-dependent manner. These results indicate that functionally-relevant alterations in mPFC GABA transmission are programmed by the early rearing environment in a hemisphere-dependent manner. These findings may model the hemispheric specialization of mPFC function thought to mediate adaptive coping responses to stressors. They also suggest the possibility that early environmental programming of hemispheric functional coupling in mPFC is involved in conferring vulnerability or resilience to stressors later in life.

Contribution of molecular analyses in diagnosing Marfan syndrome and type I fibrillinopathies: an international study of 1009 probands.

BACKGROUND: The diagnosis of Marfan syndrome (MFS) is usually initially based on clinical criteria according to the number of major and minor systems affected following international nosology. The number of FBN1 mutation carriers, at risk of aortic complications who would not be properly diagnosed based only on clinical grounds, is of growing importance owing to the increased availability of molecular screening. The aim of the study was to identify patients who should be considered for FBN1 mutation screening. METHODS: Our international series included 1009 probands with a known FBN1 mutation. Patients were classified as either fulfilling or not fulfilling "clinical" criteria. In patients with unfulfilled "clinical" criteria, we evaluated the percentage of additional patients who became positive for international criteria when the FBN1 mutation was considered. The aortic risk was evaluated and compared in patients fulfilling or not fulfilling the "clinical" international criteria. RESULTS: Diagnosis of MFS was possible on clinical grounds in 79% of the adults, whereas 90% fulfilled the international criteria when including the FBN1 mutation. Corresponding figures for children were 56% and 85%, respectively. Aortic dilatation occurred later in adults with unfulfilled "clinical criteria" when compared to the Marfan syndrome group (44% vs 73% at 40 years, p<0.001), but the lifelong risk for ascending aortic dissection or surgery was not significantly different in both groups. CONCLUSIONS: Because of its implications for aortic follow-up, FBN1 molecular analysis is recommended in newly suspected MFS when two systems are involved with at least one major system affected. This is of utmost importance in patients without aortic dilatation and in children.

Effect of mutation type and location on clinical outcome in 1,013 probands with Marfan syndrome or related phenotypes and FBN1 mutations: an international study.

Mutations in the fibrillin-1 (FBN1) gene cause Marfan syndrome (MFS) and have been associated with a wide range of overlapping phenotypes. Clinical care is complicated by variable age at onset and the wide range of severity of aortic features. The factors that modulate phenotypical severity, both among and within families, remain to be determined. The availability of international FBN1 mutation Universal Mutation Database (UMD-FBN1) has allowed us to perform the largest collaborative study ever reported, to investigate the correlation between the FBN1 genotype and the nature and severity of the clinical phenotype. A range of qualitative and quantitative clinical parameters (skeletal, cardiovascular, ophthalmologic, skin, pulmonary, and dural) was compared for different classes of mutation (types and locations) in 1,013 probands with a pathogenic FBN1 mutation. A higher probability of ectopia lentis was found for patients with a missense mutation substituting or producing a cysteine, when compared with other missense mutations. Patients with an FBN1 premature termination codon had a more severe skeletal and skin phenotype than did patients with an inframe mutation. Mutations in exons 24-32 were associated with a more severe and complete phenotype, including younger age at diagnosis of type I fibrillinopathy and higher probability of developing ectopia lentis, ascending aortic dilatation, aortic surgery, mitral valve abnormalities, scoliosis, and shorter survival; the majority of these results were replicated even when cases of neonatal MFS were excluded. These correlations, found between different mutation types and clinical manifestations, might be explained by different underlying genetic mechanisms (dominant negative versus haploinsufficiency) and by consideration of the two main physiological functions of fibrillin-1 (structural versus mediator of TGF beta signalling). Exon 24-32 mutations define a high-risk group for cardiac manifestations associated with severe prognosis at all ages.