Ocorrência rara de amiloidose por transtirretina na segunda década de vida / Rare occurrence of transthyretin amyloidosis in the second decade of life

INTRODUÇÃO: Sendo p.V50M e p.V142I as variantes mais comuns associadas à amiloidose por transtirretina hereditária (ATTRh), pode haver uma errônea correlação de que a doença se manifeste apenas em idosos já que a apresentação clínica em seus portadores geralmente se inicia tardiamente, em meia idade e acima de 60 anos, respectivamente. Entretanto, existem outras variantes que podem determinar quadro clínico mais grave e precoce. Descrevemos uma série de casos com início em idade inferior a 25 anos associados à identificação de variante rara no gene TTR. MÉTODOS: Estudo observacional de série de casos RESULTADOS: Três pacientes (p) masculinos, aparentados, portadores de ATTRh confirmada por teste molecular positivo para a variante patogênica p.F64S, com idade média de apresentação clínica de 19±3 anos. Características basais dos p expressas na tabela 1. Todos os p apresentavam fenótipo misto, sendo portadores de polineuropatia grave, disautonomia (expressa por disfunção erétil, hipotensão e alterações digestivas) e cardiopatia em graus variáveis, mais evidente no p com instalação da doença há mais tempo. Espessura média do septo de 15,6±4 mm e de 13±3 mm, da parede posterior. Um p apresentou derrame pericárdico volumoso recorrente. Nenhum óbito ocorreu durante o seguimento. Todos os p receberam tratamento específico para amiloidose: o caso índice foi submetido a transplante hepático, outro está recebendo um silenciador gênico (eplontersen em protocolo clínico) e, o último, em uso de tafamidis 20mg. DISCUSSÃO E CONCLUSÃO: descrevemos 3 p aparentados, que apresentaram os primeiros sintomas de ATTRh aos 20 anos de idade com fenótipo misto (polineuropatia e cardiopatia), determinada pela variante p.F64S. Esta variante é muito rara e encontramos 7 casos descritos na Literatura, todos muito jovens que apresentaram fenótipo predominante de polineuropatia, mas a maioria com cardiopatia associada. A variante p.V50M também pode ocorrer em jovens na forma precoce da doença, porém isto ocorre em torno da terceira década de vida. Conclui-se que a amiloidose não deve ser encarada como uma doença exclusiva da população idosa. A forma hereditária pode ocorrer em p mais jovens e a idade de início do quadro dependerá da variante encontrada. Deve-se, portanto, considerar amiloidose como diagnóstico diferencial das hipertrofias ventriculares em jovens.

The analysis of serum lipids profile in Guillain-Barre syndrome.

Background: Guillain-Barre syndrome (GBS) is an immune-mediated inflammatory peripheral neuropathy. This study aimed to conduct a systematic analysis of the serum lipids profile in GBS. Methods: We measured the serum lipids profile in 85 GBS patients and compared it with that of 85 healthy controls matched for age and sex. Additionally, we analyzed the correlation between lipids and the severity, subtypes, precursor infections, clinical outcomes, clinical symptoms, immunotherapy, and other laboratory markers of GBS. Results: Compared to the healthy controls, GBS exhibited significantly elevated levels of Apolipoprotein B (APOB), Apolipoprotein C2 (APOC2), Apolipoprotein C3 (APOC3), Apolipoprotein E (APOE), triglycerides (TG), and residual cholesterol (RC). Conversely, Apolipoprotein A1 (APOA1), Apolipoprotein A2 (APOA2), and high-density lipoprotein (HDL) were substantially lower in GBS. Severe GBS displayed noticeably higher levels of APOC3 and total cholesterol (TC) compared to those with mild disease. Regarding different clinical outcomes, readmitted GBS demonstrated higher RC expression than those who were not readmitted. Moreover, GBS who tested positive for neuro-virus antibody IGG in cerebrospinal fluid (CSF) exhibited heightened expression of APOC3 in comparison to those who tested negative. GBS with cranial nerve damage showed significantly reduced expression of HDL and APOA1 than those without such damage. Additionally, GBS experiencing limb pain demonstrated markedly decreased HDL expression. Patients showed a significant reduction in TC after intravenous immunoglobulin therapy. We observed a significant positive correlation between lipids and inflammatory markers, including TNF-α, IL-1ß, erythrocyte sedimentation rate (ESR), white blood cells, monocytes, and neutrophils in GBS. Notably, APOA1 exhibited a negative correlation with ESR. Furthermore, our findings suggest a potential association between lipids and the immune status of GBS. Conclusion: The research demonstrated a strong connection between lipids and the severity, subtypes, clinical outcomes, precursor infections, clinical symptoms, immunotherapy, inflammation, and immune status of GBS. This implies that a low-fat diet or the use of lipid-lowering medications may potentially serve as an approach for managing GBS, offering a fresh viewpoint for clinical treatment of this condition.

Inverse Problem Algorithm-Based Time-Resolved Imaging of Head and Neck Computed Tomography Angiography Contrast Kinetics with Clinical Testification.

This study mitigated the challenge of head and neck CT angiography by IPA-based time-resolved imaging of contrast kinetics. To this end, 627 cerebral hemorrhage patients with dizziness, brain aneurysm, stroke, or hemorrhagic stroke diagnosis were randomly categorized into three groups, namely, the original dataset (450), verification group (112), and in vivo testified group (65), in the Affiliated BenQ Hospital of Nanjing Medical University. In the first stage, seven risk factors were assigned: age, CTA tube voltage, body surface area, heart rate per minute, cardiac output blood per minute, the actual injected amount of contrast media, and CTA delayed trigger timing. The expectation value of the semi-empirical formula was the CTA number of the patient's left artery (LA). Accordingly, 29 items of the first-order nonlinear equation were calculated via the inverse problem analysis (IPA) technique run in the STATISTICA 7.0 program, yielding a loss function and variance of 3.1837 and 0.8892, respectively. A dimensionless AT was proposed to imply the coincidence, with a lower AT indicating a smaller deviation between theoretical and practical values. The derived formula was confirmed for the verification group of 112 patients, reaching high coincidence, with average ATavg and standard deviation values of 3.57% and 3.06%, respectively. In the second stage, the formula was refined to find the optimal amount of contrast media for the CTA number of LA approaching 400. Finally, the above procedure was applied to head and neck CTA images of the third group of 65 patients, reaching an average CTA number of LA of 407.8 ± 16.2 and finding no significant fluctuations.

The hospital Israelita Albert Einstein standards for constitutional sequence variants classification: version 2023.

BACKGROUND: Next-generation sequencing has had a significant impact on genetic disease diagnosis, but the interpretation of the vast amount of genomic data it generates can be challenging. To address this, the American College of Medical Genetics and Genomics and the Association for Molecular Pathology have established guidelines for standardized variant interpretation. In this manuscript, we present the updated Hospital Israelita Albert Einstein Standards for Constitutional Sequence Variants Classification, incorporating modifications from leading genetics societies and the ClinGen initiative. RESULTS: First, we standardized the scientific publications, documents, and other reliable sources for this document to ensure an evidence-based approach. Next, we defined the databases that would provide variant information for the classification process, established the terminology for molecular findings, set standards for disease-gene associations, and determined the nomenclature for classification criteria. Subsequently, we defined the general rules for variant classification and the Bayesian statistical reasoning principles to enhance this process. We also defined bioinformatics standards for automated classification. Our workgroup adhered to gene-specific rules and workflows curated by the ClinGen Variant Curation Expert Panels whenever available. Additionally, a distinct set of specifications for criteria modulation was created for cancer genes, recognizing their unique characteristics. CONCLUSIONS: The development of an internal consensus and standards for constitutional sequence variant classification, specifically adapted to the Brazilian population, further contributes to the continuous refinement of variant classification practices. The aim of these efforts from the workgroup is to enhance the reliability and uniformity of variant classification.

A retrospective study of myelin oligodendrocyte glycoprotein antibody-associated disease from a clinical laboratory perspective.

Objectives: To analyze the differences in laboratory data between patients with myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD), multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Methods: The study included 26 MOGAD patients who visited Beijing Tiantan Hospital from 2018 to 2021. MS and NMOSD patients who visited the clinic during the same period were selected as controls. Relevant indicators were compared between the MOGAD group and the MS/NMOSD groups, and the diagnostic performance of meaningful markers was assessed. Results: The MOGAD group showed a slight female preponderance of 57.7%, with an average onset age of 29.8 years. The absolute and relative counts of neutrophils were higher in the MOGAD group than in the MS group, while the proportion of lymphocytes was lower. The cerebrospinal fluid (CSF) IgG level, IgG index, 24-h IgG synthesis rate, and positive rate of oligoclonal bands (OCB) were lower in MOGAD patients than in the MS group. The area under ROC curve (AUC) was 0.939 when combining the relative lymphocyte count and IgG index. Compared to the NMOSD group, the MOGAD group had higher levels of serum complement C4 and lower levels of serum IgG. The AUC of serum C4 combined with FT4 was 0.783. Conclusion: Statistically significant markers were observed in the laboratory data of MOGAD patients compared to MS/NMOSD patients. The relative lymphocyte count combined with IgG index had excellent diagnostic efficacy for MOGAD and MS, while serum C4 combined with FT4 had better diagnostic efficacy for MOGAD and NMOSD.

Cell-specific genome-scale metabolic modeling of SARS-CoV-2-infected lung to identify antiviral enzymes.

Computational systems biology plays a key role in the discovery of suitable antiviral targets. We designed a cell-specific, constraint-based modeling technique for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected lungs. We used the gene sequence of the alpha variant of SARS-CoV-2 to build a viral biomass reaction (VBR). We also used the mass proportion of lipids between the viral biomass and its host cell to estimate the stoichiometric coefficients of viral lipids in the reaction. We then integrated the VBR, the gene expression of the alpha variant of SARS-CoV-2, and the generic human metabolic network Recon3D to reconstruct a cell-specific genome-scale metabolic model. An antiviral target discovery (AVTD) platform was introduced using this model to identify therapeutic drug targets for combating COVID-19. The AVTD platform not only identified antiviral genes for eliminating viral replication but also predicted side effects of treatments. Our computational results revealed that knocking out dihydroorotate dehydrogenase (DHODH) might reduce the synthesis rate of cytidine-5'-triphosphate and uridine-5'-triphosphate, which terminate the viral building blocks of DNA and RNA for SARS-CoV-2 replication. Our results also indicated that DHODH is a promising antiviral target that causes minor side effects, which is consistent with the results of recent reports. Moreover, we discovered that the genes that participate in the de novo biosynthesis of glycerophospholipids and ceramides become unidentifiable if the VBR does not involve the stoichiometry of lipids.

Identification of Anisotropic Coefficients in the Non-Principal Axis Directions of Tubular Materials Using Hole Bulging Test.

We propose an experimental method to identify anisotropic coefficients in non-principal axis directions of thin-walled tubes. The method involves extracting specimens from the parent tubes and machining a hole in the axial center. The specimens are then inserted into a tube without a hole. The inner diameter of the specimen is theoretically equal to the outer diameter of the inner tube. The double-layer tube undergoes free bulging under internal pressure in our self-developed experimental equipment, with the hole on the specimen expanding simultaneously. The stress states around the hole are uniaxial, and the hole deformation can reflect the anisotropic plastic flow characteristics of the tube. Furthermore, based on the information obtained from the proposed experimental method, a hybrid numerical-experimental method was used to identify the anisotropic coefficients of tubes. Through FE simulations, the relationships between the thickness, stress, and strain states around the hole, the hole shape, and anisotropic coefficients of non-principal axis directions are revealed, and the factors that affect the hole deformation are analyzed. Finally, the hole bulging experiments and FE simulations of AA6061-O extruded tube were conducted, and modeled with Hill48 and calibrated by uniaxial tensile and hoop tensile tests. Its in-plane anisotropy coefficients in any direction are given for the first time which first increase and then decrease from 0° to 90°, reaching a maximum of 1.13 in 60° and a minimum of 0.69 in 0°. This work can provide the key experimental data for establishing an accurate anisotropic plastic constitutive model of thin-walled tubes.

Experiment for Measuring Mechanical Properties of High-Strength Steel Sheets under Cyclic Loading by V-Shaped Double-Shear-Zone Specimens.

The simple shear test shows significant advantages when measuring the hardening and shear properties of thin sheet metal at large strains. However, previous shear tests had an end effect caused by local stress concentration and a boundary effect caused by deformation overflow, resulting in non-uniform strain distribution in the shear zone. Therefore, a unique V-shaped double-shear-zone specimen is proposed to measure the Bauschinger effect under cyclic shear loading conditions in this paper. Simple shear experiments and three different types of cycle shear experiments are conducted to analyze the uniformity of deformation in the shear zone and the effect of pre-strain and the number of cyclic loads on the Bauschinger effect of Q890 high-strength steel sheets. The results indicate that the proposed V-shaped double-shear-zone specimen can still maintain uniform shear deformation in forward/reverse cyclic loading experiments, even at large strains. Q890 high-strength steel exhibits a significant Bauschinger effect, which is more pronounced with the increase in shear pre-strain and loading cycles. The results of this paper provide a new approach for studying the hardening characteristics under large strain and the mechanical properties under cyclic shear loading for metal sheets.

Establishment of a comprehensive diagnostic model for neuromyelitis optica spectrum disorders based on the analysis of laboratory indicators and clinical data.

BACKGROUND: To establish a comprehensive diagnostic model for neuromyelitis optica spectrum disorders (NMOSDs) based on laboratory indicators and clinical data. METHODS: A retrospective method was used to query the medical records of patients with NMOSD from January 2019 to December 2021. At the same time, clinical data of other neurological diseases were also collected for comparison. Clinical data of the NMOSD group and non-NMOSD group were analyzed, and the diagnostic model was established based on these data. In addition, the model was evaluated and verified by the receiver operating curve. RESULTS: A total of 73 patients with NMOSD were included, and the ratio of males to females was 1:3.06. The indicators that showed differences between the NMOSD group and non NMOSD group included neutrophils (P = 0.0438), PT (P = 0.0028), APTT (P < 0.0001), CK (P = 0.002), IBIL (P = 0.0181), DBIL (P < 0.0001), TG (P = 0.0078), TC (P = 0.0117), LDL-C (P = 0.0054), ApoA1 (P = 0.0123), ApoB (P = 0.0217), TPO antibody (P = 0.012), T3 (P = 0.0446), B lymphocyte subsets (P = 0.0437), urine sg (P = 0.0123), urine pH (P = 0.0462), anti-SS-A antibody (P = 0.0036), RO-52 (P = 0.0138), CSF simplex virus antibody I-IGG (P = 0.0103), anti-AQP4 antibody (P < 0.0001), and anti-MOG antibody (P = 0.0036). Logistic regression analysis showed that changes in ocular symptoms, anti-SSA antibody, anti-TPO antibody, B lymphocyte subsets, anti-AQP4 antibody, anti-MOG antibody, TG, LDL, ApoB, and APTT had a significant impact on diagnosis. The AUC of the combined analysis was 0.959. The AUC of the new ROC for AQP4- and MOG- antibody negative NMOSD was 0.862. CONCLUSIONS: A diagnostic model was successfully established, which can play an important role in differential diagnosis of NMOSD.

Amiloidose cardíaca por transtirretina: mais de uma variante patogênica confere maior gravidade? / Transthyretin cardiac amyloidosis: does more than one pathogenic variant confer greater severity?

INTRODUÇÃO: Mais de 130 variantes patogênicas no gene TTR foram associadas à amiloidose por transtirretina hereditária (ATTRh), conferindo uma ampla heterogeneidade fenotípica nos indivíduos afetados, com início da doença variável e formas de apresentação distintas. Sendo ATTRh de herança autossômica dominante, uma única variante patogênica é suficiente para o desenvolvimento da doença. Descrevemos uma série de casos nos quais foi observada rara associação de duas variantes patogênicas em heterozigose composta em um único indivíduo. MÉTODOS: estudo retrospectivo observacional. RESULTADOS: De uma série total de 128 pacientes (P) com ATTRh, trêspacientes (2,34%) eram portadores de duas variantes patogênicas no gene da TTR. Dois masculinos, idades de 41, 66 e 67 anos, todos com fenótipos mistos. Dados clínicos e de exames estão listados na tabela 1.

Associação nunca descrita de variantes P. S70R E P. V142I NO GENE TTR: relato de caso / Never described association of P.S70R AND P.V142I variants IN THE TTR GENE: case report

INTRODUÇÃO: presença de mais de uma variante patogênica em indivíduos afetados com amiloidose por transtirretina hereditária é ocorrência extremamente rara. Os casos descritos de heterozigose composta envolvem as variantes mais comuns no gene TTR, c.148G>A (p. V50M) e c.424G>A (p.V142I). Descrevemos um caso envolvendo rara variante patogênica em heterozigose c.208A>C (p.S70R) em associação com p.V142I, apresentando um quadro clínico precoce e extremamente grave. MÉTODOS: estudo retrospectivo, observacional. RELATO DE CASO: Paciente (p) de 41 anos de idade, masculino, procedente de São Paulo, pai e mãe brasileiros. Mãe com acometimento neuropático, precisou ficar acamada 4 meses por dores, falecendo aos 60 anos sem diagnóstico, três irmãs com sintomas parecidos com os do p. HDA: Início dos sintomas aos 40 anos, desidrose, fraqueza muscular intensa, parestesia em membros superiores, principalmente mãos e perda da propriocepção de membros inferiores. Também referia olhos secos, palpitações esporádicas, dispneia classe funcional III/IV, tonturas frequentes e síncopes com pródromos, perda de peso, 22 kg em 1 ano, saciedade precoce e diarreia. Exame físico, PA 80/60mmHg, sem outras alterações. ECG: ritmo sinusal, baixa voltagem no plano frontal e zona inativa ânterosseptal e alteração difusa da repolarização ventricular e QTC longo (459ms), como observado na figura 1. Ecocardiograma: aumento simétrico de espessura de paredes, septo de 19 e parede posterior 15, do ventrículo direito e átrios. Fração de ejeção de 46% e padrão de apical sparing. Cintilografia com pirofosfato: grau III de Perugini e relação HTE/HTD de 2,4, como observado na figura 2. Relação kappa/ lambda normal. Estudo genético: duas variantes patogênicas em heterozigose no gene TTR, c.208A>C (p.S70R) e c.424G>A (p.V142I). COMENTÁRIOS E CONCLUSÃO: p com fenótipo misto, neurológico e cardiológico, em idade mais precoce, distinto do quadro exclusivamente neurológico descrito em um paciente japonês e duas famílias ibéricas relatados na literatura até o momento envolvendo c.208A>C (p.S70R) em heterozigose. Já c.424G>A (p.V142I), por sua vez, está quase exclusivamente associada a fenótipo cardiológico em idade mais tardia, geralmente acima dos 60 anos. A presença da segunda variante pode explicar a precocidade do fenótipo cardíaco em nosso p. Concluímos que a dupla de variantes confere maior precocidade e gravidade das manifestações clínicas.

Forming Limit Analysis of Thin-Walled Extruded Aluminum Alloy Tubes under Nonlinear Loading Paths Using an Improved M-K Model.

To meet the requirement of lighter weight and better performance in tube hydroforming, one of the most important tasks is to accurately predict the forming limit of thin-walled tubes under nonlinear loading paths. This work established the M-K+DF2012 model, a combination of the M-K model and the DF2012 ductile fracture criterion, for the forming limit prediction of thin-walled tubes under nonlinear loading paths. In this model, the failure of the groove is determined by the DF2012 criterion, and the corresponding strains in the uniform region are the limit strains. The limit strains of an AA6061 aluminum alloy tube under a set of linear loading paths and two typical nonlinear loading paths were tested. Parameter values of the M-K+DF2012 model for the tube were determined based on the experimental limit strains under linear loading paths, and the limit strains under the two nonlinear loading paths were predicted. Then the strain-based forming limit diagram (ε-FLD) and the polar effective plastic strain FLD (PEPS-FLD) of the tube under different pre-strains were predicted and discussed. The results show that the limit strains of the tube are obviously path-dependent, and the M-K+DF2012 model can reasonably capture the limit strains of the tube under both linear and nonlinear loading paths. The predicted ε-FLD shows a strong dependence on the pre-strain, while the predicted PEPS-FLD is weakly strain path-dependent and almost path-independent on the right-hand side for the AA6061 tube.

A Homogeneous Anisotropic Hardening Model in Plane Stress State for Sheet Metal under Nonlinear Loading Paths.

In sheet metal forming, the material is usually subjected to a complex nonlinear loading process, and the anisotropic hardening behavior of the material must be considered in order to accurately predict the deformation of the sheet. In recent years, the homogeneous anisotropic hardening (HAH) model has been applied in the simulation of sheet metal forming. However, the existing HAH model is established in the second-order stress deviator space, which makes the calculation complicated and costly, especially for a plane stress problem such as sheet metal forming. In an attempt to reduce the computational cost, an HAH model in plane stress state is proposed, and called the HAH-2d model in this paper. In the HAH-2d model, both the stress vector and microstructure vector contain only three in-plane components, so the calculation is significantly simplified. The characteristics of the model under typical nonlinear loading paths are analyzed. Additionally, the feasibility of the model is verified by the stress-strain responses of DP780 and EDDQ steel sheets under different two-step uniaxial tension tests. The results show that the HAH-2d model can reasonably reflect the Bauschinger effect and the permanent softening effect in reverse loading, and the latent hardening effect in cross loading, while the predictive accuracy for cross-loading softening remains to be improved. In the future, the HAH-2d model can be further modified to describe more anisotropic hardening behaviors and applied to numerical simulations.

Morphological and biochemical studies of Salvia guaranitica St. Hil. under simulated deposition with different amounts of dust.

The collection of many environmental pollutants from road dust is harmful to living things and their surroundings. Previous studies have confirmed that road dust affects plant pigmentation, pollination, and biochemical properties. However, there are no comprehensive studies on multi-level dust pollution levels and multifaceted physiological properties of plants, and more importantly, there are no studies on atmospheric dust pollution monitors. In this experiment, the effect of road dust on the morphology and biochemistry of Salvia guaranitica St.Hil.was investigated by simulated deposition of different amounts of dust, and the changes of their physiological morphology under different pollution levels were also explored. A control group CK (0.00 g/plant), four experimental groups S1 (0.015 g/plant), S2 (0.030 g/plant), S3 (0.045 g/plant) and S4 (0.060 g/plant) were sprayed with the same dust samples every other day for 30 days. It was found that after 30 days of dust exposure, different degrees of morphological changes and damage occurred in Salvia. The different pollution levels also resulted in different degrees of biochemical characteristics of Salvia. With the increase of pollution, chlorophyll content, photosynthetic and evaporation rates decreased significantly, but the activity of SOD and the content of MDA increased significantly in different experimental groups. Especially, the experiments also revealed that severe road dust pollution caused damage and deformation to stomata, as well as a significant reduction in stomatal and glandular density. In addition, the regression curves of the different physiological responses of Salvia to road dust can be used as a preliminary basis for plant monitoring of dust pollution degrees, thus provided a scientific basis for the use of plant biomonitors in the field of pollution biology.

Establishment of SARS-CoV-2 Immunoglobulins (IgM, IgG) Reference Intervals for Elder Population in China based on 3,733 Samples.

BACKGROUND: Establishment of reference intervals (RIs) for different biomarkers is essential for clinical monitoring. The purpose of this study was to establish laboratory RIs of SARS-CoV-2 IgM and IgG for elder population. MATERIALS: Performance verification was conducted with reference to the Clinical and Laboratory Standards Institute (CLSI) guidelines, including linearity, imprecision, and allowable dilution ratio. Based on CLSI C28-A3 document, a total of 3,734 serum samples were collected, and 3,733 serum samples were used for the establishment of RIs for SARS-CoV-2 IgM and IgG. The subjects were grouped by gender and age. The age groups were as follows: 60 - 69 years, 70 - 79 years, 80 - 89 years, and 90 - 101 years. The RI was defined by nonparametric 95th percentile intervals. RESULTS: Percentage deviation of all the seven dilutions were all less than 12.5% during linearity evaluation. The inter-assay and intra-assay imprecision were all less than 5%. There is no significant difference between different gender and age groups for IgM (p = 0.0818, p = 0.7094), and there is significant difference between different gender and age groups for IgG (p = 0.0011, p = 0.0013). Harris-Boyd's test did not indicate partitioning for IgM and IgG. Cutoff values of RI for SARS-CoV-2 IgM and IgG were defined as 0.1523 S/CO and 0.2663 S/CO, respectively. CONCLUSIONS: RIs of SRAR-CoV-2 IgM and IgG were established for elder population, which can play an important role in the prevention and control of the epidemic.

Genomic study of nonsyndromic hearing loss in unaffected individuals: Frequency of pathogenic and likely pathogenic variants in a Brazilian cohort of 2,097 genomes.

Hearing loss (HL) is a common sensory deficit in humans and represents an important clinical and social burden. We studied whole-genome sequencing data of a cohort of 2,097 individuals from the Brazilian Rare Genomes Project who were unaffected by hearing loss to investigate pathogenic and likely pathogenic variants associated with nonsyndromic hearing loss (NSHL). We found relevant frequencies of individuals harboring these alterations: 222 heterozygotes (10.59%) for sequence variants, 54 heterozygotes (2.58%) for copy-number variants (CNV), and four homozygotes (0.19%) for sequence variants. The top five most frequent genes and their corresponding combined allelic frequencies (AF) were GJB2 (AF = 1.57%), STRC (AF = 1%), OTOA (AF = 0.69%), TMPRSS3 (AF = 0.41%), and OTOF (AF = 0.29%). The most frequent sequence variant was GJB2:c.35del (AF = 0.72%), followed by OTOA:p. (Glu787Ter) (AF = 0.61%), while the most recurrent CNV was a microdeletion of 57.9 kb involving the STRC gene (AF = 0.91%). An important fraction of these individuals (n = 104; 4.96%) presented variants associated with autosomal dominant forms of NSHL, which may imply the development of some hearing impairment in the future. Using data from the heterozygous individuals for recessive forms and the Hardy-Weinberg equation, we estimated the population frequency of affected individuals with autosomal recessive NSHL to be 1:2,222. Considering that the overall prevalence of HL in adults ranges from 4-15% worldwide, our data indicate that an important fraction of this condition may be associated with a monogenic origin and dominant inheritance.

Combined analysis of mRNA and miRNA reveals the banana potassium absorption regulatory network and validation of miRNA160a.

Potassium (K) has an important effect on the growth and development of plants. Banana contains higher K content than many other fruits, and its plant requires more K nutrient in soil. However, the soil in the banana-producing areas in China is generally deficient in K. Therefore, understanding the mechanism of banana K absorption may assist in providing effective strategy to solve this problem. This study used two banana varieties with contrasting K tolerance, 'Guijiao No. 1' (low-K tolerant), and 'Brazilian banana' (low-K sensitive)to investigate K absorption mechanisms in response to low-K stress through miRNA and mRNA sequencing analysis. Under low-K condition, 'Guijiao No.1' showed higher plant height, dry weight, tissue K content and ATPase activity. Analysis of transcription factors showed that they were mainly in the types or classes of MYB, AP-EREBP, bHLH, etc. The sequencing results showed that 'Guijiao No. 1' had 776 differentially expressed genes (DEGs) and 27 differentially expressed miRNAs (DEMs), and 'Brazilian banana' had 71 DEGs and 14 DEMs between normal and low K treatments. RT-qPCR results showed that all miRNAs and mRNAs showed similar expression patterns with RNA-Seq and transcriptome. miRNA regulatory network was constructed by integrated analysis of miRNA-mRNA data. miR160a was screened out as a key miRNA, and preliminary functional validation was performed. Arabidopsis overexpressing miR160a showed reduced tolerance to low K, and inhibited phenotypic traits such as shorter root length, and reduced K accumulation. The overexpressed miR160a had a targeting relationship with ARF10 and ARF16 in Arabidopsis. These results indicate that miR160a may regulate K absorption in bananas through the auxin pathway. This study provides a theoretical basis for further study on the molecular mechanism of banana response to low potassium stress.

Quality and Metabolomics Analysis of Houttuynia cordata Based on HS-SPME/GC-MS.

Houttuynia cordata is a medicinal and edible plant with a wide biological interest. Many parts were discarded due to various modes of consumption, resulting in resource waste. In this study, a comprehensive study was conducted on various edible indicators and medicinal components of Houttuynia cordata to understand its edible and medicinal value. The edible indexes of each root, stem, and leaf were determined, and the metabolites of different parts were investigated using the headspace solid-phase micro-extraction technique (HS-SPME-GC-MS). The differential metabolites were screened by orthogonal partial least squares discriminant analysis (OPLS-DA) and clustering analysis. The results of the study showed that the parts of Houttuynia cordata with high edibility values as a vegetable were mainly the roots and leaves, with the highest vitamin C content in the roots and the highest total flavonoids, soluble sugars, and total protein in the leaves. The nutrient content of all the stems of Houttuynia cordata was lower and significantly different from the roots and leaves (p < 0.05). In addition, 209 metabolites were isolated from Houttuynia cordata, 135 in the roots, 146 in the stems, 158 in the leaves, and 91 shared metabolites. The clustering analysis and OPLS-DA found that the parts of Houttuynia cordata can be mainly divided into above-ground parts (leaves and stems) and underground parts (roots). When comparing the differential metabolites between the above-ground parts and underground parts, it was found that the most important medicinal component of Houttuynia cordata, 2-undecanone, was mainly concentrated in the underground parts. The cluster analysis resulted in 28 metabolites with up-regulation and 17 metabolites with down-regulation in the underground parts. Most of the main components of the underground part have pharmacological effects such as anti-inflammatory, anti-bacterial and antiviral, which are more suitable for drug development. Furthermore, the above-ground part has more spice components and good antioxidant capacity, which is suitable for the extraction of edible flavors. Therefore, by comparing and analyzing the differences between the edible and medicinal uses of different parts of Houttuynia cordata as a medicinal and food plant, good insights can be obtained into food development, pharmaceutical applications, agricultural development, and the hygiene and cosmetic industries. This paper provides a scientific basis for quality control and clinical use.

Marcapasso definitivo em jovens: estudo genético pode diagnosticar etiologia / Definitive pacemaker in young people: genetic study can diagnose etiology

INTRODUÇÃO: Algumas doenças raras estão associadas a bloqueios atrioventriculares e necessidade de implante de marcapasso definito. Com a introdução do estudo genético na prática clínica, é hoje possível além do diagnóstico destas doenças, indicar tratamento se disponível e o screening familiar. Cardiologistas clínicos lidarão com mais frequência com estas condições. Descrevemos três casos de pacientes jovens que foram submetidos a implante de marcapasso e permaneceram por muitos anos sem diagnóstico da doença básica que foi posteriormente elucidada pelo estudo genético. RESULTADOS: Paciente 1: 54 anos, feminina, por apresentar episódios frequentes de palpitações, foi feito diagnóstico de fibrilação atrial e foi indicado cardioversão elétrica. Após cardioversão, evoluiu com bradicardia sinusal importante, sintomática, com FC inferior a 40bpm, motivo pelo qual foi submetida a implante de marcapasso. Teve boa evolução. Os seus dois filhos homens, de 22 e 23 anos passaram também a apresentar episódios de fibrilação atrial. O estudo genético revelou a presença de mutação no gene PRKAG2. Paciente 2: 42 anos, evoluiu com "silêncio" atrial, com FC inferior a 40bpm, sendo indicado implante de marcapasso definitivo. Posteriormente sua filha, de 23 anos, apresentou bloqueio AV 2:1. Estudo genético evidenciou mutação no gene EMD associado a distrofia muscular de EmeryDreifuss tipo um ligada ao cromossomo X. Paciente 3: 43 anos, feminina, apresentou episódio de síncope. Evoluiu com bradicardia sinusal sintomática e ecocardiograma normal. Sua sobrinha de 17 anos após consulta oftalmológica que identificou córnea verticilata fez estudo genético que identificou doença de Fabry. No screening familiar, a p fez estudo genético que também identificou a mutação. Repetiu o ecocardiograma que demonstrou hipertrofia de todas as paredes, com septo e parede lateral de 14mm. Comentários e CONCLUSÃO: Nos três casos descritos, a história familiar foi o fator que levou a indicação de estudo genético, o que ocorreu muitos anos após o implante de marcapasso definitivo. Em apenas um paciente, foi considerado tratamento específico (reposição enzimática). O motivo da indicação do marcapasso foi, em todos, bradicardia sinusal inapropriada. Apesar do "silêncio atrial" ser considerado patognomônico da distrofia de EmeryDreifuss, este diagnóstico não foi cogitado no momento do implante. Concluimos que a realização do estudo genético pode ser útil para o diagnóstico da doença de base em pacientes jovens, principalmente se têm história familiar.

Fenocópias de cardiomiopatia hipertrófica: PRKAG2 x Doença de Fabry / Hypertrophic cardiomyopathy phenocopies: PRKAG2 x Fabry disease

INTRODUÇÃO: O diagnóstico diferencial das cardiomiopatias que evoluem com aumento da espessura miocárdica é frequentemente desafiador. Apesar de serem as causas mais frequentes a cardiopatia hipertensiva e a cardiomiopatia hipertrófica em pacientes com espessura septal maior que 12mm, amiloidose e doença de Fabry não devem ser esquecidas. Doenças mais raras, como Danon, PRKAG2 e doença de Pompe são frequentemente negligenciadas. RELATO DO CASO: Paciente de 59 anos, sexo feminino, hipertensa, apresentou episódios de flutter atrial com alta resposta ventricular. Após cardioversão elétrica evoluiu com bradicardia juncional sintomática e necessidade de implante de marcapasso (MP). Ecocardiograma com função sistólica normal e discreta hipertrofia ventricular esquerda (espessura septal de 12mm) atribuída à hipertensão arterial. Exames laboratoriais evidenciavam doença renal crônica estágio 3A. Seus dois filhos também com arritmia supraventricular, um deles submetido à ablação de fibrilação atrial. Após quatro anos, apresentou quadro de endocardite infecciosa. No ecocardiograma, chamava a atenção, além da vegetação em valva tricúspide com refluxo importante, um aumento da espessura septal para 14mm, simétrico, função biventricular preservada e hipertensão pulmonar importante. Submetida à cirurgia para troca da valva tricúspide e extração do eletrodos do MP, evoluiu no perioperatório com necessidade de doses altas de droga vasoativa, terapia de substituição renal, disfunção de múltiplos órgãos e óbito. Estudo genético recebido posteriormente identificou uma variante patogênica c.905G>A (p.Arg302Gln) no gene PRKAG2 em heretozigose. DISCUSSÃO: A mutação PRKAG2 leva a acúmulo de glicogênio e tem apresentação fenotípica heterogênea, caracterizada pela síndrome de Wolff-Parkinson-White, hipertrofia ventricular, distúrbios do sistema de condução e arritmias supraventriculares. Nesta paciente, flutter atrial de alta resposta ventricular associado à história familiar foram as pistas que levaram à suspeita diagnóstica de doença de Fabry e PRKAG2, sendo esta última confirmada com o estudo genético. CONCLUSÃO: Doenças de depósito costumam apresentar-se com um curso clínico arrastado e o atraso na sua identificação é responsável por desfechos desfavoráveis. Nos últimos anos, a maior disponibilidade para realização de teste genético, permitiu o diagnóstico de várias cardiomiopatias raras. A identificação da variante pode direcionar para um tratamento específico e modificar a evolução do paciente.