Stable Bimetallic FeII/{Fe(NO)2}9 Moiety Derived from Reductive Transformations of a Diferrous-dinitrosyl Species.

A dimeric dithiolate-bridged species, [Fe(NO)(PS2)]2 (1) containing two {FeNO}7 units, can be isolated by treating [Fe(CO)2(NO)2] with PS2H2 (PS2H2 = bis(2-dimercaptophenyl)phenylphosphine). Crystallographic studies reveal the syn-configuration of NO units and the bridging thiolates in the butterfly shape of the 2Fe2S core. Addition of PPh3 to the solution of dinuclear 1 leads to the formation of mononuclear {FeNO}7 [Fe(NO)(PS2)(PPh3)] (2) that shows electrochemical responses similar to those of 1. One-electron reduction of 1 with Cp*2Co or KC8 results in the isolation of thiolate-bridged bimetallic DNIC, [(PS2)Fe(µ-PS2)Fe(NO)2]- ([3]-), confirmed by several spectroscopies including single-crystal X-ray diffraction studies. The bimetallic DNIC [3]- is a rare example obtained from the one-electron reduction of a dinuclear Fe-NO {FeNO}7 model complex. With the assistance of redox behaviors of 2, electrochemical studies imply that the reduction of 1 leads to the formation of a mononuclear {FeNO}8 [Fe(NO)(PS2)(THF)]- intermediate, which involves disproportionation or NO- transfer to yield [3]-. Based on IR data and magnetic properties, the electronic structure of [3]- can be described as a FeII/{Fe(NO)2}9 state. Isolation of the {Fe(NO)2}9 moiety coordinated by the Fe ancillary complex lends strong support to the NO scrambling behavior in the effectiveness of the activity of flavodiiron nitric oxide reductases (FNORs).

Photoinduced NO and HNO Production from Mononuclear {FeNO}6 Complex Bearing a Pendant Thiol.

Light triggers the formation of HNO from a metal-nitrosyl species, facilitated by an intramolecular pendant thiol proton. Two {FeNO}6 complexes (the Enemark-Felthan notation), [Fe(NO)(TMSPS2)(TMSPS2H)] (1, TMSPS2H2 = 2,2'-dimercapto-3,3'-bis(trimethylsilyl)diphenyl)phenylphosphine; H is a dissociable proton) with a pendant thiol and [Fe(NO)(TMSPS2)(TMSPS2CH3)] (2) bearing a pendant thioether, are spectroscopically and structurally characterized. Both complexes are highly sensitive to visible light. Upon photolysis, complex 2 undergoes NO dissociation to yield a mononuclear Fe(III) complex, [Fe(TMSPS2)(TMSPS2CH3)] (3). In contrast, the pendant SH of 1 can act as a trap for the departing NO radical upon irradiation, resulting in the formation of an intermediate A with an intramolecular [SH···ON-Fe] interaction. As suggested by computational results (density functional theory), the NO stretching frequency (νNO) is sensitive to the intramolecular interaction between the pendant ligand and the iron-bound NO, and a shift of νNO from 1833 (1) to 1823 cm-1 (A) is observed experimentally. Subsequent photolysis of the intermediate A results in HNO production and a thiyl group that then coordinates to the Fe center for the formation of [Fe(TMSPS2)2] (4). In contrast with the common acid-base coupling pathway, the HNO is not voluntarily yielded from 1 but rather is generated by the photopromoted pathway. The photogenerated HNO can further react with [MnIII(TMSPS3)(DABCO)] (TMSPS3H3 = (2,2'2''-trimercapto-3,3',3''-tris(trimethylsilyl)triphenylphosphine; DABCO = 1,4-diazabicyclo[2.2.2]octane) in organic media to yield anionic [Mn(NO)(TMSPS3)]- (5-) with a {MnNO}6 electronic configuration, whereas [MnIII(TMSPS3)(DABCO)] reacts with NO gas for the formation of a {MnNO}5 species, [Mn(NO)(TMSPS3)] (6). Effective differentiation of the formation of HNO from complex 1 with the pendant SH versus NO from 2 with the pendant SMe is achieved by the employment of [MnIII(TMSPS3)(DABCO)].

Screening for diabetes in asymptomatic children: A simple and efficient method.

BACKGROUND/PURPOSE: Type 2 diabetes has become an important cause of diabetes in children. Since most children with type 2 diabetes are asymptomatic, a screening method is needed. However, physicians are required in the screening methods recommended by professional associations. We aimed to develop a simple and efficient screening method for children with diabetes. METHODS: A nationwide survey was conducted, which included 2,270,496 seventh-grade students. Students with two abnormal results in sequential urinalyses were given a fasting blood test. Three screening methods were developed. RESULTS: Among the screening methods, method C is simple, and can be performed by parents, teachers, or school nurses. It suggests children with two abnormal results in sequential urinalyses and who are overweight or have a family history of diabetes receive blood tests. As a result, 0.10% of boys and 0.16% of girls were recommended to receive blood tests, and 7.0% of boys and 6.7% of girls receiving blood tests were diagnosed diabetes. On average, 15,002 boys and 9056 girls had to be screened to find one child with diabetes. The cost per 1000 children by method C was 2466.84 US dollars. CONCLUSION: Urinalysis screening followed by evaluation of risk factors is a simple and efficient way to identify children with diabetes in schools.

Detecting 22q11.2 Deletion Syndrome in Newborns with Low T Cell Receptor Excision Circles from Severe Combined Immunodeficiency Screening.

OBJECTIVE: Based on experiences and results from newborn screening for severe combined immunodeficiency (SCID), we evaluated the occurrence of chromosome 22q11.2 deletion syndrome (22q11.2DS) in newborns with different T cell receptor excision circles (TREC) results and established a second tier genetic test for 22q11.2DS. STUDY DESIGN: Recalled dried blood spots from 486 newborns with TREC results <90 copies/uL were tested from the SCID newborn screening. Quantitative real-time polymerase chain reaction assay was used to detect the copy number of TBX1 and HIRA genes by simple DNA extraction method. Multiplex ligation dependent probe amplification was used for further confirmation. RESULTS: Four hundred sixty-eight cases were considered negative because their haploid copy number of TBX1 and HIRA genes was >0.75. Eighteen cases with TBX1 and/or HIRA gene copy number <0.75 were suspected as positive, and 13 cases were further confirmed with 22q11.2DS. Detection rates of 22q11.2DS were 10.7% (6/56) in TREC <30 copies, 6.8% (9/132) in <50 TREC copies, 4.6% (12/260) in <70 TREC copies, and 2.7% (13/486) in <90 TREC copies. CONCLUSIONS: 22q11.2DS detection can be incorporated into the second-tier assay in subjects with low TREC copies in SCID screening. The dried blood spot methods were feasible for 22q11.2DS newborn screening.

Taiwan National Newborn Screening Program by Tandem Mass Spectrometry for Mucopolysaccharidoses Types I, II, and VI.

OBJECTIVE: To evaluate the initial cutoff values, rates of screen positives, and genotypes for the large-scale newborn screening program for multiple mucopolysaccharidoses (MPS) in Taiwan. STUDY DESIGN: More than 100 000 dried blood spots were collected consecutively as part of the national Taiwan newborn screening programs. Enzyme activities were measured by tandem mass spectrometry from dried blood spot punches. Genotypes were obtained when a second newborn screening specimen again had a decreased enzyme activity. Additional clinical evaluation was then initiated based on enzyme activity and/or genotype. RESULTS: Molecular genetic analysis for cases with low enzyme activity revealed 5 newborns with pathogenic alpha-L-iduronidase mutations, 3 newborns with pathogenic iduronate-2-sulfatase mutations, and 1 newborn was a carrier of an arylsulfatase B mutation. Several variants of unknown pathogenic significance were also identified, most likely causing pseudodeficiency. CONCLUSIONS: The highly robust tandem mass spectrometry-based enzyme assays for MPS-I, MPS-II, and MPS-VI allow for high-throughput newborn screening for these lysosomal storage disorders. Optimized cutoff values combined with second tier testing could largely eliminate false-positive results. Accordingly, newborn screening for these lysosomal storage disorders is possible.

Functional and biological studies of α-galactosidase A variants with uncertain significance from newborn screening in Taiwan.

Fabry disease is an X-linked disorder resulted from deficiency of α-galactosidase A (GLA) activity. In Taiwan, a total of 792,247 newborns were screened from 2008 to 2014 in two newborn screening centers, and 13 variants of uncertain significance (VOUS) in the GLA gene were identified. To determine whether these variants were pathogenic or not, functional, biochemical, clinical and pedigree analyses were performed. In vitro functional assay was established through site-directed mutagenesis, and four in silico tools were used to predict pathogenesis. The enzyme activity of dried blood spots and plasma metabolite lyso-Gb3 level from subjects with the variants were measured. Additionally, clinical manifestations were evaluated extensively from the subjects and their relatives. Our results revealed that p.G104V, p.I232T, p.D322H, and p.G360C all exhibited relatively low residual enzyme activities and elevated plasma lyso-Gb3 level. These data strongly suggest that these Fabry mutations may cause classical or later-onset phenotypes. In contrast, neither significantly clinical symptoms nor elevated lyso-Gb3 level was found in cases with p.P60S, p.A108T, p.S304T, p.R356Q, and p.P362T variants, which may be non-pathogenic or milder forms of Fabry variants. More data need to be included for the patients with p.N53D, p.P210S, p.M296L, and p.K391T variants. The established system provides us more information to classify these GLA variants.

Mass Spectrometry but Not Fluorimetry Distinguishes Affected and Pseudodeficiency Patients in Newborn Screening for Pompe Disease.

BACKGROUND: Deficiency of the lysosomal enzyme acid α-glucosidase (GAA) causes Pompe disease. Newborn screening for Pompe disease is ongoing, and improved methods for distinguishing affected patients from those with pseudodeficiency, especially in the Asian population, would substantially reduce the number of patient referrals for clinical follow-up. METHODS: We measured the enzymatic activity of GAA in dried blood spots on newborn screening cards (DBS) using a tandem mass spectrometry (MS/MS) assay. The assay displayed a relatively large analytical range compared to the fluorimetric assay with 4-methylumbelliferyl-α-glucoside. DBS from newborns confirmed to have infantile-onset Pompe disease (IOPD, n = 11) or late-onset Pompe disease (LOPD) (n = 12) and those from patients bearing pseudodeficiency alleles with or without Pompe mutations, or Pompe disease carriers (n = 230) were studied. RESULTS: With use of the MS/MS GAA assay in DBS, 96% of the pseudodeficiency newborns and all of the Pompe disease carriers were well separated from the IOPD and LOPD newborns. The fluorimetric assay separated <10% of the pseudodeficiencies from the IOPD/LOPD group. CONCLUSIONS: The relatively large analytical range MS/MS GAA assay but not the fluorimetric assay in DBS provides a robust approach to reduce the number of referrals and should dramatically facilitate newborn screening of Pompe disease.

Very Early Treatment for Infantile-Onset Pompe Disease Contributes to Better Outcomes.

OBJECTIVE: To evaluate whether very early treatment in our patients would result in better clinical outcomes and to compare these data with other infantile-onset Pompe disease (IOPD) cohort studies. METHODS: In this nationwide program, 669,797 newborns were screened for Pompe disease. We diagnosed IOPD in 14 of these newborns, and all were treated and followed in our hospital. RESULTS: After 2010, the mean age at first enzyme-replacement therapy (ERT) was 11.92 days. Our patients had better biological, physical, and developmental outcomes and lower anti-rh acid α-glucosidase antibodies after 2 years of treatment, even compared with one group that began ERT just 10 days later than our cohort. No patient had a hearing disorder or abnormal vision. The mean age for independent walking was 11.6 ± 1.3 months, the same age as normal children. CONCLUSIONS: ERT for patients with IOPD should be initiated as early as possible before irreversible damage occurs. Our results indicate that early identification of patients with IOPD allows for the very early initiation of ERT. Starting ERT even a few days earlier may lead to better patient outcomes.

A large-scale nationwide newborn screening program for Pompe disease in Taiwan: towards effective diagnosis and treatment.

The aim of this study was to: (a) analyze the results of a large-scale newborn screening program for Pompe disease, and (b) establish an effective diagnostic protocol to obtain immediate, valid diagnosis of infantile-onset Pompe disease (IOPD) to promote earlier treatment and better outcomes. In this study, 402,281 newborns were screened for Pompe disease from January 1, 2008 to May 1, 2012. Infants with low acid α-glucosidase (GAA) activity were referred to Taipei Veterans General Hospital for diagnostic confirmation. Physical examination, biochemical parameter (creatine kinase [CK], alanine transaminase, aspartate aminotransferase, and lactate dehydrogenase), and echocardiogram assessments were performed immediately to effectively differentiate IOPD from suspected late-onset Pompe disease (LOPD) or false-positive cases with pseudodeficiency mutation. Six infants with IOPD all presented with hypotonia, extremely low GAA enzyme activity (≤0.5 µmol/L/hr) in initial dried blood spot analysis, high CK (≥250 U/L), and high left ventricular mass index (LVMI, ≥80 g/m(2)). By analyzing these parameters, IOPD was distinguished effectively and immediately from suspected LOPD and false-positive cases. Except for the first referred case, five of the infants with IOPD received first-time enzyme replacement therapy (ERT) within 4 hr of admission and exhibited marked improvement. Our findings indicate that certain clinical manifestations (hypotonia, high CK, enlarged LVMI, and extremely low GAA enzyme activity in initial dried blood spot analysis) can help in the rapid and effective differentiation of patients with IOPD from other patient with low GAA activity. Such differentiation allows for the early application of first-time ERT and leads to better outcomes.

Obesity and clustering of cardiovascular disease risk factors are associated with elevated plasma complement C3 in children and adolescents.

OBJECTIVES: To investigate the relationship among obesity, cardiovascular disease risk factors (CVDRFs), and plasma complement C3 concentration in children and adolescents. METHODS: In a nationwide survey conducted between 1992 and 2000, all school children aged 6-18 yr with abnormal results in repeated urine samples, including hematuria, proteinuria, and glucosuria (n = 97 312; 36 557 boys and 60 755 girls), were investigated for their body mass index (BMI), blood pressure, fasting plasma glucose, total cholesterol, and plasma complement C3 concentrations. RESULTS: Children in the higher percentile groups for BMI or having more CVDRFs, namely, hypertension, diabetes, and hypercholesterolemia, had higher plasma C3 concentrations independently (p for both trends <0.05, adjusted for age and gender). The odds ratios (ORs) for having one, two, or three CVDRFs in obese children were 4.74 [95% confidence interval (CI) = 4.47-5.03], 19.8 (95% CI = 17.8-22.0), and 139 (95% CI = 96.6-200), respectively, adjusted for age, gender, and family history of diabetes, which were substantially reduced after adjustment for plasma C3 concentrations. The ORs for children with plasma C3 concentrations in the highest quartile to have one, two, or three CVDRFs were 2.32 (95% CI = 2.21-2.44), 5.68 (95% CI = 4.83-6.67), and 58.6 (95% CI = 19.7-174), respectively, adjusted for age, gender, family history of diabetes, and BMI. CONCLUSION: Obesity is associated with clustering of CVDRFs in children and adolescents. Obesity and clustering of CVDRFs are associated with elevated plasma complement C3. Children and adolescents with higher plasma C3 concentrations have higher risk of clustering of CVDRFs independent of obesity.

An intelligent knowledge-based and customizable home care system framework with ubiquitous patient monitoring and alerting techniques.

This study develops and integrates an efficient knowledge-based system and a component-based framework to design an intelligent and flexible home health care system. The proposed knowledge-based system integrates an efficient rule-based reasoning model and flexible knowledge rules for determining efficiently and rapidly the necessary physiological and medication treatment procedures based on software modules, video camera sensors, communication devices, and physiological sensor information. This knowledge-based system offers high flexibility for improving and extending the system further to meet the monitoring demands of new patient and caregiver health care by updating the knowledge rules in the inference mechanism. All of the proposed functional components in this study are reusable, configurable, and extensible for system developers. Based on the experimental results, the proposed intelligent homecare system demonstrates that it can accomplish the extensible, customizable, and configurable demands of the ubiquitous healthcare systems to meet the different demands of patients and caregivers under various rehabilitation and nursing conditions.

A vision-based driver nighttime assistance and surveillance system based on intelligent image sensing techniques and a heterogamous dual-core embedded system architecture.

This study proposes a vision-based intelligent nighttime driver assistance and surveillance system (VIDASS system) implemented by a set of embedded software components and modules, and integrates these modules to accomplish a component-based system framework on an embedded heterogamous dual-core platform. Therefore, this study develops and implements computer vision and sensing techniques of nighttime vehicle detection, collision warning determination, and traffic event recording. The proposed system processes the road-scene frames in front of the host car captured from CCD sensors mounted on the host vehicle. These vision-based sensing and processing technologies are integrated and implemented on an ARM-DSP heterogamous dual-core embedded platform. Peripheral devices, including image grabbing devices, communication modules, and other in-vehicle control devices, are also integrated to form an in-vehicle-embedded vision-based nighttime driver assistance and surveillance system.

Pathology in Practice.

In collaboration with the American College of Veterinary Pathologists.

Colonic Intramural Hematoma in a Cat: A Case Report.

Colonic intramural hematoma is a rare condition in humans and companion animals. Its clinical presentation in cats has not previously been reported. An 8-year-old male American shorthair cat presented with acute onset of constipation and anorexia for 3 days. Laboratory examination indicated mild elevation of alanine aminotransferase, globulin, and total protein levels. Complete blood count was normal. Radiographs revealed a soft tissue opacity mass located caudodorsally to the urinary bladder, causing narrowing of the descending colonic lumen. Sonography showed a heteroechogenic intraluminal mass containing liquefied content between the submucosal and muscular layers of the descending colon. On computed tomographic images, the mass contained two different attenuated contents with an interface. Colonoscopy was then performed for intestinal biopsy, and the contents observed in the intraluminal mass were drained via surgical evacuation and considered as blood clots. Supportive medical treatment, including antibiotics and fecal softener, was administered, and the clinical signs resolved uneventfully. Mild chronic proctitis without apparent malignancy was confirmed histopathologically, and no recurrence was observed after more than 14 months, and thus a colonic intramural hematoma was presumptively diagnosed. The information provided by multimodal imaging of the mass was essential for the diagnosis and determination of the treatment in this case.

Hypertension and hypercholesterolemia aggregate in nondiabetic children and adolescents with higher fasting plasma glucose levels.

OBJECTIVE: To investigate how hypertension and hypercholesterolemia aggregate at different fasting plasma glucose (FPG) levels in children aged 6-16 yr. RESEARCH DESIGN AND METHODS: In a nationwide survey conducted between 1992 and 2000, all schoolchildren aged 6-18 yr with abnormal results in repeated urine samples were included. In this study, we recruited 27 535 students aged 6- to 16-yr whose FPG levels were 90-125 mg/dL. Another 17 907 children were randomly selected as control from schoolchildren with FPG <90 mg/dL by stratification to reflect the age- and sex-specific proportion of the whole student population. RESULTS: The risk of having hypertension or hypercholesterolemia increased at FPG level above 90 mg/dL compared with children with FPG <90 mg/dL [6-10 yr, odd ratios (OR) = 1.51 and 1.82 for FPG 90-99 and 100-125 mg/dL for girls, OR = 1.35 and 2.03 for FPG 90-99 and 100-125 mg/dL for boys; 10-16 yr, OR = 1.24 and 1.66 for FPG 90-99 and 100-125 mg/dL for girls, OR = 1.17 and 1.41 for FPG 90-99 and 100-125 mg/dL for boys, all p < 0.05]. The risk of having both hypertension and hypercholesterolemia elevated at FPG 100-125 mg/dL (6-10 yr, OR = 2.76 for girls and 2.75 for boys; 10-16 yr, OR = 2.19 for girls and 1.74 for boys, all p < 0.05). CONCLUSIONS: Aggregation of hypertension, hypercholesterolemia, and abnormal glycemia was found at FPG level above 100 mg/dL, which supported the definition of abnormal glycemia in metabolic syndrome by the International Diabetes Federation in 10- to 16-yr-old children. These findings also suggest that this FPG cutoff is reasonable for 6- to 10-yr-old children.

Vision-based finger detection, tracking, and event identification techniques for multi-touch sensing and display systems.

This study presents efficient vision-based finger detection, tracking, and event identification techniques and a low-cost hardware framework for multi-touch sensing and display applications. The proposed approach uses a fast bright-blob segmentation process based on automatic multilevel histogram thresholding to extract the pixels of touch blobs obtained from scattered infrared lights captured by a video camera. The advantage of this automatic multilevel thresholding approach is its robustness and adaptability when dealing with various ambient lighting conditions and spurious infrared noises. To extract the connected components of these touch blobs, a connected-component analysis procedure is applied to the bright pixels acquired by the previous stage. After extracting the touch blobs from each of the captured image frames, a blob tracking and event recognition process analyzes the spatial and temporal information of these touch blobs from consecutive frames to determine the possible touch events and actions performed by users. This process also refines the detection results and corrects for errors and occlusions caused by noise and errors during the blob extraction process. The proposed blob tracking and touch event recognition process includes two phases. First, the phase of blob tracking associates the motion correspondence of blobs in succeeding frames by analyzing their spatial and temporal features. The touch event recognition process can identify meaningful touch events based on the motion information of touch blobs, such as finger moving, rotating, pressing, hovering, and clicking actions. Experimental results demonstrate that the proposed vision-based finger detection, tracking, and event identification system is feasible and effective for multi-touch sensing applications in various operational environments and conditions.

Computed tomography lymphangiography via intrametatarsal pad injection is feasible in cats with chylothorax.

OBJECTIVE: To evaluate the feasibility of CT lymphangiography via intrametatarsal pad injection in cats with chylothorax. ANIMALS: 7 client-owned cats. PROCEDURES: This was a multicenter, retrospective, descriptive study. Medical records and imaging data from 4 veterinary hospitals were reviewed to identify cats with chylothorax that had undergone intrametatarsal pad injection via CT lymphangiography. In total, 7 client-owned cats were included in the study. Signalment, history, image findings, and follow-up data were recorded. Descriptive statistics were used to analyze the success rate of thoracic duct (TD) enhancement and describe relevant clinical findings. RESULTS: Enhancement of TDs was successful in 6 of the 7 cats within 5 to 15 minutes after initiating intrametatarsal pad injection under general anesthesia. Successful migration of contrast medium into the lymphatic vessels cranial to the popliteal lymph nodes was observed in all cats within 5 minutes after injection. The recommended dose of contrast medium to achieve TD enhancement was 1 mL/kg (0.5 mL/kg/pad; concentration, 350 mg of iodine/kg). Only 1 cat had mild swelling of the paws after the procedure, and it recovered quickly without pain medication; no cats experienced lameness. Similar to dogs and unlike in previously published reports, 72% of TD branches were located in the right hemithorax. CLINICAL RELEVANCE: CT lymphangiography via intrametatarsal pad injection is a feasible and safe procedure for cats with chylothorax. This technique provides detailed information regarding the unique TD anatomy and cisterna chyli location. It also contributes to surgical planning.

Nationwide survey of extended newborn screening by tandem mass spectrometry in Taiwan.

In Taiwan, during the period March 2000 to June 2009, 1,495,132 neonates were screened for phenylketonuria (PKU) and homocystinuria (HCU), and 1,321,123 neonates were screened for maple syrup urine disease (MSUD), methylmalonic academia (MMA), medium-chain acyl-coenzyme A (CoA) dehydrogenase (MCAD) deficiency, isovaleric academia (IVA), and glutaric aciduria type 1 (GA-1) using tandem mass spectrometry (MS/MS). In a pilot study, 592,717 neonates were screened for citrullinemia, 3-methylcrotonyl-CoA carboxylase deficiency (3-MCC) and other fatty acid oxidation defects in the MS/MS newborn screening. A total of 170 newborns and four mothers were confirmed to have inborn errors of metabolism. The overall incidence was approximately 1/5,882 (1/6,219 without mothers). The most common inborn errors were defects of phenylalanine metabolism [five classic PKU, 20 mild PKU, 40 mild hyperphenylalaninemia (HPA), and 13 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency]. MSUD was the second most common amino acidopathy and, significantly, most MSUD patients (10/13) belonged to the Austronesian aboriginal tribes of southern Taiwan. The most frequently detected among organic acid disorders was 3-MCC deficiency (14 newborns and four mothers). GA-1 and MMA were the second most common organic acid disorders (13 and 13 newborns, respectively). In fatty acid disorders, five carnitine transport defect (CTD), five short-chain acyl-CoA dehydrogenase deficiency (SCAD), and two medium-chain acyl-CoA dehydrogenase (MCAD) deficiency were confirmed. This is the largest case of MS/MS newborn screening in an East-Asian population to date. We hereby report the incidences and outcomes of metabolic inborn error diseases found in our nationwide MS/MS newborn screening program.

Enzyme assay and clinical assessment in subjects with a Chinese hotspot late-onset Fabry mutation (IVS4 + 919G→A).

Newborn screening for Fabry disease in Taiwan Chinese has revealed a high incidence of the late-onset GLA mutation IVS4 + 919G→A (∼1 in 1,500-1,600 males). We studied 94 adults with this mutation [22 men, 72 women; mean age: men 57.8 ± 6.0 (range 42-68), women 39.1 ± 14.1 years (range 19-82)]. Plasma α-galactosidase A activity assay was 10.4 ± 11.2% of normal in the men and 48.6 ± 19.5% of normal in the women. Echocardiography in 90 of the adults revealed left ventricular hypertrophy (LVH) in 19 (21%), including 14 of 21 men (67%) and 5 of 69 women (7%). Microalbuminuria, based on the urine albumin-to-creatinine ratio measured on at least two occasions, was present in 17 of 86 subjects (20%) (men: 5/20, 25%; women 12/66, 18%). At least one ocular manifestation consistent with Fabry disease was present in 41 of 52 subjects (79%) who underwent ophthalmologic examination, including 8 (15%) with conjunctival vessel tortuosity, 15 (29%) with cornea verticillata, 10 (19%) with Fabry cataract, and 34 (65%) with retinal vessel tortuosity. Among subjects over 40 years of age, men were more likely than women to have LVH [14/21 (67%) vs 5/25 (20%), p < 0.001]. Cardiovascular, renal and ocular abnormalities are highly prevalent in adult Taiwan Chinese subjects with the Fabry mutation IVS4 + 919G→A. Our findings contribute to the limited understanding of the course of this late-onset disease variant and underscore the need for close follow up in such patients.

Elevated blood pressure, obesity, and hyperlipidemia.

OBJECTIVES: To investigate the association of blood pressure elevation with body mass index (BMI) and total cholesterol levels in children who screened positive for proteinuria, glucosuria, and/or hamaturia. STUDY DESIGN: From 1992 to 2000, a mass urine screening program was conducted annually for nearly 3,000,000 students aged 6 to 18 years. Of 99,350 students with positive results on urine tests, further examination found 17,548 students (17.7%) had blood pressure elevation. A case-control analysis was performed with randomly selected subjects with normal blood pressure who were frequency matched by sex and age. RESULTS: The adjusted odds ratio for blood pressure elevation in obese students was 3.45 (95% CI, 3.20-3.72), compared with students of normal weight. The odds ratio for blood pressure elevation increased to 6.15 (95% CI, 4.12-9.18) for students with a total cholesterol level > or =250 mg/dL and obesity, compared with students with a total cholesterol level <200 mg/dL and normal weight. CONCLUSION: This study found a high prevalence of elevated blood pressure in children with abnormal urinalysis results, with a strong association with BMI and total cholesterol level.