Diagnostic Yield of Genetic Testing in Sudden Cardiac Death with Autopsy Findings of Uncertain Significance.

BACKGROUND: Sudden death (SD) in the young usually has an underlying genetic cause. In many cases, autopsy reveals unspecific and inconclusive results, like idiopathic left ventricular hypertrophy (LVH), nonsignificant coronary atherosclerosis (CA), and primary myocardial fibrosis (PMF). Their pathogenicity and their relation to SD cause is unknown. This study aims to evaluate the diagnostic yield of genetic testing in these cases. METHODS: SD cases, between 1 and 50 years old, with findings of uncertain significance (idiopathic LVH, nonsignificant CA and PMF) on autopsy were evaluated prospectively, including information about medical and family history and circumstances of death. Genetic testing was performed. RESULTS: In a series of 195 SD cases, we selected 31 cases presenting idiopathic LVH (n = 16, 51.61%), nonsignificant CA (n = 17, 54.84%), and/or PMF (n = 24, 77.42%) in the autopsy. Mean age was 41 ± 7.2 years. Diagnostic yield of genetic test was 67.74%, considering variants of unknown significance (VUS), pathogenic variants (PV) and likely pathogenic variants (LPV); 6.45% including only PV and LPV. Structural genes represented 41,93% (n = 13) of cases, while 38,7% (n = 12) were related to channelopathies. CONCLUSION: Molecular autopsy in SD cases between 1 and 50 years old, with findings of uncertain significance, has a low diagnostic yield, being VUS the most frequent variant observed.

Role of microsatellite instability in young patients with laryngeal carcinoma.

OBJECTIVE: To determine whether early development of carcinoma in young patients could be explained by an alternative pathway such as microsatellite instability or whether it follows the classical tumor suppressor pathway characterized by loss of heterozygosity. STUDY DESIGN: Microsatellite instability, loss of heterozygosity, and multiple mismatch repair, p16, p53, and p63 protein expression were analyzed in a series of 18 young patients with laryngeal cancer. RESULTS: Only 2 of the 18 cases showed low microsatellite instability, whereas 9 of 17 presented loss of heterozygosity in at least one of the markers tested. All cases retained multiple mismatch repair protein expression. The p53, p16, and p63 expression profiles were consistent with the classical tumor suppressor pathway. CONCLUSION: Laryngeal carcinoma in young patients develops through the classical tumor suppressor pathway.

Determination of trace chromium(VI) in drinking water using X-ray fluorescence spectrometry after solid-phase extraction.

A new, simple, and selective method for preconcentration and determination of Cr(VI) in aqueous samples. After adsorption in "batch mode" on Aliquat 336-AC, determinations were made directly on the solid by X-ray fluorescence spectrometry, which had the advantage of not requiring the step of elution of the chromium retained. The enrichment factor was calculated considering that the tablets obtained from 10 mL solution of Cr(VI) (1000 µg L(-1)) had a final thickness of 0.64 mm and a diameter of 16.7 mm; the volume deposited on the pellet was 0.14 cm(3). The preconcentration factor obtained was 71-fold, which was highly satisfactory for chromium trace analysis by XRF. Finally, the method was successfully applied to the determination of Cr(VI) in drinking water samples.

IGF activation in a molecular subclass of hepatocellular carcinoma and pre-clinical efficacy of IGF-1R blockage.

BACKGROUND & AIMS: IGF signaling has a relevant role in a variety of human malignancies. We analyzed the underlying molecular mechanisms of IGF signaling activation in early hepatocellular carcinoma (HCC; BCLC class 0 or A) and assessed novel targeted therapies blocking this pathway. METHODS: An integrative molecular dissection of the axis was conducted in a cohort of 104 HCCs analyzing gene and miRNA expression, structural aberrations, and protein activation. The therapeutic potential of a selective IGF-1R inhibitor, the monoclonal antibody A12, was assessed in vitro and in a xenograft model of HCC. RESULTS: Activation of the IGF axis was observed in 21% of early HCCs. Several molecular aberrations were identified, such as overexpression of IGF2 -resulting from reactivation of fetal promoters P3 and P4-, IGFBP3 downregulation and allelic losses of IGF2R (25% of cases). A gene signature defining IGF-1R activation was developed. Overall, activation of IGF signaling in HCC was significantly associated with mTOR signaling (p=0.035) and was clearly enriched in the Proliferation subclass of the molecular classification of HCC (p=0.001). We also found an inverse correlation between IGF activation and miR-100/miR-216 levels (FDR<0.05). In vitro studies showed that A12-induced abrogation of IGF-1R activation and downstream signaling significantly decreased cell viability and proliferation. In vivo, A12 delayed tumor growth and prolonged survival, reducing proliferation rates and inducing apoptosis. CONCLUSIONS: Integrative genomic analysis showed enrichment of activation of IGF signaling in the Proliferation subclass of HCC. Effective blockage of IGF signaling with A12 provides the rationale for testing this therapy in clinical trials.

Alveolar soft part sarcoma presenting with cutaneous metastases: report of a case with immunohistochemical and molecular characterization.

Alveolar soft part sarcoma (ASPS) is an uncommon neoplasm of uncertain histogenesis that usually behaves as a painless, slow-growing mass that metastasizes early. We report a 21-year-old woman with cutaneous metastases of ASPS, whose histologic characteristics gave rise to a wide range of differential diagnoses of both primary and metastatic cutaneous neoplasms. The tumor failed to show a characteristic immunoprofile using routine immunohistochemical procedures, but was strongly and diffusely positive for the TFE3 antibody. The molecular study identified a type 2 alveolar soft part locus-transcription factor E3 (ASPL-TFE3) fusion, secondary to der(17)t(X;17)(p11.2;q25) translocation. A computed tomography scan performed after the diagnosis was made disclosed a 13-cm primary tumor in the left buttock. Cutaneous metastases presenting as the first sign of ASPS have not been reported previously. We emphasize the difficulties in making the diagnosis of ASPS when it presents in an unusual manner.

Human papillomaviruses are identified in a subgroup of sinonasal squamous cell carcinomas with favorable outcome.

BACKGROUND: The role of human papillomavirus (HPV) in the pathogenesis of squamous cell carcinomas (SCCs) of the sinonasal tract and its clinicopathological implications were evaluated. METHODS: All SCCs of the sinonasal tract diagnosed in the Hospital Clinic of Barcelona from 1981 to 2006 were retrospectively evaluated (N = 60). Clinical and pathological data were reviewed. HPV infection was determined and typed by amplification of HPV DNA by polymerase chain reaction using the SPF-10 primers. p16(INK4a) expression was determined by immunohistochemistry. Overall and progression-free survival for HPV-positive and -negative patients was estimated by Kaplan-Meier analysis and by the use of a multivariate Cox proportional hazards model. RESULTS: HPV DNA was detected in tumor tissue of 12 of 60 (20%) patients. HPV16 was identified in 11 tumors and HPV35 in 1. Immunohistochemistry for p16(INK4a) stained all HPV-positive and no HPV-negative tumors (P < .001). No differences were observed in terms of site and histological grade or stage at presentation between HPV-positive and -negative tumors. However, HPV-positive patients had a significantly better 5-year progression-free survival (62%; 95% confidence interval [CI], 23%-86% vs 20%; 95% CI, 9%-34%; P = .0043, log-rank test) and overall survival (80%; 95% CI, 20%-96% vs 31%; 95% CI, 15%-47%; P = .036, log-rank test) than patients with HPV-negative tumors. In multivariate analysis, HPV-positive tumors were associated with improved progression-free survival (hazard ratio, 0.21; 95% CI, 0.17-0.98; P = .012). CONCLUSIONS: A subgroup of sinonasal SCCs is associated with HPV infection. These tumors have a significantly better prognosis.

Slurry sampling in serum blood for mercury determination by CV-AFS.

The heavy metal mercury (Hg) is a neurotoxin known to have a serious health impact even at relatively low concentrations. A slurry method was developed for the sensitive and precise determination of mercury in human serum blood samples by cold vapor generation coupled to atomic fluorescence spectrometry (CV-AFS). All variables related to the slurry formation were studied. The optimal hydrochloric concentration and tin(II) chloride concentration for CV generation were evaluated. Calibration within the range 0.1-10 microg L(-1) Hg was performed with the standard addition method, and compared with an external calibration. Additionally, the reliability of the results obtained was evaluated by analyzing mercury in the same samples, but submitted to microwave-assisted digestion method. The limit of detection was calculated as 25 ng L(-1) and the relative standard deviation was 3.9% at levels around of 0.4 microg L(-1)Hg.

Cloud point extraction of mercury with PONPE 7.5 prior to its determination in biological samples by ETAAS.

Cloud point extraction (CPE) has been used for the pre-concentration of mercury, after the formation of a complex with 2-(5-bromo-2-pyridylazo)-5-(diethylamino)-phenol (5-Br-PADAP), and later analysis by electrothermal atomic absorption spectrometry (ETAAS) using polyethyleneglycolmono-p-nonyphenylether (PONPE 7.5) as surfactant. The chemical variables affecting the separation step were optimized. Under the optimum conditions, i.e, pH 8.5, cloud point temperature 80 degrees C, 5-Br-PADAP=4x10(-5) mol L(-1), PONPE 7.5=0.2%, sample volume=1.0 mL, an enhancement factor of 22-fold was reached. The lower limit of detection (LOD) obtained under the optimal conditions was 0.01 microg L(-1). The precision for 10 replicate determinations at 2.0 microg L(-1) Hg was 4.0% relative standard deviation (R.S.D.). The calibration graph using the pre-concentration system for mercury was linear with a correlation coefficient of 0.9994 at levels near the detection limits up to at least 16 microg L(-1). The method was successfully applied to the determination of mercury in biological samples and in certified reference material (QC METAL LL3).

Determination of cobalt in urine by FI-ICP-AES with online preconcentration.

A method for the preconcentration and determination of cobalt in human urine samples was developed. The online preconcentration and determination were attained using inductively coupled plasma atomic emission spectromety (ICP-AES) coupled to a flow injection (FI) method. Cobalt was retained on an Amberlite XAD-7 resin as cobalt-2-(5-bromo-2-pyridylazo)-5-diethylaminophenol complex at pH 9.5. Cobalt was removed from the microcolumn with perchloric acid. A sensitivity enhancement factor of 90 was obtained with respect to cobalt determination by ICP-AES without preconcentration. The value of detection limit for the preconcentration method proposed was 25 ng/L. The precision for 10 replicate determinations at the 5 mg/L (mean +/- SD, 5.1 +/- 0.14) Co level was 2.7% relative standard deviation, calculated from the peak heights obtained. The calibration graph preconcentration method for cobalt was linear with a correlation coefficient of 0.9994 from approximately 0.25 mg/L up to at least 100 mg/L. The method was successfully applied to the determination of cobalt in human urine samples.