Clinical Interpretation of Genetic Variants in the Evaluation and Management of Thoracic Aortic Aneurysm and Dissection.

BACKGROUND: We aimed to elucidate clinical implications of genetic variant interpretation in assessing disease severity and progression in thoracic aortic aneurysm and dissection (TAAD) patients. METHODS: Consecutive TAAD patients with aortic root and/or ascending aortic aneurysms seen between 2011 and 2020 were included. Serial echocardiography, family history of TAAD, and management information were retrospectively collected and analyzed. Patients were classified into gene-positive (Gen-P), variants of uncertain significance, and gene-negative (Gen-N) groups. RESULTS: A total of 407 patients were included: mean age 53.7 ± 15.4 years, 64.4% men, and 38% with reported family history of TAAD. Thirty-seven (9.1%) were Gen-P; 147 (36.1%) had a variant of uncertain significance. The maximal aneurysm diameter was 4.78 mm larger in Gen-P than the other groups (P < .001). In 162 unoperated TAAD patients with serial echocardiographic measurements, aneurysms enlarged at a significantly higher rate in the Gen-P (1.36 mm/year, 95% CI: 0.77-1.95) than variants of uncertain significance and Gen-N groups (0.83 mm/year vs 0.89 mm/year, respectively; P < .001). Aneurysms were 20% more likely to require surgical intervention for every millimeter increase in diameter. When considered on an individual basis, the highest growth rates were found in the variants of uncertain significance group. CONCLUSIONS: While aneurysms linked to variants of uncertain significance demonstrate average growth rates comparable to those in Gen-N, close follow-up and genetic counseling in the variants of uncertain significance group are recommended for assessment of pathogenicity on a case-by-case basis. Early familial gene testing in TAAD is important to develop individualized preventive and therapeutic criteria.

Survival Into the Seventh Decade of Life Following Mustard Repair.

Atrial switch procedures (Senning and Mustard) for transposition of the great arteries have largely been abandoned for arterial switch procedures. The number of surviving patients who have undergone atrial switch procedures is declining. We present a case of the oldest known survivor (aged 67 years) of the Mustard procedure. (Level of Difficulty: Beginner.).

Myocardial Work in Apical Hypertrophic Cardiomyopathy.

BACKGROUND: Pressure-strain loop analysis is a novel echocardiographic technique to calculate myocardial work indices that has not been applied to patients with apical hypertrophic cardiomyopathy (ApHCM). We hypothesized that myocardial work indices differ between patients with ApHCM and those with non-ApHCM. This study aimed to (1) evaluate myocardial work indices in patients with ApHCM compared with those with non-ApHCM, (2) describe associations with relevant clinical variables, and (3) examine associations with significant late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging. METHODS: We retrospectively identified 48 patients with ApHCM and 69 with non-ApHCM who had measurements of global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency. We evaluated available cardiac magnetic resonance imaging data on 34 patients with ApHCM and 51 with non-ApHCM. Multivariable regression models correcting for traditional cardiac risk factors were used to evaluate the associations of myocardial work indices with relevant clinical variables. RESULTS: Median GLS (-11% vs -18%, P < .001), GWI (966 mm Hg% vs 1803 mm Hg%, P < .001), and GCW (1,050 mm Hg% vs 1,988 mm Hg%, P < .001) were significantly impaired in patients with ApHCM compared with those with non-ApHCM. Increasing N-terminal pro b-type natriuretic peptide, abnormal ultrasensitive troponin, and increasing maximal left ventricular wall thickness were significantly associated with reduced GWI and GCW in patients with ApHCM (P < .05). Global constructive work had only modest accuracy (area under the curve [AUC] = 0.70) to predict LGE in patients with ApHCM. However, in patients with non-ApHCM, GLS was the strongest predictor of LGE (AUC = 0.91), with a -17% cutoff yielding 81% sensitivity and 80% specificity. CONCLUSION: Myocardial work indices are significantly impaired in patients with ApHCM compared to those with non-ApHCM and correlate with important clinical variables. Global longitudinal strain, GWI, and GCW are more strongly predictive of fibrosis in patients with non-ApHCM than ApHCM.

The search for commercial sweet white lupin (Lupinus albus L.) adaptive to Ethiopian growing condition seems not successful: what should be done?

The study was conducted to find new adaptive commercial sweet white lupin (Lupinus albus L.) varieties and evaluate the effect of inoculum on herbage and seed yields of white and blue lupin varieties in Ethiopia for two growing seasons in two locations. For the experiment a factorial arrangement (seven variety * two inoculation) in a randomized complete block design with three replication was used. Three sweet blue (Bora, Sanabor and Vitabor), three sweet white (Dieta, Energy and Feodora) and one bitter white local landrace lupin varieties were tested in the experiment. Analysis of variance was done using the general linear model procedure in SAS. The effects of location and inoculum were insignificant (P ≥ 0.0761) on yield and yield parameters. The effect of variety was observed (P ≤ 0.035) only on plant height, fresh biomass yield and thousand seed weight in both seasons except for fresh biomass yield in season two. However, its effect on other parameters was not shown (P ≥ 0.134) in both growing seasons or only shown in either season. The mean dry matter yield of all varieties was 2.45 ton per ha. However, sweet blue entries performed better than white entries. The mean seed yield of blue sweet lupin entries and white local check was 2.6 ton per ha. Sweet blue and white local landrace varieties were found tolerant while, commercial sweet white lupin varieties were susceptible for anthracnose and fusarium diseases that occurred immediately after flowering. As a result imported commercial sweet white varieties failed to give seed yield. Developing adaptive, disease resistant and high yielding sweet white lupin through crossing the local and commercial varieties and looking for species specific inoculum should be the future research agendas.

Pangenome of white lupin provides insights into the diversity of the species.

White lupin is an old crop with renewed interest due to its seed high protein content and high nutritional value. Despite a long domestication history in the Mediterranean basin, modern breeding efforts have been fairly scarce. Recent sequencing of its genome has provided tools for further description of genetic resources but detailed characterization of genomic diversity is still missing. Here, we report the genome sequencing of 39 accessions that were used to establish a white lupin pangenome. We defined 32 068 core genes that are present in all individuals and 14 822 that are absent in some and may represent a gene pool for breeding for improved productivity, grain quality, and stress adaptation. We used this new pangenome resource to identify candidate genes for alkaloid synthesis, a key grain quality trait. The white lupin pangenome provides a novel genetic resource to better understand how domestication has shaped the genomic variability within this crop. Thus, this pangenome resource is an important step towards the effective and efficient genetic improvement of white lupin to help meet the rapidly growing demand for plant protein sources for human and animal consumption.

Familial LEOPARD Syndrome With Hypertrophic Cardiomyopathy.

Multiple lentigines syndrome is an autosomal dominant inherited condition with variable expressivity that is also known as LEOPARD syndrome. LEOPARD stands for lentigines, electrocardiographic conduction defects, ocular hypertelorism, pulmonary valve stenosis, abnormalities of genitalia, retardation of growth, and deafness. LEOPARD syndrome most frequently develops secondary to a missense mutation of protein-tyrosine phosphatase nonreceptor type 11 gene, which encodes tyrosine phosphatase. The missense mutation p.Tyr279Cys can either occur as a de novo mutation or affect multiple family members. Although hypertrophic cardiomyopathy is not part of the LEOPARD acronym, it is the most frequent cardiac anomaly observed in this syndrome. The recognition of increased left or right ventricular wall thickness in patients with LEOPARD syndrome may have significant impact on their clinical course similar to classic hypertrophic cardiomyopathy, which may require septal reduction procedures for relief of left or right ventricular outflow tract obstruction or implantable cardioverter-defibrillator placement for sudden cardiac death prevention. We describe a case series of a family with diffuse lentigines and hypertrophic cardiomyopathy in which the son carries the protein-tyrosine phosphatase nonreceptor type 11 (p.Tyr279Cys) gene mutation and both the son and daughter underwent left ventricular myectomy at an early age. In conclusion, our case series of a family with LEOPARD syndrome illustrates the importance of recognizing hypertrophic cardiomyopathy as part of this syndrome.

Invasive Wild Pigs as Primary Nest Predators for Wild Turkeys.

Depredation of wild turkey (Meleagris gallopavo) nests is a leading cause of reduced recruitment for the recovering and iconic game species. Invasive wild pigs (Sus scrofa) are known to depredate nests, and have been expanding throughout the distributed range of wild turkeys in North America. We sought to gain better insight on the magnitude of wild pigs depredating wild turkey nests. We constructed simulated wild turkey nests throughout the home ranges of 20 GPS-collared wild pigs to evaluate nest depredation relative to three periods within the nesting season (i.e., early, peak, and late) and two nest densities (moderate = 12.5-25 nests/km2, high = 25-50 nests/km2) in south-central Texas, USA during March-June 2016. Overall, the estimated probability of nest depredation by wild pigs was 0.3, equivalent to native species of nest predators in the study area (e.g., gray fox [Urocyon cinereoargenteus], raccoon [Procyon lotor], and coyote [Canis latrans]). Female wild pigs exhibited a constant rate of depredation regardless of nesting period or density of nests. However, male wild pigs increased their rate of depredation in areas with higher nest densities. Management efforts should remove wild pigs to reduce nest failure in wild turkey populations especially where recruitment is low.

Kinetics of 99Tc speciation in aerobic soils.

Technetium-99 is a significant and long-lived component of spent nuclear fuel relevant to long-term assessments of radioactive waste disposal. Whilst 99Tc behaviour in poorly aerated environments is well known, the long-term bioavailability in aerobic soils following direct deposition or transport to the surface is less well understood. This work addresses two questions: (i) to what extent do soil properties control 99Tc kinetics in aerobic soils and (ii) over what experimental timescales must 99Tc kinetics be measured to make reliable long-term predictions of impact in the terrestrial environment? Soil microcosms spiked with 99TcO4- were incubated for 2.5 years and 99Tc transformations were periodically monitored by a sequential extraction, which enabled quantification of the reaction kinetics. Reduction in soluble 99Tc was slow and followed a double exponential kinetic model including a fast component enhanced by low pH, a slow component controlled by pH and organic matter, and a persistently soluble 99Tc fraction. Complexation with soil humus was key to the progressive immobilisation of 99Tc. Evidence for slow transfer to an unidentified 'sink' was found, with estimated decadal timeframes. Our data suggest that short-term experiments may not reliably predict long-term 99Tc solubility in soils with low to moderate organic matter contents.

Evaluation of movement behaviors to inform toxic baiting strategies for invasive wild pigs (Sus scrofa).

BACKGROUND: Invasive wild pigs damage agriculture, property, and natural ecosystems. To curtail damage, an effective and humane toxic bait containing microencapsulated sodium nitrite is under development. Strategies for delivering the toxic bait are needed to establish adequate spacing of bait sites, and for simultaneously accustoming wild pigs to the novel bait and wild pig-specific bait stations designed to exclude non-target species. RESULTS: We monitored movements of 32 Global Positioning System (GPS)-collared wild pigs relative to 41 bait sites containing placebo bait. Among the bait sites, we compared three experimental baiting strategies (and a control) to evaluate which strategy led to the most wild pigs accessing the placebo bait inside bait stations. We found that bait sites should be spaced 0.5-1 km apart to maximize opportunities for all wild pigs to find and utilize the bait sites. Baiting strategies that allowed ≥ 15 days for accustoming wild pigs to bait stations were most effective and resulted in nearly 90% of wild pigs accessing the placebo bait inside the bait stations. Bait stations excluded all non-target animals, except one instance with a raccoon (Procyon lotor). CONCLUSION: These results demonstrate the potential for toxic bait to be an effective tool for reducing populations of wild pigs with minimal risks to non-target species, if optimized delivery procedures are followed. © 2018 Society of Chemical Industry.

Hypertrophic cardiomyopathy clinical phenotype is independent of gene mutation and mutation dosage.

Over 1,500 gene mutations are known to cause hypertrophic cardiomyopathy (HCM). Previous studies suggest that cardiac ß-myosin heavy chain (MYH7) gene mutations are commonly associated with a more severe phenotype, compared to cardiac myosin binding protein-C (MYBPC3) gene mutations with milder phenotype, incomplete penetrance and later age of onset. Compound mutations can worsen the phenotype. This study aimed to validate these comparative differences in a large cohort of individuals and families with HCM. We performed genome-phenome correlation among 80 symptomatic HCM patients, 35 asymptomatic carriers and 35 non-carriers, using an 18-gene clinical diagnostic HCM panel. A total of 125 mutations were identified in 14 genes. MYBPC3 and MYH7 mutations contributed to 50.0% and 24.4% of the HCM patients, respectively, suggesting that MYBPC3 mutations were the most frequent cause of HCM in our cohort. Double mutations were found in only nine HCM patients (7.8%) who were phenotypically indistinguishable from single-mutation carriers. Comparisons of clinical parameters of MYBPC3 and MYH7 mutants were not statistically significant, but asymptomatic carriers had high left ventricular ejection fraction and diastolic dysfunction when compared to non-carriers. The presence of double mutations increases the risk for symptomatic HCM with no change in severity, as determined in this study subset. The pathologic effects of MYBPC3 and MYH7 were found to be independent of gene mutation location. Furthermore, HCM pathology is independent of protein domain disruption in both MYBPC3 and MYH7. These data provide evidence that MYBPC3 mutations constitute the preeminent cause of HCM and that they are phenotypically indistinguishable from HCM caused by MYH7 mutations.

Use of Essential Oils Following Traumatic Burn Injury: A Case Study.

Hospital admissions related to burn injury reach 40,000 annually. Patients who experience extensive burns require longer hospital stays and are at increased risk for infection and hospital acquired conditions. This comparative case study is a two patient matched case control design that follows the hospital course of two children who experienced burn injuries. For one of these patients, with the consent of the child's parents, the grandmother treated her granddaughter with essential oils. Essential oils have the potential to inhibit microbial growth, support treatment of wounds, and facilitate healing. However, there have been no large scale studies on essential oils. Data for the two cases were retrieved from the electronic medical record at a Midwestern Pediatric Hospital. Retrieved data included burn site description, treatment for burns, number of days on the ventilator, white blood cell count, length of hospital stay, number of ICU days, infections diagnosed by positive culture and pain ratings. While the goals for treatment were the same for both children, the child who received only standard care was diagnosed with two blood stream infections and four hospital acquired conditions while the child who received supplemental treatment with essential oils did not develop any blood stream infections, was diagnosed with one hospital acquired condition, was in the PICU one day less, and had a four day shorter length of hospital stay. While these case findings are intriguing, research is needed to expand understanding of the role of essential oils in the treatment of burns.

Mutation Yield of a 34-Gene Solid Tumor Panel in Community-Based Tumor Samples.

BACKGROUND: Several targeted therapies have been approved for treatment of solid tumors. Identification of gene mutations that indicate response to these therapies is rapidly progressing. A 34-gene next-generation sequencing (NGS) panel, developed and validated by us, was evaluated to detect additional mutations in community-based cancer specimens initially sent to our reference laboratory for routine molecular testing. METHODS: Consecutive de-identified clinical specimens (n = 121) from melanoma cases (n = 31), lung cancer cases (n = 27), colorectal cancer cases (n = 33), and breast cancer cases (n = 30) were profiled by NGS, and the results were compared with routine molecular testing. RESULTS: Upon initial mutation testing, 20 % (24/121) were positive. NGS detected ≥1 additional mutation not identified by routine testing in 74 % of specimens (90/121). Of the specimens with additional mutations, 16 harbored mutations in National Comprehensive Cancer Network guideline genes. These various additional mutations were in gene regions not routinely covered, in genes not routinely tested, and/or present at low allele frequencies. Moreover, NGS yielded no false negatives. Overall, NGS detected mutations in 59 % of the genes (20/34) included in the panel, 75 % of which (15/20) were detected in multiple tumor types. Mutations in TP53 were found in 51 % of tumors tested (62/121). Mutations in at least one other (non-TP53) gene present in the panel were detected in 64 % of cases (77/121). CONCLUSION: This assay provides improved breadth and sensitivity for profiling clinically relevant genes in these prevalent solid tumor types.

High-efficiency stable transformation of the model fern species Ceratopteris richardii via microparticle bombardment.

Ferns represent the most closely related extant lineage to seed plants. The aquatic fern Ceratopteris richardii has been subject to research for a considerable period of time, but analyses of the genetic programs underpinning developmental processes have been hampered by a large genome size, a lack of available mutants, and an inability to create stable transgenic lines. In this paper, we report a protocol for efficient stable genetic transformation of C. richardii and a closely related species Ceratopteris thalictroides using microparticle bombardment. Indeterminate callus was generated and maintained from the sporophytes of both species using cytokinin treatment. In proof-of-principle experiments, a 35S::ß-glucuronidase (GUS) expression cassette was introduced into callus cells via tungsten microparticles, and stable transformants were selected via a linked hygromycin B resistance marker. The presence of the transgene in regenerated plants and in subsequent generations was validated using DNA-blot analysis, reverse transcription-polymerase chain reaction, and GUS staining. GUS staining patterns in most vegetative tissues corresponded with constitutive gene expression. The protocol described in this paper yields transformation efficiencies far greater than those previously published and represents a significant step toward the establishment of a tractable fern genetic model.

Detection of BRAF V600 mutations in metastatic melanoma: comparison of the Cobas 4800 and Sanger sequencing assays.

Detection of the BRAF V600E mutation is required for use of the BRAF inhibitor, vemurafenib, in patients with metastatic melanoma. Although the Roche Cobas 4800 BRAF V600 Mutation Test is approved, it detects primarily the single-nucleotide V600E mutation and could miss other potentially relevant V600 mutations. To assess the detection rate of the cobas assay for V600 mutations in clinical specimens, we compared the results of this assay with Sanger sequencing in 295 melanoma FFPE samples. Twenty samples were excluded because of invalid results on the cobas (n = 3), sequencing (n = 15), or both (n = 2). V600 mutations were detected by the cobas test in 96 (34.9%) of 275 samples and by Sanger sequencing in 118 (42.9%) of 275 samples. Thus, relative to Sanger sequencing, the cobas test exhibited 80.5% sensitivity (95% CI, 72.4% to 86.6%) and 99.4% specificity (95% CI, 96.5% to 99.9%). Of 23 samples with positive sequencing results but negative cobas results, 21 harbored dinucleotide mutations (V600E in 6, V600K in 10, and V600R in 5); the other two involved single-nucleotide mutations (V600E and V600G). These findings indicate that the cobas assay may miss many V600 mutations in clinical specimens. In our study, the addition of Sanger sequencing for samples with negative cobas results increased the detection rate to 42.9%. This approach could help maximize the number of patients who benefit from BRAF inhibitor treatment.