Clinical Exome Sequencing as a Novel Tool for Diagnosing Loeys-Dietz Syndrome Type 3.

OBJECTIVE/BACKGROUND: In rare genetic vascular syndromes the diagnosis may not be apparent from the phenotype, but might be important for proper management. METHODS: A previously healthy woman without dysmorphic features presented with pregnancy associated vascular dissections and aneurysms. Next generation clinical exome sequencing was performed. RESULTS: The differential diagnosis of spontaneous arterial dissection is outlined. The patient's diagnosis became evident after clinical exome sequencing detected a novel missense mutation in the evolutionary conserved region of SMAD3, confirming the diagnosis of Loeys-Dietz syndrome (LDS) type 3. A brief overview of the various types of LDS and their management is presented. CONCLUSION: Clinical exome sequencing proved useful in diagnosing LDS type 3 where detailed vascular surveillance and timely intervention with a low threshold is recommended.

Computer-based assessment for facioscapulohumeral dystrophy diagnosis.

The paper presents a computer-based assessment for facioscapulohumeral dystrophy (FSHD) diagnosis through characterisation of the fat and oedema percentages in the muscle region. A novel multi-slice method for the muscle-region segmentation in the T1-weighted magnetic resonance images is proposed using principles of the live-wire technique to find the path representing the muscle-region border. For this purpose, an exponential cost function is used that incorporates the edge information obtained after applying the edge-enhancement algorithm formerly designed for the fingerprint enhancement. The difference between the automatic segmentation and manual segmentation performed by a medical specialists is characterised using the Zijdenbos similarity index, indicating a high accuracy of the proposed method. Finally, the fat and oedema are quantified from the muscle region in the T1-weighted and T2-STIR magnetic resonance images, respectively, using the fuzzy c-mean clustering approach for 10 FSHD patients.

Detection of the electrocardiogram fiducial points in the phase space using the Euclidian distance measure.

The paper proposes a phase-space based algorithm applying the Euclidian distance measure enabling detection of heartbeats and characteristic (fiducial) points from a single-lead electrocardiogram (ECG) signal. It extends the QRS detection in the phase space by detecting the P and T fiducial points. The algorithm is derived by reconstructing the ECG signals in a two-dimensional (2D) phase space according to the delay method and utilizes geometrical properties of the reconstructed phase portrait of the signal in the phase space for the heartbeat and fiducial-point detection. It uses adaptive thresholding and the Euclidian distance measure between the signal points in the phase portrait as an alternative to the phase-portrait area calculation (Lee et al., 2002). It was verified with the QT Database (2011) and its performance was assessed using sensitivity (Se) and the positive predictive value (PPV). Results for the proposed algorithm are 99.06%, 99.75% and 99.66% for Se and 94.87%, 99.75% and 99.66% for PPV for the P points, heartbeats and T points, respectively.

Transport of endogenous nucleosides in guinea pig heart.

The purpose of this study was to investigate the characteristics of transport of endogenous nucleosides into cardiac tissue from coronary circulation. The study was performed on the isolated perfused guinea pig heart, using the rapid paired tracers single-pass technique. The maximal cellular uptake (U(max)) and total cellular uptake (U(tot)) of adenosine, deoxyadenosine, thymidine, uridine, and cytidine were determined. The cellular uptake of adenosine was significantly higher than the cellular uptake of other studied nucleosides. To elucidate the mechanisms of nucleoside transport, competition studies were performed and the influence of S-(p-nitrobenzyl)-6-thioinosine (NBTI) and sodium ion absence on U(max) and U(tot) was investigated. Self- and cross-inhibition studies indicated the saturable mechanism of nucleosides transport into cardiac tissue and the involvement of different transport mechanisms for purine and pyrimidine nucleosides. The study also showed that both equilibrative-sensitive (es) and sodium-dependent transport were responsible for adenosine and thymidine cellular uptake.

[Treatment and results of therapy in autoimmune hemolytic anemia]. / Lecenje i rezultati lecenja autoimunske hemoliticke anemije.

Basic principles in the therapy of idiopathic autoimmune hemolytic anemia induced by warm antibody were glucocorticoides and splenectomy. Immunosupresive drugs, plasmaferesis and intravenous high doses gamma globulin therapy are also useful. In secundary autoimmune hemolytic anemia induced by warm antibody we treated basic illness. During the period of 1990-1992 we treated 21 patients with primary autoimmune hemolytic anemia and 6 patients with secondary /4 CLL and 2 Non-Hodgkin's lymphoma/. Complete remission we found as a normalisation of reticulocites and hemoglobin level respectively. Complete remission by corticoides we got in 14/21 patients, partial response in 2/21 respectively. Complete response by splenectomy we got in 2/3 splenoctomized patients (idiopathic type). For successful treatment secondary hemolytic anemias we treated primary diseases (CLL and malignant lymphoma) and we got in 4/6 patients complete remission. Our results were standard in both type of autoimmune hemolytic anaemias induced by warm antibody.

[Treatment and results of therapy in chronic idiopathic thrombocytopenic purpura]. / Lecenje rezultati lecenja hronicne imunske trombositopenije.

Basic principles in the therapy of chronic idiopathic thrombocytopenic purpura are glucocorticoides and splenectomy. Other measures: Intravenous high doses gamma globulin therapy, attenuated androgenes, immunosupresive drugs and plasmaferesis are less effective. During the period of 1989-1992 we treated 34 patients. From 34 patients, 23 were women and 11 were men. We treated patients primarily by prednisolon approximaly for 2 - 4 weeks. Rarely we use doses of 3 mg/kg per day for short periods of time (5 to 10 days) or "pulse therapy" of 500 mg per day. Those doses may be effective in elevating platelet count if the response is poor. If response occurs, high dosages of steroides should be tareped to determine the amount that will maintain the platelet count in the range of 30x10(9)/l to 50x10(9)/l (to minimaze the toxic sade effects of steroides). If steroides are ineffective, we perform splenectomy. From 34 treated patients by glucocorticoides, in 16 we got remission and in 11 partial response. We discussed in detailes relationship duration of treatment with glucocorticoides and level of platelets, and also correlation duration of treatment with prognosis. From 6 splenectomized patients 3 were successful. In two patients we applied intravenous gamma globulin therapy and attenuated androgen successfuly. In one patients therapy with gamma globulin, immunosupresive drugs, androgen and other measures was ineffective. In one patients without splenectomy we administrated successfuly gamma globulin therapy and androgen for peroid of two years.