Syndrome Phenotype Research Articles

ART outcomes in lean compared to obese phenotypes of polycystic ovarian syndrome.

To investigate differences in reproductive outcomes among IVF patients with lean compared to obese polycystic ovarian syndrome (PCOS) phenotypes. A retrospective cohort study of patients with PCOS who underwent IVF in a single, academically affiliated infertility center in the USA between December 2014 and July 2020. The diagnosis of PCOS was assigned based on Rotterdam criteria. Patients were designated as lean (< 25) or overweight/obese (≥ 25) PCOS phenotype based on BMI (kg/m2) at cycle start. Baseline clinical and endocrinologic laboratory panel, cycle characteristics, and reproductive outcomes were analyzed. The cumulative live birth rate included up to 6 consecutives cycles. A Cox proportional hazards model and Kaplan-Meier curve for estimating live birth rates were used to compare the two phenotypes. A total of 1395 patients who underwent 2348 IVF cycles were included. The mean (SD) BMI was 22.7 (2.4) in the lean and 33.8 (6.0) in the obese group (p < 0.001). A number of endocrinological parameters were similar between lean and obese phenotypes: total testosterone 30.8ng/dl (19.5) vs 34.1 (21.9), p > 0.02 and pre-cycle hemoglobin A1C 5.33% (0.38) vs 5.51% (0.51) p > 0.001, respectively. The CLBR was higher in those with a lean PCOS phenotype: 61.7% (373/604) vs 54.0% (764/1414) respectively. Miscarriage rates were significantly higher for O-PCOS patients (19.7% (214/1084) vs 14.5% (82/563) p < 0.001) and the rate of aneuploids was similar (43.5%, 43.8%, p = 0.8). A Kaplan-Meier curve estimating the proportion of patients with a live birth was higher in the lean group (log-rank test p = 0.013). After adjusting for potential confounders, the lean phenotype was associated with an increased hazard ratio for live birth: HR = 1.38 p < 0.001. Lean PCOS phenotype is associated with a significantly higher CLBR compared to their obese counterparts. Miscarriage rates were significantly higher among obese patients, despite comparable pre-cycle HBA1C and similar aneuploidy rates in patients who underwent PGT-A.

Consider Non-Syndromic Mitochondrial Disorders as Part of the Pediatric Phenotypic Spectrum

With interest we read the article by Ardissone et al. about a retrospective, singlecenter study of 150 pediatric patients with a genetically confirmed mitochondrial disorder (MID) due to a pathogenic mtDNA variant (mtDNA point mutation or single mtDNA deletion) [1]. The study is excellent but has limitations that are cause of concerns and should be discussed. A limitation of the study is that only syndromic MIDs were included [1]. Since MIDs often do not fit into any of the syndromic phenotypes, we should know whether these patients were deliberately excluded or did not appear at the study center at all. We should know whether the entire group of 902 patients also included patients with nonsyndromic MIDs. Another limitation is that heteroplasmy rates were only determined by estimating the densitometric ratio between wild-type and mutant mtDNA [1]. Heteroplasmy is usually determined by a number of quantitative methods, such as Sanger sequencing, high performance liquid chromatography, pyrosequencing, Snapshot, high resolution melt profiling (HRM), temporal temperature gradient gel electrophoresis (TTGE), invader assay, amplification refractory mutation system (ARMS), endonuclease method using Surveyor nuclease, and next generation sequencing (NGS) [2]. These techniques usually provide more accurate results than semi-quantitative estimation. There is a discrepancy between the statement in the method section ("only few data were not available from all patients”) and the results section (“CSF data were available from only 17 %, follow-up data only from 47%, and biochemical data only from 58 % of patients”) [1]. This discrepancy should be clarified. Another limitation is that the total observation time up to the last follow-up was not given [1]. Knowing this latency is important to assess the speed of disease progression and estimate the outcome. There is also a discrepancy between the statement in the result section that “outcome data were evaluated from 70 patients” and the detailed description in the results section, which included 71 patients. Which number is correct? Surprisingly, the biochemical examination was normal in almost a quarter of the patients with Leigh syndrome. We should know if these results are from studies of just muscle or fibroblasts, or if other tissues have been studied as well If only muscle or fibroblasts were examined, we should know whether or not these tissues were clinically affected in the one quarter of the Leigh patients. Surprisingly, only two thirds of the MELAS patients presented with stroke-like episodes (SLEs), which are pathognomonic for MELAS. We should know if this was due to the short observation or follow-up time in these patients. According to what criteria were these patients without SLE classified as MELAS? Were the Hirano or Japanese criteria applied? We should also know how “MELAS-like” was defined. There is no mention of the underlying mutations in the PEO patients. It would be interesting to know if these patients all carried a single mtDNA deletion, a nuclear DNA-located variant, or an mtDNA point mutation. Overall, the interesting study has limitations that call the results and their interpretation into question. With a prospective design and extensive and long-term follow-up, the study goals could be better achieved.

Glucagon-like Peptide 1 Receptor Agonists for the Treatment of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Since the Polycystic Ovary Syndrome (PCOS) phenotype might change at different points in a person's life, individualized diagnosis and treatment are required. Since glucagon-like peptide 1 (GLP-1) receptor agonists (RA) improve insulin sensitivity and reduce the risk of cardiovascular disease, they offer a unique opportunity to treat many comorbid diseases and phenotypic aspects of (PCOS) all at once.&#x0D; Methods: The PICO framework—which includes the terms "participants," "intervention," "control," and "outcome"—formed the basis for the search parameters. The appropriate research publications were identified by searching many databases, including Web of Sciences, PubMed, Scopus and PRISMA flow chart was constructed. RevMan 5.4 was utilized for the meta-analysis, while RoB-2.0 was employed for quality control.&#x0D; Results: After following PRISMA, 14 research articles were included in the present systematic review and meta-analysis. GLP-1 RAs alone or in combination gave good results when compared with control/placebo/other drugs. In the meta-analysis, GLP-1 RA was compared to control (Metformin, a comparative drug, a placebo, and other treatments) for Menestral frequency rate (MFR), Free Androgen Index (FAI), Homeostasis Model Assessment-estimated Insulin Resistance (HOMA-IR), and Total Testosterone (Total T). The results showed that GLP-1 RA had a statistically significant effect on MFR and Total T, indicating that the intervention was more effective than the control group but had no effect on FAI and HOMA-IR, suggesting that both GLP-1 RA and the control group were equally effective. When the quality assessment was done, 7 studies had low risk of bias, and 7 had some concerns, while no study had a high risk of bias.&#x0D; Conclusion: GLP-1 RAs may be suitable for obese patients with PCOS, particularly those with insulin resistance. However, as 7 studies had questions about randomization. There has to be more high-quality studies conducted on GLP-1 RAs to determine their effectiveness for PCOS in women.

Thyroid Peroxidase Antibodies in Infertile Women with Polycystic Ovary Syndrome.

To compare the rate of positive thyroid peroxidase antibodies (TPO Ab) between women with different polycystic ovary syndrome (PCOS) phenotypes and women without PCOS. This is a retrospective cohort study. Women with PCOS at My Duc Hospital between June 1, 2020, and March 27, 2021, were matched with non-PCOS women by age. TPO Ab (cut-off: 34IU/mL) and thyroid-stimulating hormone (TSH) levels were measured as markers of Hashimoto thyroiditis and thyroid function, respectively. One thousand eight hundred eight infertile women were included, 904 with PCOS (mean age 29.0 ± 3.58years) and 904 without PCOS (29.1 ± 3.4years; controls). Women with PCOS had a higher body mass index (22.8 ± 3.84 vs. 19.9 ± 2.23kg/m2, p < 0.001), but most were not overweight/obese. Rates of positive TPO Ab in women with versus without PCOS were 8.2% and 8.4%, respectively (p = 0.932). Rates of positive TPO Ab in patients with PCOS phenotype A, B, C, or D were not statistically different (7.5%, 2.9%, 20.0%, and 7.8%, respectively). Median TSH concentrations were similar in the PCOS and control groups (1.84 mIU/L vs. 1.78 mIU/L, respectively; p = 0.194). Based on a linear regression model, there was no correlation between either BMI or the estradiol to progesterone ratio and TPO Ab status. In a large population of infertile women with PCOS who were mostly lean patients, rates of positive TPO Ab across all four PCOS phenotypes did not differ significantly from those in women without PCOS. These findings did not support the hypothesis that PCOS is a risk factor for Hashimoto thyroiditis.

MATERNAL PROTEIN MALNUTRITION DURING LACTATION PREDISPOSES TO A METABOLIC SYNDROME PHENOTYPE IN MALE WISTAR RATS

Maternal nutritional insults during lactation can modulate the offspring phenotype associatedwith the risk of non-communicable diseases at different stages of ontogenetic development.The aim of this research was to analyze biometric and biochemical parameters of male Wistarrats, born to dams fed a low-protein diet in the first two-thirds of lactation. Therefore, themothers received ad libitum a normal (NP, 23%) or low-protein (LP, 4%) diet, originatingtwo experimental groups that were evaluated at 14 days old (NP-14 and LP-14). The resultsshowed that the LP-14 offspring male rats had lower body weight (p&amp;lt;0.0001), reduced liver(p&amp;lt;0.0001) and higher brown fat deposits (p&amp;lt;0.0001), compared to the equivalent control.They also exhibited hyperglycemia (p&amp;lt;0.05), hypercholesterolemia (p&amp;lt;0.0001), and increasedserum β-hydroxybutyrate (p&amp;lt;0.0001), contrasting with reduced triglycerides (p&amp;lt;0.05) levels.We conclude that maternal exposure to a low-protein diet during lactation was able toprogram 14-day-old male neonates to develop a metabolic syndrome phenotype, probably dueto restriction of body and visceral growth in these animals.

Bi-allelic variants of FILIP1 cause congenital myopathy, dysmorphism and neurological defects.

Filamin-A-interacting protein 1 (FILIP1) is a structural protein that is involved in neuronal and muscle function and integrity and interacts with FLNa and FLNc. Pathogenic variants in filamin-encoding genes have been linked to neurological disorders (FLNA) and muscle diseases characterized by myofibrillar perturbations (FLNC), but human diseases associated with FILIP1 variants have not yet been described. Here, we report on five patients from four unrelated consanguineous families with homozygous FILIP1 variants (two nonsense and two missense). Functional studies indicated altered stability of the FILIP1 protein carrying the p.[Pro1133Leu] variant. Patients exhibit a broad spectrum of neurological symptoms including brain malformations, neurodevelopmental delay, muscle weakness and pathology and dysmorphic features. Electron and immunofluorescence microscopy on the muscle biopsy derived from the patient harbouring the homozygous p.[Pro1133Leu] missense variant revealed core-like zones of myofibrillar disintegration, autophagic vacuoles and accumulation of FLNc. Proteomic studies on the fibroblasts derived from the same patient showed dysregulation of a variety of proteins including FLNc and alpha-B-crystallin, a finding (confirmed by immunofluorescence) which is in line with the manifestation of symptoms associated with the syndromic phenotype of FILIP1opathy. The combined findings of this study show that the loss of functional FILIP1 leads to a recessive disorder characterized by neurological and muscular manifestations as well as dysmorphic features accompanied by perturbed proteostasis and myopathology.

Correlation between Selected Clinical Symptoms and Severity of Aggression, Impulsiveness and Their Selected Behavioral Manifestations in Patients with Polycystic Ovary Syndrome Phenotype A.

Previous studies on aggressiveness and impulsiveness in women with polycystic ovary syndrome (PCOS) are ambiguous. Furthermore, no biochemical or clinical factors related to these variables have been definitively confirmed. The aim of the study was to clarify whether, in women with phenotype A of PCOS, variables such as body mass index and clinical and biochemical hyperandrogenism have an impact on either the intensity of impulsivity or aggression or on other selected behavioral manifestations of these variables. The study included 95 patients diagnosed with PCOS phenotype A. The criterion for recruitment into the study group and the control group was body mass index. The study was conducted with the use of a closed-format questionnaire and calibrated clinical scales. Higher body mass index (BMI) values in women with PCOS phenotype A are associated with poor eating habits. The severity of impulsivity and aggression syndrome, as well as the tendency to engage in risky sexual behavior and patterns of alcohol consumption among patients diagnosed with PCOS phenotype A, are not dependent on BMI. The severity of impulsiveness and the syndrome of aggression in women with phenotype A PCOS are not associated with clinical symptoms of hyperandrogenism or with androgen levels.

Polycystic ovary syndrome phenotype and therapeutic outcomes

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Two novel CSNK2A1 variants associated with mild Okur-Chung neurodevelopmental syndrome phenotype.

Wafik, Mohameda; Kuoppamaa, Heidib; Hirani, Priyalb; Hignett, Johnb; Lillis, Suzanneb; Lascelles, Karinec; Sardesai, Shwetad; Gomez, Kumudinie; Holder-Espinasse, Muriela Author Information

Clinical and Hormonal Profile of Polycystic Ovary Syndrome Phenotypes

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous androgen-excess disorder with varying degrees of reproductive and metabolic abnormalities, whose diagnosis is based on anthropometric, biochemical, and radiological abnormalities. This study was conducted to observe the frequency of different phenotypes of PCOS and to observe the pattern of clinical profile and hormonal changes among them. Methods: This cross-sectional observational study was conducted at the Endocrinology and Obstetrics and Gynecology Outpatient Department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine, and Metabolic Disorders over the period of 13 months, dated from April 2016 to April 2017. Eighty patients clinically diagnosed as a case of PCOS were included in this study as per inclusion and exclusion criteria. Patients were categorized into four different phenotypes based on the presence of oligo-anovulation (O), hyperandrogenism (H), and polycystic ovarian morphology (P): (i) Phenotype A (O + H + P), (ii) Phenotype B (O + H), (iii) Phenotype C (H + P), and (iv) Phenotype D (O + P). Demographic, clinical, anthropometric, and hormonal profiles were recorded and compared among phenotypes of PCOS by ANOVA and Chi-square test. Results: Most prevalent phenotype in the study population was Phenotype A (55%), followed by Phenotype D (22.5%), Phenotype B (15%), and Phenotype C (7.5%). Hirsutism, acne, acanthosis nigricans, and family history of diabetes mellitus were more common in Phenotype A and Phenotype B than in Phenotype C and Phenotype D (P &lt; 0.001, P = 0.029, P = 0.008, and P = 0.048, respectively). Relatively, higher body mass index, waist circumference, and waist–hip ratio were found in Phenotypes A and B than in other phenotypes (P &lt; 0.001, P &lt; 0.001, and P &lt; 0.001, respectively). Phenotypes A and B had higher serum total testosterone, luteinizing hormone (LH), free androgen index, and lower sex hormone-binding globulin than other phenotypes (P = 0.003, P = 0.007, P = 0.001, and P &lt; 0.001, respectively). Follicle-stimulating hormone (FSH), LH/FSH ratio, prolactin, and thyroid-stimulating hormone were comparable in all phenotypes (P 0.445, 0.204, 0.748, and 0.811, respectively). Conclusions: The PCOS in certain subgroups such as Phenotypes A and B had higher hyperandrogenism and was associated with adverse anthropometric and clinical parameters. Clinical and hormonal findings are different in different phenotypes.

TYRO3 protects podocyte via JNK/c-jun-P53 pathway.

Podocyte injury plays a critical role in diabetic nephropathy (DN). Our previous work demonstrated a protective role of tyrosine-protein kinase receptor TYRO3 in glomerular disease; However, the downstream signaling of TYRO3 remains unclear. Our data showed that genetic ablation of tyro3 in zebrafish recapitulated a nephrotic syndrome phenotype. TYRO3 expression was suppressed by high glucose and TGF-β, which may contribute to decreased TYRO3 expression in progressive DN. Moreover, knockdown of TYRO3 expression with siRNA induced podocytes apoptosis and cytoskeleton rearrangement. Further study revealed that TYRO3 conferred antiapoptotic effects through the activation of JNK/c-jun-P53 in podocytes. Our results revealed a novel signaling module of TYRO3 in podocyte homeostasis, which provides a new molecular insight of TYRO3 effect in podocyte protection.

Abstract #1401109: Quetiapine-induced Hypoglycemia in an Elderly Non-diabetic Patient with Dementia

Quetiapine is a second-generation antipsychotic agent (SGA) widely prescribed for the treatment of psychotic and mood disorders. In elderly patients, quetiapine is often used to treat psychotic symptoms associated with dementia. A metabolic syndrome phenotype of weight gain, hyperglycemia, and hyperlipidemia is a potential adverse effect of SGA’s, though hypoglycemia caused by SGA’s is documented. We report a case of quetiapine-induced hypoglycemia in a non-diabetic patient. A 79-year-old male with Lewy body dementia was admitted to hospital for management of a myocardial infarction. The patient had no history of diabetes mellitus, renal failure, or hepatic insufficiency, and nobody living with the patient was treated for diabetes. Plasma glucose on admission was 84 mg/dL. Quetiapine was started to control delirium, but within 24 h the patient had worsening confusion and a capillary blood glucose (CBG) measurement of 52 mg/dL. Symptoms improved with administration of dextrose, and the patient ultimately required a 10% dextrose infusion to maintain CBG’s >80 mg/dL. An ACTH-stimulation test (30 min stimulated cortisol 24.8 μg/dL, expected >18) and hypoglycemic medications panel (sulfonylureas and meglitinides) were unremarkable. Quetiapine was stopped, and hypoglycemia resolved. No hypoglycemia occurred during a subsequent 48-h diagnostic fast followed by a mixed meal tolerance test. Due to the patient’s advanced age and comorbidities, it was decided not re-challenge with quetiapine and observe for recurrence of hypoglycemia. Hypoglycemia is a rare complication of SGA’s, and diagnosis may be delayed or missed in patients with baseline confusion or agitation. In addition to quetiapine, there are case reports of hypoglycemia occurring during treatment with risperidone, olanzapine, aripiprazole, and paliperidone. Clozapine and olanzapine increase insulin release from isolated pancreatic islets in vitro, though quetiapine did not demonstrate this effect. However, endogenous hyperinsulinemia has been documented in case reports of quetiapine-induced hypoglycemia. The physiologic pathway by which SGA’s increase insulin release is unknown; some authors have focused on the antagonism of M1 muscarinic receptors, but the muscarinic M1 receptor antagonist pirenzepine has been demonstrated to reduce insulin secretion induced by the muscarinic receptor agonist carbachol from isolated rat pancreatic islets in vitro. Though the mechanism by which hypoglycemia occurs is unclear, this case demonstrates that hypoglycemia should be considered in patients with worsening mental status during treatment with SGA’s.

Multiple morbidity across the lifespan in people with Down syndrome or intellectual disabilities: a population-based cohort study using electronic health records

The Down syndrome phenotype is well established, but our understanding of its morbidity patterns is limited. We comprehensively estimated the risk of multiple morbidity across the lifespan in people with Down syndrome compared with the general population and controls with other forms of intellectual disability. In this matched population-based cohort-study design, we used electronic health-record data from the UK Clinical Practice Research Datalink (CRPD) from Jan 1, 1990, to June 29, 2020. We aimed to explore the pattern of morbidities throughout the lifespan of people with Down syndrome compared with people with other intellectual disabilities and the general population, to identify syndrome-specific health conditions and their age-related incidence. We estimated incidence rates per 1000 person-years and incidence rate ratios (IRRs) for 32 common morbidities. Hierarchical clustering was used to identify groups of associated conditions using prevalence data. Between Jan 1, 1990, and June 29, 2020, a total of 10 204 people with Down syndrome, 39 814 controls, and 69 150 people with intellectual disabilities were included. Compared with controls, people with Down syndrome had increased risk of dementia (IRR 94·7, 95% CI 69·9-128·4), hypothyroidism (IRR 10·6, 9·6-11·8), epilepsy (IRR 9·7, 8·5-10·9), and haematological malignancy (IRR 4·7, 3·4-6·3), whereas asthma (IRR 0·88, 0·79-0·98), cancer (solid tumour IRR 0·75, 0·62-0·89), ischaemic heart disease (IRR 0·65, 0·51-0·85), and particularly hypertension (IRR 0·26, 0·22-0·32) were less frequent in people with Down syndrome than in controls. Compared to people with intellectual disabilities, risk of dementia (IRR 16·60, 14·23-19·37), hypothyroidism (IRR 7·22, 6·62-7·88), obstructive sleep apnoea (IRR 4·45, 3·72-5·31), and haematological malignancy (IRR 3·44, 2·58-4·59) were higher in people with Down syndrome, with reduced rates for a third of conditions, including new onset of dental inflammation (IRR 0·88, 0·78-0·99), asthma (IRR 0·82, 0·73-0·91), cancer (solid tumour IRR 0·78, 0·65-0·93), sleep disorder (IRR 0·74, 0·68-0·80), hypercholesterolaemia (IRR 0·69, 0·60-0·80), diabetes (IRR 0·59, 0·52-0·66), mood disorder (IRR 0·55, 0·50-0·60), glaucoma (IRR 0·47, 0·29-0·78), and anxiety disorder (IRR 0·43, 0·38-0·48). Morbidities in Down syndrome could be categorised on age-related incidence trajectories, and their prevalence clustered into typical syndromic conditions, cardiovascular diseases, autoimmune disorders, and mental health conditions. Multiple morbidity in Down syndrome shows distinct patterns of age-related incidence trajectories and clustering that differ from those found in the general population and in people with other intellectual disabilities, with implications for provision and timing of health-care screening, prevention, and treatment for people with Down syndrome. The European Union's Horizon 2020 Research and Innovation Programme, the Jérôme Lejeune Foundation, the Alzheimer's Society, the Medical Research Council, the Academy of Medical Sciences, the Wellcome Trust, and William Harvey Research Limited.

Impact of a prenatal screening program on the Down syndrome phenotype: An interrupted time series analysis.

We hypothesized that children with Down syndrome who were born after the implementation of first-trimester combined screening for trisomy 13, 18, and 21 and a second-trimester ultrasound scan in Denmark would show a milder syndrome phenotype. We investigated the birth biometry, prevalence of congenital malformations, and early childhood morbidity of children with Down syndrome before and after implementation of this screening program. A nationwide register-based study of all live born singletons with Down syndrome in Denmark from 1995 to 2018. In interrupted time series analyses, we studied the temporal developments in birth biometry, prevalence of congenital malformations, and early childhood morbidity related to the implementation of a national prenatal screening program. We included 602 singletons with Down syndrome born before and 308 after implementation of the screening program. Z-scores of birthweight and head circumference increased over time before screening, but this temporal development changed after implementation by -0.05 (95% confidence interval [CI]: -0.11 to 0.01) and -0.05 (95% CI -0.12 to 0.02), respectively. Just after implementation, the prevalence of non-severe congenital heart disease decreased (relative change in odds 0.48 [95% CI: 0.24-0.94]). For severe congenital heart disease, atrioventricular septal defect, and non-heart malformations, this change was 1.16 (95% CI: 0.56-2.41), 0.95 (95% CI: 0.43-2.03), and 0.98 (95% CI: 0.33-2.76), respectively. For all malformations, pre-existing temporal developments did not change following implementation of screening. The implementation was associated with higher odds of admission to a neonatal intensive care unit (relative change 1.98 [95% CI: 0.76-5.26]) and an increased risk of hearing impairment (risk difference 3.4% [95% CI: -0.4% to 7.1%]). In contrast, the implementation was not associated with the incidence of hospital admissions by 2 years of age or with the probability of a thyroid disorder. After implementation of a national prenatal screening program, we did not observe a milder Down syndrome phenotype apart from an apparent reduction in the proportion of children with non-severe congenital heart disease; this result is, however, limited by small numbers.

OPTN: A Possible Genetic Cause of Both CBS and ALS (P9-11.013)

<h3>Objective:</h3> To report a patient with a mutation typically associated with familial amyotrophic lateral sclerosis (ALS), but instead presenting with the corticobasal syndrome (CBS) phenotype. <h3>Background:</h3> CBS is defined by atypical parkinsonism and specific examination findings indicating cortical dysfunction. In contrast, corticobasal degeneration (CBD) is a pathological entity and is the principal pathology underlying CBS. CBD and frontotemporal dementia (FTD) often involve tau deposition, but in different topographical distributions, and also in different molecular forms. Many cases of CBD and FTD may, in addition, overlap clinically. By comparison, there is significantly less clinical overlap between ALS and the pathologies that cause CBS. Here we report a case of CBS linked to a mutation in the OPTN gene. This individual has several close relatives diagnosed with familial ALS who also have been found to carry the same OPTN mutation. <h3>Design/Methods:</h3> NA <h3>Results:</h3> We report a 49-year-old man with 6 months of involuntary movements of the right upper extremity, followed by gait unsteadiness and memory changes. Family history was notable for two siblings with ALS linked to a mutation in the OPTN gene. On exam, we noted right hemidystonia, as well as bradykinesia and brisk reflexes in the right arm. There was gait ataxia, as well as right-sided astereognosis, agraphesthesia, tactile extinction, and ideomotor apraxia. No ocular abnormalities, orthostasis, or other upper-motor neuron features were seen. MRI showed left peri-Rolandic fissure atrophy. Gene testing revealed homozygosity for a loss of function splice-site mutation in the OPTN gene. <h3>Conclusions:</h3> This case illustrates differential effects of the same gene mutation in different family members. It is interesting that the pathology causing CBS in this patient shares the same mutation with an inherited form of ALS. The heterogeneity of OPTN phenotypes may be a consequence of the same neuropathology, but with differential topographical distribution in the nervous system. <b>Disclosure:</b> Dr. Feldman has nothing to disclose. Dr. Benatar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. The institution of Dr. Benatar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Arrowhead. Dr. Benatar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Annexon. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UniQure. Dr. Benatar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Immunovant. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alector. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Benatar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Benatar has received intellectual property interests from a discovery or technology relating to health care. Dr. Benatar has received intellectual property interests from a discovery or technology relating to health care. Dr. Saraf Lavi has nothing to disclose. Dr. Latchman has nothing to disclose. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amneal. Dr. Singer has received personal compensation in the range of $10,000-$49,999 for serving as a Video Panel with CNS Ratings LLC. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Course Organiztion with Omniprex Scientific Medical Eduaction. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Reviewer with Health Monitor Network. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Movement Disorders Society. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Workshop Moderator with International Neurotoxin Association Inc. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Lecturer with CME Outfitteres LLC.

Dimensional Assessment of Depression and Anxiety in a Clinical Sample of Adults With Chronic Tic Disorder.

Among adults with Tourette syndrome, depression and anxiety symptoms are widely prevalent and consistently associated with poor quality of life. Important knowledge gaps remain regarding mood and anxiety dimensions of the adult Tourette syndrome phenotype. Taking a dimensional approach, this study sought to determine the prevalence, severity, and clinical correlates of depression and anxiety symptoms in a clinical sample of adults with Tourette syndrome and other chronic tic disorders. A retrospective chart review was conducted of all adults with a chronic tic disorder presenting to a tertiary care Tourette syndrome clinic between December 2020 and July 2022. Information extracted during chart review included data from scales administered as part of routine care: Quality of Life in Neurological Disorders (Neuro-QoL) Depression Short Form, Neuro-QoL Anxiety Short Form, Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale, Dimensional Obsessive-Compulsive Scale, and Yale Global Tic Severity Scale. Relationships between variables were examined by conducting between-group, correlation, and multivariable regression analyses. Data from 120 adult patients with a chronic tic disorder (77 men and 43 women) were analyzed. Neuro-QoL Anxiety scores were elevated in 66% of the cohort; Neuro-QoL Depression scores were elevated in 26%. Neuro-QoL Anxiety scores were significantly higher than general population norms, whereas Neuro-QoL Depression scores were not. After adjustment for covariates, depressive and anxiety symptom severity scores were significantly associated with each other and with obsessive-compulsive disorder symptom severity but not with tic severity. Sex-based differences emerged in the analyses. Among adults with chronic tic disorder, anxiety symptoms were more prevalent and severe than depressive symptoms, co-occurring psychiatric symptoms were more tightly linked with each other than with tic severity, and sex-based differences were evident.

The Progress of Colorectal Polyposis Syndrome in Chinese Population.

The pathogenesis, clinical phenotype, treatment strategy, and family management of hereditary tumor syndromes are different from those of sporadic tumors. Nearly a quarter of patients with colorectal cancer show significant familial aggregation and genetic predisposition, and 5 to 10% are associated with definite genetic factors. According to the clinical phenotype, it can be divided into nonpolyposis syndrome and polyposis syndrome. Among the polyposis syndrome patients with definite clinical symptoms, there are still some patients with unknown etiology (especially attenuated familial adenomatous polyposis), which is a difficult problem in clinical diagnosis and treatment. Therefore, for this rare disease, it is urgent to carry out multicenter studies, complete the gene variation spectrum, explore new pathogenic factors, and accumulate clinical experience. This article mainly introduces the research progress and related work of colorectal polyposis syndrome in China.

Wild-type MECP2 expression coincides with age-dependent sensory phenotypes in a female mouse model for Rett syndrome.

Rett syndrome is characterized by an early period of typical development and then, regression of learned motor and speech skills in girls. Loss of MECP2 protein is thought to cause Rett syndrome phenotypes. The specific underlying mechanisms from typical developmental trajectory to regression features throughout life are unclear. Lack of established timelines to study the molecular, cellular, and behavioral features of regression in female mouse models is a major contributing factor. Due to random X-chromosome inactivation, female patients with Rett syndrome and female mouse models for Rett syndrome (Mecp2Heterozygous , Het) express a functional copy of wild-type MECP2 protein in approximately half of all cells. As MECP2 expression is regulated during early postnatal development and experience, we characterized the expression of wild-type MECP2 in the primary somatosensory cortex of female Het mice. Here, we report increased MECP2 levels in non-parvalbumin-positive neurons of 6-week-old adolescent Het relative to age-matched wild-type controls, while also displaying typical levels of perineuronal net expression in the barrel field subregion of the primary somatosensory cortex, mild tactile sensory perception deficits, and efficient pup retrieval behavior. In contrast, 12-week-old adult Het express MECP2 at levels similar to age-matched wild-type mice, show increased perineuronal net expression in the cortex, and display significant tactile sensory perception deficits. Thus, we have identified a set of behavioral metrics and the cellular substrates to study regression during a specific time in the female Het mouse model, which coincides with changes in wild-type MECP2 expression. We speculate that the precocious increase in MECP2 expression within specific cell types of adolescent Het may provide compensatory benefits at the behavioral level, while the inability to further increase MECP2 levels leads to regressive behavioral phenotypes over time.

The fungal grid: Fungal communication via electrical signals has inspired the hypothesis of a Wood Wide Web of plants and fungi: Fungal communication via electrical signals has inspired the hypothesis of a Wood Wide Web of plants and fungi.

The observation that soil-dwelling fungi seem to exchange information via electrical impulses has raised new interest about their interactions with plants and their ecological significance.

New Molecular and Biological Markers in Cutaneous T Cell Lymphoma: Therapeutic Implications.

Cutaneous T cell lymphomas (CTCLs) exhibit a wide variety of clinical features, histologic characteristics, and genetic drivers. We review novel molecular findings that inform our understanding of the pathogenesis of CTCL, with a focus on the tumor microenvironment (TME). There is increasing evidence challenging the model of TCM:mycosis fungoides (MF) and TEM:Sézary syndrome (SS) phenotype. Phylogenetic analysis performed using whole-exome sequencing (WES) raises the possibility that MF can arise without a common ancestral T cell clone. The detection of ultraviolet (UV) marker signature 7 mutations in the blood of patients with SS raises questions about the role of UV exposure in CTCL pathogenesis. There is also increasing interest on the role of the TME in CTCL. Existing therapies such as the RXR retinoid bexarotene and the anti-CCR4 monoclonal antibody mogamulizumab may act through the CTCL TME by impacting the CCL22:CCR4 axis, while cancer-associated fibroblasts (CAFs) in the CTCL TME contribute to drug resistance, as well as a Th2 milieu and tumor growth via secretion of pro-tumorigenic cytokines. Staphylococcus aureus (SA) is a frequent cause of morbidity among CTCL patients. SA may positively select for malignant T cells through adaptive downregulation of alpha-toxin surface receptors and promotion of tumor growth via upregulation of the JAK/STAT pathway. Recent molecular advancements have contributed to our understanding of the pathogenesis of CTCL and shed light into the potential mechanisms of existing therapies. Further understanding of the CTCL TME may fuel the discovery of novel therapies for CTCL.