Assignment of two loci for autosomal dominant adolescent idiopathic scoliosis to chromosomes 9q31.2-q34.2 and 17q25.3-qtel

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity, affecting up to 4% of children worldwide. Familial inheritance of AIS is now recognised and several potential candidate loci have been found.

METHODS

We studied 25 multi-generation AIS families of British descent with at least 3 affected members in each family. A genomewide screen was performed using microsatellite markers spanning approximately 10-cM intervals throughout the genome. This analysis revealed linkage to several candidate chromosomal regions throughout the genome. Two-point linkage analysis was performed in all families to evaluate candidate loci. After identification of candidate loci, two-point linkage analysis was performed in the 10 families that segregated, to further refine disease intervals.

RESULTS

Significant linkage was obtained in a total of 10 families: 8 families to the telomeric region of chromosome 9q, and 2 families to the telomeric region of 17q. A significant LOD score was detected at marker D9S2157 Z(max) = 3.64 ( theta= 0.0) in a four-generation family (SC32). Saturation mapping of the 9q region in family SC32 defined the critical disease interval to be flanked by markers D9S930 and D9S1818, spanning approximately 21 Mb at 9q31.2-q34.2. In addition, seven other families segregated with this locus on 9q. In two multi-generation families (SC36 and SC23) not segregating with the 9q locus, a maximum combined LOD score of Z(max) = 4.08 ( = 0.0) was obtained for marker AAT095 on 17q. Fine mapping of the 17q candidate region defined the AIS critical region to be distal to marker D17S1806, spanning approximately 3.2 Mb on chromosome 17q25.3-qtel.

CONCLUSION

This study reports a common locus for AIS in the British population, mapping to a refined interval on chromosome 9q31.2-q34.2 and defines a novel AIS locus on chromosome 17q25.3-qtel.

Improving community knowledge of obstetric fistula prevention and treatment

In recent years, information has emerged in the scientific literature regarding the experience of physicians and clinical staff who try to prevent and treat obstetric fistulas at health facilities in developing countries. However, little is known about attempts to match the services they provide with policy and programmatic interventions in the communities they serve. To determine what is known about community involvement in the prevention and treatment of obstetric fistulas, the authors inquired into experiments carried out by EngenderHealth and partners in 15 African and Asian countries. From raw data, gray literature, and personal communications with those working in the field, they learned that engaging the community may be the keystone in the eradication of fistulas in low-resource settings, and they learned how to engage the community.

Long term outcome for extra-anatomic arch reconstruction. An analysis of 143 procedures

PURPOSE

With the FDA approval of thoracic endografts, extra-anatomic reconstruction of the aortic arch has allowed for more suitable proximal landing zones and increased applicability of thoracic endovascular procedures. We evaluated our short term and long term results of extra-anatomic reconstruction of the carotid and subclavian vessels.

METHODS

One hundred and forty three (143) procedures were performed for extra-anatomic carotid and subclavian reconstruction. Of these 143 operations: 85 were carotid subclavian reconstructions, 22 were carotid crossover bypasses, 30 were subclavian carotid reconstructions and 6 were carotid subclavian transpositions. Sixty (42%) were male, 20 (14%) were diabetic, and 63 (44%) were current smokers. Mean age was 63 (SD +/- 12.3). Indication for surgery was primarily for occlusive or embolic disease (97%). In those patients undergoing bypass graft, prosthetic (ePTFE) was used in 93%. Follow-up was performed at 3 and 6 month intervals by ultrasound and pulse volume recordings where indicated. Life table analyses were used to analyze patency.

RESULTS

Of the 143 reconstructions operative mortality was 1 (0.7%). Non-fatal complications included 3 (2.1%) for bleeding, 1 (0.7%) wound infection, 2 (1.4%) TIA, 1 (0.7%) suffered a non-fatal stroke, 2 (1.4%) had postoperative myocardial infarctions, and 6 (4.3%) late (>30-day) occlusions. Follow-up was 1 to 124 months (mean: 39 months). Primary patency at 1 year was 98%, 3 years 96%, and 5 years was 92%.

CONCLUSION

Extra-anatomic arch reconstruction can be performed safely and appears to be durable over long term follow-up. Its use with endovascular grafting should provide a durable reconstruction for patients who require aortic "debranching" prior endovascular thoracic aortic aneurysm repair.

Obesity amongst affluent adolescent girls

OBJECTIVE

To assess the prevalence and type of obesity in affluent schoolgirls aged 16 and 17 yr.

METHODS

A cross-sectional study was conducted in 2002, in 4 randomly selected public schools of Delhi. All girls from randomly chosen classes were included. Weight, height and waist and hip circumferences were measured for all 414 schoolgirls and their socio-demographic profile was recorded. Body mass index [BMI] and waist hip ratio [WHR] were calculated for all the girls. BMI > 30 (i.e.--95th percentile) denotes obesity and BMI > 25 (i.e.--85th percentile) denotes overweight as according to International Obesity Task Force (IOTF) criteria. WC > 80 cm or WHR > 0.85 denote central obesity.

RESULTS

Prevalence of obesity and overweight amongst the study subjects was 5.3% and 15.2% respectively (IOTF). Out of the 22 obese girls central obesity was present in 21 girls (95.4%) [WC > 80 cm] and 12 girls (54.5%) [WHR > 0.85].

CONCLUSION

There is significant prevalence of obesity in affluent schoolgirls in Delhi and more than half of them have central obesity.

Outcome for metastatic (M+) medulloblastoma (MB) treated with carboplatin during craniospinal radiotherapy (CSRT) followed by cyclophosphamide (CPM) and vincristine (VCR): Preliminary results of COG 99701

2017

Background: The outcome for patients with metastatic medulloblastoma has historically been poor. Carboplatin is both a potent radiosensitizer and has activity against medulloblastoma. In this study, we evaluated the feasibility of administering carboplatin during CSRT and the impact of anaplasia as an independent predictor of outcome. Methods: All patients underwent surgical debulking followed by 36 Gy CSRT with boosts to the posterior fossa and sites of bulk disease. During CSRT, patients received weekly VCR as well as carboplatin doses ranging from 30 mg/m2/dose x 15 to 45 mg/m2/dose x 30 given 1–4 hours prior to each RT fraction, using a Phase I design. G-CSF was given for neutropenia during CSRT. Six weeks after completing chemoradiotherapy, patients received six courses of monthly CPM (2 gm/m2) and VCR. Central pathology review was performed to confirm the diagnosis and assess for anaplasia. Results: 57 patients (median age 7.3 yrs, range 3.1–18.1 years, M/F ratio of 2.6:1) with centrally reviewed M+ MB were enrolled. Thrombocytopenia was dose limiting and 35 mg/m2/dose x 30 was selected as the maximum tolerated carboplatin dose. 20 patients (35%) had severe anaplasia. There was no difference in age, M/F ratio or distribution of M-stage between those with or without anaplasia. Median follow-up for surviving patients is 4.5 yrs. Four-year overall survival (OS) and event-free survival (EFS) for the entire group is 81 ± 5% and 66 ± 6%. Four-year OS is 89 ± 5% for patients without anaplasia vs. 65 ± 11% for those with anaplasia (log-rank p=0.002). Four-year EFS is 76 ± 7% for patients without anaplasia vs. 48 ± 12% for those with anaplasia (log-rank p=0.02). There was no difference in survival based on M-stage. Conclusions: The use of daily carboplatin as a radiosensitizer appears to be a promising strategy for patients with metastatic MB. The presence of anaplasia is a significant negative predictor of outcome.

No significant financial relationships to disclose.

Ranolazine: a novel agent that improves dysfunctional sodium channels

Treatment for coronary heart disease is usually directed at either increasing myocardial oxygen supply or decreasing myocardial oxygen demand. Although combination therapy with beta-blockers, calcium-channel blockers and nitrates are effective, many patients suffer from adverse effects of hypotension and bradycardia. Ranolazine is a novel medication that reduces ischaemia by preventing sodium induced calcium overload in myocardial cells without adversely affecting haemodynamic parameters. This agent is the first in the USA to be approved to treat angina in over 10 years. The purpose of this review is to evaluate the pharmacology, pharmacokinetics, clinical trials for safety and efficacy, precautions, adverse effects, drug interactions, and dosage and administration of ranolazine in the treatment of chronic stable angina and acute coronary syndrome.

Incidence of colonic ischemia after repair of ruptured abdominal aortic aneurysm with endograft

BACKGROUND

Colonic ischemia after open repair of ruptured abdominal aortic aneurysm (rAAA) has been reported to be as high as 42% and is associated with high mortality rates when transmural necrosis is involved. With the evolution of endovascular aortic repair (EVAR) devices, some centers now primarily use this technique for rAAA. The objective of this study was to determine the incidence of colonic ischemia after EVAR of rAAA.

STUDY DESIGN

All patients who underwent EVAR of rAAA from January 2002 to January 2006 were included in this review. All flexible sigmoidoscopies were performed within 48 hours, ischemia was graded consistently, and treatment was initiated per protocol based on grade of ischemia. Patients with grades I and II ischemia were followed up with medical management and in some cases, repeat colonoscopy. All patients with grade III ischemia underwent bowel resection.

RESULTS

Forty-four patients underwent EVAR of rAAA during the study period. Operative mortality was 11%. Sigmoidoscopy was performed in 36 of 39 patients who survived longer than 24 hours. Bowel ischemia was documented in 8 of the 36 patients (23%). Of these, five had grade I or grade II ischemia at both initial and repeat endoscopy, so these patients did not progress to resection. Three patients underwent exploratory laparotomy with bowel resection because of grade III ischemia; one of these procedures was performed for worsening ischemia discovered at repeat colonoscopy.

CONCLUSIONS

This study demonstrated that the overall incidence of colonic ischemia (23%) after EVAR of rAAA is less than that reported for the open repair. We would continue to recommend mandatory flexible sigmoidoscopy for these patients.

A comparison of the effect of reduced illumination and tinted lenses on stereospsis at near

Relative depth may be appreciated with the use of one eye using linear perspective, shadows, parallax and texture as monocular cues to depth. Stereopsis, on the other hand, is the directappreciation of relative depth that requires the use of both eyes to construct a three-dimension-al percept from disparate two-dimensional retinal images. The advantage of stereopsis is with respect to complex visual tasks especially that requiring accurate hand-eye coordination. Tinted lenses are prescribed for a variety of reasons, including but not limited to photophobia, asthenopia, improving colour perception in colour deficient individuals, enhancing cosmesis and protection against glare or harmful radiation and enhancing visual performance as in sports. The aim of this study was to investigate the comparative effects of six specific CR39 tinted spectacle lenses (grade B), and a white CR39 lens, against a no lens condition, on stereoacuity over a range of illumination levels. Illumination was varied with the use of neutral density (ND) filters, while the Titmus Fly Stereotest (TFS) wasused to measure stereoacuity. Participants (n =60) between the ages of 17 - 29 years (mean =23.58; sd = 3.14) were purposively sampled from a clinical practice to participate in this research study.  Using repeated measures ANOVA and appropriate post-hoc multivariate analysis, it was evident that there was a significant decline in stereopsis as the level ofillumination decreased,regardless of tint condition; also there was no statistically significant difference in stereopsis between the no lens and white lens conditions at each level of illumination; and stereopsis wassignificantly superior with the no lens conditioncompared to all six other tint conditions (gradeB), at each level of illumination. These results indicate that stereoacuity, as measured by the TFS, is adversely affected by adecline in retinal illuminance and by the use of tinted lenses. This information could be utilised to advise patients on the performance implications of the six tinted lenses tested with respectto their effects on stereoacuity under different illumination levels.