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Casalino R, Avila BA, Tonico FO, Santos FLM, Oikawa F, Parrillo E, Nascimento A, Leite TA, Mendes TM, Berlinck MF. P3608Mortality impact with a novel preoperative management in acute coronary syndrome patients with cardiac surgery indication. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Baggio CH, Gordon M, Nascimento A, Cipriani T, MacNaughton W. A86 NON-PREBIOTIC EFFECTS OF RHAMNOGALACTURONAN ON INTESTINAL EPITHELIAL BARRIER FUNCTION AND WOUND HEALING. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nascimento A, Villalobos-Pinto E. [A new phenotype of infantile-onset Pompe disease]. Rev Neurol 2018; 66:121-124. [PMID: 29435968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Infantile-onset Pompe disease is a kind of glycogenosis resulting from a deficit of the enzyme acid alpha-glucosidase. Before specific enzyme replacement therapy (ERT) became available, the classic form was fatal during the first two years of life. ERT increases survival and improves cardiac, respiratory and motor functioning. CASE REPORTS Case 1: 2-month-old infant with predominantly axial hypotonia who required the use of a nasogastric tube as a result of difficulties in sucking and swallowing. Myopathy and hypertrophic cardiomyopathy were observed. The patient was diagnosed with Pompe disease, ERT was established and improved heart and motor functioning were noted. Nevertheless, she presented recurring respiratory infections that finally made it necessary to perform a tracheostomy. She is currently still undergoing ERT, walks with a walker and presents a mild ventricular dysfunction. Case 2: 3-week-old infant who was taken to see his paediatrician for a routine check-up. The examination revealed a systolic bruit and axial and proximal hypotonia. Cardiology tests revealed hypertrophic cardiomyopathy. The patient was sent to a referral centre, where he was diagnosed with Pompe disease and a cross-reactive immunological material-negative status. The patient received immunomodulator treatment and ERT. Progress was favourable, although he presented frequent respiratory infections. The patient is currently capable of walking by himself, although the gait is unsteady. CONCLUSIONS Both cases illustrate the new phenotype of infantile-onset Pompe disease treated with ERT. Despite the motor limitations and respiratory involvement presented by the patients, both survival and autonomy have increased.
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Completo A, Nascimento A, Girão AF, Fonseca F. Biomechanical evaluation of pyrocarbon proximal interphalangeal joint arthroplasty: An in-vitro analysis. Clin Biomech (Bristol, Avon) 2018; 52:72-78. [PMID: 29407860 DOI: 10.1016/j.clinbiomech.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/20/2017] [Accepted: 01/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pyrocarbon proximal interphalangeal joint arthroplasty provided patients with excellent pain relief and joint motion, however, overall implant complications have been very variable, with some good outcomes at short-medium-term follow-up and some bad outcomes at longer-term follow-up. Implant loosening with migration, dislocation and implant fracture were the main reported clinical complications. The aim of the present work was to test the hypothesis that the magnitude proximal interphalangeal joint cyclic loads in daily hand functions generates stress-strain behaviour which may be associated with a risk of pyrocarbon component loosening in the long-term. METHODS This study was performed using synthetic proximal and middle phalanges to experimentally predict the cortex strain behaviour and implant stability considering different load conditions for both intact and implanted states. Finite element models were developed to assess the structural behaviour of cancellous-bone and pyrocarbon components, these models were validated against experimentally measured cortex strains. FINDINGS Cortex strains showed a significant increase at dorsal side and reduction at palmar side between intact and implanted states. Cancellous-bone adjacent to the condylar implant base components suffers a two to threefold strain increase, comparing with the intact condition. INTERPRETATION The use of pyrocarbon implant changes the biomechanical behaviour of the joint phalanges and is associated with a potential risk of support cancellous-bone suffer fatigue failure in mid to long term due to the strain increase for cyclic loads in the range of daily hand activities, this risk is more prominent than the risk of bone resorption due to strain-shielding effect.
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Nascimento A, Villalobos Pinto E. Nuevo fenotipo de la enfermedad de Pompe infantil. Rev Neurol 2018. [DOI: 10.33588/rn.6604.2017492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Natera-de Benito D, Töpf A, Vilchez JJ, González-Quereda L, Domínguez-Carral J, Díaz-Manera J, Ortez C, Bestué M, Gallano P, Dusl M, Abicht A, Müller JS, Senderek J, García-Ribes A, Muelas N, Evangelista T, Azuma Y, McMacken G, Paipa Merchan A, Rodríguez Cruz PM, Camacho A, Jiménez E, Miranda-Herrero MC, Santana-Artiles A, García-Campos O, Dominguez-Rubio R, Olivé M, Colomer J, Beeson D, Lochmüller H, Nascimento A. Molecular characterization of congenital myasthenic syndromes in Spain. Neuromuscul Disord 2017; 27:1087-1098. [PMID: 29054425 DOI: 10.1016/j.nmd.2017.08.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
Congenital myasthenic syndromes (CMS) are a heterogeneous group of genetic disorders, all of which impair neuromuscular transmission. Epidemiological data and frequencies of gene mutations are scarce in the literature. Here we describe the molecular genetic and clinical findings of sixty-four genetically confirmed CMS patients from Spain. Thirty-six mutations in the CHRNE, RAPSN, COLQ, GFPT1, DOK7, CHRNG, GMPPB, CHAT, CHRNA1, and CHRNB1 genes were identified in our patients, with five of them not reported so far. These data provide an overview on the relative frequencies of the different CMS subtypes in a large Spanish population. CHRNE mutations are the most common cause of CMS in Spain, accounting for 27% of the total. The second most common are RAPSN mutations. We found a higher rate of GFPT1 mutations in comparison with other populations. Remarkably, several founder mutations made a large contribution to CMS in Spain: RAPSN c.264C > A (p.Asn88Lys), CHRNE c.130insG (Glu44Glyfs*3), CHRNE c.1353insG (p.Asn542Gluf*4), DOK7 c.1124_1127dup (p.Ala378Serfs*30), and particularly frequent in Spain in comparison with other populations, COLQ c.1289A > C (p.Tyr430Ser). Furthermore, we describe phenotypes and distinguishing clinical signs associated with the various CMS genes which might help to identify specific CMS subtypes to guide diagnosis and management.
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Pastorello R, Nascimento A, Werneck I, Saieg MA. Enigma portal case: Pleural effusion. Cytopathology 2017; 29:211-212. [PMID: 29134731 DOI: 10.1111/cyt.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 11/29/2022]
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Ben Yaou R, Dabaj I, Yun P, Norato G, Xiong H, Nascimento A, Maggi L, Sarkozy A, Monges S, Bertoli M, Komaki H, Mercuri E, Zanoteli E, Bushby K, Muntoni F, Rutkowski A, Bönnemann C, Quijano-Roy S, Bonne G. First results from the international LMNA -related congenital and childhood onset muscular dystrophy retrospective natural history study. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Natera-de Benito D, Alarcon M, Ortez C, Nascimento A, Jou C, Medina J, Vigo M, Codina A, Frongia A, Colomer J, Jimenez-Mallebrera C. Clinical and genetic characterization of collagen VI-related myopathies: difficulties in phenotypic characterization in the first years of life. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Natera-de Benito D, Alarcon M, Borrás A, Armas J, Frongia A, Itzep D, Vigo M, Medina J, Ortez C, Colomer J, Nascimento A. Prospective cohort study of spinal muscular atrophy types 2 and 3 in Spanish population. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ortez C, Natera D, Colomer J, Itzep D, Alarcón M, Frongia A, Jou C, Codina A, Jimenez-Mallebrera C, Martorell L, Biancalana V, González L, Gallano P, Nascimento A. X-Linked myotubular myopathy (XLMTM): phenotypic variability. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dabaj I, Ben Yaou R, Bönnemann C, Nascimento A, Rutkowski A, Erazo Torricelli R, Muntoni F, Lagrue E, Dowling J, Bushby K, Casteglioni C, Kleinsteuber K, Lorenzo M, Ishiyama A, Sejersen T, Gurgel-Giannetti J, Monges S, Bonne G, Quijano-roy S. Corticosteroid treatment in early-onset lamin A/C related muscular dystrophies. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Colomer J, De B, Ortez C, Jou C, Jiménez-Mallebrera C, Olivé M, Codina A, Alarcón M, Mamiesse AF, Corbera J, Lia A, Roldan M, Nascimento A. C-terminal binding protein 1 (CtBP1) deficiency, mimicking congenital myopathy during infancy. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nascimento A, Ortez C, Colomer J, Natera D, Frongia A, Alarcon M, Itzep D, Jou C, Codina A, Corbera J, Rodriguez M, Rodriguez M, González L, Gallano P, Sacher M, Topf A, Straub V, Jimenez-Mallebrera C. A case of severe encephalopathy and movement disorder due to mutations in the TRAPPC11 gene. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Farah C, Nascimento A, Bolea G, Meyer G, Gayrard S, Lacampagne A, Cazorla O, Reboul C. Key role of endothelium in the eNOS-dependent cardioprotection with exercise training. J Mol Cell Cardiol 2017; 102:26-30. [DOI: 10.1016/j.yjmcc.2016.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
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Completo A, Pereira J, Nascimento A, Almeida F. Strain shielding in distal radius after wrist arthroplasty with a current generation implant: An in vitro analysis. J Biomech 2016; 52:169-175. [PMID: 28012551 DOI: 10.1016/j.jbiomech.2016.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 11/17/2022]
Abstract
A systematic review of peer reviewed articles has shown that the main cause for wrist arthroplasty revision is carpal and radial prosthetic loosening and instability. To improve arthroplasty outcomes, successive generations of implants have been developed over time. The problem with the current generation of implants is the lack of long-term outcomes data. The aim of the present work was to test the hypothesis that the current generation Maestro WRS implant has a stress, strain and stability behaviour which may be associated with a reduced risk of long-term radial component loosening. This study was performed using synthetic radii to experimentally predict the cortex strain behaviour and implant stability considering different load conditions for both intact and implanted conditions. Finite element models were developed to assess the structural behaviour of cancellous-bone and bone-cement, these models were validated against experimentally measured cortex strains. Measured cortex strains showed a significant reduction between intact and implanted states. Cancellous bone adjacent to the radial body component suffers a two to threefold strain reduction, comparing with the intact condition, while along the radial stem, in the axial direction, a strain increase was observed. It is concluded that the use of contemporary Maestro WRS implant changes the biomechanical behaviour of the radius and is associated with a potential risk of bone resorption by stress-shielding in the distal radius region for wrist loads in the range of daily activities.
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Yubero D, Adin A, Montero R, Jou C, Jiménez-Mallebrera C, García-Cazorla A, Nascimento A, O'Callaghan MM, Montoya J, Gort L, Navas P, Ribes A, Ugarte MD, Artuch R. A statistical algorithm showing coenzyme Q 10 and citrate synthase as biomarkers for mitochondrial respiratory chain enzyme activities. Sci Rep 2016; 6:15. [PMID: 28442759 PMCID: PMC5431365 DOI: 10.1038/s41598-016-0008-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/23/2016] [Indexed: 11/15/2022] Open
Abstract
Laboratory data interpretation for the assessment of complex biological systems remains a great challenge, as occurs in mitochondrial function research studies. The classical biochemical data interpretation of patients versus reference values may be insufficient, and in fact the current classifications of mitochondrial patients are still done on basis of probability criteria. We have developed and applied a mathematic agglomerative algorithm to search for correlations among the different biochemical variables of the mitochondrial respiratory chain in order to identify populations displaying correlation coefficients >0.95. We demonstrated that coenzyme Q10 may be a better biomarker of mitochondrial respiratory chain enzyme activities than the citrate synthase activity. Furthermore, the application of this algorithm may be useful to re-classify mitochondrial patients or to explore associations among other biochemical variables from different biological systems.
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Completo A, Nascimento A, Neto F. Total arthroplasty of basal thumb joint with Elektra prothesis: an in vitro analysis. J Hand Surg Eur Vol 2016; 41:930-938. [PMID: 27424207 DOI: 10.1177/1753193416659230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The reported outcomes of the Elektra thumb carpo-metacarpal joint implant have been very variable. This study evaluates the influence of daily cyclic loads and the type of the screw-fit cup insertion technique in the trapezium, with and without prior threading, on the structural bone behaviour. The study was performed experimentally to predict initial implant stability and cortical bone strains. Computational models were developed to assess the structural cancellous bone behaviour. The use of Elektra implant considerably changed the bone strain behaviour compared with the intact joint. This may be associated with risks of cancellous bone fatigue failure due to overload, particularly in the trapezium. The joint load magnitude has a more important structural role than that of the screw-fit cup insertion technique. Limiting the magnitude of thumb loads after arthroplasty may contribute positively to the longevity of this procedure. LEVEL OF EVIDENCE V.
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Nascimento A, Ortez C, Jou C, Corbera J, Codina A, Frongia A, Borras A, Jimenez-Mallebrera C, Colomer J. Lambert–Eaton syndrome in children, a rare unrecognized treatable neuromuscular disorder: Is there any useful feature in the muscle biopsy? Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ortez C, Jou C, Campistol J, Nascimento A, Jimenez-Mallebrera C, Topf A, Johnson K, Straub V, Codina A, Corbera J, Colomer J. Exercise intolerance and myalgia: First clinical sign of a primary alpha-sarcoglycanopathy. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Llano-Diez M, Ortez C, Alvarez L, Paco S, Kalko S, Jou C, Colomer J, Nascimento A, Jimenez-Mallebrera C. Digital PCR quantification of miR-30c and miR-181a as serum biomarkers in Duchenne muscular dystrophy. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rodriguez M, Osorio-Conles O, Montori-Grau M, Fernández G, Kalko S, Puigdelloses M, Jou C, Ortez C, Nascimento A, Colomer J, Jiménez-Mallebrera C. Collagen VI and endotrophin regulate glucose homeostasis in skeletal muscle. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pascual-Pascual SI, Nascimento A, Fernandez-Llamazares CM, Medrano-Lopez C, Villalobos-Pinto E, Martinez-Moreno M, Ley M, Manrique-Rodriguez S, Blasco-Alonso J. [Clinical guidelines for infantile-onset Pompe disease]. Rev Neurol 2016; 63:269-279. [PMID: 27600742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Infantile-onset Pompe disease has a fatal prognosis in the short term unless it is diagnosed at an early stage and enzyme replacement therapy is not started as soon as possible. A group of specialists from different disciplines involved in this disease have reviewed the current scientific evidence and have drawn up an agreed series of recommendations on the diagnosis, treatment and follow-up of patients. We recommend establishing enzyme treatment in any patient with symptomatic Pompe disease with onset within the first year of life, with a clinical and enzymatic diagnosis, and once the CRIM (cross-reactive immunological material) status is known.
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Natera-de Benito D, Domínguez-Carral J, Muelas N, Nascimento A, Ortez C, Jaijo T, Arteaga R, Colomer J, Vilchez JJ. Phenotypic heterogeneity in two large Roma families with a congenital myasthenic syndrome due to CHRNE 1267delG mutation. A long-term follow-up. Neuromuscul Disord 2016; 26:789-795. [PMID: 27634344 DOI: 10.1016/j.nmd.2016.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/22/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
Abstract
Congenital myasthenic syndromes (CMS) are a heterogeneous group of genetic disorders. Mutations in CHRNE are one of the most common cause of them and the ɛ1267delG frameshifting mutation is described to be present on at least one allele of 60% of patients with CHRNE mutations. We present a comprehensive description of the heterogeneous clinical features of the CMS caused by the homozygous 1267delG mutation in the AChR Ɛ subunit in nine members of two large Gipsy kindreds. Our observations indicate that founder Roma mutation 1267delG leads to a phenotype further characterized by ophthalmoplegia, bilateral ptosis, and good response to pyridostigmine and 3,4-DAP; but also by facial weakness, bulbar symptoms, neck muscle weakness, and proximal limb weakness that sometimes entails the loss of ambulation. Interestingly, we found in our series a remarkable proportion of patients with a progressive or fluctuating course of the disease. This finding is in some contrast with previous idea that considered this form of CMS as benign, non progressive, and with a low impact on the capacity of ambulation.
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Nascimento AF, Oliveira JS, Silva Junior JC, Barbosa AAL. Genomic ancestry evaluated by ancestry-informative markers in patients with sickle cell disease. GENETICS AND MOLECULAR RESEARCH 2016; 15:gmr7604. [PMID: 27051031 DOI: 10.4238/gmr.15017604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The β(s) mutation is responsible for the most aggressive form of sickle cell disease, has a predominantly African origin, and arrived in Brazil through the slave trade. However, the Brazilian population is highly miscegenated, underscoring the importance of ancestry-informative markers (AIMs) for the identification of the genetic structure of a population. In this study, we have estimated the genetic contributions of various ethnicities in individuals with sickle cell disease in the microregion of Jequié, Bahia, in Brazil, by using AIMs, and compared the findings to those from a phenotypic characterization. Eight AIMs were analyzed: AT3 (rs3138521), DRD2 (rs1079598), APO (rs3138522), PV92, Sb19.3 (rs3138524), CKM (rs4884), LPL (rs285), and CCR5Δ32 (rs333). Samples were subjected to polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism. The amplified products were electrophoresed on agarose gels, and the data were statistically analyzed using Genepop, FSTAT 2.9, and Admix3. Phenotypic classification showed a high frequency of mulattos (85%) in the Brazilian population; however, ancestry-informative markers indicated that 44, 42, and 11% of the population had European, African, and native American ancestries, respectively. The phenotypic classification is justified as a complementary method for the characterization of the genetic ancestry in patients with sickle cell disease, as it confirms the molecular findings regarding ancestry.
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