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Long S, O'Leary P, Dickinson JE. Women's responses to prenatal genetic diagnosis and attitudes to termination of pregnancy after non-invasive prenatal testing: An online survey of Western Australian women. Aust N Z J Obstet Gynaecol 2023; 63:219-227. [PMID: 36068728 DOI: 10.1111/ajo.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-invasive prenatal testing (NIPT) using cell-free DNA (cfDNA) has expanded from detecting chromosome aneuploidy to testing for a variety of genetic conditions, including some select single gene disorders. As next generation sequencing/whole exome sequencing technology develops, it may be possible to expand NIPT of cfDNA to identify hundreds of single gene and chromosomal disorders in a fetus, thereby increasing the complexity of pretest counselling and parental decision-making. AIM The aim of this study was to assess the views of women on the phenotypes of genetic conditions potentially detectable with expanded NIPT that they would consider severe enough to warrant pregnancy termination. MATERIALS AND METHODS Using multiple clinical scenarios, we asked women via an online survey about the early detection of several well-described genetic phenotypes in pregnancy that in theory could be detected by expanded NIPT. RESULTS Two hundred and nineteen women participated in this study. There was high support for early diagnosis and the option for termination of pregnancy in conditions perceived as severe (52-71%). Women expressed a preference for testing to be provided by general practitioners and assigned a high value to genetic counselling support (75-90%). In the case of a continuing pregnancy, women recognised the essential role of ongoing psychosocial counselling for family members and childhood early intervention programs. CONCLUSION Women expressed clear preferences for termination of pregnancy for severe conditions and as early in gestation as feasible. Information and support from genetic counsellors are a highly valued resource in decision-making following a prenatal diagnosis of a fetal genetic abnormality.
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Affiliation(s)
- Sarah Long
- Genetic Services of Western Australia, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter O'Leary
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Perth, Western Australia, Australia
| | - Jan E Dickinson
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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Simpson-Golabi-Behmel syndrome in one of the Dichorionic-diamniotic twin: a case report and literature review. BMC Pregnancy Childbirth 2022; 22:42. [PMID: 35038998 PMCID: PMC8762945 DOI: 10.1186/s12884-021-04309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Simpson-Golabi-Behmel syndrome (SGBS) is a rare X-linked overgrowth syndrome. The main clinical manifestations are overgrowth and multiple malformations. Case presentation A 38-year-old Chinese woman was pregnant with dichorionic-diamniotic (DCDA) twins after in-vitro fertilization. Series of ultrasound examinations indicated that the measurements (abdominal circumference and estimated foetal weight) of one twin were significantly greater than those of the other one. The genetic testing results of the larger baby indicated of Simpson-Golabi-Behmel syndrome. Conclusion SGBS is difficult to diagnose due to different clinical manifestations. Clinicians need to be more aware of typical SGBS’s clinical findings and choose genetic testing methods individually to improve its prenatal diagnosis.
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Wou K, DeBie I, Carroll J, Brock JA, Douglas Wilson R. Fetal Exome Sequencing on the Horizon. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:64-67. [PMID: 30580830 DOI: 10.1016/j.jogc.2018.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/03/2018] [Accepted: 06/06/2018] [Indexed: 10/27/2022]
Abstract
Prenatal whole exome sequencing has recently been introduced. It is evolving and although not currently ready for everyday clinical practice, it will likely become part of the diagnostic arsenal available to clinicians caring for couples carrying a pregnancy for which fetal anomalies have been identified. This commentary discusses what it is, its indications, its benefits, and its limitations.
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Affiliation(s)
- Karen Wou
- Department of Gynecology and Obstetrics, McGill University Health Centre, Montréal, QC.
| | - Isabelle DeBie
- Department of Medical Genetics, McGill University, Montréal, QC
| | - June Carroll
- Department of Family & Community Medicine, University of Toronto, Toronto, ON
| | - Jo-Ann Brock
- Department of Obstetrics & Gynecology, Dalhousie University, Halifax, NS
| | - R Douglas Wilson
- Department of Obstetrics & Gynaecology, University of Calgary, Calgary, AB
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Lamont RE, Xi Y, Popko C, Lazier J, Bernier FP, Lauzon JL, Innes AM, Parboosingh JS, Thomas MA. Next-Generation Sequencing Using a Cardiac Gene Panel in Prenatally Diagnosed Cardiac Anomalies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:1417-1423. [PMID: 30473118 DOI: 10.1016/j.jogc.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 02/01/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Most prenatally identified congenital heart defects (CHDs) are the sole structural anomaly detected; however, there is a subgroup of cases where the specific genetic cause will impact prognosis, including chromosome abnormalities and single-gene causes. Next-generation sequencing of all the protein coding regions in the genome or targeted to genes involved in cardiac development is currently possible in the prenatal period, but there are minimal data on the clinical utility of such an approach. This study assessed the outcome of a CHD gene panel that included single-gene causes of syndromic and non-syndromic CHDs. METHOD Sixteen cases with a fetal CHD identified on prenatal ultrasound were studied using a 108 CHD gene panel. DNA was extracted from cultured amniocytes. RESULTS There was no diagnostic pathogenic variant identified in these cases. There was an average of 2.9 reportable variants identified per case and the majority of them were variants of uncertain significance. CONCLUSION Next-generation sequencing has the potential for increased genetic diagnosis for fetal anomalies. However, the large number of variants and the absence of an examinable patient make the interpretation of these variants challenging.
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Affiliation(s)
- Ryan E Lamont
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB; Alberta Children's Hospital Research Institute, Calgary, AB
| | - Yanwei Xi
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Claire Popko
- Bachelor of Health Sciences Program, University of Calgary, Calgary, AB
| | - Joanna Lazier
- Department of Medical Genetics, University of Alberta, Edmonton, AB
| | - Francois P Bernier
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB; Alberta Children's Hospital Research Institute, Calgary, AB
| | - Julie L Lauzon
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - A Micheil Innes
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB; Alberta Children's Hospital Research Institute, Calgary, AB
| | - Jillian S Parboosingh
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB; Alberta Children's Hospital Research Institute, Calgary, AB
| | - Mary Ann Thomas
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB; Alberta Children's Hospital Research Institute, Calgary, AB.
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Abstract
New genetic tests have rapidly entered clinical care with little consistency in laboratory testing and reporting. Non-invasive prenatal screening using cell free DNA (cfDNA) may either screen for common aneuploidies alone or include chromosomal microdeletions. All cfDNA screening tests have false positives and false negatives, and accordingly laboratories should report positive and negative predictive values. In addition, since fetal fraction plays a significant role in the reliability of results, this should also be reported with all test results. Chromosomal microarray addresses significant clinically relevant information beyond that detected with standard karyotype testing but may, in less than one percent of cases, result in a variant of uncertain significance (VUS). Laboratories should indicate their policies for reporting these VUS findings. In addition, physicians using this testing should be aware of the advantages and disadvantages of the laboratory platforms. Whole-exome and whole-genome sequencing are just entering clinical care and issues of VUS, incidental findings, and phenotype/genotype correlations need to be investigated before these techniques enter routine clinical care.
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Affiliation(s)
- Karen Wou
- Division of Medical Genetics, Department of Pediatrics, Columbia University, United States
| | - Wendy K Chung
- Division of Medical Genetics, Department of Pediatrics, Columbia University, United States
| | - Ronald J Wapner
- Division of Reproductive Genetics, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 W. 168th St, PH-16-66, New York, NY 10032, United States.
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Harel T, Hacohen N, Shaag A, Gomori M, Singer A, Elpeleg O, Meiner V. Homozygous null variant in CRADD
, encoding an adaptor protein that mediates apoptosis, is associated with lissencephaly. Am J Med Genet A 2017; 173:2539-2544. [DOI: 10.1002/ajmg.a.38347] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/24/2017] [Accepted: 06/09/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Tamar Harel
- Department of Genetics and Metabolic Diseases; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Nuphar Hacohen
- Department of Genetics and Metabolic Diseases; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Avraham Shaag
- Department of Genetics and Metabolic Diseases; Hadassah-Hebrew University Medical Center; Jerusalem Israel
- Monique and Jacques Roboh Department of Genetic Research; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Moshe Gomori
- Department of Radiology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Amihood Singer
- Genetics Institute; Barzilai Medical Center; Ashkelon Israel
| | - Orly Elpeleg
- Department of Genetics and Metabolic Diseases; Hadassah-Hebrew University Medical Center; Jerusalem Israel
- Monique and Jacques Roboh Department of Genetic Research; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Vardiella Meiner
- Department of Genetics and Metabolic Diseases; Hadassah-Hebrew University Medical Center; Jerusalem Israel
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Westerfield LE, Braxton AA, Walkiewicz M. Prenatal Diagnostic Exome Sequencing: a Review. CURRENT GENETIC MEDICINE REPORTS 2017. [DOI: 10.1007/s40142-017-0120-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Konialis C, Assimakopoulos E, Hagnefelt B, Karapanou S, Sotiriadis A, Pangalos C. Prenatal diagnosis of X-linked myopathy associated with a VMA21 gene mutation afforded through a novel targeted exome sequencing strategy applied in fetuses with abnormal ultrasound findings. Clin Case Rep 2017; 5:308-311. [PMID: 28265396 PMCID: PMC5331204 DOI: 10.1002/ccr3.822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/13/2016] [Accepted: 12/25/2016] [Indexed: 01/23/2023] Open
Abstract
Fetal malformations detected through routine prenatal ultrasound examination comprise a heterogeneous group potentially associated with genetic disorders where the underlying cause is difficult to establish. We present the prenatal diagnosis of a rare X‐linked myopathy involving a new VMA21 gene mutation, detected through a novel prenatal exome sequencing‐based approach.
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Affiliation(s)
- Christopher Konialis
- InterGenetics - Diagnostic Genetics Centre Athens 11526 Greece; Genomis Ltd, Lynton House London WC1H 9BQ UK
| | - Efstratios Assimakopoulos
- 2nd Department of Obstetrics and Gynecology Ippokrateion General Hospital Aristotle University of Thessaloniki Thessaloniki Greece
| | - Birgitta Hagnefelt
- InterGenetics - Diagnostic Genetics Centre Athens 11526 Greece; Genomis Ltd, Lynton House London WC1H 9BQ UK
| | | | - Alexandros Sotiriadis
- 2nd Department of Obstetrics and Gynecology Ippokrateion General Hospital Aristotle University of Thessaloniki Thessaloniki Greece
| | - Constantinos Pangalos
- InterGenetics - Diagnostic Genetics Centre Athens 11526 Greece; Genomis Ltd, Lynton House London WC1H 9BQ UK
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Feingold-Zadok M, Chitayat D, Chong K, Injeyan M, Shannon P, Chapmann D, Maymon R, Pillar N, Reish O. Mutations in the NEB
gene cause fetal akinesia/arthrogryposis multiplex congenita. Prenat Diagn 2017; 37:144-150. [DOI: 10.1002/pd.4977] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/23/2016] [Accepted: 11/25/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Michal Feingold-Zadok
- Genetic Institute; Assaf Harofeh Medical Center; Zerifin Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Obstetrics and Gynecology Ward, Ultrasound Unit; Assaf Harofeh Medical Center; Zerifin Israel
| | - David Chitayat
- Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and gynecology, Mount Sinai Hospital; University of Toronto; Toronto Ontario Canada
| | - Karen Chong
- Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and gynecology, Mount Sinai Hospital; University of Toronto; Toronto Ontario Canada
| | - Marie Injeyan
- Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and gynecology, Mount Sinai Hospital; University of Toronto; Toronto Ontario Canada
| | - Patrick Shannon
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital; University of Toronto; Toronto Ontario Canada
| | - Daphne Chapmann
- Genetic Institute; Assaf Harofeh Medical Center; Zerifin Israel
| | - Ron Maymon
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Obstetrics and Gynecology Ward, Ultrasound Unit; Assaf Harofeh Medical Center; Zerifin Israel
| | - Nir Pillar
- Bioinformatic Division, Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Orit Reish
- Genetic Institute; Assaf Harofeh Medical Center; Zerifin Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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Kehrer C, Hoischen A, Menkhaus R, Schwab E, Müller A, Kim S, Kreiß M, Weitensteiner V, Hilger A, Berg C, Geipel A, Reutter H, Gembruch U. Whole exome sequencing and array-based molecular karyotyping as aids to prenatal diagnosis in fetuses with suspected Simpson-Golabi-Behmel syndrome. Prenat Diagn 2016; 36:961-965. [PMID: 27589329 DOI: 10.1002/pd.4920] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 08/25/2016] [Accepted: 08/27/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Simpson-Golabi-Behmel (SGBS) syndrome type 1 and type 2 represent rare X-linked prenatal overgrowth disorders. The aim of our study is to describe the prenatal sonographic features as well as the genetic work-up. METHOD Retrospective analysis of four cases with a pre- or postnatal diagnosis of SGBS in a single tertiary referral center within a period of 4 years. RESULTS In the study period, four male fetuses with SGBS were detected. The final diagnosis was made prenatally in three cases. In all cases the second trimester anomaly scan revealed left sided congenital diaphragmatic hernia (CDH) with additional anomalies; three fetuses with SGBS type 1 showed fetal overgrowth. In two of these, whole exome sequencing showed a possible frameshift mutation and a point mutation in the gene GPC3, respectively. In the third case, multiplex ligation-dependent probe amplification (MLPA) revealed a hemizygous duplication of exon 3-7 in the gene GPC3. In the fourth case, SGBS type 2 was confirmed by array comparative genomic hybridization (CGH) of amniotic fluid cells showing a deletion of the gene OFD1. CONCLUSION We could demonstrate, that in the presence of a CDH, syndromes of the fetus can be increasingly differentiated by detailed sonography followed by a selective and graded molecular diagnostic using microarray techniques and whole exome sequencing. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Christina Kehrer
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Alexander Hoischen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ralf Menkhaus
- Center for Assisted Reproduction and Prenatal Diagnosis, Minden, Germany
| | - Eva Schwab
- Medical Office for Human Genetics, Wiesbaden, Germany
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care, University of Bonn, Bonn, Germany
| | - Sarah Kim
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Martina Kreiß
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | | | - Alina Hilger
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Anne Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Heiko Reutter
- Department of Neonatology and Pediatric Intensive Care, University of Bonn, Bonn, Germany.,Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.
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Pangalos C, Hagnefelt B, Lilakos K, Konialis C. First applications of a targeted exome sequencing approach in fetuses with ultrasound abnormalities reveals an important fraction of cases with associated gene defects. PeerJ 2016; 4:e1955. [PMID: 27168972 PMCID: PMC4860337 DOI: 10.7717/peerj.1955] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/30/2016] [Indexed: 01/15/2023] Open
Abstract
Background. Fetal malformations and other structural abnormalities are relatively frequent findings in the course of routine prenatal ultrasonographic examination. Due to their considerable genetic and clinical heterogeneity, the underlying genetic cause is often elusive and the resulting inability to provide a precise diagnosis precludes proper reproductive and fetal risk assessment. We report the development and first applications of an expanded exome sequencing-based test, coupled to a bioinformatics-driven prioritization algorithm, targeting gene disorders presenting with abnormal prenatal ultrasound findings. Methods. We applied the testing strategy to14 euploid fetuses, from 11 on-going pregnancies and three products of abortion, all with various abnormalities or malformations detected through prenatal ultrasound examination. Whole exome sequencing (WES) was followed by variant prioritization, utilizing a custom analysis pipeline (Fetalis algorithm), targeting 758 genes associated with genetic disorders which may present with abnormal fetal ultrasound findings. Results. A definitive or highly-likely diagnosis was made in 6 of 14 cases (43%), of which 3 were abortuses (Ellis-van Creveld syndrome, Ehlers-Danlos syndrome and Nemaline myopathy 2) and 3 involved on-going pregnancies (Citrullinemia, Noonan syndrome, PROKR2-related Kallmann syndrome). In the remaining eight on-going pregnancy cases (57%), a ZIC1 variant of unknown clinical significance was detected in one case, while in seven cases testing did not reveal any pathogenic variant(s). Pregnancies were followed-up to birth, resulting in one neonate harboring the PROKR2 mutation, presenting with isolated minor structural cardiac abnormalities, and in seven apparently healthy neonates. Discussion. The expanded targeted exome sequencing-based approach described herein (Fetalis), provides strong evidence suggesting a definite and beneficial increase in our diagnostic capabilities in prenatal diagnosis of otherwise chromosomally balanced fetuses with troubling ultrasound abnormalities. Furthermore, the proposed targeted exome sequencing strategy, designed primarily as a diagnostic rather than a research discovery tool, overcomes many of the problems and limitations associated with clinical wide-scale WES testing in a prenatal setting.
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Affiliation(s)
- Constantinos Pangalos
- Genomis Ltd, London, United Kingdom; InterGenetics-Diagnostic Genetic Centre, Athens, Greece
| | | | - Konstantinos Lilakos
- Department of Haematology, "Laikon" General Hospital - University of Athens Medical School , Athens , Greece
| | - Christopher Konialis
- Genomis Ltd, London, United Kingdom; InterGenetics-Diagnostic Genetic Centre, Athens, Greece
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