CRISPRi-mediated functional analysis of lung disease-associated loci at non-coding regions

Genome-wide association studies have identified lung disease-associated loci; however, the functions of such loci are not well understood in part because the majority of such loci are located at non-coding regions. Hi-C, ChIP-seq and eQTL data predict potential roles (e.g. enhancer) of such loci; however, they do not elucidate the molecular function. To determine whether these loci function as gene-regulatory regions, CRISPR interference (CRISPRi; CRISPR/dCas9-KRAB) has been recently used. Here, we applied CRISPRi along with Hi-C, ChIP-seq and eQTL to determine the functional roles of loci established as highly associated with asthma, cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF). Notably, Hi-C, ChIP-seq and eQTL predicted that non-coding regions located at chromosome 19q13 or chromosome 17q21 harboring single-nucleotide polymorphisms (SNPs) linked to asthma/CF/COPD and chromosome 11p15 harboring an SNP linked to IPF interact with nearby genes and function as enhancers; however, CRISPRi indicated that the regions with rs1800469, rs2241712, rs12603332 and rs35705950, but not others, regulate the expression of nearby genes (single or multiple genes). These data indicate that CRISPRi is useful to precisely determine the roles of non-coding regions harboring lung disease-associated loci as to whether they function as gene-regulatory regions at a genomic level.

Favorable outcomes in high-risk congenital pulmonary airway malformations treated with multiple courses of maternal betamethasone

BACKGROUND/PURPOSE

Congenital pulmonary airway malformations (CPAMs) are rare congenital lung lesions often diagnosed by prenatal ultrasound. High-risk cases can result in hydrops and prenatal or postnatal demise. Antenatal betamethasone has resulted in improved survival but it is unclear how to manage patients who do not respond to a single course.

METHODS

We present a bi-institutional retrospective review of patients treated with multiple courses of prenatal steroids for high-risk CPAMs between 2007 and 2013.

RESULTS

Nine patients met inclusion criteria. All but one either had an increased CPAM volume ratio (CVR) or number of fluid-containing compartments involved after a single course of antenatal betamethasone, prompting additional courses. Four patients stabilized, three improved and two progressed after the second course. The two cases with disease progression underwent an in utero resection. There were one in utero fetal demise and two deaths within the delivery room. Both fetuses that underwent a fetal resection died. All but one mother who delivered a viable fetus had complications of pregnancy.

CONCLUSIONS

Multiple courses of antenatal betamethasone for high-risk fetal CPAMs often result in favorable short-term outcomes without the need for open fetal resection. Pregnancy complications are common and women within this cohort should be monitored closely.

Fetal MRI of Torsed Bronchopulmonary Sequestration with Tension Hydrothorax and Hydrops in a Twin Gestation

While bronchopulmonary sequestration typically has a benign course, this congenital lung malformation has a high mortality rate when associated with untreated in utero tension hydrothorax and hydrops. Hydrops related to bronchopulmonary sequestration is believed to result from torsion of the mass with compromise of the associated blood supply. The impaired venous return of the mass then leads to tension hydrothorax with compression of the heart and mediastinal vessels, impairing global venous return. To our knowledge, this scenario has only been described prenatally by ultrasound. We present the imaging findings of a dichorionic, diamniotic twin gestation with one fetus developing tension hydrothorax and hydrops from presumed intermittent torsion of a bronchopulmonary sequestration. This diagnosis was only able to be confirmed by MRI prior to the use of ultrasound-guided interstitial laser photocoagulation for the treatment of this anomaly.

Prenatal Diagnosis of Infantile Myofibroma with Postnatal Imaging Correlation

Infantile myofibroma is the most common fibrous tumor in infancy. A majority of these lesions are solitary and occur in the head and neck region. Unless visceral sites are involved, the clinical course is typically benign. However, the difficulty in these cases is the differentiation of a benign myofibroma from a solitary malignant neoplasm and determination of visceral involvement. Prenatal diagnosis of this condition is rarely described in the literature, but it does indeed have a role in perinatal management. Our patient was initially identified by prenatal ultrasound with fetal MRI for further characterization of the mass. We present the case of a prenatally diagnosed solitary infantile myofibroma of the lower extremity and highlight the role of prenatal imaging in the diagnosis and treatment of this condition.

Tracheal agenesis with tracheoesophageal fistulae: fetal MRI diagnosis with confirmation by ultrasound during an ex utero intrapartum therapy (EXIT) delivery and postdelivery MRI

Tracheal agenesis is a rare and essentially lethal anomaly with divergent prenatal imaging findings depending on the presence or absence of a tracheoesophageal fistula. All prenatally diagnosed cases of tracheal agenesis reported to date have not had a tracheoesophageal fistula and presented with thoracoabdominal findings similar to congenital high airway obstruction syndrome. We present the case of a 32-week gestation fetus with rapid onset of polyhydramnios and no persistent findings of congenital high airway obstruction syndrome that was ultimately diagnosed with tracheal agenesis plus tracheoesophageal fistula by fetal MRI. Additionally, we present the novel uses of intraoperative US during a staged ex utero intrapartum therapy delivery and postdelivery MRI, facilitated by proximity within the neonatal ICU, to confirm diagnosis and direct patient management while minimizing unnecessary investigations.

Community violence in Jamaica: A public health issue for the health profession

Societal violence is a public health concern that confronts different countries. In this paper, the author examines the situation of community violence in Jamaica and discusses steps which could be taken by the health community to curb the pervasive and growing problem of community violence.

Lung volume reduction surgery at a community hospital: program development and outcomes

STUDY OBJECTIVES

Description of the development and results of a program in lung volume reduction surgery (LVRS) at a community hospital.

DESIGN

Prospective data collection.

SETTING

A 320-bed community hospital.

PATIENTS

Fifty-five patients consecutively discharged from the hospital following LVRS. The mean preoperative FEV1 averaged 28% (+/-8%) of predicted values, while the preoperative PaCO2 averaged 49 mm Hg (+/-11.5 mm Hg). Forty-eight patients completed a preoperative conditioning regimen and underwent the procedure on an elective basis. Seven patients underwent the procedure during a hospital admission for a COPD exacerbation. Eight patients required mechanical ventilation preoperatively, including three who had required long-term mechanical ventilatory support.

RESULTS

Three patients (5%) died in the hospital following surgery. One patient developed chronic ventilator dependence. All three of the patients who required long-term mechanical ventilation preoperatively were weaned from the ventilator and returned home. Follow-up pulmonary function testing is available for 42 patients 3 months after surgery, and for 20 patients 6 months after the operation. At 3 months, the mean FEV1 improved 0.19 L (p=0.0002), the mean improvement for FVC was 0.37 L (p=0.0001), and the mean drop in residual volume was 0.97 L (p=0.0001). Similar changes are seen at 6 months. Highly significant improvements were also seen in quality of life measurements and exercise performance. The benefits of surgical treatment of emphysema seemed similar in both elective and urgent groups.

CONCLUSIONS

LVRS can be done safely and effectively at a community hospital, with significant improvement in pulmonary function and quality of life.

Promotional strategies in occupational health. Can it be extrapolated to general preventive medicine in the Caribbean Region?

This article highlights promotional strategies that are currently in use in occupational health which have yielded positive results in terms of cost-effectiveness and the prevention of occupational disease. Suggestions are offered on the possible extrapolation of these strategies to disease prevention programmes in medical practice in the Caribbean Region.

Ciguatoxin-induced food poisoning in a community. Implications for disease surveillance and medical practice in Jamaica

This article highlights an outbreak of food poisoning, the result of ingestion of Ciguatoxin-infected fish in a community. The case presentations of the patients involved are used to illustrate the clinical aspects of Ciguatoxin poisoning. The public health aspects of this incident and their relevance to disease surveillance are then discussed. Information of significance to general medical practice in relation to this particular type of fish poisoning, the effect of which could prove fatal in some cases, is also discussed.

Occupational carbamate pesticide intoxication in three farm workers. Implications and significance for occupational health in Jamaica

The importance of occupational health practice principles in the delivery of health care to the working population is stressed by the authors' management of an incident of occupational pesticide poisoning. The clinical management of the patients involved, as well as the occupational and environmental health management of that incident, is discussed. An illustrative case report is used to describe an occurrence of carbofuran pesticide poisoning in three female farm workers in Jamaica. This report highlights the implications and significance of this incident in terms of the sensitivity of the medical profession to similar occupational health problems.