Expanding the clinical spectrum of biglycan-related Meester-Loeys syndrome

Pathogenic loss-of-function variants in BGN, an X-linked gene encoding biglycan, are associated with Meester-Loeys syndrome (MRLS), a thoracic aortic aneurysm/dissection syndrome. Since the initial publication of five probands in 2017, we have considerably expanded our MRLS cohort to a total of 18 probands (16 males and 2 females). Segregation analyses identified 36 additional BGN variant-harboring family members (9 males and 27 females). The identified BGN variants were shown to lead to loss-of-function by cDNA and Western Blot analyses of skin fibroblasts or were strongly predicted to lead to loss-of-function based on the nature of the variant. No (likely) pathogenic missense variants without additional (predicted) splice effects were identified. Interestingly, a male proband with a deletion spanning the coding sequence of BGN and the 5' untranslated region of the downstream gene (ATP2B3) presented with a more severe skeletal phenotype. This may possibly be explained by expressional activation of the downstream ATPase ATP2B3 (normally repressed in skin fibroblasts) driven by the remnant BGN promotor. This study highlights that aneurysms and dissections in MRLS extend beyond the thoracic aorta, affecting the entire arterial tree, and cardiovascular symptoms may coincide with non-specific connective tissue features. Furthermore, the clinical presentation is more severe and penetrant in males compared to females. Extensive analysis at RNA, cDNA, and/or protein level is recommended to prove a loss-of-function effect before determining the pathogenicity of identified BGN missense and non-canonical splice variants. In conclusion, distinct mechanisms may underlie the wide phenotypic spectrum of MRLS patients carrying loss-of-function variants in BGN.

202 VTE Prophylaxis Post-Laparoscopic Cholecystectomy

Introduction

VTE refers to a clot that causes stenosis or blockage of the blood flow in a vein. VTEs are classified as hospital-acquired if they occur within 90 days of hospital admission. Recent hospitalisation and associate immobilisation are well-acknowledged risk factors also included in Well’s score, which is used as part of the diagnostic work up.

NICE guidelines state that patient over 16 years old must be offered VTE prophylaxis either in the form of LMWH or fondaparinux for at least 7 days after an abdominal surgery.

The aim of the audit is to explore whether NICE guidelines regarding the VTE prophylaxis post-laparoscopic cholecystectomy are followed.

Method

The data from all the patients who had laparoscopic cholecystectomy in a two-month period was collected and discharge summaries and TTOs were reviewed to identify whether thromboprophylaxis was prescribed for 7 days following the operation. A second cycle was completed after results of first cycle presented to the surgical team.

Results

Increased in compliance with VTE prophylaxis guidelines observed, although though still suboptimal. 14% of patients received prophylaxis in first cycle, and 34% in the second.

Conclusion

Increased compliance with VTE guidelines observed, however the second cycle only included a small sample of patients which limited reliability. Furthermore, as highlighted by the surgical team, NICE guidelines are vague. There is no clarification regarding types of abdominal operations. No VTE incidences are yet to be identified post-operatively. Medico-legal aspects were also considered.

The efficacy of a cognitively orientated carers group in an early intervention in psychosis service--a pilot study

A significant amount of evidence has demonstrated that families and carers play an important role in an individual's recovery from a first episode of psychosis (FEP) and can significantly reduce relapse rates. This, in addition to the fact that caring for an individual experiencing their FEP can be incredibly stressful, suggests that the development of appropriate support for carers must be an integral part of any Early Intervention in Psychosis Service (EIPS). This study examines the efficacy of a closed structured group designed for carers of individuals experiencing their FEP based in Southampton city. A 12-session cognitively orientated group programme covering a range of areas was attended by 18 carers over a 6-month period. Following the group, a significant decrease was found in the carer's negative appraisals of the impact of psychosis, feelings of burden, depression and anxiety rates as measured by the Experience of Caregiving Inventory (ECI), Caregiver Burden Inventory (CBI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). A significant positive correlation was also found between carer's negative appraisals and their anxiety and depression rates, although further research is needed to clarify the causality of this relationship.

Localisation of a novel region of recurrent amplification in follicular lymphoma to an approximately 6.8 Mb region of 13q32-33

Follicular lymphoma (FL) is characterised by the presence of the t(14;18)(q32;q21) and represents approximately 25% of new cases of non-Hodgkin's lymphoma. While the t(14;18) is a well-documented rearrangement, the role of secondary cytogenetic abnormalities in the development and progression of these tumours remains unclear. Comparative genomic hybridisation was used to characterise changes in DNA copy number in tumour DNA from patients with this malignancy. The mean numbers of deletion and amplification events found in each of the 45 samples studied were 1.8 and 2.3, respectively. Regions of recurrent (>10% tumour samples) gain involved chromosomes 2p13-16 (16%), 7 (20%), 12 (16%), 13q21-33 (18%), 18 (27%), and X (36%) and frequent losses localised to 6q (29%) and 17p (20%). Amplification of chromosome 13 represents a novel finding in FL. The minimal amplified region was refined to a 6.8-Mb interval of 13q32-33 between the BAC clones 88K16 and 44H20 by fluorescence in situ hybridisation studies using metaphase chromosomes derived from tumour material. There are a number of reports in the literature suggesting that amplification of chromosome 13 also occurs in other human cancers. The location of the putative oncogene on 13q described here in follicular and transformed lymphoma may also be important in the evolution of many other malignancies.