Promising response to vemurafenib and cobimetinib treatment for BRAF V600E mutated craniopharyngioma: a case report and literature review

Craniopharyngiomas are tumors that arise from the remnants of Rathke's pouch along the nasopharynx to the diencephalon. Current standard of care includes maximal surgical resection versus adjuvant radiation if a maximal resection is unfeasible. Pharmacological therapy with MAPK targeted agents is an emerging therapeutic option for tumors with BRAF V600E mutations. We report a 45-year-old male with a strictly third ventricle papillary craniopharyngioma with a BRAF V600E mutation. After initial surgery with subtotal resection, the patient demonstrated durable response to targeted BRAF and MEK inhibitor therapy with vemurafenib and cobimetinib. Our report suggests that targeted therapy may reduce the need for radiation and impact surgical interventions in select cases.

Application of Machine Learning to Metabolomic Profile Characterization in Glioblastoma Patients Undergoing Concurrent Chemoradiation

We here characterize changes in metabolite patterns in glioblastoma patients undergoing surgery and concurrent chemoradiation using machine learning (ML) algorithms to characterize metabolic changes during different stages of the treatment protocol. We examined 105 plasma specimens (before surgery, 2 days after surgical resection, before starting concurrent chemoradiation, and immediately after chemoradiation) from 36 patients with isocitrate dehydrogenase (IDH) wildtype glioblastoma. Untargeted GC-TOF mass spectrometry-based metabolomics was used given its superiority in identifying and quantitating small metabolites; this yielded 157 structurally identified metabolites. Using Multinomial Logistic Regression (MLR) and GradientBoostingClassifier (GB Classifier), ML models classified specimens based on metabolic changes. The classification performance of these models was evaluated using performance metrics and area under the curve (AUC) scores. Comparing post-radiation to pre-radiation showed increased levels of 15 metabolites: glycine, serine, threonine, oxoproline, 6-deoxyglucose, gluconic acid, glycerol-alpha-phosphate, ethanolamine, propyleneglycol, triethanolamine, xylitol, succinic acid, arachidonic acid, linoleic acid, and fumaric acid. After chemoradiation, a significant decrease was detected in 3-aminopiperidine 2,6-dione. An MLR classification of the treatment phases was performed with 78% accuracy and 75% precision (AUC = 0.89). The alternative GB Classifier algorithm achieved 75% accuracy and 77% precision (AUC = 0.91). Finally, we investigated specific patterns for metabolite changes in highly correlated metabolites. We identified metabolites with characteristic changing patterns between pre-surgery and post-surgery and post-radiation samples. To the best of our knowledge, this is the first study to describe blood metabolic signatures using ML algorithms during different treatment phases in patients with glioblastoma. A larger study is needed to validate the results and the potential application of this algorithm for the characterization of treatment responses.

TMET-08. METABOLOMIC CHANGES IN GLIOBLASTOMA PATIENTS UNDERGOING CONCURRENT CHEMORADIATION THERAPY

OBJECTIVE

To illustrate changes of untargeted metabolomics in patients with glioblastoma IDH wildtype undergoing concurrent radiation therapy (RT) with temozolomide (TMZ). This study implemented machine learning (ML) algorithms to predict treatment phase: pre-surgery, post-surgery, pre-radiation, and post radiation based on untargeted metabolomics data.

METHODS

Thirty-six patients with glioblastoma IDH wildtype (18 methylguanine methyltransferase [MGMT] methylated, 16 MGMT unmethylated, 2 MGMT status unknown) were enrolled into this study. Serum samples obtained from patients on the same day before surgery, 2 days after surgery, before starting their concurrent chemoradiation, and after concluding this phase of treatment. Blood samples were obtained via antecubital phlebotomy without regard for time of the day, diet, or fasting status. Untargeted metabolomics by GC-TOF mass spectrometry were obtained and compared. The proposed ML models analyzed 105 samples from 36 patients utilizing 157 structurally identified blood metabolites. Multinomial Logistic Regression (MLR) and GradientBoostingClassifier (GB Classifier) were used to classify patient samples based on detected changes in blood metabolites. The classification performance of these models was evaluated using performance metrics and AUC scores.

RESULTS

Post radiation; significant increase in the following metabolites: glycine, serine, threonine, oxoproline, 6-deoxyglucose, gluconic acid, glycerol-alpha-phosphate, ethanolamine, propyleneglycol, triethanolamine, xylitol, and fumaric acid were noted while significant decrease in 3-aminopiperidine 2,6-dione was noted post radiation. MLR produced 78% accuracy, 75% precision, and AUC = 0.89, and GB Classifier produced 75% accuracy, 77% precision and AUC = 0.91. Finally, we presented a pattern of metabolites changes per clinical stage based on pairwise correlations.

CONCLUSIONS

This study represent the first serum metabolic signature associated with RT in patients with glioblastoma. The results from the classification algorithms and pairwise correlations showed that blood metabolites have the potential to predict phase of treatment and potentially enable to evaluate response to treatment in patients with glioblastoma in a relatively small cohort.

Performance of Iris pseudacorus and Typha domingensis for furosemide removal in a hydroponic system

The potential of Iris pseudacorus and Typha domingensis to remove the pharmaceutical active compound (PhAC) Furosemide from a nutrient solution was assessed. Both plants were exposed to 2 mg L^-1 of furosemide during 21 days and the removal of furosemide was monitored. Vessels without furosemide were also implemented as control systems for plants development. Likewise, unplanted vessels with furosemide were employed to assess abiotic removal mechanisms. All vessels were covered with aluminum foil to avoid photodegradation of the compound. Both plants showed potential to remove Furosemide, attaining, at the end of the experiment, a removal of 42.0-66.9% and 40.5-57.8%, for Typha and Iris, respectively. The plants do not presented a visible negative stress response to the exposure to furosemide, having a positive growth rate at the end of the experiment. Biodegradation seems to play an important role in furosemide removal, being enhanced by the presence of the plants. The two macrophytes presented different removal behaviors, particularly in the first 48 h of contact time. FUR removal by Iris follows a pseudo-first order while by Typha is divide in different phases. These results indicate that different plants species seem to have different mechanisms to remove pollutants from water.HighlightsPhACs removal potential of Iris pseudacorus and Typha domingensis was assessed.Plants were exposed to 2 mg L^-1 of furosemide during 21 days.Both macrophytes showed good removal efficiencies.Biodegradation of furosemide seems to be the main removal mechanism.Plants demonstrated different removal behavior along the experiment.Removal mechanisms of plants seem to differ between species.

Glioblastoma Multiforme of the Conus Medullaris—Management Strategies and Complications

Primary spinal glioblastoma multiforme (GBM) of the conus medullaris is a rare and devastating pathologic entity. The presenting symptoms commonly include progressive neurologic deficits in the lower extremities, bowel and bladder dysfunction, and low back pain. Histologically, these tumors have high-grade features similar to their intracranial counterparts. However, recent advancements in the field of molecular oncology have been beginning to elucidate a unique molecular blueprint for these spinal gliomas. Given the lack of standardized treatment strategies, we have presented our institutional experience in treating a small series of patients with conus medullaris GBM and have reviewed the reported data on the relevant molecular markers, management strategies, and complication avoidance for this malignant pathologic entity.

Abstract P3-12-25: Dosimetric impact of patient rotation during prone breast radiotherapy

Purpose

Prone positioning has been used as a viable alternative to conventional supine position for patients receiving breast radiation therapy. However, little research has been done exploring the axial rotation of patients toward the treated breast when “sinking” into the opening of the breast board and its potentially negative effects on dosimetric outcomes, which may include increased heart and lung dose. The physician may need to move the posterior border away from the chest wall to reduce heart and lung dose.

Methodology

49 consecutive female patients with left sided early stage breast cancer treated at University of California Davis Medical Center were assessed from 2015 to 2018 (age range: 42-84 years, median age: 62 years). All patients underwent prone whole breast therapy with conventional external beam radiation therapy (EBRT) at doses of 50 Gy (n = 12) or hypofractionated at 42.56 Gy (n = 37). Treatment plans and dose volumes were retrospectively analyzed for each patient. Standard tangents were designed for each patient using clinical landmarks of the midaxillary line and midsternal line, which were then compared to the delivered tangent beams. The angle created between a vertical line centered on center sternum and a line drawn from center sternum to center spinal cord served to define degree of axial rotation. Breast depth was defined by the longest horizontal length from outer rib to edge of breast on sagittal view. Patients were divided into subgroups by degree of rotation and absolute breast depth. A two tailed paired Student's t-test was used for analysis.

Results

Overall mean heart and lung dose were 82.2 cGy and 50.43 cGy for the entire cohort, respectively. For standard tangents, patients with degree of rotation < 5 degrees in the prone position (n = 23) had significant lung sparing as compared to patients with degree of rotation > 5 cm (n = 26) (mean lung dose: 61.8 cGy vs 129.6 cGy, p = 0.00329). This was also seen for cardiac sparing (mean heart dose: 105.9 cGy vs 183.9 cGy, p = 0.000235). Even with reduction of posterior border for treatment delivery, there remained a significant increase in mean heart and lung dose with increased rotation (p = 0.038, p = 0.046). Although not statistically significant, for patients with > 5 degrees of rotation there was a trend toward increased reduction of the posterior border of the tangent (13 mm vs. 7.5 mm, p = 0.13). A significant predictor of increased rotation was breast depth > 10 cm (p = 0.01). Patients with absolute breast depth > 10 cm (n = 23) in the prone position had significant lung sparing as compared to patients with absolute breast depth < 10 cm (n = 26) (mean lung dose: 58.6 cGy vs 40.8 cGy, p = 0.042).

Conclusion

To our knowledge, this is the first dosimetric comparison of prone breast therapy exploring the degree of patient roll into the prone-breast setup cavity. This study demonstrates a significant increase in mean lung and heart dose when patient rotation is greater than 5 degrees. Given this, the posterior border may have to be reduced to prevent a higher than intended dose to the heart and lung. Proper attention during simulation is important to allow for optimal dose distribution and special attention should be paid to women with smaller breast size.

Citation Format: Cheng K, Hoopingarner S, Wright C, Daly M, Fragoso R, Zhao X. Dosimetric impact of patient rotation during prone breast radiotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-25.

Furosemide removal in constructed wetlands: Comparative efficiency of LECA and Cork granulates as support matrix

The removal efficiency of LECA and cork granulates as support matrix for pharmaceuticals active compounds in a constructed wetland system was investigated using the diuretic drug Furosemide. Kinetics studies were performed testing three different concentrations of Furosemide in an ultrapure water matrix, along seven days. LECA achieved higher removal values compared to cork granulates. However, cork granulates presented a higher removal in the first 24 h of contact time compared to the other adsorbent. The kinetic studies showed that LECA and cork granulates have different adsorption behaviours for Furosemide which is controlled by different adsorption mechanisms. Both materials showed good removal efficiencies and a combination of the two should be further explored in order to applied both materials as support matrix to cope with different furosemide concentrations.

Overview of the state of the art of constructed wetlands for decentralized wastewater management in Brazil

Conventional wastewater treatment plants (WWTPs) commonly require large capital investments as well as operation and maintenance costs. Constructed wetlands (CWs) appear as a cost-effective treatment, since they can remove a broad range of contaminants by a combination of physical, chemical and biological processes with a low cost. Therefore, CWs can be successfully applied for decentralized wastewater treatment in regions with low population density and/or with large land availability as Brazil. The present work provides a review of thirty nine studies developed on CWs implemented in Brazil to remove wastewater contaminants. Brazil current sanitation data is also considered to evaluate the potential role of CWs as decentralized wastewater treatment. Performance of CWs was evaluated according to (i) type of wetland system, (ii) different support matrix (iii) vegetation species and (iv) removal efficiency of chemical oxygen demand (COD), biological oxygen demand (BOD₅), nitrogen (N), and phosphorus (P). The reviewed CWs in overall presented good efficiencies, whereas H-CWs achieved the highest removals for P, while the higher results for N were attained on VF-CW and for COD and BOD₅ on HF-CW. Therefore, was concluded that CWs are an interesting solution for decentralized wastewater treatment in Brazil since it has warm temperatures, extensive radiation hours and available land. Additionally, the low percentage of population with access to the sewage network in the North and Northeast regions makes these systems especially suitable. Hence, the further implementation of CW is encouraged by the authors in regions with similar characteristics as Brazil.

Water-energy nexus: Anaerobic co-digestion with elephant grass hydrolyzate

The anaerobic co-digestion process in a continuous stirred-tank reactor (CSTR) was carried out under mesophilic conditions (37 ± 0.2 °C). All the trials were performed at a hydraulic retention time (HRT) of 15 days and the AD reactor was daily fed with a mixture of sewage sludge (SS) and elephant grass hydrolyzate (EGH). In this study, three different trials were assessed, with different mixture proportions of SSSS and EGH: F0 (100:0,v/v), F1 (75:25, v/v) and F2 (50:50, v/v), during 90 days each trial, keeping the organic loading rate (OLR) in a range of 0.94-1.16 g VS L(-1) day(-1). The experimental results obtained showed that the soluble chemical oxygen demand (SCOD) removal efficiency was around 77% and 86% for trials F1 and F2, respectively. SS co-digestion with EGH enhanced methane yield, leading to an increment between 23% and 38%, in comparison with the reference scenario (F0).

Intraoperative Extracorporeal Irradiation for the Treatment of the Meningioma-Infiltrated Calvarium

Objectives Complete removal of infiltrated bone is required to achieve a Simpson Grade 1 meningioma resection. Reconstruction of the resulting bone defect is typically achieved with a nonnative implant that can result in poor cosmesis, foreign body reaction, or infection. Extracorporeal irradiation and reimplantation of tumorous bone has been used for limb-sparing surgery with excellent results, but this treatment option is not routinely considered in meningioma surgery. We present a case of anterior fossa meningioma with tumorous overlying calvarium that was successfully managed with intraoperative extracorporeal irradiation and reimplantation.

Design, Setting, and Participant A 37-year-old woman with persistent chronic headaches was found to have an anterior skull base meningioma with extension into the forehead frontal bone. Concurrently with mass resection, the bone flap was irradiated intraoperatively with 120 Gy. After resection of the tumor, the bone flap was replaced in its native position.

Main Outcome Measures and Results Twenty-nine months postoperatively, the patient had an excellent cosmetic outcome with no radiographic evidence of tumor recurrence or significant bone flap resorption.

Conclusion Intraoperative extracorporeal irradiation of tumorous calvaria during meningioma surgery is an effective, logistically feasible treatment option to achieve local tumor control and excellent cosmetic outcome.

Anaerobic co-digestion of dairy cattle manure and pear waste

Anaerobic co-digestion of pre-treated dairy cattle manure (LCM) with pear waste after a storage period (PLF) was tested at four inclusion levels: 0%, 25%, 75% and 100%. Inclusion levels consisted in the replacement of the volatile solids (VS) from the LCM with the VS from PLF keeping the organic loading rate around 1.1 ± 0.4 g SVL(-1)d(-1). The introduction of the co-substrate clearly enhanced methane production rate (MPR) in comparison to single substrate (phase I) as phases II and III, respectively, achieving values 1.3 and 2.8 times higher than phase I. The overall performance was optimized for the mixture 25:75 (LCM:PLF; v:v). Moreover, storage of pear waste did not compromise its use in AD. This fact is important once it can improve waste management from pear production through its valorisation as co-substrate in AD process.

Improved clinical outcomes with multi-modality therapy for sinonasal undifferentiated carcinoma of the head and neck

OBJECTIVE

To examine outcomes among patients treated for sinonasal undifferentiated carcinoma (SNUC) of the head and neck.

STUDY DESIGN

Retrospective review.

METHODS

The records of 16 consecutive patients with newly diagnosed, non-metastatic SNUC were analyzed. Initial treatment consisted of: surgery alone (6 patients), surgery with post-operative chemoradiotherapy (4 patients), and primary radiation therapy with concurrent chemotherapy (6 patients).

RESULTS

The median survival for patients treated by surgery followed by postoperative chemoradiotherapy was 30 months compared to 7 months and 9 months for patients treated by surgery alone and upfront chemoradiotherapy, respectively (p=0.20). The 2-year locoregional control was 18% for patients treated with upfront chemoradiotherapy, 37% for patients treated with surgery alone, and 78% for patients treated with surgery plus chemoradiotherapy (p=0.49).

CONCLUSION

While the potential role of selection bias must be considered, multi-modality therapy using surgery and post-operative chemoradiotherapy yielded the most favorable outcomes for SNUC and should be recommended whenever feasible.

Fractionated stereotactic radiation therapy improves cranial neuropathies in patients with skull base meningiomas: a retrospective cohort study

BACKGROUND

Skull base meningiomas commonly present with cranial neuropathies. Fractionated stereotactic radiation therapy (FSRT) has been used to treat these tumors with excellent local control, but rates of improvement in cranial neuropathies have not been well defined. We review the experience at Thomas Jefferson University using FSRT in the management of these patients with a focus on symptom outcomes.

METHODS

We identified 225 cases of skull base meningiomas treated with FSRT at Thomas Jefferson University from 1994 through 2009. The target volume was the enhancing tumor, treated to a standard prescription dose of 54 Gy. Symptoms at the time of RT were classified based on the cranial nerve affected. Logistic regression was performed to determine predictors of symptom improvement after FSRT.

RESULTS

The median follow-up time was 4.4 years. In 92% of cases, patients were symptomatic at the time of RT; the most common were impaired visual field/acuity (58%) or extraocular movements (34%). After FSRT, durable improvement of at least one symptom occurred in 57% of cases, including 40% of visual acuity/visual field deficits, and 40% of diplopia/ptosis deficits. Of all symptomatic patients, 27% experienced improvement of at least one symptom within 2 months of the end of RT.

CONCLUSIONS

FSRT is very effective in achieving improvement of cranial neuropathies from skull base meningiomas, particularly visual symptoms. Over half of treated patients experience a durable improvement of at least one symptom, frequently within 2 months from the end of RT.

Intracranial administration of human activated NK cells in a xenogeneic model of orthotopic glioblastoma (169.18)

Glioblastoma multiforme (GBM) is a highly invasive end-stage glioma which conveys an extremely poor prognosis. Based on our in vitro data showing very powerful anti-tumor activity of cytokine activated human natural killer cells against the GBM cell line U87MG, we sought to develop a xenograft model of GBM engraftment into NSG mice which would be treated with an intracranial administration of human NK cells. Such NK cell-based therapies allow for autologous NK cells to be utilized, thus minimizing toxicities. While rhIL-2 administered every other day significantly increased NK cell engraftment compared to saline treated controls, a single hydrodynamic injection of human IL15-encoding plasmid produced a far superior engraftment in the brain, spleen, liver, bone marrow and peritoneal fluid 4 days after injection with no toxicities observed. Activated human NK cells were then administered to mice bearing U87MG-luciferase gliomas five days after the orthotopic injection of tumor cells along with IL-2. While NK cell therapy provided a significant tumor volume reduction in the first several weeks after administration, this therapy was unable to protect mice in the long-term from tumor growth and death. Future studies will utilize IL-15 as well as IL-2 in a similar model. These combined data demonstrate the feasibility of NK cell-based therapies for gliomas as well as their potential role as a secondary treatment to target chemotherapy- and irradiation-resistant tumor cells.

Crouzon with acanthosis nigricans. Further delineation of the syndrome

Patients with Crouzon and acanthosis nigricans syndrome show craniofacial features similar to those observed in patients with classic Crouzon syndrome, in addition to acanthosis nigricans with peculiar characteristics. More severe physical manifestations, such as Chiari malformation, hydrocephalus, and atresia or stenosis of the choanas, which are unusual in individuals with classic Crouzon syndrome, are reported in these patients. The molecular abnormality associated with Crouzon syndrome with acanthosis nigricans (CAN) is a transition in the transmembrane domain of the FGFR3 gene that results in an Ala391Glu mutation. We describe two unrelated patients showing this mutation and compare their clinical features with those of other patients with CAN reported in the literature. In addition to craniosynostosis with crouzonoid facies and acanthosis nigricans (present in all patients), melanocytic nevi, choanal atresia or stenosis, hydrocephalus, Chiari malformations and oral abnormalities were observed in the majority of the 35 patients analyzed. Vertebral anomalies and conductive hearing loss were present with less frequency. Some characteristics considered typical of this condition (jaw cementomas, acanthomas and finger abnormalities) were absent in most of the patients.

Analysis of the formed track in solid state materials using atomic force microscopy

The track formation in solid state materials, from the theoretical point of view, is still under study. One way to understand the track formation mechanisms and radiation damage of the charged particles in some materials such as polymers, glasses and minerals, is to analyse the surface topography effects. In this work, the track formation analysis in polycarbonate material is presented using an atomic force microscope (AFM) to characterise the evolution of the track on the material surface and beyond a thin layer of the surface material. The AFM is very useful to obtain valuable information at the level of the atomic structure of the materials and of the nuclear tracks, due to its high resolution and very easy operation involving also a simple sample preparation. The results show the development of the formed track by means of induced surface effects after being exposed to ionising radiation and chemical etching.

Intrathymic signals in thymocytes are mediated by p38 mitogen-activated protein kinase

Thymocytes develop into mature functional T cells in the inductive environment of the thymus where thymocyte-stromal cell interactions and cytokines provide survival and differentiation signals as cues for thymocyte maturation. Disruption of the thymic microenvironment results in attenuation of T cell maturation, suggesting that intrathymic signals are essential for differentiation and repertoire selection. We have previously shown that several inducible nuclear factors such as AP-1, NF-AT, and NF-kappaB are activated in response to intrathymic signals. Here we demonstrate that in thymocytes p38 mitogen-activated protein (MAP) kinase, a member of the MAP kinase family of proteins that include the extracellular-signal regulated kinases and Jun aminoterminal kinases, is highly activated in response to intrathymic signals in vivo. These studies suggest a role for p38 MAP kinase in T cell survival and differentiation.

Intrathymic signals in thymocytes are mediated by p38 mitogen-activated protein kinase

Thymocytes develop into mature functional T cells in the inductive environment of the thymus where thymocyte-stromal cell interactions and cytokines provide survival and differentiation signals as cues for thymocyte maturation. Disruption of the thymic microenvironment results in attenuation of T cell maturation, suggesting that intrathymic signals are essential for differentiation and repertoire selection. We have previously shown that several inducible nuclear factors such as AP-1, NF-AT, and NF-kappaB are activated in response to intrathymic signals. Here we demonstrate that in thymocytes p38 mitogen-activated protein (MAP) kinase, a member of the MAP kinase family of proteins that include the extracellular-signal regulated kinases and Jun aminoterminal kinases, is highly activated in response to intrathymic signals in vivo. These studies suggest a role for p38 MAP kinase in T cell survival and differentiation.

Generalized osteoporosis in a patient with oculocutaneous hypopigmentation syndrome (OOCHS), without cerebral defects. A new syndrome?

An 8-year-old male patient presented a unique pattern of congenital anomalies. Prominent findings included a combination of severe osteoporosis and congenital oculocutaneous hypopigmentation. The patient may represent a hitherto undescribed syndrome of unknown etiology.

Identification of upstream signals regulating interleukin-6 gene expression during in vitro treatment of human B cells with pokeweed mitogen

The present studies have characterized the regulation of interleukin-6 (IL-6) gene expression during pokeweed mitogen (PWM)-driven human B-cell differentiation. PWM induced an early and transient increase in the expression of immediate-early response genes of the jun/fos leucine zipper family (c-jun, jun B, c-fos, and fos-B). The induction of c-jun mRNA by PWM was concentration dependent. Nuclear run-on assays showed that PWM treatment is associated with an increased rate of c-jun gene transcription. The induction of c-jun mRNA precedes the induction of IL-6 gene expression and IL-6 secretion by the B cells. c-Jun antisense, but not sense, oligodeoxynucleotide (ODN) significantly decreases PWM-related B-cell (1) proliferation; (2) IL-6 mRNA induction; (3) IL-6 secretion; and (4) nuclear extract binding to AP-1 in electrophoretic mobility shift assay. In contrast, c-Fos anti-sense ODN did not effect either IL-6 mRNA induction or IL-6 secretion triggered in B cells by PWM. The results further show activation of c-Raf-1 kinase in PWM-treated B cells. Raf-1 acts upstream to mitogen-activated protein (MAP) kinase; therefore, studies were performed to assay for MAP kinase activation in these cells. The results show an increase in phosphorylation of myelin basic protein (MBP) and c-Jun "Y" peptide in PWM-treated B cells. Taken together, these findings suggest that PWM is able to initiate an intracytoplasmic signaling cascade in normal human splenic B cells, which, at least in part, involves serine/threonine protein kinases. These results show transient induction of immediate-early response genes in B cells and support a potential role for the c-jun gene product in regulation of IL-6 transcription and secretion.

Centromeric association of a microchromosome in a Turner syndrome patient with a pseudodicentric Y

A 12-year-old patient with Turner syndrome was found to have a complex mosaicism for a microchromosome (MC) and a psu dic(Y)(q11). The MC was smaller than Yp, appeared pale in G, C and late replicating bands, had a pair of small centromeric dots, was associated with other chromosomes in most metaphases, and was rather stable both in size and during mitosis. The psu dic(Y) was Cd-positive only at the active centromere, had two pericentromeric heterochromatic regions, and lacked the Yq12 band. No cells with both abnormal chromosomes were found. To evaluate the association of the MC with all ordinary chromosomes, 857 G-banded cells with the marker were screened. The MC was considered as "associated" whenever the distance between it and other chromosome(s) was equal to, or smaller than, 18p. Out of 848 associations registered, 489 (57.7%) were centromeric, 202 (23.8%) telomeric, and 157 (18.5%) interstitial; i.e., centromeric associations were overrepresented (P < 0.001) and showed a random distribution, except for an excessive involvement of chromosome 8. This association pattern, also exhibited by two similar MCs in human beings, the minute Y of a marsupial and certain B chromosomes in plants, probably reflects the Rabl orientation of chromosomes in interphase.

[Recessive autosomal inheritance in Marfan syndrome]

Three brothers 9, 12, and 14 years of age were studied. The three of them fulfilled the diagnostic criteria of Marfan Syndrome that was made based on physical and ophthalmologic examination, these criteria included musculoskeletal abnormalities, subluxation of lens, myopia and aortic aneurysm. The three siblings died due to complications of the aortic aneurysm, which had an early onset as well as the other clinical manifestations of the disease. They were 2 brothers and one sister. There was neither mental or psychomotor retardation, nor metabolic disease in any of the patients. Family history did not show any clinical manifestation of the disease in parents or grandparents. We propose that the hereditary pattern is recessive autosomic instead of dominant autosomic given the features of these cases and their history.

Achalasia microcephaly syndrome in a patient with consanguineous parents: support for a.m. being a distinct autosomal recessive condition

A 4 9/12-year-old boy with achalasia microcephaly syndrome (AMS), born to a consanguineous couple, is reported. Comparative analysis of this case and the patients previously described in a Mexican family supports the notion that the syndrome is a distinct autosomal recessive condition. It is interesting that the area of origin and ethnicity of both the present and the previously reported cases is northwest Mexico.

Ehlers-Danlos features with progeroid facies and mild mental retardation. Further delineation of the syndrome

A syndrome characterized by progeroid facies, multiple nevi, mild mental retardation, skin hyperextensibility, bruisability, moderate skin fragility, joint hypermobility principally in digits, is described in two unrelated patients. Electron microscopy of the skin showed some fragmentation of the elastic fibers' portion and moderate electrodensity in the amorphous portion. Since a practically identical constellation of clinical features was previously reported in three patients, the individualization of a distinct connective tissue disorder, probably autosomal dominant, with variable expressivity is concluded.

Ciliary and superciliary hypotrichosis. A distinct autosomal dominant trait

A woman and her four children showed congenital sparse eyebrows, short, thin, misplaced and very scanty upper eyelashes and absent lower eyelashes. Erosion of the corneal epithelium was a common complication. This report confirms the condition as an autosomal dominant disorder.

Cortical blindness, growth and psychomotor retardation and postaxial polydactyly: a probably distinct autosomal recessive syndrome

A 14-month-old female infant with a syndrome mainly consisting of cortical blindness, psychomotor retardation and postaxial polydactyly (type B in hands and type A in feet) was studied. Two deceased sibs were similarly affected. Differential diagnosis and the review of medical literature permit the individualization of a distinct syndrome with a probable autosomal recessive pattern of inheritance.

A new psychomotor retardation syndrome with peculiar facies and marfanoid habitus

We studied four sibs, two males and two females, who presented psychomotor retardation, typical flat facies and some features of the Marfan phenotype such as tall stature, long and slim limbs, arm span larger than height, "arachnodactyloid" hands and feet, little subcutaneous fat and muscle hypotonia. It is concluded that the aggregate of morphoneurological anomalies constitute a new syndrome probably inherited in an autosomal recessive fashion.

3-M slender-boned nanism. An intrauterine growth retardation syndrome

Three sisters with 3-M slender-boned nanism are described. The main features were low birth weight, disproportionate dwarfism, large head for height, triangular-shaped face with wide anteverted nostrils, long philtrum and full lips, short neck, elbow malformation, pes planus with prominent heels, slender bones with thin diaphyses, small pelvis, and mild mental deficiency. Comparative analysis with the eight other cases reported in the literature permits further clinical delineation and the corroboration of autosomal recessive inheritance.

Severe mental deficiency, proportionate dwarfism, and delayed sexual maturation. A distinct inherited syndrome

Two 46,XY brothers were found to have a previously undescribed syndrome characterized by severe mental deficiency, proportionate dwarfism, and delayed sexual development. A recessive mode of inheritance, either autosomal or X-linked, is assumed.

[Hypermethioninemia. Apropos of a case in a consanguineous couple]

We describe a female child from a consanguineous marriage (uncle-niece) with hypermethioninemia and hypermethioninuria without homocystinuria. She had several signs and symptoms previously undescribed in this pathology as growth retardation, generalized hypotonia, digestive disturbances, white skin, hypochromia of iris, thin, sparse and blond scalp hair. The pedigree suggests an autosomal recessive inheritance pattern.