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Chan HW, Van den Broeck F, Cools A, Walraedt S, Joniau I, Verdin H, Balikova I, Van Nuffel S, Delbeke P, De Baere E, Leroy BP, Nerinckx F. Paediatric cataract surgery with 27G vitrectomy instrumentation: the Ghent University Hospital Experience. Front Med (Lausanne) 2023; 10:1197984. [PMID: 37601772 PMCID: PMC10435324 DOI: 10.3389/fmed.2023.1197984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Objective To describe a cohort of paediatric patients who underwent unilateral or bilateral lens extractions at Ghent University hospital using the Dutch Ophthalmic Research Center (D.O.R.C.) ultra-short 27G vitrectomy system. Methods Retrospective analysis of the medical and surgical records of all children that underwent lens extraction between September 2016 and September 2020 using the D.O.R.C. ultra-short 27G vitrectomy system. Results Seventy-two eyes of 52 patients were included. The most important aetiologies in this study were of secondary (25.5%), developmental (13.7%), or genetic (13.7%) nature. No definitive cause could be established in more than a quarter of cases (27.5%) despite extensive work-up, them being deemed idiopathic. The remainder of cases (19.6%) was not assigned a final aetiologic designation at the time of the study due to contradicting or missing diagnostic data. This study could not identify any cataract cases related to infection or trauma. Surgical complications rate was 61.1% of which posterior capsule opacification was the most frequent with a rate of 25%. A significant short-term postoperative best-corrected visual acuity gain (≤ -0.2 LogMAR) was observed in 60.5% of eyes for which usable acuity data were available (n = 38). Conclusion Many different instruments and techniques have been described and used in the context of paediatric lens extractions, each with its advantages and disadvantages. This study illustrates that an ultra-short 27G vitrectomy system can be used to perform paediatric lens extractions with good surgical outcomes. Further studies and comparative trials are needed to ascertain this further.
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Affiliation(s)
- Hwei Wuen Chan
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
- Department of Ophthalmology, National University Singapore, Singapore, Singapore
| | - Filip Van den Broeck
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Axelle Cools
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Sophie Walraedt
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Inge Joniau
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Hannah Verdin
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Irina Balikova
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Elfride De Baere
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Bart P. Leroy
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Ghent, Belgium
- Division of Ophthalmology, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Fanny Nerinckx
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
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Vitoria I, Melendreras F, Vázquez-Palazón A, Rausell D, Correcher P, González-Lamuño D, García-Peris M. Lactose and Galactose Content in Spanish Cheeses: Usefulness in the Dietary Treatment of Patients with Galactosaemia. Nutrients 2023; 15:nu15030594. [PMID: 36771301 PMCID: PMC9920515 DOI: 10.3390/nu15030594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
In galactosaemia, a strict galactose-free diet is necessary to prevent or resolve acute symptoms in infants. However, because the body produces up to 10 times more galactose than is found in a galactose-restricted diet, excessively restrictive diets should be avoided in children and adults to prevent nutritional deficiencies. Since cheese is a nutritional source of the calcium necessary for bone health, the latest international guidelines on the management of classical galactosaemia (2017) allow the consumption of cured cheeses with less than 25 mg of galactose/100 g and recommend that each country verifies the adequacy of the cheeses, since most mature cheeses do not always have a lower galactose content. In total, 32 cheese samples were purchased (19 Spanish and 13 international cheeses), and their lactose and galactose contents were analysed using ion chromatography with pulsed amperometric detection (IC-PAD). Five Spanish cheeses contained less than 25 mg of galactose/100 g: García Baquero semi-cured cheese; Hacendado, Gran Reserva and Mahón cured cheeses; and García Baquero Reserva 12-month cured cheese. In addition, eight international cheeses were confirmed as suitable: Comté, Gouda, Gruyere, Maasdam, Parmigiano, Edam, Emmental, and some samples of Cheddar. In addition to the well-known low-galactose Swiss and Dutch cheeses, according to the current results, five Spanish cheeses can be safely consumed. The greater availability of types of cheese favours better bone health in patients with galactosaemia.
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Affiliation(s)
- Isidro Vitoria
- Nutrition and Metabolopathies Unit, La Fe University Hospital, 46025 Valencia, Spain
- Correspondence:
| | | | | | - Dolores Rausell
- Metabolopathies Laboratory, La Fe University Hospital, 46026 Valencia, Spain
| | - Patricia Correcher
- Nutrition and Metabolopathies Unit, La Fe University Hospital, 46025 Valencia, Spain
| | - Domingo González-Lamuño
- Pediatric Nephrology and Metabolism, “Marqués de Valdecilla” University Hospital, 39008 Santander, Spain
| | - Mónica García-Peris
- Nutrition and Metabolopathies Unit, La Fe University Hospital, 46025 Valencia, Spain
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3
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Milner D, Boyle F, McNulty J, Knerr I. Assessment of Dietary Intake of Iodine and Risk of Iodine Deficiency in Children with Classical Galactosaemia on Dietary Treatment. Nutrients 2023; 15:nu15020407. [PMID: 36678278 PMCID: PMC9860822 DOI: 10.3390/nu15020407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/24/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
Iodine is an essential mineral required for the synthesis of thyroid hormones. Iodine plays a critical role in growth and neurocognitive development. Classical galactosaemia is a disorder resulting from an inborn error in galactose metabolism. Its current management consists of life-long lactose and galactose dietary restriction. This study estimated dietary intakes of iodine in infants and children with classical galactosaemia in the Republic of Ireland. The diets of 43 participants (aged 7 months-18 years) with classical galactosaemia were assessed for iodine intake using an iodine-specific food frequency questionnaire. Intakes were compared to the European Food Safety Authority (EFSA) dietary recommendations for iodine intake. The potential role of iodine fortification of dairy alternative products was also examined. There were no significant differences observed between sex, ethnicity and parental education and meeting dietary iodine recommendations. Differences, however, were seen between age groups, causing the p value to approach statistical significance (p = 0.06). Infants consuming infant formula were likely to meet iodine recommendations. However, over half (53%) of children aged 1-18 years had average intakes below the recommendations for age. For these children, consumption of iodine-fortified dairy alternative milk was the leading source of iodine in the diets, followed by fish/shellfish and eggs. An assessment of iodine intake should be undertaken during dietetic reviews for those with classical galactosaemia. Mandatory iodine fortification of all dairy alternative products would result in 92% of the total population cohort meeting iodine recommendations based on their current consumption.
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Affiliation(s)
- Dearbhla Milner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, D04 V2P1 Dublin, Ireland
| | - Fiona Boyle
- Department of Nutrition and Dietetics, National Centre for Inherited Metabolic Disorders, Children’s Health Ireland, Temple Street, D01 XD99 Dublin, Ireland
- Correspondence:
| | - Jenny McNulty
- Department of Nutrition and Dietetics, National Centre for Inherited Metabolic Disorders, Children’s Health Ireland, Temple Street, D01 XD99 Dublin, Ireland
| | - Ina Knerr
- National Centre for Inherited Metabolic Disorders, Children’s Health Ireland, Temple Street, D01 XD99 Dublin, Ireland
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Abstract
Inherited metabolic disorders are a large group of rare disorders affecting normal biochemical pathways. Many metabolic disorders can present with symptoms affecting the eye, and eye disorders can evolve later in the natural history of an already diagnosed metabolic disorder. The ophthalmic involvement can be very varied affecting any part of the eye, including abnormalities of cornea, lens dislocation and cataracts, retina and the distal optic pathway, and extraocular muscles. Awareness of inherited metabolic disorders is important to facilitate early diagnosis and in some cases instigate early treatment if a patient presents with eye involvement suggestive of a metabolic disorder. Ophthalmological interventions are also an important component of the multisystem holistic approach to treating patients with metabolic disorders.
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Affiliation(s)
- James E. Davison
- Metabolic Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, NIHR GOSH Biomedical Research Centre (BRC), London WC1N 3JH, UK
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5
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Cohen AS, Baurek M, Lund AM, Dunø M, Hougaard DM. Including Classical Galactosaemia in the Expanded Newborn Screening Panel Using Tandem Mass Spectrometry for Galactose-1-Phosphate. Int J Neonatal Screen 2019; 5:19. [PMID: 33072978 PMCID: PMC7510209 DOI: 10.3390/ijns5020019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/02/2019] [Indexed: 12/04/2022] Open
Abstract
Galactosaemia has been included in various newborn screening programs since 1963. Several methods are used for screening; however, the predominant methods used today are based on the determination of either galactose-1-phosphate uridyltransferase (GALT) activity or the concentration of total galactose. These methods cannot be multiplexed and therefore require one full punch per sample. Since the introduction of mass spectrometry in newborn screening, many diseases have been included in newborn screening programs. Here, we present a method for including classical galactosaemia in an expanded newborn screening panel based on the specific determination of galactose-1-phosphate by tandem mass spectrometry. The existing workflow only needs minor adjustments, and it can be run on the tandem mass spectrometers in routine use. Furthermore, compared to the currently used methods, this novel method has a superior screening performance, producing significantly fewer false positive results. We present data from 5500 routine newborn screening samples from the Danish Neonatal Screening Biobank. The cohort was enriched by including 14 confirmed galactosaemia positive samples and 10 samples positive for other metabolic disorders diagnosed through the Danish newborn screening program. All galactosaemia positive samples were identified by the method with no false positives. Furthermore, the screening performance for other metabolic disorders was unaffected.
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Affiliation(s)
- Arieh S. Cohen
- Danish Center for Newborn Screening, Statens Serum Institut, 2300 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-3568-3520
| | - Marta Baurek
- Danish Center for Newborn Screening, Statens Serum Institut, 2300 Copenhagen, Denmark
| | - Allan M. Lund
- Centre for Inherited Metabolic Diseases, Departments of Paediatrics and Clinical Genetics, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Morten Dunø
- Centre for Inherited Metabolic Diseases, Departments of Paediatrics and Clinical Genetics, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - David M. Hougaard
- Danish Center for Newborn Screening, Statens Serum Institut, 2300 Copenhagen, Denmark
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6
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Papachristoforou R, Petrou PP, Sawyer H, Williams M, Drousiotou A. Classic galactosaemia in the Greek Cypriot population: An epidemiological and molecular study. Ann Hum Genet 2019; 83:291-298. [PMID: 30994193 PMCID: PMC6766971 DOI: 10.1111/ahg.12318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/15/2019] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
Abstract
Classic galactosaemia is an inherited metabolic disorder of galactose metabolism caused by deficiency of the enzyme galactose-1-phosphate uridyltransferase (GALT) resulting from mutations in the GALT gene. The objectives of the present study were the determination of the carrier frequency of classic galactosaemia in the Greek Cypriot population and the molecular characterization of the disease alleles. We performed an epidemiological study involving 528 Greek Cypriots originating from all parts of Cyprus. Carriers were identified by measuring GALT activity in red blood cells and were subsequently subjected to mutation analysis. A total of five mutations were identified in patients and carriers of classic galactosaemia: a large deletion of 8.5 kb previously reported by us (55% of alleles), the known mutations p.Lys285Asn (30%), p.Pro185Ser (5%), and c.820+13A>G (5%), and a novel mutation c.378-12G>A (5%). Interestingly, the most common mutation in European populations, p.Gln188Arg, was not identified in this Cypriot cohort. The carrier frequency for classic galactosaemia among Greek Cypriots was estimated to be 1:88, predicting a homozygote incidence of 1:31,000 births. The Duarte 1 and Duarte 2 variants were found to be present at a frequency of 5.5% and 2.5%, respectively.
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Affiliation(s)
- Rena Papachristoforou
- Department of Biochemical Genetics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Petros P Petrou
- Department of Biochemical Genetics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,The Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Hilary Sawyer
- Bristol Genetics Laboratory, Southmead Hospital, Bristol, United Kingdom
| | - Maggie Williams
- Bristol Genetics Laboratory, Southmead Hospital, Bristol, United Kingdom
| | - Anthi Drousiotou
- Department of Biochemical Genetics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,The Cyprus School of Molecular Medicine, Nicosia, Cyprus
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Abstract
Classical galactosemia is an inherited disorder of the carbohydrate metabolism, most often caused by the deficient activity of the enzyme galactose-1-phosphate-uridyltransferase. Classical galactosemia presents in the neonatal period with life threatening illness after galactose is introduced in the diet. Symptoms and signs include poor feeding, vomiting, and diarrhea, weight loss, jaundice, hypotension, cataracts, hepatosplenomegaly, hepatocellular insufficiency, and encephalopathy. Since 1975 the testing for galactosemia is part of the neonatal screening program in Hungary. Affected newborns are recognized in the first days of their life, and special diet is introduced immediately. The therapy of galactosemia is the lactose-free and galactose-poor diet for life. As a result of the nationwide newborn screening and the lifelong medical therapy, early treatment with galactosemia can achieve a normal life without serious complications. Orv Hetil. 2017; 158(47): 1864-1867.
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Affiliation(s)
- Erika Kiss
- I. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Bókay J. u. 53.,1083
| | - Lídia Balogh
- I. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Bókay J. u. 53.,1083
| | - Péter Reismann
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
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8
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Abstract
Patients with classical galactosaemia (galactose-1-phosphate uridyltransferase (GALT) deficiency) manifest clinical complications despite strict dietary galactose restriction. Therefore the significance of endogenous galactose production has been assessed. Previous in vivo studies primarily focused on patients homozygous for the most common genetic variant Q188R but little is known about other genetic variants. In the present study the endogenous galactose release in a group of non-Q188R homozygous galactosaemic patients (n = 17; 4-34 years) exhibiting comparably low residual GALT activity in red blood cells was investigated. Primed continuous infusion studies with D-[1-(13)C]galactose as substrate were conducted under post-absorptive conditions and in good metabolic control. The results demonstrate that all patients exhibiting residual GALT activity of <1.5% of control showed a comparable pathological pattern of increased endogenous galactose release irrespective of the underlying genetic variations. Possible implications of the findings towards a more differentiated dietary regimen in galactosaemia are discussed.
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Affiliation(s)
- Peter Schadewaldt
- Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Leibniz Center for Diabetes Research , Duesseldorf , Germany and
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9
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Michel MA, Raucourt E, Bednarek N, Garnotel R. [What disorders suspect following an increase of phenylalanine on newborn screening?]. Ann Biol Clin (Paris) 2014; 72:193-6. [PMID: 24736139 DOI: 10.1684/abc.2014.0942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
Screening for PKU, in France, is made on the 3rd day of life by measuring the concentration of phenylalanine in dried blood spot samples. In this study, the goal was to examine the final diagnosis of patients who showed a hyperphenylalaninemia during newborn screening laboratory. Over a period of 11 years from 1 February 2002 to 31 January 2013, all newborns with a phenylalanine concentration increase (>180 μmol/L) have been identified and the cause of this increase was noted. Of the 165,113 newborns screened, hyperphenylalaninemia was identified in 90 patients during the newborn screening laboratory. During this period 35% of cases were due to classical phenylketonuria or hyperphenylalaninemia. In 4.4% of cases, increase concentrations were due to other diseases (biopterine deficiency, galactosemia, MSUD). However, 48.9% of high concentrations have not been confirmed by a second sample and 11% were children who died rapidely during their first days of life. The positive predictive value (PPV) of the test with a threshold of positivity >180 μmol/L was 40%. Our study showed that the positivity threshold of 180 μmol/L proposed by the Association française pour le dépistage et la prévention des handicaps de l'enfant (AFDPHE) provides a comprehensive detection of all phenylketonuria cases as well as mild hyperphenylalaninemia permanent and transient cases. Eventhough the use of a higher threshold would have the advantage of increasing the PPV of the test, none the less we would have missed out on some cases to follow.
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Affiliation(s)
- Marc-Antoine Michel
- Laboratoire de biologie et de recherche pédiatriques, American Memorial Hospital, CHU Reims, France
| | | | - Nathalie Bednarek
- ARCAMMHE, Alix de Champagne, CHU Reims, France, Service de néonatologie, Alix de Champagne, CHU Reims, France
| | - Roselyne Garnotel
- Laboratoire de biologie et de recherche pédiatriques, American Memorial Hospital, CHU Reims, France, ARCAMMHE, Alix de Champagne, CHU Reims, France
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10
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Cheung KL, Tang N, Hsiao KJ, Law LK, Wong W, Ng PC, Pang CP, Applegarth DA, Fok TF, Hjelm NM. Classical galactosaemia in Chinese: A case report and review of disease incidence. J Paediatr Child Health 1999; 35:399-400. [PMID: 28871650 DOI: 10.1046/j.1440-1754.1999.00373.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of galactose-1-phosphate uridyl transferase (GALT) deficiency in a full-term Chinese neonate, who presented with atypical biochemical features of hyperammonaemia in addition to the classical presenting features of jaundice and lethargy after feeding. Red cell GALT activity was virtually absent in the patient while 50% of normal activity was found in parents and a sibling. Mutation screening excluded both Q188R and N314D as the causative mutation in GALT gene, which suggested a possible genetic segregation among ethnic groups. Data from a Taiwan screening program suggested that the incidence of the disease was approximately 1 in 400 000 in the Chinese population which was a sixth of that in Caucasian populations.
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Affiliation(s)
- K L Cheung
- Departments of Pediatrics and,Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,,Institutes of Genetics, National Yang-Ming University, Taiwan, and Department of Medical Research and Education, Veterans General Hospital - Taipei, Taiwan,,Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - Nls Tang
- Departments of Pediatrics and,Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,,Institutes of Genetics, National Yang-Ming University, Taiwan, and Department of Medical Research and Education, Veterans General Hospital - Taipei, Taiwan,,Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - K J Hsiao
- Departments of Pediatrics and,Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,,Institutes of Genetics, National Yang-Ming University, Taiwan, and Department of Medical Research and Education, Veterans General Hospital - Taipei, Taiwan,,Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - L K Law
- Departments of Pediatrics and,Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,,Institutes of Genetics, National Yang-Ming University, Taiwan, and Department of Medical Research and Education, Veterans General Hospital - Taipei, Taiwan,,Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - W Wong
- Departments of Pediatrics and,Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,,Institutes of Genetics, National Yang-Ming University, Taiwan, and Department of Medical Research and Education, Veterans General Hospital - Taipei, Taiwan,,Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - P C Ng
- Departments of Pediatrics and,Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,,Institutes of Genetics, National Yang-Ming University, Taiwan, and Department of Medical Research and Education, Veterans General Hospital - Taipei, Taiwan,,Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - C P Pang
- Departments of Pediatrics and,Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,,Institutes of Genetics, National Yang-Ming University, Taiwan, and Department of Medical Research and Education, Veterans General Hospital - Taipei, Taiwan,,Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - D A Applegarth
- Departments of Pediatrics and,Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,,Institutes of Genetics, National Yang-Ming University, Taiwan, and Department of Medical Research and Education, Veterans General Hospital - Taipei, Taiwan,,Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - T F Fok
- Departments of Pediatrics and,Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,,Institutes of Genetics, National Yang-Ming University, Taiwan, and Department of Medical Research and Education, Veterans General Hospital - Taipei, Taiwan,,Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - N M Hjelm
- Departments of Pediatrics and,Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,,Institutes of Genetics, National Yang-Ming University, Taiwan, and Department of Medical Research and Education, Veterans General Hospital - Taipei, Taiwan,,Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
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