Tubulin mutations in human neurodevelopmental disorders

Mutations causing dysfunction of tubulins and microtubule-associated proteins, also known as tubulinopathies, are a group of recently described entities that lead to complex brain malformations. Anatomical and functional consequences of the disruption of tubulins include microcephaly, combined with abnormal corticogenesis due to impaired migration or lamination and abnormal growth cone dynamics of projecting and callosal axons. Key imaging features of tubulinopathies are characterized by three major patterns of malformations of cortical development (MCD): lissencephaly, microlissencephaly, and dysgyria. Additional distinctive MRI features include dysmorphism of the basal ganglia, midline commissural structure hypoplasia or agenesis, and cerebellar and brainstem hypoplasia. Tubulinopathies can be diagnosed as early as 21-24 gestational weeks using imaging and neuropathology, with possible extreme microlissencephaly with an extremely thin cortex, lissencephaly with either thick or thin/intermediate cortex, and dysgyria combined with cerebellar hypoplasia, pons hypoplasia and corpus callosum dysgenesis. More than 100 MCD-associated mutations have been reported in TUBA1A, TUBB2B, or TUBB3 genes, whereas fewer than ten are known in other genes such TUBB2A, TUBB or TUBG1. Although these mutations are scattered along the α- and β-tubulin sequences, recurrent mutations are consistently associated with almost identical cortical dysgenesis. Much of the evidence supports that these mutations alter the dynamic properties and functions of microtubules in several fashions. These include diminishing the abundance of functional tubulin heterodimers, altering GTP binding, altering longitudinal and lateral protofilament interactions, and impairing microtubule interactions with kinesin and/or dynein motors or with MAPs. In this review we discuss the recent advances in our understanding of the effects of mutations of tubulins and microtubule-associated proteins on human brain development and the pathogenesis of malformations of cortical development.

Severe Acute Flaccid Myelitis Associated With Enterovirus in Children: Two Phenotypes for Two Evolution Profiles?

Acute flaccid myelitis (AFM) is an acute paralysis syndrome defined by a specific inflammation of the anterior horn cells of the spinal cord. From 2014, worrying waves of life-threatening AFM consecutive to enterovirus infection (EV-D68 and EV-A71) have been reported. We describe 10 children displaying an AFM with an EV infection, the treatments performed and the 1 to 3-years follow-up. Two groups of patients were distinguished: 6 children (“polio-like group”) had severe motor disability whereas 4 other children (“brainstem group”) displayed severe brainstem weakness requiring ventilation support. Electrodiagnostic studies (n = 8) support the presence of a motor neuronopathy associated to myelitis. The best prognosis factor seems to be the motor recovery after the first 4 weeks of the disease.

A direct multi-volume rendering method aiming at comparisons of 3-D images and models

We present a new method for direct volume rendering of multiple three-dimensional (3-D) functions using a density emitter model. This work aims at obtaining visual assessment of the results of a 3-D image registration algorithm which operates on anisotropic and non segmented medical data. We first discuss the fundamentals associated with direct, simultaneous rendering of such datasets. Then, we recall the fuzzy classification and fuzzy surface rendering theory within the density emitter model terminology, and propose an extension of standard direct volume rendering that can handle the rendering of two or more 3-D functions; this consists of the definition of merging rules that are applied on emitter clouds. The included rendering applications are related on one hand, to volume-to-volume registration, and on the other hand, to surface-to-volume registration: the first case is concerned with global elastic registration of CT data, and the second one presents fitting of an implicit surface over a CT data subset. In these two medical imaging application cases, our rendering scheme offers a comprehensive appreciation of the relative position of structural information.

Continuous monitoring of uterine contractions to control intra-amniotic administration of prostaglandin F2 alpha for therapeutic and missed abortion

Intra-amniotic prostaglandin F2 alpha (PGF2 alpha) was administered to 10 patients for midtrimester therapeutic abortion and to 20 patients for missed abortion. An epidural catheter was placed into the amniotic cavity and the other end was connected to a physiological pressure transducer to measure the uterine contractions continuously. The dosage was adjusted according to the uterine contractions, and was therefore individualized for each patient. Half the patients with therapeutic abortion required PGF2 alpha 30 mg or less, and only 20% of patients with missed abortion needed more than 30 mg. Complications such as uterine cervical lacerations could be prevented by administration of the correct dosage of prostaglandin in each case.