The clinical management of children with achondroplasia in Italy: results of clinician and parent/caregiver surveys

PURPOSE

This study aimed to assess the real-world management of achondroplasia in Italy.

METHODS

Two online surveys addressed to (1) parents/caregivers of individuals with achondroplasia and (2) Italian clinicians managing individuals with achondroplasia were conducted to assess real-world perspectives on achondroplasia management. Both surveys collected data on either patient or clinician demographics, details on diagnoses and referrals, disease complications, and views/experiences with limb lengthening surgery.

RESULTS

In total, 42 parents/caregivers and 19 clinicians (from 18 hospitals) completed the surveys. According to parents/caregivers, achondroplasia diagnosis was most commonly made in the third trimester of gestation (55% of respondents), with a genetic test performed to confirm the diagnosis in all but one case. In contrast, the clinicians indicated that, while achondroplasia was typically suspected during the prenatal period (78%), diagnosis was more frequently confirmed postnatally (72%). Parents/caregivers reported that the greatest impact of achondroplasia-related complications occurred in their children between the ages of 2-5 years. The most significant complications were otitis, sleep apnoea, stenosis of the foramen magnum or pressure on the spinal cord, and hearing difficulties. Lengthening surgery had been presented as a treatment option to 92% of responding parents/caregivers, with 76% of clinicians viewing surgery favourably. Typically, clinicians' reasons for suggesting limb lengthening surgery were to improve patient quality of life, increase patient autonomy and self-acceptance, improve trunk-limb disproportion, short stature and walking, and ensure that all possible treatment options had been presented to the parents/caregivers.

CONCLUSION

This survey provides insight into the real-world management of individuals with achondroplasia in Italy.

Assessment of community efforts to advance network-based prediction of protein-protein interactions

Comprehensive understanding of the human protein-protein interaction (PPI) network, aka the human interactome, can provide important insights into the molecular mechanisms of complex biological processes and diseases. Despite the remarkable experimental efforts undertaken to date to determine the structure of the human interactome, many PPIs remain unmapped. Computational approaches, especially network-based methods, can facilitate the identification of previously uncharacterized PPIs. Many such methods have been proposed. Yet, a systematic evaluation of existing network-based methods in predicting PPIs is still lacking. Here, we report community efforts initiated by the International Network Medicine Consortium to benchmark the ability of 26 representative network-based methods to predict PPIs across six different interactomes of four different organisms: A. thaliana, C. elegans, S. cerevisiae, and H. sapiens. Through extensive computational and experimental validations, we found that advanced similarity-based methods, which leverage the underlying network characteristics of PPIs, show superior performance over other general link prediction methods in the interactomes we considered.

Pavement Distress Estimation via Signal on Graph Processing

A comprehensive representation of the road pavement state of health is of great interest. In recent years, automated data collection and processing technology has been used for pavement inspection. In this paper, a new signal on graph (SoG) model of road pavement distresses is presented with the aim of improving automatic pavement distress detection systems. A novel nonlinear Bayesian estimator in recovering distress metrics is also derived. The performance of the methodology was evaluated on a large dataset of pavement distress values collected in field tests conducted in Kazakhstan. The application of the proposed methodology is effective in recovering acquisition errors, improving road failure detection. Moreover, the output of the Bayesian estimator can be used to identify sections where the measurement acquired by the 3D laser technology is unreliable. Therefore, the presented model could be used to schedule road section maintenance in a better way.

Phase/Amplitude Synchronization of Brain Signals During Motor Imagery BCI Tasks

In the last decade, functional connectivity (FC) has been increasingly adopted based on its ability to capture statistical dependencies between multivariate brain signals. However, the role of FC in the context of brain-computer interface applications is still poorly understood. To address this gap in knowledge, we considered a group of 20 healthy subjects during an EEG-based hand motor imagery (MI) task. We studied two well-established FC estimators, i.e. spectral- and imaginary-coherence, and we investigated how they were modulated by the MI task. We characterized the resulting FC networks by extracting the strength of connectivity of each EEG sensor and we compared the discriminant power with respect to standard power spectrum features. At the group level, results showed that while spectral-coherence based network features were increasing in the sensorimotor areas, those based on imaginary-coherence were significantly decreasing. We demonstrated that this opposite, but complementary, behavior was respectively determined by the increase in amplitude and phase synchronization between the brain signals. At the individual level, we eventually assessed the potential of these network connectivity features in a simple off-line classification scenario. Taken together, our results provide fresh insights into the oscillatory mechanisms subserving brain network changes during MI and offer new perspectives to improve BCI performance.

Allergooncology: an expanding research area

The relationship between allergic diseases and cancer is a very controversial topic, widely discussed in the last decades. Many studies have demonstrated inverse association between allergy and cancer, but others have reached neutral conclusions or have indicated a positive role of allergy in the development of cancer. However, either inhibiting or favoring, many cells and molecules relevant in the allergic process play a role in tumorigenesis. On the one hand, activated immune cells, like classically activated macrophages "M1", activated dendritic cells, IL-33 and amphiregulin stimulated Innate Lymphoid Cells (ILC2), Th1, IFN-γ producing T CD8+ and B lymphocytes have inhibitory effects on tumorigenesis and tumor progression. On the other hand, tolerogenic immune cells, like alternatively activated macrophages "M2" (M2a, M2b and M2c), tolerogenic dendritic cells, ILC3, T regulatory and B regulatory lymphocytes, while inhibiting allergic sensitization and response, appear to favour carcinogenesis. Furthermore, M2 subtypes macrophages (M2a, M2b), IL-25 stimulated ILC2 and Th2 lymphocytes have a role both in inducing allergic reactions and in favouring cancer progression. In addition, mast cells, pivotal cells in allergy, have a different effect of tumorigenesis based on their location - they can promote cancer progression or inhibit it. Finally, eosinophils have shown a prevalent tumoricidal function mediated by α-defensins, TNF-α, granzymes A and IL-18. Better understanding the role of various cells on carcinogenesis can help in developing new strategies (diagnostic, therapeutic and of follow up) against tumor.

Say-Barber-Biesecker-Young-Simpson syndrome and Genitopatellar syndrome: Lumping or splitting?

The Say-Barber-Biesecker-Young-Simpson variant of Ohdo syndrome (SBBYSS) and Genitopatellar syndrome (GTPTS) are 2 rare but clinically well-described diseases caused by de novo heterozygous sequence variants in the KAT6B gene. Both phenotypes are characterized by significant global developmental delay/intellectual disability, hypotonia, genital abnormalities, and patellar hypoplasia/agenesis. In addition, congenital heart defects, dental abnormalities, hearing loss, and thyroid anomalies are common to both phenotypes. This broad clinical overlap led some authors to propose the concept of KAT6B spectrum disorders. On the other hand, some clinical features could help to differentiate the 2 disorders. Furthermore, it is possible to establish a genotype-phenotype correlation when considering the position of the sequence variant along the gene, supporting the notion of the 2 disorders as really distinct entities.

Green Compressive Sampling Reconstruction in IoT Networks

In this paper, we address the problem of green Compressed Sensing (CS) reconstruction within Internet of Things (IoT) networks, both in terms of computing architecture and reconstruction algorithms. The approach is novel since, unlike most of the literature dealing with energy efficient gathering of the CS measurements, we focus on the energy efficiency of the signal reconstruction stage given the CS measurements. As a first novel contribution, we present an analysis of the energy consumption within the IoT network under two computing architectures. In the first one, reconstruction takes place within the IoT network and the reconstructed data are encoded and transmitted out of the IoT network; in the second one, all the CS measurements are forwarded to off-network devices for reconstruction and storage, i.e., reconstruction is off-loaded. Our analysis shows that the two architectures significantly differ in terms of consumed energy, and it outlines a theoretically motivated criterion to select a green CS reconstruction computing architecture. Specifically, we present a suitable decision function to determine which architecture outperforms the other in terms of energy efficiency. The presented decision function depends on a few IoT network features, such as the network size, the sink connectivity, and other systems’ parameters. As a second novel contribution, we show how to overcome classical performance comparison of different CS reconstruction algorithms usually carried out w.r.t. the achieved accuracy. Specifically, we consider the consumed energy and analyze the energy vs. accuracy trade-off. The herein presented approach, jointly considering signal processing and IoT network issues, is a relevant contribution for designing green compressive sampling architectures in IoT networks.

Space-time multichannel adaptive filtering scheme for VLC color cross-talk equalization

In the emerging framework of visible light communications, the limitation of modulation bandwidth of light emitting diodes (LEDs) transmitters is counterbalanced by the use of red-green-blue (RGB) LEDs since they exhibit higher modulation bandwidth. Using RGB LEDs allows to exploit the spatial multiplexing aspects, that is obtaining parallel channels for transmission. In this context, we used at the receiver RGB-tuned photodiodes (PDs). Hence each PD can, in principle, detect only the information its tuning is matched to. The drawback of increasing spectral efficiency is the presence of cross-talk at the single PD due to the signals emitted by the remaining colors when a perfect color filtering is not applied. In this paper we consider amplitude shift keying (ASK) modulation, investigate the issue of the spatial (color) interference and we present a blind multichannel adaptive equalizer able to mitigate the temporary intersymbol interference (ISI) and also the spatial (color) ISI, this latter partially suppressed using suitable color filters. We analyze also the convergence of the adaptive algorithm and compare its performance with the literature.

Metameric MIMO-OOK transmission scheme using multiple RGB LEDs

In this work, we propose a novel visible light communication (VLC) scheme utilizing multiple different red green and blue triplets each with a different emission spectrum of red, green and blue for mitigating the effect of interference due to different colors using spatial multiplexing. On-off keying modulation is considered and its effect on light emission in terms of flickering, dimming and color rendering is discussed so as to demonstrate how metameric properties have been considered. At the receiver, multiple photodiodes with color filter-tuned on each transmit light emitting diode (LED) are employed. Three different detection mechanisms of color zero forcing, minimum mean square error estimation and minimum mean square error equalization are then proposed. The system performance of the proposed scheme is evaluated both with computer simulations and tests with an Arduino board implementation.

Diagnostic application of a capture based NGS test for the concurrent detection of variants in sequence and copy number as well as LOH

Whole exome sequencing (WES) has made the identification of causative SNVs/InDels associated with rare Mendelian conditions increasingly accessible. Incorporation of softwares allowing CNVs detection into the WES bioinformatics pipelines may increase the diagnostic yield. However, no standard protocols for this analysis are so far available and CNVs in non-coding regions are totally missed by WES, in spite of their possible role in the regulation of the flanking genes expression. So, in a number of cases the diagnostic workflow contemplates an initial investigation by genomic arrays followed, in the negative cases, by WES. The opposite workflow may also be applied, according to the familial segregation of the disease. We show preliminary results for a diagnostic application of a single next generation sequencing panel permitting the concurrent detection of LOH and variations in sequences and copy number. This approach allowed us to highlight compound heterozygosity for a CNV and a sequence variant in a number of cases, the duplication of a non-coding region responsible for sex reversal, and a whole-chromosome isodisomy causing reduction to homozygosity for a WFS1 variant. Moreover, the panel enabled us to detect deletions, duplications, and amplifications with sensitivity comparable to that of the most widely used array-CGH platforms.

ASK-based spatial multiplexing RGB scheme using symbol-dependent self-interference for detection

We propose a vsible light communication scheme utilizing red, green and blue light-emitting diodes (LEDs) and three color-tuned photodiodes. Amplitude shift keying modulation is considered, and its effect on light emission in terms of flickering, dimming, and color rendering is discussed. The presence of interference at each photodiode generated by the other two colors is used to improve detection since interference is symbol-dependent. Moreover, the capability of the photodiodes to follow the LEDs speed is considered by analyzing the possibility of equalizing the received signal, and also self-interference mitigation is proposed. The system performance is evaluated both with computer simulations and tests on an Arduino board implementation.

SNORD116 deletions cause Prader-Willi syndrome with a mild phenotype and macrocephaly

Prader-Willi syndrome is a complex condition caused by lack of expression of imprinted genes in the paternally derived region of chromosome 15 (15q11q13). A small number of patients with Prader-Willi phenotype have been discovered to have narrow deletions, not encompassing the whole critical region, but only the SNORD116 cluster, which includes genes codifying for small nucleolar RNAs. This kind of deletion usually is not detected by the classic DNA methylation analysis test. We present the case of a male patient with a mild Prader-Willi phenotype and a small deletion including SNORD116, diagnosed by methylation-sensitive multiplex ligation-dependent probe amplification (MLPA. The patient showed neonatal hypotonia, hyperphagia, obesity, central hypogonadism, hypothyroidism, strabismus. Stature and intellectual development are within the normal range. The presence of macrocephaly, observed in other cases of SNORD116 deletions as well, is uncommon for the classic phenotype of the syndrome.

Insights into genotype-phenotype correlations from CREBBP point mutation screening in a cohort of 46 Rubinstein-Taybi syndrome patients

The genetic basis of Rubinstein-Taybi syndrome (RSTS), a rare, sporadic, clinically heterogeneous disorder characterized by cognitive impairment and a wide spectrum of multiple congenital anomalies, is primarily due to private mutations in CREBBP (approximately 55% of cases) or EP300 (approximately 8% of cases). Herein, we report the clinical and the genetic data taken from a cohort of 46 RSTS patients, all carriers of CREBBP point mutations. Molecular analysis revealed 45 different gene alterations including 31 inactivating (21 frameshift and 10 nonsense), 10 missense and 4 splicing mutations. Bioinformatic tools and transcript analyses were used to predict the functional effects of missense and splicing alterations. Of the 45 mutations, 42 are unreported and 3 were described previously. Recurrent mutations maybe a key tool in addressing genotype-phenotype correlations in patients sharing the same defects (at the genomic or transcript level) and specific clinical signs, demonstrated here in two cases. The clinical data of our cohort evidenced frequent signs such as arched eyebrows, epicanthus, synophrys and/or frontal hypertrichosis and broad phalanges that, previously overlooked in RSTS diagnosis, now could be considered. Some suggested correlations between organ-specific anomalies and affected CREB-binding protein domains broaden the RSTS clinical spectrum and perhaps will enhance patient follow-up and clinical care.

Clinical and molecular characterization of Rubinstein-Taybi syndrome patients carrying distinct novel mutations of the EP300 gene

Rubinstein-Taybi syndrome (RSTS) is a rare congenital neurodevelopmental disorder characterized by postnatal growth deficiency, skeletal abnormalities, dysmorphic features and cognitive deficit. Mutations in two genes, CREBBP and EP300, encoding two homologous transcriptional co-activators, have been identified in ˜55% and ˜3-5% of affected individuals, respectively. To date, only eight EP300-mutated RSTS patients have been described and 12 additional mutations are reported in the database LOVD. In this study, EP300 analysis was performed on 33 CREBBP-negative RSTS patients leading to the identification of six unreported germline EP300 alterations comprising one deletion and five point mutations. All six patients showed a convincing, albeit mild, RSTS phenotype with minor skeletal anomalies, slight cognitive impairment and few major malformations. Beyond the expansion of the RSTS-EP300-mutated cohort, this study indicates that EP300-related RSTS cases occur more frequently than previously thought (˜8% vs 3-5%); furthermore, the characterization of novel EP300 mutations in RSTS patients will enhance the clinical practice and genotype-phenotype correlations.

Histone acetylation deficits in lymphoblastoid cell lines from patients with Rubinstein-Taybi syndrome

BACKGROUND

Rubinstein-Taybi syndrome (RSTS) is a congenital neurodevelopmental disorder defined by postnatal growth deficiency, characteristic skeletal abnormalities and mental retardation and caused by mutations in the genes encoding for the transcriptional co-activators with intrinsic lysine acetyltransferase (KAT) activity CBP and p300. Previous studies have shown that neuronal histone acetylation is reduced in mouse models of RSTS.

METHODS

The authors identified different mutations at the CREBBP locus and generated lymphoblastoid cell lines derived from nine patients with RSTS carrying distinct CREBBP mutations that illustrate different grades of the clinical severity in the spectrum of the syndrome. They next assessed whether histone acetylation levels were altered in these cell lines.

RESULTS

The comparison of CREBBP-mutated RSTS cell lines with cell lines derived from patients with an unrelated mental retardation syndrome or healthy controls revealed significant deficits in histone acetylation, affecting primarily histone H2B and histone H2A. The most severe defects were observed in the lines carrying the whole deletion of the CREBBP gene and the truncating mutation, both leading to a haploinsufficiency state. Interestingly, this deficit was rescued by treatment with an inhibitor of histone deacetylases (HDACi).

CONCLUSIONS

The authors' results extend to humans the seminal observations in RSTS mouse models and point to histone acetylation defects, mainly involving H2B and H2A, as relevant molecular markers of the disease.

Brain activity during the memorization of visual scenes from TV commercials: an application of high resolution EEG and steady state somatosensory evoked potentials technologies

The aim of this study was to elucidate if the TV commercials that were remembered by the subjects after their observation within a documentary elicited particular brain activity when compared to the activity generated during the observation of TV commercials that were forgotten. High resolution EEG recordings were performed in a group of 10 healthy subjects with the steady state somatosensory evoked potentials (SSSEPs) technique, in which a series of light electrical stimulation at the left wrist were delivered at the frequency of 20Hz. The brain activity was indexed by the phase delay of the EEG spectral responses at 20Hz with respect to the stimulus delivering and evaluated at the scalp level as well as at the cortical surface using several regions of interest coincident with the Brodmann areas (BAs). Results suggest that the cerebral processes involved during the observation of TV commercials that were remembered by the population examined (RMB dataset) are generated by the posterior parietal cortices and the prefrontal areas, rather bilaterally. These results are compatible with previously results obtained in literature by using MEG and fMRI devices during similar experimental tasks. High resolution EEG is able to summarize, with the use of SSSEPs methodologies, the behavior of the estimated cortical networks subserving the proposed memory tasks. It is likely that such tool could play a role in the next future for the investigation of the neural substrates of the human behavior in decision-making and recognition tasks.

Assessing the memorization of TV commercials with the use of high resolution EEG: a pilot study

The present work intends to evaluate the functional characteristics of the cerebral network during the successful memory encoding of TV commercials. We estimated the functional networks in the frequency domain from a set of high-resolution EEG data. High resolution EEG recordings were performed in a group of healthy subjects and the cortical activity during the observation of TV commercials was evaluated in several regions of interest coincident with the Brodmann areas (BAs). Summarizing the main results of the present study, a sign of the memorization of a particular set of TV commercials have been found in a group of investigated subjects with the aid of advanced modern tools for the acquisition and the processing of EEG data. The cerebral processes involved during the observation of TV commercials that were remembered successively by the population examined (RMB dataset) are generated by the posterior parietal cortices and the prefrontal areas, rather bilaterally and are irrespective of the frequency bands analyzed. Such results are compatible with previously results obtained from EEG recordings with superficial electrodes as well as with the brain activations observed with the use of MEG and fMRI devices.

Interleukin (IL)-6 and receptor activator of nuclear factor (NF)-kappaB ligand (RANKL) are increased in the serum of a patient with primary pachydermoperiostosis

Primary pachydermoperiostosis (PDP) is a rare syndrome, characterized by digital clubbing, periostosis, and pachydermia. We have evaluated biochemical bone turnover markers, including components of interleukin-6 (IL-6) and osteoprotegerin/receptor activator of nuclear factor (NF)-kappaB ligand (OPG/RANKL) systems, in an 18-year-old man affected by primary PDP. The acute phase of the disease was characterized in our patient by high serum levels of IL-6 and RANKL. The observed high serum levels of these parameters are associated with increased values in markers of bone resorption (degradation products of C-terminal telopeptides of type-I collagen and urinary hydroxyproline/creatinine ratio) and reduced serum levels of bone alkaline phosphatase, a marker of bone formation. Serum levels of osteotrophic hormones were in the normal range. Our data suggest that, despite the radiographic findings, the acute phase of primary PDP is characterized by increased bone resorption, probably mediated by IL-6 and RANKL.

Clinical score of 62 Italian patients with Cornelia de Lange syndrome and correlations with the presence and type of NIPBL mutation

Cornelia de Lange syndrome (CdLS) is a rare multisystem disorder characterized by facial dysmorphisms, upper limb abnormalities, growth and cognitive retardation. About half of all patients with CdLS carry mutations in the NIPBL gene. The first Italian CdLS cohort involving 62 patients (including 4 related members) was screened for NIPBL mutations after a clinical evaluation using a quantitative score that integrates auxological, malformation and neurodevelopmental parameters. The patients were classified as having an overall 'severe', 'moderate' or 'mild' phenotype. NIPBL screening showed 26 mutations so classified: truncating (13), splice-site (8), missense (3), in-frame deletion (1) and regulatory (1). The truncating mutations were most frequently found in the patients with a high clinical score, whereas most of the splice-site and all missense mutations clustered in the low-medium score groups. The NIPBL-negative group included patients covering the entire clinical spectrum. The prevalence of a severe phenotype in the mutated group and a mild phenotype in the non-mutated group was statistically significant. In terms of the isolated clinical signs, the statistically significant differences between the mutation-positive and mutation-negative individuals were pre- and post-natal growth deficits, limb reduction, and delayed speech development. The proposed score seems to be a valuable means of prioritizing the patients with CdLS to undergo an NIPBL mutation test.

WNT4 deficiency--a clinical phenotype distinct from the classic Mayer-Rokitansky-Kuster-Hauser syndrome: a case report

The pathways leading to female sexual determination in mammals are incompletely defined. Loss-of-function mutations in the WNT4 gene appear to cause developmental abnormalities of sexual differentiation in women and mice. We recruited six patients with different degrees of Müllerian abnormalities, with or without renal aberrations and a normal female 46,XX karyotype. A clear androgen excess was found only in one patient. This 19-year-old woman was affected by primary amenorrhoea, absence of Müllerian ducts derivatives, clinical (acne and hirsutism) and biochemical (repeatedly high levels of testosterone) signs of androgen excess. Direct sequencing of her WNT4 gene followed by functional studies in human ovarian cells (OVCAR3) was performed. This patient carried the novel R83C loss-of-function dominant negative mutation in her WNT4, confirming the role of WNT4 in the development and maintenance of the female phenotype in women. Our study can also help refine the phenotype of WNT4 deficiency in humans. In fact, it appears that at least in this limited casuistic small group of patients, the absence of a uterus (and not other Müllerian abnormalities) and the androgen excess are the pathognomonic signs of WNT4 defects, suggesting that this might be a clinical entity distinct from the classic Mayer-Rokitansky-Kuster-Hauser syndrome.

Reduced complexity rotation invariant texture classification using a blind deconvolution approach

In this paper, we present a texture classification procedure that makes use of a blind deconvolution approach. Specifically, the texture is modeled as the output of a linear system driven by a binary excitation. We show that features computed from one-dimensional slices extracted from the two-dimensional autocorrelation function (ACF) of the binary excitation allows representing the texture for rotation-invariant classification purposes. The two-dimensional classification problem is thus reconduced to a more simple one-dimensional one, which leads to a significant reduction of the classification procedure computational complexity.

Mutation analysis of the NSD1 gene in a group of 59 patients with congenital overgrowth

Sotos syndrome is characterized by pre- and post-natal overgrowth, typical craniofacial features, advanced bone age, and developmental delay. Some degree of phenotypic overlap exists with other overgrowth syndromes, in particular with Weaver syndrome. Sotos syndrome is caused by haploinsufficiency of the NSD1 (nuclear receptor SET domain containing gene 1) gene. Microdeletions involving the gene are the major cause of the syndrome in Japanese patients, whereas intragenic mutations are more frequent in non-Japanese patients. NSD1 aberrations have also been described in some patients diagnosed as Weaver syndrome. Some authors have suggested a certain degree of genotype-phenotype correlation, with a milder degree of overgrowth, a more severe mental retardation, and a higher frequency of congenital anomalies in microdeleted patients. Data on larger series are needed to confirm this suggestion. We report here on microdeletion and mutation analysis of NSD1 in 59 patients with congenital overgrowth. Fourteen novel mutations, two previously described and one microdeletion were identified. All patients with a NSD1 mutation had been clinically classified as "classical Sotos," although their phenotype analysis demonstrated that some major criteria, such as overgrowth and macrocephaly, could be absent. All patients with confirmed mutations shared the typical Sotos facial gestalt. A high frequency of congenital heart defects was present in patients with intragenic mutations, supporting the relevance of the NSD1 gene in the pathogenesis of this particular defect.

Prenatal diagnosis of severe structural congenital malformations in Europe

OBJECTIVES

To assess at a population-based level the frequency with which severe structural congenital malformations are detected prenatally in Europe and the gestational age at detection, and to describe regional variation in these indicators.

METHODS

In the period 1995-1999, data were obtained from 17 European population-based registries of congenital malformations (EUROCAT). Included were all live births, fetal deaths and terminations of pregnancy diagnosed with one or more of the following malformations: anencephalus, encephalocele, spina bifida, hydrocephalus, transposition of great arteries, hypoplastic left heart, limb reduction defect, bilateral renal agenesis, diaphragmatic hernia, omphalocele and gastroschisis.

RESULTS

The 17 registries reported 4366 cases diagnosed with the 11 severe structural malformations and of these 2300 were live births (53%), 181 were fetal deaths (4%) and 1863 were terminations of pregnancy (43%); in 22 cases pregnancy outcome was unknown. The overall prenatal detection rate was 64% (range, 25-88% across regions). The proportion of terminations of pregnancy varied between regions from 15% to 59% of all cases. Gestational age at discovery for prenatally diagnosed cases was less than 24 weeks for 68% (range, 36-88%) of cases. There was a significant relationship between high prenatal detection rate and early diagnosis (P < 0.0001). For individual malformations, the prenatal detection rate was highest for anencephalus (469/498, 94%) and lowest for transposition of the great arteries (89/324, 27%). Termination of pregnancy was performed in more than half of the prenatally diagnosed cases, except for those with transposition of the great arteries, diaphragmatic hernia and gastroschisis, in which 30-40% of the pregnancies with a prenatal diagnosis were terminated.

CONCLUSION

European countries currently vary widely in the provision and uptake of prenatal screening and its quality, as well as the "culture" in terms of decision to continue the pregnancy. This inevitably contributes to variation between countries in perinatal and infant mortality and in childhood prevalence and cost to health services of congenital anomalies.

Robust rotation-invariant texture classification using a model based approach

In this paper, a model based texture classification procedure is presented. The texture is modeled as the output of a linear system driven by a binary image. This latter retains the morphological characteristics of the texture and it is specified by its spatial autocorrelation function (ACF). We show that features extracted from the ACF of the binary excitation suffice to represent the texture for classification purposes. Specifically, we employ a moment invariants based technique to classify the ACF. The resulting proposed classification procedure is thus inherently rotation invariant. Moreover, it is robust with respect to additive noise. Experimental results show that this approach allows obtaining high correct rotation-invariant classification rates while containing the size of the feature space.

Deletion of the SHOX gene in patients with short stature of unknown cause

A fluorescence in situ hybridization (FISH) study was performed in 56 patients with short stature of unknown cause in order to establish the role of deletion of the SHOX gene in this population. FISH analysis was carried out on metaphase spreads and interphase lymphocytes from blood smears using a probe specific for the SHOX gene. Deletion of SHOX was found in four patients (7.1%). No skeletal abnormalities were detected in these patients either at the physical examination or at X-rays of the upper and lower limbs. Present results indicate that SHOX plays an important role also in short stature of unknown cause, and FISH analysis appears as an easy, appropriate, and inexpensive method for the detection of SHOX deletion.

Multichannel blind image deconvolution using the Bussgang algorithm: spatial and multiresolution approaches

This work extends the Bussgang blind equalization algorithm to the multichannel case with application to image deconvolution problems. We address the restoration of images with poor spatial correlation as well as strongly correlated (natural) images. The spatial nonlinearity employed in the final estimation step of the Bussgang algorithm is developed according to the minimum mean square error criterion in the case of spatially uncorrelated images. For spatially correlated images, the nonlinearity design is rather conducted using a particular wavelet decomposition that, detecting lines, edges, and higher order structures, carries out a task analogous to those of the (preattentive) stage of the human visual system. Experimental results pertaining to restoration of motion blurred text images, out-of-focus spiky images, and blurred natural images are reported.

A multiresolution approach for texture synthesis using the circular harmonic functions

In this paper, an unsupervised model-based texture reproduction technique is described. In accordance with the Julesz's (1962) conjecture, the statistical properties of the prototype up to the second order are copied in order to generate a synthetic texture perceptually indistinguishable from the given sample. However, this task is accomplished using a hybrid approach which operates partially in the spatial domain and partially in a multiresolution domain. The latter employed is the circular harmonic function (CHF) domain since it has been proven to be well suited for mimicking the behavior of the human visual system (HVS). This approach allows, for a wide range of textures typologies, obtaining synthetic textures that better match the prototype with respect to the ones obtained using techniques based on the Julesz's conjecture operating only in the spatial domain, and to dramatically reduce the computational complexity of similar methods operating only in the multiresolution domain.

Synthesis and stability of phytochelatins induced by cadmium and lead in the marine diatom Phaeodactylum tricornutum

The synthesis of phytochelatins (PC), intracellular metal-binding polypeptides characterized by a repeating sequence of gamma-glutamic acid- cysteine (gamma-Glu-Cys) pairs, has been studied in laboratory cultures of the marine diatom Phaeodactylum tricornutum exposed to Cd, Pb or Zn. Cd and Pb were able to induce PC of different degree of polymerization. The accumulation of the peptides follows a direct relationship with the metal exposure. No PC induction was observed in Zn-treated cultures, although the intracellular concentration of Zn increased during exposure. Both in short-term (7 h exposure, 10 microM Cd or Pb) and 3-day experiments (metal concentration less than 0.5 microM), the major fraction of total PC gamma-Glu-Cys subunits synthesized was polymerized as PC2 when cells were exposed to Pb, but as PC4 when cells were exposed to Cd. In short-term experiments about 50% of the gamma-Glu-Cys residues of the cellular pool of glutathione was quickly and almost quantitatively converted into PC. Recovery experiments, in which metal-stressed cells are suspended in a metal-free medium, showed a decrease of the PC pool and a concomitant increase of glutathione, suggesting a mechanism of degradation and release of metal-phytochelatin complexes.

Evaluation of benzene exposure in children living in Campania (Italy) by urinary trans,trans-muconic acid assay

The urinary benzene metabolite trans,trans-muconic acid (MA) was determined in 144 children living in Campania (Italy): 92 from Naples (1,300,000 inhabitants), designated as an urban source, and compared to 52 from Pollica (300 inhabitants), considered a rural, background exposure for benzene. The children participating in the study were tested by an anonymous questionnaire about the possible sources of exposure to benzene. Quantifiable levels of MA were found in 63% of the urine samples analyzed. Setting the value of nondetectable urinary samples at 7 microg/L MA, a value that is one-half of the instrument detection limit of 14 microg/L, the mean urinary concentration levels were 98.7+/-81.0 microg/L and 48.4+/-71.7 microg/L in Naples and Pollica, respectively; adjustment of these values to creatinine clearance resulted in MA levels of 141.2+/-145.4 microg/L in Naples and 109.8+/-133.2 microg/L in Pollica. Passive smoke exposure did not significantly affect urinary MA levels, but proximity of the home to traffic increased urine MA content. Data show that MA can be utilized as a biomarker for exposure; however, a clear-cut association to benzene requires personal monitoring and control of dietary sorbic acid.

Use of automated solid-phase extraction equipment for the determination of isoniazid in milk

The possibility of using automated equipment for solid phase extraction of isoniazid from milk has been investigated. This equipment provides two noteworthy advantages: it shortens the time of analysis and avoids SPE column plugging, stabilizing flow rates. After setting the correct programme on software controlling the equipment, some validation parameters have been determined to obtain recovery and repeatability data. The mean recovery for spiked samples resulted in the range 75-95%, the standard error ranged from -5 to -20% while the RSD varied from 2 to 22%. Therefore the method can be considered reliable and fast.

[Floating-Harbor syndrome: first case in Italy associated with growth hormone deficiency]

The Floating-Harbor Syndrome (FHS) is a rare entity characterised by a clinical triad: facial dysmorphism, retarded speech development and short stature with delayed bone age. The case of a 9-year and 8/12 months old boy showing the typical features of this syndrome associated to a severe GH deficiency is reported. At diagnosis of FHS, the weight was 16 kg (< 3 degrees percentile), height 112 cm (< 3 degrees percentile), cranial circumference 53.8 cm (> 90 degrees percentile). The evaluation of growth hormone secretion by two Insulin Tolerance Tests confirmed an insufficient GH peaks response (2.7 ng/ml and 4.6 ng/ml). He had a slight mental delay (IQ: 60) involving language skills. After 1 year of treatment with r-hGH (0.6 IU/kg/week), an increase in growth velocity (11 cm/year) in the length (123 cm), and in body weight (20.5) has been observed. This case is the 22nd report with this syndrome and the first in Italy. The association between GH deficiency and FHS, and the beneficial effects of a substitutive treatment are described.

Reduced complexity modeling and reproduction of colored textures

An unsupervised color texture synthesis-by analysis method is described. The texture is reproduced to appear perceptually similar to a given prototype by copying its statistical properties up to the second order. The synthesized texture is obtained at the output of a single-input three-output nonlinear system driven by a realization of a white Gaussian random field. Significant complexity reduction is gained by exploiting the rank deficiency of the cross power spectral density matrix of the color texture samples.

Mosaic trisomy 17 in amniocytes: phenotypic outcome, tissue distribution, and uniparental disomy studies

Mosaicism for trisomy 17 in amniocyte cultures is a rare finding, whilst postnatal cases are exceptional. In order to gain insight into the possible effects of the distribution of the trisomic line and of uniparental disomy (UPD) on embryofoetal development, we have performed follow-up clinical, cytogenetic and molecular investigations into three newly detected prenatal cases of trisomy 17 mosaicism identified in cultured amniotic fluid. In the first case, the pregnancy ended normally with the birth of a healthy girl, and analysis of newborn lymphocytes and of multiple extra-embryonic tissues was indicative of confined placental mosaicism. The second case was also associated with a normal pregnancy outcome and postnatal development, and only euploid cells were found in peripheral blood after birth. However, maternal isodisomy 17 consequent to a meiosis II error and loss of a chromosome 17 homologue was detected in peripheral lymphocytes postnatally. In the third case, pathological examination after termination of pregnancy showed growth retardation and minor dysmorphisms, and the trisomic line was detected in foetal skin fibroblasts. In addition, biparental derivation of chromosome 17 was demonstrated in the euploid lineage. These results, together with previously reported data, indicate that true amniotic trisomy 17 mosaicism is more commonly of extra-embryonic origin and associated with normal foetal development. Phenotypic consequences may arise when the trisomic line is present in foetal tissues. Case 2 also represents the first observation of maternal UPD involving chromosome 17; the absence of phenotypic anomalies in the child suggests that chromosome 17 is not likely to be subject to imprinting in maternal gametes.

Use of automated solid-phase extraction equipment for the determination of ivermectin residues in animal liver by HPLC

An improvement of the method commonly used for the determination of ivermectin is proposed. An automatic system is used for the solid-phase extraction column purification stage in order to provide more efficient and fast sample preparation, prior to separation and quantification by HPLC. Some tests were performed to obtain recovery and repeatability data. The mean recovery for spiked samples (five replicates twice at three concentration levels) was more than 90% in the concentration range 7.5-30 ng g-1. The tests for accuracy (five replicates at three concentration levels) gave a standard error of -2.0% at the highest and -19.2% at the lowest concentration. Concerning repeatability data (five replicates twice at three concentration levels), in the concentration range 7.5-30 ng g-1 the RSD varied from 9.29 to 2.15%. The described method was used in a survey on the presence of ivermectin in food-producing animals in two regions of southern Italy; no positives out of 250 liver samples were found.

Texture synthesis-by-analysis with hard-limited Gaussian processes

A twin stage texture synthesis-by-analysis method is presented. It aims to approximate first- and second-order distributions of the texture, accordingly to the Julesz conjecture. In the first stage, the binary textural behavior of a given prototype is represented by means of a hard-limited Gaussian process. In the second stage, the texture is synthesized by passing the binary hard-limited Gaussian process through a linear filter followed by a zero memory histogram equalizer.

The Williams syndrome: an Italian collaborative study

Williams syndrome (WS) is a multiple congenital anomalies/mental retardation syndrome caused by a microdeletion on the long arm of chromoome 7 including the elastin gene. Possibly it is a contiguous gene syndrome with autosomal dominant transmission. Seventy-seven WS patients from 11 Italian Pediatric-Dysmorphology-Genetics Units were collected by means of a questionnaire designed to draw a comprehensive clinical picture, to define the frequency of different traits and associations thereof, to better understand the clinical evolution, to improve the prognosis and to ameliorate the follow-up. The most important signs for diagnosis, based on their relative frequencies, are: mental retardation with characteristic outgoing behaviour and hoarse voice; facial findings like stellate iris, periorbital fullness and thick lips; congenital heart disease. The frequency of the clinical signs reported in our patients are on the whole concordant with those found in the literature; the only significant differences concern low stature, hallus valgus, hypoplastic nails, joint contractures and ear infections. The multisystemic nature of this syndrome requires a coordinated and integrated approach in order to avoid fragmentary interventions.

Merosin positive congenital muscular dystrophy with severe involvement of the central nervous system

Congenital muscular dystrophy (CMD) is one of the most frequent dystrophies of childhood, which is commonly characterized by neonatal muscle impairment with or without clinical evidence of central nervous system involvement. Several variants of CMD have been described and the disease has recently been classified into five clinically distinct forms: the two classical CMDs with and without deficit of the laminin M chain (merosin), the Fukuyama CMD described in Japanese patients and recently linked to the chromosome 9q31-33, the clinically more severe Walker-Warburg syndrome and the rare muscle-eye-brain disease described in Finnish patients. The most of these forms have central nervous system involvement. This is usually not seen in the classical merosin positive CMD, but can be very severe in the others. Here we describe a 3-year-old Mediterranean child with clinical and histopathological signs of CMD, normal expression of merosin, severe clinical and radiological evidence of central nervous system involvement without defects of neuronal migration or brain malformations and without ocular anomalies. This report suggests that new forms of CMD and cerebral involvement can still be recognized and confirms the heterogeneity of this group of infantile diseases.

Novel findings in a patient with Weaver or a Weaver-like syndrome

We report on a young male patient with an overgrowth syndrome, who had normal birth weight. He had a number of manifestations typical of the Weaver syndrome (WS), such as advanced bone age, peculiar craniofacial appearance, and camptodactyly. He also showed severe mental and speech retardation and demineralisation of the bones of the hands and feet. The latter can be considered as unreported manifestations of WS, or the patient could represent an example of a new WS-like syndrome.

Archaeal elongation factor 1 beta is a dimer. Primary structure, molecular and biochemical properties

The elongation factor 1 beta (EF-1 beta), that in eukarya and archaea promotes the replacement of GDP by GTP on the elongation factor 1 alpha x GDP complex, was purified to homogeneity from the thermoacidophilic archaeon Sulfolobus solfataricus (SsEF-1 beta). Its primary structure was established by sequenced Edman degradation of the entire protein or its proteolytic peptides. The molecular weight of SsEF-1 beta was estimated as about 10000 or 20000 under denaturing or native conditions respectively; this finding suggests that the native protein exists as a dimer. The peptide chain of SsEF-1 beta is much shorter than that of its eukaryotic analogues and homology is found only at their C-terminal region; no homology exists between SsEF-1 beta and eubacterial EF-Ts. At 50 degrees C, at a concentration of SsEF-1 beta 5-fold higher than that of SsEF-1 alpha x [3H]GDP the rate of the exchange of [3H]GDP for GTP becomes about 160-fold faster. An analysis of the values of the energetic parameters indicates that in the presence of SsEF-1 beta the GDP/GTP exchange is entropically favoured. At 100 degrees C the half-life of SsEF-1 beta is about 4 h.

The site for GTP hydrolysis on the archaeal elongation factor 2 is unmasked by aliphatic alcohols

An appropriate mixture of ethylene glycol and BaCl2 enhanced the otherwise very low intrinsic GTPase activity of the elongation factor 2 isolated from the archaeon Sulfolobus solfataricus (SsEF-2). The enzymatic activity became up to 300-fold higher than that of the SsEF-2 GTPase measured in the absence of any stimulator, but remained 20-fold lower than that stimulated by ribosome. The stimulatory effect of ethylene glycol/Ba2+ was attributed to the increased affinity for GTP, probably related to a conformational change occurring in a hydrophobic region near the catalytic site.

Effect of paternal age in achondroplasia, thanatophoric dysplasia, and osteogenesis imperfecta

The paternal ages of nonfamilial cases of achondroplasia (AC) (n = 78), thanatophoric dysplasia (TD) (n = 64), and osteogenesis imperfecta (OI) (n = 106), were compared with those of matched controls, from an Italian Indagine Policentrica Italiana sulle Malformazioni Congenite and a South American Estudio Colaborativo Latinoamericano de Malformaciones Congénitas series. The degree of paternal age effect on the origin of these dominant mutations differed among the three conditions. Mean paternal age was highly elevated in AC, 36.30 +/- 6.74 years in the IPIMC, and 37.19 +/- 10.53 years in the ECLAMC; less consistently elevated in TD, 33.60 +/- 7.08 years in the IPIMC, and 36.41 +/- 9.38 years in the ECLAMC; and only slightly elevated in OI in the ECLAMC, 31.15 +/- 9.25 years, but not in the IPIMC, 32.26 +/- 6.07 years. Increased maternal age or birth order in these conditions disappeared when corrected for paternal age. Approximately 50% of AC and TD cases, and only 30% of OI cases, were born to fathers above age 35 years. For AC and TD, the increase in relative incidence with paternal age fitted an exponential curve. The variability of paternal age effect in these new mutations could be due, among other reasons, to the high proportion of germ-line mosaicism in OI parents, or to the localization of the AC gene, mapped to the 4p16.3 region, in the neighborhood of an unstable DNA area.

Social and geographical inequalities in prenatal care in Italy

The purpose of this study was to find out possible differences in prenatal diagnosis (PD) by amniocentesis or chorionic villus sampling and ultrasound examination before 16 weeks' gestation (early ultrasound examination, EUE), according to area of residence and level of education of the mothers. Data come from a multicentre study in Italy involving 43 maternity hospitals (Mercurio project) and were collected through structured interviews a few days after delivery. Study subjects were 1541 mothers of single non-malformed infants born between April 1992 and March 1994. Overall, the incidence of PD and EUE was 5.8 and 80 per cent, respectively. After adjustment for maternal age and other possible confounders, the odds ratios for PD were 2.19 (95 per cent confidence interval (CI) = 1.26-3.81) when women residing in the northern regions were compared with those residing in the southern regions, and 2.06 (95 per cent CI = 1.12-3.79) and 4.08 (95 per cent CI = 1.97-8.42) when women with medium and high levels of education were compared with those with low level. For EUE, the odds ratios were 1.77 (95 per cent CI = 1.32-2.36) and 2.88 (95 per cent CI = 1.56-5.29) when comparing women with medium and high levels of education with those with low level. No relationship was found between area of residence and EUE. These geographical and social inequalities in prenatal care in Italy should be taken into account for the organization, delivery, and evaluation of pregnancy services in the coming years.

Relevance of histidine-84 in the elongation factor Tu GTPase activity and in poly(Phe) synthesis: its substitution by glutamine and alanine

Substitution of His-84 (-->Gln and -->Ala), a residue of the switch II region of E. coli elongation factor (EF) Tu, hardly affected the binding of GTP or GDP. The activity in poly(Phe) synthesis and GTP hydrolysis of EF-Tu H84Q were both reduced to about 35%, as compared to EF-Tu wt, whereas EF-Tu H84A was inactive in poly(Phe) synthesis but still showed a 10% residual GTPase activity. Phe-tRNAPhe exerted a similar inhibitory effect on the GTPase activity of EF-Tu wt and EF-Tu H84Q while abolishing that of EF-Tu H84A. Ribosomes enhanced the GTPase activity of EF-Tu H84Q, but not that of EF-Tu H84A, on which they even seemed to exert an inhibitory effect. The one-round GTP hydrolysis associated with the EF-TuH84Q-dependent binding of Phe-tRNAPhe to poly(U)-programmed ribosomes was less efficient than with EF-Tu wt. Kirromycin stimulated the GTPase activities of both mutants less than EF-Tu wt. The results of this work do not support a catalytic role of His-84 in the intrinsic GTPase of EF-Tu, but they emphasize the importance of its side-chain for polypeptide synthesis and GTP hydrolysis.