A New Phenotype of TUBB4A Mutation in a Family With Adult-Onset Progressive Spastic Paraplegia and Isolated Hypomyelination Leukodystrophy: A Case Report and Literature Review

Tubulin beta 4A class IVa (TUBB4A) spectrum disorders include autosomal dominant dystonia type 4 or hypomyelination with atrophy of the basal ganglia and cerebellum (H-ABC syndrome). However, in rare cases, only mild hypomyelination in the cortex with no basal ganglia atrophy may be observed. We report a case of a family with TUBB4A mutation and complicated hereditary spasticity paraplegia (HSP). We performed quadro whole-exome sequencing (WES) on the family to identify the causative gene of progressive spastic paraparesis with isolated hypomyelination leukodystrophy. We identified a novel TUBB4A p.F341L mutation, which was present in all three affected patients but absent in the unaffected father. The affected patients presented with adult-onset TUBB4A disorder, predominant spastic paraparesis with/without ataxia, and brain hypomyelination with no cognitive impairment or extrapyramidal symptoms. In the literature, HSP is considered a TUBB4A spectrum disorder.

Novel Compound Heterozygous Mutations in the SYNE1 Gene in a Taiwanese Family: A Case Report and Literature Review

Mutations in the synaptic nuclear envelope protein 1 (SYNE1) gene are associated with substantial clinical heterogeneity. Here, we report the first case of SYNE1 ataxia in Taiwan due to two novel truncating mutations. Our patient, a 53-year-old female, exhibited pure cerebellar ataxia with c.1922del in exon 18 and c. C3883T mutations in exon 31. Previous studies have indicated that the prevalence of SYNE1 ataxia among East Asian populations is low. In this study, we identified 27 cases of SYNE1 ataxia from 22 families in East Asia. Of the 28 patients recruited in this study (including our patient), 10 exhibited pure cerebellar ataxia, and 18 exhibited ataxia plus syndromes. We could not find an exact correlation between genotypes and phenotypes. Additionally, we established a precise molecular diagnosis in our patient's family and extended the findings on the ethnic, phenotypic, and genotypic diversity of the SYNE1 mutational spectrum.

Surveys of HIV-1, HTLV-I, and other sexually transmitted diseases in female sex workers in Taipei City, Taiwan, from 1993 to 1996

Between 1993 and 1996 in Taipei, Taiwan, we studied the prevalences of HIV-1, HTLV-I, HSV-2, Chlamydia trachomatis, and syphilis infection in female commercial sex workers (CSW) and the pathogens' associated risk factors. Female CSW from nine massage parlors, two karaoke bars (KB), and 22 brothels in Taipei city participated in this study. Two of 557 (0.4%) KB CSWs from those who participated during the period from 1993 to 1994 had HIV-1 infection, whereas no KB CSWs in the periods 1994 to 1995 or 1995 to 1996 had HIV-1 infection. None of the 725 MP CSWs or 291 brothel CSWs who participated in the study between 1993 and 1996 had HIV-1 infection. In contrast, CSWs from brothels had elevated rates of both HTLV-I and active chlamydia infections compared with KB and MP CSWs (p < .05 and p < .005, respectively). KB CSWs showed an elevated rate of HSV-2 infection in the years 1993 and 1994 when compared with CSWs employed by brothels and MPs (p < .005). The prevalence rates of syphilis for CSWs from brothels dropped from 42.8% in the year 1993 to 1994 to 26.3% in the 1995 to 1996 period, whereas for KB and MP CSWs, the rates were < 6% in each of year studied.

Can cardiac catheterization accurately assess the severity of aortic stenosis? An in vitro pulsatile flow study

An accurate hemodynamic assessment of aortic stenosis has important clinical implications. In clinical practice, cardiac catheterization is often used to assess the severity of aortic stenosis. However, in conducting catheterization, the precise position of the catheter tip is often not known or controlled. From the standpoint of hydrodynamics, the position of the catheter tip may affect pressure measurement due to the complicated flow fields distal to the valve. This fact is particularly true when the diagnosed valve is stenotic. The study was aimed to investigate how the position of the catheter tip in catheterizing aortic stenosis affects pressure measurement. The experiments were conducted in an in vitro pulse duplicator system. Laser flow visualization was used to examine the flow fields in the vicinity of varying degrees of aortic stenosis, and a pressure transducer with a side-hole catheter was used to measure pressures. Minimal variation in transvalvular pressure drop measured along the radial direction was observed for varying degrees of valvular aortic stenosis. This implies that, in catheterization, the placement of the catheter tip along the radial direction does not seem to affect pressure measurement. However, along the axial direction, pressure recovery was observed for all the cases studied. Therefore, within the region of pressure recovery, the position of the catheter tip may affect the pressure drop measurement. This may cause inaccuracy in assessing the severity of aortic stenosis. However, this concern may be overcome by pulling the catheter slightly further downstream, so that the position of the catheter tip is outside of the pressure recovery region.