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The onset of Non Syndromic Hearing Loss (NSHL) typically occurs without any other symptoms and can vary from person to person, even within the same family. Hearing loss can be unilateral or bilateral and can range from mild to profound degrees of hearing loss. Epidermodysplasia Verruciformis (EDV) is a dermatologic condition in which patients show reduced immunologic ability to defend and eradicate certain types of Human Papillomavirus (HPV), leading to persistent infection and an increased lifetime risk of developing cutaneous dysplasia and malignancy. Both conditions have a genetic background. However, their concurrent occurrence is very rare. Therefore, a case study is presented of a four-year-old female child who visited the dermatology outpatient department with a chief complaint of hearing loss and white-coloured lesions covering her arms, neck, back, and chest for the last two years. The hearing loss was gradual, not apparent at birth, and progressed slowly to complete hearing loss. A final diagnosis of EDV with Non Syndromic Sensorineural Hearing Loss (NSSNHL) was made based on clinical and histological examination.

The onset of Non Syndromic Hearing Loss (NSHL) typically occurs without any other symptoms and can vary from person to person, even within the same family. Hearing loss can be unilateral or bilateral and can range from mild to profound degrees of hearing loss. Epidermodysplasia Verruciformis (EDV) is a dermatologic condition in which patients show reduced immunologic ability to defend and eradicate certain types of Human Papillomavirus (HPV), leading to persistent infection and an increased lifetime risk of developing cutaneous dysplasia and malignancy. Both conditions have a genetic background. However, their concurrent occurrence is very rare. Therefore, a case study is presented of a four-year-old female child who visited the dermatology outpatient department with a chief complaint of hearing loss and white-coloured lesions covering her arms, neck, back, and chest for the last two years. The hearing loss was gradual, not apparent at birth, and progressed slowly to complete hearing loss. A final diagnosis of EDV with Non Syndromic Sensorineural Hearing Loss (NSSNHL) was made based on clinical and histological examination. [ABSTRACT FROM AUTHOR]

Ali Osman Saatci,1 Ferdane Ataş,2 Gökhan Ozan Çetin,3 Mustafa Kayabaşı1 1Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey; 2Department of Ophthalmology, Çerkezköy State Hospital, Tekirdağ, Turkey; 3Department of Medical Genetics, Pamukkale University, Denizli, TurkeyCorrespondence: Ali Osman Saatci, Department of Ophthalmology, Dokuz Eylul University, Mustafa Kemal Sahil Bulvari, No: 73 A Blok, Daire 9, Narlidere, Izmir, Turkey, Tel +90 5327437071, Email osman.saatci@gmail.comAbstract: Bietti crystalline dystrophy (BCD) is a rare, genetically determined chorioretinal dystrophy presenting with intraretinal crystalline deposits and varying degrees of progressive chorioretinal atrophy commencing at the posterior pole. In some cases, there can be concomitant corneal crystals noted first in the superior or inferior limbus. CYP4V2 gene, a member of the cytochrome P450 family is responsible for the disease and more than 100 mutations have been defined thus far. However, a genotype–phenotype correlation has not been established yet. Visual impairment commonly occurs between the second and third decades of life. By the fifth or sixth decade of life, vision loss can become so severe that the patient may potentially become legally blind. Multitudes of multimodal imaging modalities can be utilized to demonstrate the clinical features, course, and complications of the disease. This present review aims to reiterate the clinical features of BCD, update the clinical perspectives with the help of multimodal imaging techniques, and overview its genetic background with future therapeutic approaches.Keywords: Bietti crystalline dystrophy, chorioretinal dystrophy, corneal crystals, inherited disorder, vision loss

Noonan syndrome with multiple lentigines (NSML, formerly known as LEOPARD syndrome) is a variant of Noonan syndrome which is an autosomal dominant disorder. Most cases of NSML are secondary to mutations of the protein-tyrosine phosphatase nonreceptor type 11 (PTPN11). Hypertrophic cardiomyopathy (HCM) remains the most frequent and serious cardiac abnormality in this inherited syndrome, and it may lead to sudden cardiac death related to HCM-associated outflow obstruction and fatal arrhythmia. Beyond cardiac involvement, NSML may present with multiple lentigines, ocular hypertelorism, genital anomalies, short stature and deafness. Herein, we report three patients with NSML among three generations in one family, all presenting with multiple lentigines, HCM and other distinctive clinical and molecular features, including facial dysmorphism, deafness, family history of sudden death and PTPN11 mutations. This case series highlights the importance of early echocardiography examinations for patients with NSML. Careful family screening and genetic counselling are also necessary, especially in patients with diffuse lentigines or a history of sudden death among family members. We also discuss the distinctive cardiac features and phenotypic characteristics at different stages of NSML, including childhood, adulthood and elderhood.

Mitochondria, the cell powerhouse, are membrane-bound organelles present in the cytoplasm of almost all the eukaryotic cells. Their main function is to generate energy in the form of adenosine triphosphate (ATP). In addition, mitochondria store calcium for the cell signaling activities, generate heat, harbor pathways of intermediate metabolism and mediate cell growth and death. Primary mitochondrial diseases (MDs) form a clinically as well as genetically heterogeneous group of inherited disorders that result from the mitochondrial energetic metabolism malfunctions. The lifetime risk of the MDs development is estimated at 1:1470 of newborns, which makes them one of the most recurrent groups of inherited disorders with an important burden for society.

Hypophosphatasia (HPP) is an inherited disease caused by mutation of the alkaline phosphatase (ALPL) gene in an autosomal dominant or an autosomal recessive manner. The main symptoms of HPP are bone hypomineralization and early exfoliation of the primary teeth. Some of the mutations identified in autosomal dominant families are reported to have dominant negative effects. In addition, the penetrance can vary among patients with the same variant even within the same family, resulting in various phenotypes of systemic symptoms. However, differences in dental symptoms between patients with HPP and carriers with the same ALPL variant have not been reported. Herein, we report on two sisters who had the same heterozygous ALPL variant with dominant negative effects. The older sister had bone and dental symptoms and was diagnosed with childhood HPP. In contrast, the younger sister was a carrier with no bone and dental symptoms. It can be inferred that this phenomenon was caused by the difference in penetrance. This case revealed that carriers with the ALPL mutation may have no dental symptoms characteristic of HPP. Because HPP is sometimes progressive, it is very important to carefully monitor carriers to detect the possible onset of dental and systemic symptoms. [ABSTRACT FROM AUTHOR]

Fanconi anemia (FA) is a rare form of an inherited disorder that mainly results in aplastic anemia. In our case, a three-year-old female child presented with recurrent episodes of fever and persistent pancytopenia refractory to any treatment. The chromosomal breakage analysis (CBA) with mitomycin C and solid staining was done, which showed no chromosomal breakage. Considering negative results due to mosaicism, her younger brother’s CBA was performed, which showed a positive result. Therefore, based on clinical features, persistent cytopenia, and the younger siblings’ CBA, both children were diagnosed with FA.

Background Neurofibromatosis type I is rarely associated with vascular abnormalities. Here, we report a case of rapid airway stenosis caused by a ruptured occipital artery that was treated with surgical airway management. Case Presentation A 40‐year‐old woman, with no medical history, presented with a chief complaint of a sudden neck pain on the left side. She had a prominent mass in the outer left side of the neck. After arrival at the emergency room, the patient complained of severe dyspnea and experienced a rapid drop in oxygen saturation. Supplemental ventilation was ineffective, and tracheal intubation was attempted; however, laryngeal expansion could not be observed because of the enlarged cervical mass. Therefore, to manage the surgical airway, a cricothyrotomy was first carried out, which resulted in an immediate increase in oxygen saturation. Two percutaneous embolizations and one surgical procedure were carried out, and the patient was discharged without any complications. Conclusion For a sudden onset cervical mass, airway management should be undertaken, keeping in mind the possibility of worsening rapid airway narrowing due to bleeding.

Whether or not conditions should be included in publicly funded newborn screening (NBS) programs should be discussed according to objective and transparent criteria. Certain criteria have been developed for the introduction of NBS programs in the context of individual countries; however, there are no standard selection criteria for NBS programs in Japan. This study aimed to develop a quantitative scoring model to assess newborn screening that incorporates the views of a variety of stakeholders in Japan. The five recommended eligibility criteria for NBS were stratified based on previous studies and expert opinions, using the analytic hierarchy process. We conducted a cross-sectional, web-based questionnaire targeting a wide range of people involved in NBS to investigate pairwise comparisons of the evaluation items between February and April of 2022. There were 143 respondents. Most of our respondents (44.1%) were physicians. Fifty-eight respondents (40.6%) had been engaged in NBS-related research or work for more than 10 years. The distribution of allocation points was the highest for ‘intervention’, ‘screening test’, ‘follow-up setting’, ’economic evaluation’, and ’disease/condition’, in that order. The algorithm in this study will guide decision makers in collecting and evaluating objective data, thus enabling transparent discussions to occur.

Familial hypercholesterolemia (FH) is an inherited, autosomal dominant metabolic disorder mostly associated with disease-causing variant in LDLR, APOB or PCSK9. Although the dominant changes are small-scale missense, frameshift and splicing variants, approximately 10% of molecularly defined FH cases are due to copy number variations (CNVs). The first-line strategy is to identify possible pathogenic SNVs (single nucleotide variants) using multiple PCR, Sanger sequencing, or with more comprehensive approaches, such as NGS (next-generation sequencing), WES (whole-exome sequencing) or WGS (whole-genome sequencing). The gold standard for CNV detection in genetic diagnostics are MLPA (multiplex ligation-dependent amplification) or aCGH (array-based comparative genome hybridization). However, faster and simpler analyses are needed. Therefore, it has been proposed that NGS data can be searched to analyze CNV variants. The aim of the study was to identify novel CNV changes in FH patients without detected pathogenic SNVs using targeted sequencing and evaluation of CNV calling tool (DECoN) working on gene panel NGS data; the study also assesses its suitability as a screening step in genetic diagnostics. A group of 136 adult and child patients were recruited for the present study. The inclusion criteria comprised at least "possible FH" according to the Simon Broome diagnostic criteria in children and the DLCN (Dutch Lipid Clinical Network) criteria in adults. NGS analysis revealed potentially pathogenic SNVs in 57 patients. Thirty selected patients without a positive finding from NGS were subjected to MLPA analysis; ten of these revealed possibly pathogenic CNVs. Nine patients were found to harbor exons 4–8 duplication, two harbored exons 6–8 deletion and one demonstrated exon 9–10 deletion in LDLR. To test the DECoN program, the whole study group was referred for bioinformatic analysis. The DECoN program detected duplication of exons 4–8 in the LDLR gene in two patients, whose genetic analysis was stopped after the NGS step. The integration of the two methods proved to be particularly valuable in a five-year-old girl presenting with extreme hypercholesterolemia, with both a pathogenic missense variant (c.1747C>T) and exons 9–10 deletion in LDLR. This is the first report of a heterozygous deletion of exons 9 and 10 co-occurring with SNV. Our results suggest that the NGS-based approach has the potential to identify large-scale variation in the LDLR gene and could be further applied to extend CNV screening in other FH-related genes. Nevertheless, the outcomes from the bioinformatic approach still need to be confirmed by MLPA; hence, the latter remains the reference method for assessing CNV in FH patients. [ABSTRACT FROM AUTHOR]

Hypophosphatasia (HPP) is an inherited disease caused by mutation of the alkaline phosphatase (ALPL) gene in an autosomal dominant or an autosomal recessive manner. The main symptoms of HPP are bone hypomineralization and early exfoliation of the primary teeth. Some of the mutations identified in autosomal dominant families are reported to have dominant negative effects. In addition, the penetrance can vary among patients with the same variant even within the same family, resulting in various phenotypes of systemic symptoms. However, differences in dental symptoms between patients with HPP and carriers with the same ALPL variant have not been reported. Herein, we report on two sisters who had the same heterozygous ALPL variant with dominant negative effects. The older sister had bone and dental symptoms and was diagnosed with childhood HPP. In contrast, the younger sister was a carrier with no bone and dental symptoms. It can be inferred that this phenomenon was caused by the difference in penetrance. This case revealed that carriers with the ALPL mutation may have no dental symptoms characteristic of HPP. Because HPP is sometimes progressive, it is very important to carefully monitor carriers to detect the possible onset of dental and systemic symptoms.

Cherubism is a rare inherited disorder involving the jaws exclusively and mainly seen in the pediatric population. It has distinctive clinical features and shares radiographic and histopathologic characteristics with other fibro-osseous lesions. Cherubism is caused by a mutation in the SH3BP2 gene located on chromosome 4. Two atypical genetic cases of cherubism from different families that associated with SH3BP2 gene point mutations c.1253C > A and c.1258 G > A in exon 9 were reported. The first case, a 7 years old boy, showed reduced penetrance as the father who is carrying the same mutation did not show any phenotypic features of cherubism. While in the second case, a 6 years old boy, both of his parents proved to be negative for the mutation. Hence the mutation of the child has occurred sporadically. Although the disease seems to be a simple monogenic disease characterized by specific features, a varied genetic presentation can be expected. Understanding such potential influence could highlight possible therapeutic intervention for cherubism. [ABSTRACT FROM AUTHOR]

Newborn screening (NBS) programmes are essential in the diagnosis of inherited metabolic diseases (IMDs) and for access to disease modifying treatment. Most European countries follow the World Health Organisation (WHO) criteria to determine which disorders are appropriate for screening at birth; however, these criteria are interpreted and implemented by individual countries differently, creating disparities. Advances in research and diagnostics, together with the promise of new treatments, offer new possibilities to accelerate the expansion of evidence-based screening programmes. A novel and robust algorithm was built to objectively assess and prioritise IMDs for inclusion in NBS programmes. The Wilson and Jungner classic screening principles were used as a foundation to develop individual and measurable criteria. The proposed algorithm is a point-based system structured upon three pillars: condition, screening, and treatment. The algorithm was tested by applying the six IMDs currently approved in the United Kingdom NBS programme. The algorithm generates a weight-based score that could be used as the first step in the complex process of evaluating disorders for inclusion on NBS programmes. By prioritising disorders to be further evaluated, individual countries are able to assess the economic, societal and political aspects of a potential screening programme.

Fabry disease (FD) is a rare, X-linked disorder caused by mutations in the GLA gene encoding the enzyme α-galactosidase A. Complete or partial deficiency in this enzyme leads to intracellular accumulation of globotriaosylceramide (Gb3) and other glycosphingolipids in many cell types throughout the body, including the kidney. Progressive accumulation of Gb3 in podocytes, endothelial cells, epithelial cells, and tubular cells contribute to the renal symptoms of FD, which manifest as proteinuria and reduced glomerular filtration rate leading to renal insufficiency. A correct diagnosis of FD, although challenging, has considerable implications regarding treatment, management, and counseling. The diagnosis may be confirmed by demonstrating the enzyme deficiency in males and by identifying the specific GLA gene mutation in male and female patients. Treatment with enzyme replacement therapy, as part of the therapeutic strategy to prevent complications of the disease, may be beneficial in stabilizing renal function or slowing its decline, particularly in the early stages of the disease. Emergent treatments for FD include the recently approved chaperone molecule migalastat for patients with amenable mutations. The objective of this report is to provide an updated overview on Fabry nephropathy, with a focus on the most relevant aspects of its epidemiology, diagnosis, pathophysiology, and treatment options.

Researching Waardenburg syndrome (WS) underscores its rarity and complex symptomatology, presenting as a congenital disorder predominantly inherited in an autosomal dominant pattern. It exhibits incomplete penetrance, which results in a wide range of clinical manifestations, with variable phenotypic presentations within the same family as well. The most commonly found features are facial abnormalities, hypopigmentation of the skin, heterochromia iridis, and conductive deafness. Adding to the eccentricities of this syndrome are its four subtypes, each presenting with its specific clinical features, which helps in delineating the subtype. A mutated paired box 3 ( PAX3 ​​​​​) gene manifests as type 1 Waardenburg, which is characterized by sideways displacement of the inner angles of the eyes (i.e., dystopia canthorum), widely spaced eyes, congenital sensorineural hearing impairment, and patchy pigmentation of the iris, skin, and hair. Due to insufficient research, it has been difficult to isolate all the genetic mutations responsible for type 2, but its phenotype is very similar to type 1 with minor differences. Type 3 is characterized by musculoskeletal abnormalities. Waardenburg-Shah syndrome (type 4), which is associated with Hirschsprung disease, is the rarest subtype and is caused by genetic mutations in the endothelin receptor type B ( EDNRB ), endothelin-3 ( EDN3 ), or sex-determining region Y (SRY) box 10 ( SOX10 ) gene. We present a case series of this unique subtype that presented with a typical history of constipation due to Hirschsprung disease and had phenotypic manifestations of white forelock, heterochromia iridis, and bilateral sensorineural hearing loss (SNHL). In parallel with a positive 1° family history of a white forelock, we reflect on the fundamentals of this unique syndrome, as well as its management protocols, highlighting the importance of genetic counseling and cultivation of a high index of suspicion for its diagnosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kankipati et al.)

Oro-facial-digital syndrome, specifically Mohr syndrome, is an uncommon genetic disorder characterized by predominant oro-facial anomalies and polysyndactyly. While typically associated with autosomal recessive and X-linked dominant inheritance patterns, this case presents an autosomal dominant mode of transmission. This report documents the clinical presentation of three individuals, a 12-year-old male child and two females, 10-year-old and eight-year-old, who have inherited the disorder from their ancestors. The observed features include post-axial polysyndactyly in both upper and lower limbs, with the male child exhibiting additional manifestations of strabismus and knee joint defects. Symptomatic management is pursued due to the absence of complications, with surgical interventions and subsequent cosmetic repairs planned for all three children. Post-surgical physiotherapy is scheduled as part of their comprehensive treatment plan. The prognosis for this disorder is generally favorable, with a complete recovery anticipated and no complications expected., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Tiwari et al.)

• PTCY is feasible in patients with life-threatening primary immune deficiencies and osteopetrosis. • Reduction of conditioning intensity needs to be prospectively evaluated to spare toxicities. • Acute GVHD was frequent but mainly grade II, and late occurrence of autoimmunity needs to be monitored. • Despite frequent viral reactivation, life-threatening viral infections were rare. • Evidence of early T cell immune reconstitution was documented. Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for some inherited disorders, including selected primary immunodeficiencies (PIDs). In the absence of a well-matched donor, HSCT from a haploidentical family donor (HIFD) may be considered. In adult recipients high-dose post-transplant cyclophosphamide (PTCY) is increasingly used to mitigate the risks of graft failure and graft-versus-host disease (GVHD). However, data on the use of PTCY in children (and especially those with inherited disorders) are scarce. We reviewed the outcomes of 27 children transplanted with an HIFD and PTCY for a PID (n = 22) or osteopetrosis (n = 5) in a single center. The median age was 1.5 years (range,.2 to 17). HSCT with PTCY was a primary procedure (n = 21) or a rescue procedure after graft failure (n = 6). The conditioning regimen was myeloablative in most primary HSCTs and nonmyeloablative in rescue procedures. After a median follow-up of 25.6 months, 24 of 27 patients had engrafted. Twenty-one patients are alive and have been cured of the underlying disease. The 2-year overall survival rate was 77.7%. The cumulative incidences of acute GVHD grade ≥ II, chronic GVHD, and autoimmune disease were 45.8%, 24.2%, and 29.6%, respectively. There were 2 cases of grade III acute GVHD and no extensive cGVHD. The cumulative incidences of blood viral replication and life-threatening viral events were 58% and 15.6%, respectively. There was evidence of early T cell immune reconstitution. In the absence of an HLA-identical donor, HIFD HSCT with PTCY is a viable option for patients with life-threatening inherited disorders. [ABSTRACT FROM AUTHOR]

Background: Familial adenomatous polyposis (FAP) is an inherited disorder. At present, an increasing number of medications are being employed to treat FAP; however, only a few have been assessed for their efficacy and safety. Therefore, this study aimed to conduct a network meta-analysis to compare the therapeutic outcomes and adverse drug reactions of all FAP-associated medications., Methods: Six relevant databases were searched to identify pertinent randomized controlled trials (RCTs), and information on the dosage and frequency of various drugs was extracted. Additionally, data on changes in polyp counts and dimensions, as well as treatment-related adverse reactions for different medications were collected. The Bayesian method was employed to directly or indirectly compare the impact of different treatment regimens on changes in polyp numbers and diameters, and the safety of the drugs was investigated., Results: CXB at 16 mg/kg/day significantly reduced polyp numbers. Celecoxib at 8 mg/kg/day and sulindac (150 mg twice daily) plus erlotinib (75 mg/day) were effective for tolerant FAP patients. Additionally, EPAFFA 2 g daily and sulindac (150 mg twice daily) plus erlotinib (75 mg/day) emerged as the most effective for reducing polyp size., Conclusion: The most effective treatment for reducing the number of colorectal polyps is celecoxib 16 mg/kg/day. On the other hand, a daily dosage of 2 g EPA-FFA demonstrates the best results in terms of decreasing colorectal polyp diameter., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Thyroid hormone resistance (THR) is a rare inherited disorder that affects approximately one in every 40,000 live births. This condition arises from a mutation in the thyroid hormone receptor β, leading to reduced responsiveness of target tissues. It can result in a combination of hypothyroidism and hyperthyroidism symptoms in different tissues. The thyroid hormone is crucial for controlling blood pressure, and even small changes in its levels can have an effect on vascular resistance, cardiac performance, and heart rhythm. Both hypo- and hyperthyroidism have been associated with elevated blood pressure, underscoring the significant link between thyroid hormone sensitivity and vascular function. Considering thyroid hormone sensitivity is essential in clinical practice, particularly when managing patients with hypertension, to ensure personalized and effective treatment approaches. Monitoring thyroid function is essential during the diagnosis of hypertension, as thyroid dysfunction can often be corrected to normalize blood pressure. It's crucial to distinguish between essential hypertension and hypertension associated with a thyroid abnormality in THR. The mechanisms behind the development of hypertension in THR include reduced nitric oxide production, dysregulation of the renin-angiotensin-aldosterone system, impaired endothelial function, and mutations in the deiodinases. Physicians should understand the underlying mechanisms of THR and identify new therapeutic targets for hypertension in THR., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Prakash et al.)

Fabry disease (FD) is a rare, X-linked disorder caused by mutations in the GLA gene encoding the enzyme α-galactosidase A. Complete or partial deficiency in this enzyme leads to intracellular accumulation of globotriaosylceramide (Gb3) and other glycosphingolipids in many cell types throughout the body, including the kidney. Progressive accumulation of Gb3 in podocytes, endothelial cells, epithelial cells, and tubular cells contribute to the renal symptoms of FD, which manifest as proteinuria and reduced glomerular filtration rate leading to renal insufficiency. A correct diagnosis of FD, although challenging, has considerable implications regarding treatment, management, and counseling. The diagnosis may be confirmed by demonstrating the enzyme deficiency in males and by identifying the specific GLA gene mutation in male and female patients. Treatment with enzyme replacement therapy, as part of the therapeutic strategy to prevent complications of the disease, may be beneficial in stabilizing renal function or slowing its decline, particularly in the early stages of the disease. Emergent treatments for FD include the recently approved chaperone molecule migalastat for patients with amenable mutations. The objective of this report is to provide an updated overview on Fabry nephropathy, with a focus on the most relevant aspects of its epidemiology, diagnosis, pathophysiology, and treatment options. [ABSTRACT FROM AUTHOR]

Along with haemophilia A and B, von Willebrand disease (VWD) and rare bleeding disorders (RBDs) cover all inherited bleeding disorders of coagulation. Bleeding tendency, which can range from extremely severe to mild, is the common symptom. VWD, due to a deficiency and/or abnormality of von Willebrand factor (VWF), represents the most frequent bleeding disorder, mostly inherited as an autosomal dominant trait. The diagnosis may be difficult, based on a bleeding history and different diagnostic assays, which evaluate the pleiotropic functions of VWF. Different treatment options are available for optimal management of bleeding and their prevention, and long-term outcomes are generally good. RBDs are autosomal recessive disorders caused by a deficiency of any other clotting factor, apart from factor XII, and cover roughly 5% of all bleeding disorders. The prevalence of the severe forms can range from 1 case in 500,000 up to 1 in 2-3 million, according to the defect. Diagnosis is based on bleeding history, coagulation screening tests and specific factor assays. A crucial problem in RBDs diagnosis is represented by the non-linear relationship between clinical bleeding severity and residual clotting levels; genetic diagnosis may help in understanding the phenotype. Replacement therapies are differently available for patients with RBDs, allowing the successful treatment of the vast majority of bleeding symptoms. [ABSTRACT FROM AUTHOR]

Genodermatoses refers to group of inherited monogenic disorders with skin manifestations. Many of these disorders are rare and also have oral manifestations, called oral genodermatoses. This article provides a focused review of molecular basis of important genodermatoses that affects the oral cavity and also have prominent associated dermatologic features. In several conditions discussed here, the oral findings are distinct and may provide the first clue of an underlying genetic diagnosis. The article also emphasises on the prenatal diagnosis, genetic counselling and the treatment oral genodermatoses.

The aim of the paper was to analyse congenital disorders in the Czech cattle population in 1986-2001. The offspring of 474 sires - 215 Czech Simmental, 236 Holstein, and 23 beef - were diagnosed with congenital disorders which were unevenly distributed because only 18 occurred in the progeny of 10 and more sires, in contrast to 88 occurring in the progeny of 1 sire only. Umbilical hernia was the most frequently noted disorder, and 136 sires fathered progeny with limb anomalies. The most frequent gestational accident was schistosomus reflexus, the results suggesting a familial burden. Three sires fathering offspring with the afflicted spinal column and limbs were heterozygous for Complex Vertebral Malformation (CVM) though they had not been reported as such. Foetal defects and stillbirth were quite frequent, and the calves affected were fathered by 56 sires. In rare disorders with a low incidence, an accurate genetic analysis or even simple discrimination between inherited and acquired defects is problematic. It would be our recommendation that those sires with a higher incidence of defects among their offspring should be disqualified from fathering stock bulls, or culled.

Objective: To determine the frequency of consanguineous marriages in parents and grand parents of alladmitted children in a pediatric unit Design: An observational study. Methodology: All patients admitted over one year period from January to December 2001 in Unit 1 ofPediatric Department were included. Information was obtained regarding consanguinity of parents andg ran d p a ren ts o f the ch ild ren . C lin ic a lly ev id en t in h e rite d d iso rd e rs were also noted.Results: Consanguinity was found in 72.7% of marriages. First cousin marriages were seen in 87% whilesecond cousin marriages were seen in 12%. Consanguinity was also seen in the grandparents. It was foundin 64.15% of maternal and 60.3% of paternal grandparents. Conclusion: Cousin-marriages are a norm in the population studied. Its effect on inherited disorders deservesfurther studies.

Mammalian SWI/SNF or BAF chromatin-remodeling complexes are polymorphic assemblies of homologous subunit families that remodel nucleosomes. BAF57 is a subunit of the BAF complexes; it is encoded only in higher eukaryotes and is present in all mammalian assemblies. Its main structural feature is a high-mobility group domain, the DNA-binding properties of which suggest that BAF57 may play topological roles as the BAF complex enters or exits the nucleosome. BAF57 displays specific interactions with a number of proteins outside the BAF complex. Through these interactions, it can accomplish specific functions. In the embryo, BAF57 is responsible for the silencing of the CD4 gene during T-cell differentiation, and during the repression of neuronal genes in non-neuronal cells, BAF57 interacts with the transcriptional corepressor, Co-REST, and facilitates repression. Extensive work has demonstrated a specific role of BAF57 in regulating the interactions between BAF and nuclear hormone receptors. Despite its involvement in oncogenic pathways, new generation sequencing studies do not support a prominent role for BAF57 in the initiation of cancer. On the other hand, evidence has emerged to support a role for BAF57 as a metastasis factor, a prognosis marker and a therapeutic target. In humans, BAF57 is associated with disease, as mutations in this gene predispose to important congenital disorders, including menigioma disease or the Coffin-Siris syndrome. In this article, we present an exhaustive analysis of the BAF57 molecular and biochemical properties, cellular functions, loss-of-function phenotypes in living organisms and pathological manifestations in cases of human mutations. [ABSTRACT FROM AUTHOR]

Genodermatoses refers to group of inherited monogenic disorders with skin manifestations. Many of these disorders are rare and also have oral manifestations, called oral genodermatoses. This article provides a focused review of molecular basis of important genodermatoses that affects the oral cavity and also have prominent associated dermatologic features. In several conditions discussed here, the oral findings are distinct and may provide the first clue of an underlying genetic diagnosis. The article also emphasises on the prenatal diagnosis, genetic counselling and the treatment oral genodermatoses. [ABSTRACT FROM AUTHOR]

Protein destabilization by amino acid substitutions is proposed to play a prominent role in widespread inherited human disorders, not just those known to involve protein misfolding and aggregation. To test this hypothesis, we computationally evaluate the effects on protein stability of all possible amino acid substitutions in 20 disease-associated proteins with multiple identified pathogenic missense mutations. For 18 of the 20 proteins studied, substitutions at known positions of pathogenic mutations are significantly more likely to destabilize the native protein fold (as indicated by more positive values of ∆∆ G). Thus, positions identified as sites of disease-associated mutations, as opposed to non-disease-associated sites, are predicted to be more vulnerable to protein destabilization upon amino acid substitution. This finding supports the notion that destabilization of native protein structure underlies the pathogenicity of broad set of missense mutations, even in cases where reduced protein stability and/or aggregation are not characteristic of the disease state. [ABSTRACT FROM AUTHOR]

Monitoring and surveillance strategies are imperative for managing genetic defects in livestock populations in order to avoid detrimental effects on animal welfare and productivity. Recently, a number of previously unknown defects have been described in cattle, fostered by the huge progress in genome analysis and genomic selection. In response to reports about a potentially new defect in Holstein cattle, case–control studies were carried out to confirm a genetic background of the defect and to evaluate its phenotypic relevance. Eighty-five potentially affected offspring of a suspected carrier sire for the defect and 41 matched control calves were subjected to clinical and epidemiological monitoring on 39 farms. Forty-one animals, all offspring of the suspected carrier sire, showed pathognomonic tail malformations providing highly significant evidence for a congenital inherited defect, which was subsequently termed vertebral and spinal dysplasia (VSD). The defect is characterised by vertebral (specifically tail) deformities and neurological dysfunctions with gait abnormalities of the hind limbs. The deformities and neurological dysfunctions varied from very mild (only tail deformities) to severe (paraparesis). Detailed epidemiological monitoring provided no indication of environmental factors affecting VSD. The malformations and dysfunctions associated with VSD, as well as its mode of inheritance and the genotyping of the suspected carrier sire, indicated that VSD is a defect previously not described in cattle. VSD is inherited in a dominant mode, but shows incomplete penetrance of the phenotype, which impedes unequivocal identification of VSD carriers. A direct diagnostic genetic test for VSD is available. [ABSTRACT FROM AUTHOR]

AIMS: To explore veterinary perceptions of inherited disorders in pedigree dogs within New Zealand and how these affect animal health and welfare. METHODS: An online questionnaire was distributed to the 647 members of the Companion Animal Society of the New Zealand Veterinary Association using an online survey system. The questionnaire collected details of practitioners, pedigree dog breeds and disorders most often encountered in practice, and responses to questions and statements regarding inherited disorders and pedigree dogs. RESULTS: Of the 216 respondents, 194 (89.8%) believed inherited disorders in dogs were a significant issue. The most commonly identified breeds presenting with inherited disorders were Boxer, Bulldog and German Shepherd dog. The most commonly reported inherited disorders were hip dysplasia, brachycephalic syndromes and elbow dysplasia. Of 207 respondents, 100 (48.3%) had advised clients against purchasing a pedigree dog due to common inherited disorders and 183 (85.6%) considered the health and welfare of some breeds to be too compromised to continue breeding. Of 199 respondents, 132 (66.3%) reported seeing no change in prevalence of inherited conditions, 103/204 (50.5%) reported seeing a positive change in attitudes towards inherited disorders among dog owners, and 81/207 (39.1%) thought legislative support would help decrease inherited disorders in pedigree dogs. Attitudes were not associated with time since graduation or ownership of a New Zealand Kennel Club registered breed of dog. The most common suggestions to decrease prevalence of inherited disorders were to alter breed standards, educate public or buyers and compulsory genetic testing. CONCLUSIONS: Among respondents, veterinarians considered inherited disorders as significant issues in a number of pedigree breeds. Veterinarians were concerned about inherited disorders in pedigree dogs, felt they had an obligation to treat such animals and were supportive of measures to make genetic testing for inheritable disorders a requirement for registration of pedigree breeds. CLINICAL RELEVANCE: Prevalence and perceived importance of inherited disorders influences how clinicians advise their clients. Respondents to this survey provided a number of mechanisms by which inherited disorders may be managed and these could form the basis of future discussions within the profession. [ABSTRACT FROM AUTHOR]

The search for the components of the platelet surface that mediate platelet adhesion and platelet aggregation began for earnest in the late 1960s when electron microscopy demonstrated the presence of a carbohydrate-rich, negatively charged outer coat that was called the "glycocalyx." Progressively, electrophoretic procedures were developed that identified the major membrane glycoproteins (GP) that constitute this layer. Studies on inherited disorders of platelets then permitted the designation of the major effectors of platelet function. This began with the discovery in Paris that platelets of patients with Glanzmann thrombasthenia, an inherited disorder of platelet aggregation, lacked two major GP. Subsequent studies established the role for the GPIIb-IIIa complex (now known as integrin aIIbß3) in binding fibrinogen and other adhesive proteins on activated platelets and the formation of the protein bridges that join platelets together in the platelet aggregate. This was quickly followed by the observation that platelets of patients with the Bernard-Soulier syndrome, with macrothrombocytopenia and a distinct disorder of platelet adhesion, lacked the carbohydrate-rich, negatively charged, GPIb. It was shown that GPIb, through its interaction with von Willebrand factor, mediated platelet attachment to injured sites in the vessel wall. What follows is a personal reflection on the studies that were performed in the early pioneering days. [ABSTRACT FROM AUTHOR]

Background: Purine nucleoside phosphorylase (PNP) deficiency is a rare form of autosomal recessive combined primary immunodeficiency caused by a enzyme defect leading to the accumulation of inosine, 2'-deoxy-inosine (dIno), guanosine, and 2'-deoxy-guanosine (dGuo) in all cells, especially lymphocytes. Treatments are available and curative for PNP deficiency, but their efficacy depends on the early approach. PNP--combined immunodeficiency complies with the criteria for inclusion in a newborn screening program. Objective: This study evaluate whether mass spectrometry can identify metabolite abnormalities in dried blood spots (DBSs) from affected patients, with the final goal of individuating the disease at birth during routine newborn screening. Methods: DBS samples from 9 patients with genetically confirmed PNP-combined immunodeficiency, 10,000 DBS samples from healthy newborns, and 240 DBSs from healthy donors of different age ranges were examined. Inosine, dIno, guanosine, and dGuo were tested by using tandem mass spectrometry (TMS). T-cell receptor excision circle (TREC) and kappa-deleting recombination excision circle (KREC) levels were evaluated by using quantitative RT-PCR only for the 2 patients (patients 8 and 9) whose neonatal DBSs were available. Results: Mean levels of guanosine, inosine, dGuo, and dIno were 4.4,133.3, 3.6, and 3.8 µmol/L, respectively, in affected patients. No indeterminate or false-positive results were found. In patient 8 TREC levels were borderline and KREC levels were abnormal; in patient 9 TRECs were undetectable, whereas KREC levels were normal. Conclusion: TMS is a valid method for diagnosis of PNP deficiency on DBSs of affected patients at a negligible cost. TMS identifies newborns with PNP deficiency, whereas TREC or KREC measurement alone can fail. [ABSTRACT FROM AUTHOR]

Fraser syndrome is an autosomal recessive inherited disorder with multiple anomalies that have always been seen with cryptophthalmos. In this study, a 14-year girl with cryptophthalmos, syndactyly of the upper and lower limbs finger, cardiac and urogenital abnormalities referred to ophthalmology department of Kermanshah's Imam Khomeini Hospital in 2011. There was no visual organized globe in ocular ultrasound examination. Separation of the lens of the anterior and posterior segments was not visible. On both sides of a large cystic space was seen anterolateral globe. Although we did the ultrasound, there was no visual potential, but the patient at the time of the photo flash light response suggests that there is some degree of health of the visual pathway, but these symptoms alone cannot be the reason for the surgery. Therefore, we recommend preoperative ultrasonography and if the confirmation of visual potential and organized globe, lid opening can be done to prevent suffering and unnecessary further surgery. [ABSTRACT FROM AUTHOR]

Background: Adenosine deaminase (ADA)–severe combined immunodeficiency (SCID) is caused by genetic variants that disrupt the function of ADA. In its early-onset form, it is rapidly fatal to infants. Delayed or late-onset ADA-SCID is characterized by insidious progressive immunodeficiency that leads to permanent organ damage or death. Quantification of T-cell receptor excision circles (TRECs) or tandem mass spectrometry (tandem-MS) analysis of dried blood spots (DBSs) collected at birth can identify newborns with early-onset ADA-SCID and are used in screening programs. However, it is not clear whether these analyses can identify newborns who will have delayed or late-onset ADA-SCID before symptoms appear. Objective: We performed a retrospective study to evaluate whether tandem-MS and quantitative TREC analyses of DBSs could identify newborns who had delayed-onset ADA-SCID later in life. Methods: We tested stored DBSs collected at birth from 3 patients with delayed-onset ADA-SCID using tandem-MS (PCT EP2010/070517) to evaluate levels of adenosine and 2′-deoxyadenosine and real-time PCR to quantify TREC levels. We also analyzed DBSs from 3 newborns with early-onset ADA-SCID and 2 healthy newborn carriers of ADA deficiency. Results: The DBSs taken at birth from the 3 patients with delayed-onset ADA-SCID had adenosine levels of 10, 25, and 19 μmol/L (normal value, <1.5 μmol/L) and 2′-deoxyadenosine levels of 0.7, 2.7, and 2.4 μmol/L (normal value, <0.07 μmol/L); the mean levels of adenosine and 2′-deoxyadenosine were respectively 12.0- and 27.6-fold higher than normal values. DBSs taken at birth from all 3 patients with delayed-onset ADA deficiency had normal TREC levels, but TRECs were undetectable in blood samples taken from the same patients at the time of diagnosis. Conclusion: Tandem-MS but not TREC quantification identifies newborns with delayed- or late-onset ADA deficiency. [Copyright &y& Elsevier]

The inverted teat defect is characterized by the failure of teats to protrude from the udder surface and has a negative effect on the economic efficiency of pig production. The inverted teat defect is influenced by genetic factors, but the number and identity of relevant genes are unknown. In this study, we compared the mRNA expression of teat tissues from unaffected pigs and affected pigs by using microarrays. Simultaneously, 24,123 probe sets were screened, of which some 15,000 had present calls and were analyzed for differential expression between mesenchymal and epithelial tissue of 3 categories of teats (i.e., normal teats of unaffected and affected animals, and inverted teats of the latter). Differential expression was more pronounced in epithelial than in mesenchymal tissue, and the comparisons among the 3 categories of teats showed that local processes at the side of the affected area as well as processes taking place at the level of the organ contribute to the development of inverted teats. Genes related to biofunctions of cell maintenance, proliferation, differentiation, and replacement; organismal, organ, and tissue development; genetic information and nucleic acid processing; and cell-to-cell signaling and interaction were differentially expressed, depending on the teat phenotype and the status of the animal as affected or unaffected. In particular, genes encoding members of canonical pathways of growth factor signaling were highlighted. Complementary to previous real-time quantitative reverse-transcription PCR experiments showing upregulation of growth factors (epidermal growth factor, fibroblast growth factor, hepatocyte growth factor, platelet-derived growth factor, vascular endothelial growth factor) and their receptors in the inverted teat, here it is shown that the abundance of transcripts encoding subordinated proteins (acid phosphatase 1, soluble; activating transcription factor 2; casein kinase 2, α 1 polypeptide; casein kinase 2, α prime polypeptide; actinin, α 2; and Homo sapiens growth factor receptor-bound protein 2) within the growth factor signaling pathways are also affected. Tuning of the expression of genes of these pathways balances the differentiation and proliferation of epithelial and mesenchymal teat tissue and finally affects the shape and structure of the teats [ABSTRACT FROM AUTHOR]

The United Kingdom pedigree-dog industry has faced criticism because certain aspects of dog conformation stipulated in the UK Kennel Club breed standards have a detrimental impact on dog welfare. A review of conformation-related disorders was carried out in the top 50 UK Kennel Club registered breeds using systematic searches of existing information. A novel index to score severity of disorders along a single scale was also developed and used to conduct statistical analyses to determine the factors affecting reported breed predisposition to defects. According to the literature searched, each of the top 50 breeds was found to have at least one aspect of its conformation predisposing it to a disorder; and 84 disorders were either directly or indirectly associated with conformation. The Miniature poodle, Bulldog, Pug and Basset hound had most associations with conformation-related disorders. Further research on prevalence and severity is required to assess the impact of different disorders on the welfare of affected breeds. [ABSTRACT FROM AUTHOR]

In this study 8 genes of growth factors and their receptors were investigated that are known to play a significant role in signaling pathways involved in the ontogenetic, but also tumorigenic, development of breast and mammary glands. Differential expression of fibroblast growth factor receptor 2 (FCFR2), GH receptor (GHR), hepatocyte growth factor (HCF), hepatocyte growth factor receptor (HGFR), plateletderived growth factor a (PDCFA), platelet-derived growth factor receptor a (PDGFRA), platelet-derived growth factor 3 (PDGFB), and vascular endothelial growth factor (VEGF) was analyzed in mesenchymal and epithelial teat tissue of peripubertal pigs affected and nonaffected by the inverted teat defect. Comparisons were made at the level where pigs were affected between samples derived from nonaffected animals and affected animals, including specimens of normal and inverted teats. In addition, comparisons were made at the level of the teat phenotype with normal teats of nonaffected animals vs. either the normal or the inverted teat of affected animals. All genes tested, except HGFR, showed significant differential expression at P < 0.05 in the mesenchymal or the epithelial teat tissue or both. In general, we observed more pronounced differences when comparing samples obtained from inverted tissues vs. samples from normal ones. Therefore, results of our study suggest that gene expression of the growth factors and their receptors associates directly with the teat phenotype rather than with the affection status of the investigated animals, suggesting that local processes and tissue-specific compensation by means of differential expression of growth factors and their receptors are responsible for the development of impaired teat phenotypes. [ABSTRACT FROM AUTHOR]

Parathyroid hormone-like hormone gene ( PTHLH) and its receptor, parathyroid hormone/ parathyroid hormone-like hormone receptor 1 ( PTHR1), play a role in epithelial mesenchymal interactions during growth and differentiation of different tissues and anatomic structures, including teats. Therefore, PTHLH and PTHR1 were evaluated as functional candidate genes for their effects on number and shape of teats in pigs. In particular, focus was on the occurrence and number of inverted teats, the most frequent and economically relevant teat developmental defect in pigs. For this purpose, association and linkage of the PTHLH gene and the PTHR1 gene with inverted teat defect and the total number of teats and inverted teats were studied in an experimental Duroc and Berlin Miniature pig (DUMI) population. Polymorphism C1819T of PTHR1 was significantly associated with inverted teat phenotype (p = 0.014), total number of teats (p = 0.047) and was close to significance with the number of inverted teats (p = 0.078). Polymorphism C375T of PTHLH was close to significance with the inverted teat phenotype (p = 0.122) and showed no significant association with the total number of teats (p = 0.621) and the number of inverted teats (p = 0.256) in the DUMI population. Association analyses were also performed for combined effects of PTHLH and PTHR1 in order to address potential interaction, however, revealed no indication of effects of interaction. The function, position and the association shown here promote PTHR1 as a candidate gene for number of teats and in particular for affection by and number of inverted teats. [ABSTRACT FROM AUTHOR]

Abstract: Noonan syndrome is a mostly autosomal dominant inherited disorder, which can be accompanied by hearing disorders or deafness, coagulation disorders, combined heart defects and developmental disorders. We are reporting on two children with an established Noonan syndrome with a severe bilateral hearing loss of respectively 95 and 100dB and proper findings in the CT/MRI of the petrous bone. After complete otologic and radiologic diagnostics, both children underwent bilateral cochlear implantation successfully. According to the authors’ knowledge, this is the first time that cochlear implant therapy is discussed in patients with Noonan syndrome. [Copyright &y& Elsevier]

Factor V (FV; proaccelerin or labile factor) is the plasma cofactor for the prothrombinase complex that activates prothrombin to thrombin. FV deficiency can be caused by mutations in the FV gene or in genes encoding components of a putative cargo receptor that transports FV (and factor VIII) from the endoplasmic reticulum to the Golgi. Because FV is present in platelet α-granules as well as in plasma, low FV levels are also seen in disorders of platelet granules. Additionally, acquired FV deficiencies can occur in the setting of rheumatologic disorders, malignancies, and antibiotic use and, most frequently, with the use of topical bovine thrombin. FV levels have limited correlation with the risk of bleeding, but overall, FV-deficient patients appear to have a less severe phenotype than patients with haemophilia A or B. The most commonly reported symptoms are bleeding from mucosal surfaces and postoperative haemorrhage. However, haemarthroses and intramuscular and intracranial haemorrhages can also occur. Because no FV-specific concentrate is available, fresh frozen plasma remains the mainstay of treatment. Antifibrinolytics can also provide benefit, especially for mucosal bleeding. In refractory cases, or for patients with inhibitors, prothrombin complex concentrates, recombinant activated FVIIa, and platelet transfusions have been successfully used. Some patients with inhibitors may also require immunosuppression. [ABSTRACT FROM AUTHOR]

For over two decades gene therapy has been actively pursued as a treatment modality for the inherited diseases that affect the paediatric population, however, it is still to make a real impact in the clinic. There are many reasons for this including inadequate technology and a lack of understanding of the biological complexities that impact on the efficiency of gene delivery and its outcomes, both positive and negative. However, recent progress is now addressing these issues and indicates that these problems can be overcome, and that gene therapy will play a significant role in the treatment of at least some of these disorders. This review will first give a short overview of relevant gene delivery technologies, what strategies can be used and which diseases are potential targets for gene therapy, and then illustrate several specific diseases for which gene therapy is actively being developed. [ABSTRACT FROM AUTHOR]

Protein misfolding is a common event in living cells. In young and healthy cells, the misfolded protein load is disposed of by protein quality control (PQC) systems. In aging cells and in cells from certain individuals with genetic diseases, the load may overwhelm the PQC capacity, resulting in accumulation of misfolded proteins. Dependent on the properties of the protein and the efficiency of the PQC systems, the accumulated protein may be degraded or assembled into toxic oligomers and aggregates. To illustrate this concept, we discuss a number of very different protein misfolding diseases including phenylketonuria, Parkinson's disease, α-1-antitrypsin deficiency, familial neurohypophyseal diabetes insipidus, and short-chain acyl-CoA dehydrogenase deficiency. Despite the differences, an emerging paradigm suggests that the cellular effects of protein misfolding provide a common framework that may contribute to the elucidation of the cell pathology and guide intervention and treatment strategies of many genetic and age-dependent diseases. [ABSTRACT FROM AUTHOR]

Identification of COL4A5 defects in Alport’s syndrome by immunohistochemistry of skin. Background. The COL4A3-COL4A4-COL4A5 network in the glomerular basement membrane is affected in the inherited renal disorder Alport’s syndrome (AS). Approximately 85% of the AS patients are expected to carry a mutation in the X-chromosomal COL4A5 gene and 15% in the autosomal COL4A3 and COL4A4 genes. The COL4A5 chain is also present in the epidermal basement membrane (EBM). It is predicted that approximately 70% of the COL4A5 mutations prevent incorporation of this chain in basement membranes. Methods. We investigated whether or not COL4A5 defects could be detected by immunohistochemical analysis of the EBM. Punch skin biopsies were obtained from 22 patients out of 17 families and two biopsy specimens from healthy males were used as controls. Results. In four cases with the COL4A5 frameshift or missense mutations, the COL4A5 chain was either lacking from the EBM (male) or showed a focally negative pattern (female). In three other patients with a COL4A5 missense mutation, a COL4A3 and a COL4A4 mutation, respectively, the COL4A5 staining was normal. A (focally) negative EBM-COL4A5 staining was found in three patients of six families with a diagnosis of AS and in one family of a group of four families with possible AS. Conclusions. The (focal) absence of COL4A5 in the EBM of skin biopsy specimens can be used for fast identification of COL4A5 defects. Combined with polymorphic COL4A5 markers, both postnatal and prenatal DNA diagnosis are possible in the family of the patient. [ABSTRACT FROM AUTHOR]

A 10-year old girl with Leprechaunism was studied by clinical examination, blood tests and skin biopsies. She is one of the few cases of such tong survival and the first one with two missence mutations demonstrated in the alpha-I subunit of the insulin receptor. The case is interesting not only because of its rarity and typical morphology but also because nowadays it is possible to explain the clinical features at a metabolic and hormonal level. [ABSTRACT FROM AUTHOR]