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The rapid transcriptional response to the transcription factor, glucocorticoid receptor (GR), including gene activation or repression, is mediated by the spatial association of genes with multiple GR binding sites (GBSs) over large genomic distances. However, only a minority of the GBSs have independent GR-mediated activating capacity, and GBSs with independent repressive activity were rarely reported. To understand the positive and negative effects of GR we mapped the regulatory environment of its gene targets. We show that the chromatin interaction networks of GR-activated and repressed genes are spatially separated and vary in the features and configuration of their GBS and other non-GBS regulatory elements. The convergence of the KLF4 pathway in GR-activated domains and the STAT6 pathway in GR-repressed domains, impose opposite transcriptional effects to GR, independent of hormone application. Moreover, the ROR and Rev-erb transcription factors serve as positive and negative regulators, respectively, of GR-mediated gene activation. We found that the spatial crosstalk between GBSs and non-GBSs provides a physical platform for sequestering the Ep300 co-activator from non-GR regulatory loci in both GR-activated and -repressed gene compartments. While this allows rapid gene repression, Ep300 recruitment to GBSs is productive specifically in the activated compartments, thus providing the basis for gene induction.

Gene transcription is regulated by distant regulatory elements via combinatorial binding of transcription factors. It is increasingly recognized that alterations in chromatin state and transcription factor binding in these distant regulatory elements may have key roles in cancer development. Here we focused on the first stages of oncogene-induced carcinogenic transformation, and characterized the regulatory network underlying transcriptional changes associated with this process. Using Hi-C data, we observe spatial coupling between differentially expressed genes and their differentially accessible regulatory elements and reveal two candidate transcription factors, p53 and CTCF, as determinants of transcriptional alterations at the early stages of oncogenic HRas-induced transformation in human mammary epithelial cells. Strikingly, the malignant transcriptional reprograming is promoted by redistribution of chromatin binding of these factors without major variation in their expression level. Our results demonstrate that alterations in the regulatory landscape have a major role in driving oncogene-induced transcriptional reprogramming., By integrating transcriptome, regulatory element and chromosome topology profiles, Schwartz et al identify redistribution of p53 and CTCF genomic binding to be associated with transcriptional and phenotypical changes during Ras-induced transformation of mammary epithelial cells.

Approximately one in three Ashkenazi Jews are carriers for an autosomal recessive Jewish genetic disease (JGD). However, studies indicate that most Jews are uneducated on this topic and obstetricians do not routinely offer carrier screening to Jewish patients. Both the Reform and Conservative movements of Judaism call for JGD education to take place within the synagogue; however, little is known about the extent of this education occurring today. An online survey was created for Reform and Conservative rabbis to assess the types of JGD education taking place within the synagogue. Additionally, the survey included questions to assess JGD knowledge and possible factors that could predict counseling activity and knowledge level. Of the 94 participants, 91% had provided education about JGDs to congregants, with 98.8% providing this education during premarital counseling sessions. For most respondents, explaining recessive inheritance pattern and carrier screening was the extent of the discussion. Additionally, the majority of rabbis scored below 50% on the knowledge portion of the survey, with an average score of 1.9/4. There were no statistically significant differences between JGD education in Reform vs. Conservative synagogues, and there were no statistically significant predictors of knowledge score or JGD education frequency. In conclusion, while the number of rabbis discussing this topic is encouraging, discussion topics were found to be limited and their knowledge of JGDs was found to be poor.

Background: Obesity is associated with increased breast cancer incidence and progression. Breast adipose tissue produces a number of factors hypothesized to contribute to this observation, including estrogens, adipokines, inflammatory mediators, and free fatty acids. Adipose tissue also releases extracellular vesicles (EVs) that can act locally or circulate to distant sites. EVs are nano-sized particles that are characterized by their lipid bilayer and contain nucleic acids, proteins, lipids and other molecules that can affect target cells. Recently, EVs derived from adipose tissue have received increasing attention and numerous studies have been conducted to explore the relationship between adipose tissue-derived EVs and different types of cancers, including breast cancer. Here, we provide novel insights into the sustained effects of EVs, collected from fresh breast adipose tissue, via effects on mitochondrial mass and respiration in estrogen receptor (ER)-positive breast cancer cells. Methods: EVs were collected from fresh breast adipose tissue from reduction mammoplasties. Long-term education was performed by treating MCF7 and T47D breast cancer cell lines with 3 doses of EVs over the course of 7 days. xCelligence was used to quantify cell proliferation. RNA Seq was performed on one of the educated MCF7 pairs. Mitochondrial respiration was evaluated using the Seahorse XF instrument. MitoTracker Green fluorescent staining and transmission electron microscopy (TEM) were used to assess mitochondrial density and morphology. Western blotting was used to identify pathways that may be involved in the effects of adipose tissue derived EVs on breast cancer cells. Results: EVs derived from adipose tissue of overweight/obese individuals (O-EVs) stimulate proliferation of MCF7 breast cancer cells compared with that from lean individuals (L-EVs). Compared with controls, O-EVs also induce proliferation of T47D breast cancer cells. RNA-Seq data reveal that genes involved in oxidative phosphorylation (OXPHOS) are significantly upregulated in O-EV-treated MCF7 cells compared to control. Compared with control cells, basal mitochondrial respiration of O-EV-treated MCF7 cells is significantly higher than control. Metformin, which inhibits mitochondrial complex I and ATP synthase, inhibits the O-EV-stimulated proliferation of MCF7 cells, while having no effect on the proliferation of control cells. Both MitoTracker Green fluorescent staining and TEM demonstrate increased mitochondrial mass/number. Western blotting reveals that O-EVs significantly increase phosphorylation of Akt, which is the major upstream regulator of mTOR signaling, and phosphorylation of P70 S6 kinase and 4EBP1, which are two main downstream effectors of mTOR signaling, affecting both protein synthesis and mitochondrial respiration. Conclusions: Breast adipose tissue EVs from overweight and obese women stimulate the proliferation of ER+ breast cancer cells by increasing mitochondrial mass and stimulating mitochondrial respiration, providing a novel mechanistic link between obesity and breast cancer. Our studies also suggest that metformin or mTOR-targeting drugs, may prove useful to break obesity-breast cancer link. Support: NIH R01CA215797, Anne Moore Breast Cancer Research Fund Citation Format: Shuchen Liu, Alberto Benito-Martin, Phoebe Piloco, Catherine Liu, Paul Paik, Jason A Spector, Fanny A Pelissier Vatter, David Lyden, David M Otterburn, Leslie Cohen, Olivier Elemento, Rohan Bareja, Leona Cohen-Gould, Samuel Calto, Kristy A Brown. Extracellular vesicles from obese human breast adipose tissue promote breast cancer cell proliferation by increasing mitochondrial mass and stimulating mitochondrial respiration [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-05-02.

This article describes how implementation science and intervention research guided the process of selecting and implementing an evidence-informed intervention (Tuning in to Teens; TINT). TINT was provided as a selective prevention effort offered to families with youth aged 10 to 13 years old, with characteristics that suggest an elevated risk for post-permanency discontinuity. Usability testing findings: Contact was made with 54% of families, and 12% participated in the intervention. Multivariate results found no statistically significant differences between families who responded to outreach efforts and those who did not; families who participated in TINT and those who did not.Large public child welfare systems wanting to implement evidence-informed interventions can follow the steps detailed in this paper for selecting, adapting and implementing an intervention. Further, providers that seek to offer post adoption and guardianship services, a growing service need, may gain some insights into activities that promote service usage with this population.

Adults with Down syndrome (DS) are surviving longer, yet data delineating life skills are lacking. As providers are encouraged to provide a "balanced" description of DS to family members/caregivers, more quantitative data are required to accurately describe the abilities and potential of adults with DS. This study assessed health, social, communication, and daily living skills of adults with DS to describe the range of abilities and to show how increasing age contributes to functional abilities. Caregivers of an adult with DS 20 years of age or older participated in an online questionnaire. Descriptive statistics and scores from scales assessed relationships between the number of health issues reported and functional abilities, and how the abilities changed as age increased. Of 188 participants, 157 completed the survey with partial results included. Communication, independence, and social activity scores were compared to the number of congenital and non-congenital health issues reported. Linear regression results showed those with more health issues were significantly less likely to be independent and social. However, only current health issues affected communication skills. No significant correlation occurred between the number of congenital abnormalities and scores for independence/life skills as an adult. T-test by age group found decreasing abilities after 40 years of age. In conclusion, quantitative data and information from this study is beneficial for providers in order to describe the potential for an individual with DS and to assist caregivers to plan accordingly for the future of their adult with DS.

Social media is a common method of communication in people's personal lives and professional settings. Gallagher et al. (2016) recommended, "it is time for genetic counselors to embrace social media as a means of communicating with patients or other healthcare professionals." Full members of the National Society of Genetic Counselors (NSGC) in the USA and Canada and genetics patients in Cleveland, OH, were surveyed to determine interest in using social media for patient-provider interactions. Both cohorts indicated that patient privacy and confidentiality would be a concern; however, survey results indicated patients would be interested in using social media to receive general information about genetic counseling and to learn about genetics services. Genetic counselors indicated privacy issues were not concerning if social media were to be used in this capacity. The majority of genetic counselor participants (88.7%) indicated they would welcome national guidelines for patient-provider social media use. Data from this study demonstrated that sharing what to expect at a genetic counseling appointment, defining genetic counseling, and announcing community outreach events are possible ways genetic counselors could utilize social media to communicate with and educate patients.

The genetic counseling profession is a relatively new medical specialty that has evolved over time in keeping with advanced in the medical genetics field. Genetic counselors are master's-level trained individuals who apply their skills to assist patients in understanding the genetic etiology of disease, assessing risk for genetic disease, and providing support to those who are encountering a genetic disorder in themselves or family member. Formal training of genetic counselors began nearly 50 years, and since then, the field has been expanding and advancing. Defining the tenets and practice of the genetic counseling profession has also similarly changed over time; however, the core guiding principles of the profession have remained rooted in the concept of patient autonomy and client-centered care. Competency in the field is achieved by successfully graduating from an accredited master's-level training program in which the curriculum is based on standards set forth by the Accreditation Council of Genetic Counseling. Curricula are developed so that trainees are exposed to didactic work, hands-on clinical fieldwork, and research so that at the end of one's training they have become competent in The Practice Based Competencies that have been established for the profession. Upon graduation, genetic counselors find themselves working in a number of professional settings and subspecialties in genetics. As the underlying genetic cause of disease has become clearer, the areas in which genetic counselors practice have expanded and allows for diverse clinical practice. The profession has, and will, continue to adapt along with the advances in molecular genetics.

Tetrasomy 9p is a rare condition initially reported by Ghymers et al. Reported cases are a mix of prenatal and neonatal/pediatric cases in non-mosaic and mosaic cases. We report on the common mechanism leading to this form of chromosome abnormality, the various types of tetrasomy 9p as well as the prenatal sonographic and laboratory presentation of our case and previously reported cases with mosaic and non-mosaic tetrasomy 9p. From these reported cases, a recognizable syndrome is emerging. Multiple fetal abnormalities amenable to ultrasound diagnosis are likely to be present. However, neither ultrasound study alone nor the first-trimester screen for the common aneuploidies can suggest the correct diagnosis. Chromosome study of more than a single tissue is necessary in order to establish the correct diagnosis and to differentiate between mosaic and non-mosaic tetrasomy 9p cases.

Cornelia de Lange syndrome (CdLS) is a genetic disorder associated with delayed growth, intellectual disability, limb reduction defects, and characteristic facial features. Germline mosaicism has been a described mechanism for CdLS when there are several affected offspring of apparently unaffected parents. Presently, the recurrence risk for CdLS has been estimated to be as high as 1.5%; however, this figure may be an underrepresentation. We report on the molecularly defined germline mosaicism cases from a large CdLS database, representing the first large case series on germline mosaicism in CdLS. Of the 12 families, eight have been previously described; however, four have not. No one specific gene mutation, either in the NIPBL or the SMC1A gene, was associated with an increased risk for germline mosaicism. Suspected or confirmed cases of germline mosaicism in our database range from a conservative 3.4% up to 5.4% of our total cohort. In conclusion, the potential reproductive recurrence risk due to germline mosiacism should be addressed in prenatal counseling for all families who have had a previously affected pregnancy or child with CdLS.

Tetrasomy 9p is a rare condition initially reported by Ghymers et al. Reported cases are a mix of prenatal and neonatal/pediatric cases in non-mosaic and mosaic cases. We report on the common mechanism leading to this form of chromosome abnormality, the various types of tetrasomy 9p as well as the prenatal sonographic and laboratory presentation of our case and previously reported cases with mosaic and non-mosaic tetrasomy 9p. From these reported cases, a recognizable syndrome is emerging. Multiple fetal abnormalities amenable to ultrasound diagnosis are likely to be present. However, neither ultrasound study alone nor the first-trimester screen for the common aneuploidies can suggest the correct diagnosis. Chromosome study of more than a single tissue is necessary in order to establish the correct diagnosis and to differentiate between mosaic and non-mosaic tetrasomy 9p cases.

The purpose of this study was to identify risk factors predictive of severe nonocclussive ischemic colitis (IC) requiring operation or resulting in mortality. One hundred seventeen patients with nonocclussive IC were identified and divided into two groups: those with severe disease (n = 24) and those with disease that resolved with supportive care (n = 93). Univariate and multivariate logistic regression models were used. The splenic flexure was the most common involved segment (57.3%), whereas the right colon was involved in 17.9 per cent of patients. Multivariate logistic regression identified three independent risk factors for severe disease: leukocytosis greater than 15 3 109/L (odds ratio [OR], 5.7; confidence interval [CI], 1.5 to 21), hematocrit less than 35 per cent (OR, 4.5; CI, 1.1 to 17), and history of atrial fibrillation (OR, 15; CI, 1.3 to 190). Right-sided IC and chronic renal insufficiency did not affect severity. Special attention should be given to patients with the following risk factors for a severe course: atrial fibrillation, elevated white blood cell count, and anemia. These factors might enable earlier identification of patients who may benefit from early operation. Further prospective studies focusing on subgroups of IC (occlusive and nonocclusive) are required.

A historical overview of the pragmatic and multidisciplinary field of child psychopathology, its origins, evolving trends, and future directions, supplements the 1998 edition of Ollendick and Hersen's Handbook of Child Psychopathology, A detailed review of this comprchensive 26-chapter handbook follows. Editors Ollendick and Hersen, with some 50 authors, successfully showcase contemporary, mainly cognitive and behavioral, interventions for DSM and medically-related disorders of childhood, offering a wealth of practicable information for clinicians. The handbook illustrates an integrative trend in child psychology research, combining nomothetic approaches from the developmental tradition, idiographic approaches from clinical psychopathology, and attention to numerous intrinsic and extrinsic variables from systems theory. Beyond the handbook, the review presents research achieving even fuller integration, arguing that better prevention and treatment requires research measuring idiographic, social interaction variables to discover their interrelationships with aggregate level variables of developmental approaches.

Considerable scientific evidence demonstrates the reduction in risk for neural tube defects (NTDs) associated with maternal preconceptional folic acid supplementation. The National Society of Genetic Counselors (NSGC) endorses the U.S. Public Health Service recommendations for folic acid supplementation at the 0.4 mg level for women in the general population and at the 4.0 mg level for women at high or increased risk for NTD pregnancies for at least 4 weeks prior to active pursuit of conception. We encourage targeted educational efforts and surveillance to assess results of this dietary supplementation. The NSGC further urges the Food and Drug Administration to fortify staple foodstuffs with folic acid for a population-based approach to minimize the number of NTD births.

Hypertrophic scar is the result of abnormal healing that often follows thermal injury. Hypertrophic scar is characterized by excessive dermal fibrosis and scarring. Five cases of human hypertrophic scar were compared with normal skin using in situ hybridization to localize mRNAs for procollagen types I and III and transforming growth factor-beta 1. Expression of type I procollagen and TGF-beta 1 were also examined with immunohistochemistry. The results demonstrated a significant increase in the expression of mRNA for types I and III procollagen and type I procollagen protein by fibroblasts in hypertrophic scar compared with normal skin. In all cases of hypertrophic scar, significant numbers of cells expressed TGF-beta 1 mRNA or peptide. Neither TGF-beta 1 mRNA nor protein was detected in control tissues. These results suggest a profound increase in production and expression of types I and III collagen mRNA by the fibroblasts in hypertrophic scar. This may result from increased TGF-beta 1 production, through paracrine and autocrine pathways, as have been described for this fibrogenic cytokine.

In January 2007 the American Medical Association added a new Current Procedural Terminology(R) (CPT) code, 96040, for "Medical Genetics and Genetic Counseling Services." In order to identify the impact of having this new code and to identify issues with implementation of the code, the National Society of Genetic Counselors (NSGC) CPT(R) Working Group surveyed NSGC members using an internet-based survey tool. The majority of respondents (94%) reported being aware of the new code and over half of the respondents (69%) said they were billing for genetic counseling. Approximately 24% of those billing reported using 96040. Many facilities are not using this code and the reported success of billing using 96040 is highly varied. Continued education may be beneficial to encourage reimbursement for 96040 and follow up is needed to assess the ongoing implementation and impact of the new CPT(R) code.

Angiosarcoma is a rare endothelial tumor representing less than 1% of all sarcomas of the head and neck.1,2 Primary and metastic tumors in the oral cavity are extremely rare. Only 4% are found in the pharynx, oral cavity, or paranasal sinuses. The origin of these tumors is unknown; however, radiation therapy, chronic lymphoedema, arsenic exposure, and previous trauma have been implicated.3,4 Only a few postirradiation angiosarcomas arising from the head and neck have been reported.1 This case report describes a tumor that was initially diagnosed as osteoradionecrosis. However, the subsequent clinical course and histologic examination resulted in a diagnosis of angiosarcoma. This case demonstrates the possible relationship between radiation treatment and later development of angiosarcoma.

A partnership between inner-city neighbors—the University of Pennsylvania and West Philadelphia High School (WPHS)—was funded by the National Science Foundation (NSF) to the benefit of all involved...