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Cet article présente une étude de cas pour évaluer les interactions entre un grand système d’assainissement et une crue entraînant des débordements, sur la base d’une modélisation hydraulique. L’étude de cas présentée ici est réalisée sur le réseau d’assainissement de la zone centrale de l’Île-de-France, confrontée à une inondation majeure le long du bassin de la Seine et de la Marne. Ce réseau joue un rôle majeur de protection contre les inondations en évacuant les flux excédentaires des précipitations, de l’aquifère et des débordements directs des rivières. Il peut néanmoins également induire une aggravation des inondations en cas de saturation des postes de pompage ou de défaillance d’équipements. Le présent document décrit les étapes de construction et de calage du modèle sur la base des données disponibles pour les crues de janvier 2018 et de juin 2016. Ce modèle repose sur l’utilisation de la plateforme logicielle Hydra/Qgis. L’accent est mis sur l’ajustement des apports supplémentaires du fleuve et de l’aquifère dans le système d’assainissement, ainsi que sur la précision et les performances de calcul du modèle. L’objectif final de ce projet est d’évaluer la résilience des réseaux d’assainissement sur la zone de collecte étudiée et de produire un outil d’aide à la décision pour améliorer la gestion du système d’assainissement en période de crue, en considérant les dommages potentiels en fonction du niveau d’inondation.

The majority of variants of unknown clinical significance (VUCS) in the CFTR gene are missense variants. While change on the CFTR protein structure or function is often suspected, impact on splicing may be neglected. Such undetected splicing default of variants may complicate the interpretation of genetic analyses and the use of an appropriate pharmacotherapy.We selected 15 variants suspected to impact CFTR splicing after in silico predictions on 319 missense variants (214 VUCS), reported in the CFTR-France database. Six specialized laboratories assessed the impact of nucleotide substitutions on splicing (minigenes), mRNA expression levels (quantitative PCR), synthesis and maturation (western blot), cellular localization (immunofluorescence) and channel function (patch clamp) of the CFTR protein. We also studied maturation and function of the truncated protein, consecutive to in-frame aberrant splicing, on additional plasmid constructs.Six of the 15 variants had a major impact on CFTR splicing by in-frame (n = 3) or out-of-frame (n = 3) exon skipping. We reclassified variants into: splicing variants; variants causing a splicing defect and the impairment of CFTR folding and/or function related to the amino acid substitution; deleterious missense variants that impair CFTR folding and/or function; and variants with no consequence on the different processes tested.The 15 variants have been reclassified by our comprehensive approach of in vitro experiments that should be used to properly interpret very rare exonic variants of the CFTR gene. Targeted therapies may thus be adapted to the molecular defects regarding the results of laboratory experiments.

Study question Is there an impact of CFTR (cystic fibrosis transmembrane-conductance regulator) gene mutation type and/or general health condition of men with CF and the ICSI outcomes? Summary answer Neither genetic severity nor clinical severity seems to have a negative impact on the biological or clinical ICSI issues for cystic fibrosis men patients. What is known already CFTR protein regulates electrolyte and fluid transport in many tissues with exocrine function, including male reproductive tract. Mutation of CFTR gene causes CF, which affects the function of several organs, and impairs male fertility. CF is generally associated to an obstructive azoospermia because of bilateral absence of vas deferens and seminal vesicles degeneration. CFTR protein is detected in human fetus at the early developmental stages and highly expressed in testis and epididymis. CFTR provides establishment of specific fluid environment for germ cell differentiation and maturation. According to literature, it seems likely that CFTR mutations affect sperm quality and embryo development. Study design, size, duration This cohort study was conducted in the Assisted Reproduction Center of an university hospital on 52 patients, for whom a CF has been diagnosed and monitored in the same hospital. The CF diagnosis was based on CFTR genetic tests and clinical symptoms. All men were azoospermic and underwent on a microscopic epididymal sperm aspiration (MESA) and/or a testicular sperm extraction (TESE). 52 couples underwent in total 107 ICSI with frozen sperm between 1999 and 2019. Participants/materials, setting, methods Clinical data- one year preceding surgical sperm collection and freeze - related to the severity of the CF were collected: respiratory spirometry data, Pseudomonas aeruginosa colonization, number of antibiotic treatment, BMI and Pancreatic insufficiency, as well as CFTR mutations. Linear regression tests (fisher and χ²) were carried out to establish or not correlation between biological and clinical ICSI outcomes and on the other hand genotype and/ or each clinical parameter. Main results and the role of chance The mean age of patients at sperm retrieval was 31.3 years [21-55]. Mean BMI was 21.3. Patients with severe genotype represented 67.8% and likely (67.3%) with external pancreatic deficiency. P.aeroginosa colonization was revealed in 30% of cases and 45.6% patients received at least one IV antibiotic treatment. Respiratory function has been impaired in 18 cases, with a maximal expiratory volume per second < 40%. Spermatozoa were found and frozen for all patients after surgical sperm retrieval (20 MESA and 32 MESA + TESE). The mean number of epididymal motile progressive spermatozoa was satisfactory (10.2±18.83 million). Women mean age was 30 years at ICSI and female infertility was associated in 15.4%. Fertilization and cleavage rates were 66% both. Mean number of transferred and/or frozen embryos per attempt was 3. Implantation rate was 20%. A total of 50 pregnancies and 44 live births were obtained (35.5% of cumulative clinical pregnancy rate per ICSI and 29.1% of live birth rate per transfer). Fertilization rate, absence of pregnancy or absence of live birth were not affected by the genetic severity (p = 0.63, p = 0.46 and p = 0.16 respectively). Likewise, and after several univariate analyses there was no statistically significant correlation between clinical severity and ICSI outcomes. Limitations, reasons for caution Practices of assisted reproduction have constantly evolved during the study period, this concerns the controlled ovarian stimulation protocols, IVF techniques, equipment and culture media used. Our study needs to be completed by a multivariate analyse Wider implications of the findings Regarding to better quality of life of CF patients nowadays and to our results- with no significant correlation between genetic and/or clinical severity and ICSI outcomes, surgical sperm collection can be proposed only in case of a conceptional project or before transplantation and immunosuppressive agents in order to perform ICSI. Trial registration number for non-clinical trials

International audience; Objectives: The coronavirus disease 2019 (COVID-19) pandemic has caused major sanitary crisis worldwide. Half of the world has been placed in quarantine. In France, this large-scale health crisis urgently triggered the restructuring and reorganization of health service delivery to support emergency services, medical intensive care units and continuing care units. Health professionals mobilized all their resources to provide emergency aid in a general climate of uncertainty. Concerns about the mental health, psychological adjustment, and recovery of health care workers treating and caring for patients with COVID-19 are now arising. The goal of the present article is to provide up-to-date information on potential mental health risks associated with exposure of health professionals to the COVID-19 pandemic.Methods: Authors performed a narrative review identifying relevant results in the scientific and medical literature considering previous epidemics of 2003 (SARS-CoV-1) and 2009 (H1N1) with the more recent data about the COVID-19 pandemic. We highlighted most relevant data concerning the disease characteristics, the organizational factors and personal factors that may contribute to developing psychological distress and other mental health symptoms.Results: The disease characteristics of the current COVID-19 pandemic provoked a generalized climate of wariness and uncertainty, particularly among health professionals, due to a range of causes such as the rapid spread of COVID-19, the severity of symptoms it can cause in a segment of infected individuals, the lack of knowledge of the disease, and deaths among health professionals. Stress may also be caused by organizational factors, such as depletion of personal protection equipment, concerns about not being able to provide competent care if deployed to new area, concerns about rapidly changing information, lack of access to up-to-date information and communication, lack of specific drugs, the shortage of ventilators and intensive care unit beds necessary to care for the surge of critically ill patients, and significant change in their daily social and family life. Further risk factors have been identified, including feelings of being inadequately supported, concerns about health of self, fear of taking home infection to family members or others, and not having rapid access to testing through occupational health if needed, being isolated, feelings of uncertainty and social stigmatization, overwhelming workload, or insecure attachment. Additionally, we discussed positive social and organizational factors that contribute to enhance resilience in the face of the pandemic. There is a consensus in all the relevant literature that health care professionals are at an increased risk of high levels of stress, anxiety, depression, burnout, addiction and post-traumatic stress disorder, which could have long-term psychological implications.Conclusions: In the long run, this tragic health crisis should significantly enhance our understanding of the mental health risk factors among the health care professionals facing the COVID-19 pandemic. Reporting information such as this is essential to plan future prevention strategies. Protecting health care professionals is indeed an important component of public health measures to address large-scale health crisis. Thus, interventions to promote mental well-being in health care professionals exposed to COVID-19 need to be immediately implemented, and to strengthen prevention and response strategies by training health care professionals on mental help and crisis management.

The coronavirus disease 2019 (COVID-19) pandemic has caused major sanitary crisis worldwide. Half of the world has been placed in quarantine. In France, this large-scale health crisis urgently triggered the restructuring and reorganization of health service delivery to support emergency services, medical intensive care units and continuing care units. Health professionals mobilized all their resources to provide emergency aid in a general climate of uncertainty. Concerns about the mental health, psychological adjustment, and recovery of health care workers treating and caring for patients with COVID-19 are now arising. The goal of the present article is to provide up-to-date information on potential mental health risks associated with exposure of health professionals to the COVID-19 pandemic.Authors performed a narrative review identifying relevant results in the scientific and medical literature considering previous epidemics of 2003 (SARS-CoV-1) and 2009 (H1N1) with the more recent data about the COVID-19 pandemic. We highlighted most relevant data concerning the disease characteristics, the organizational factors and personal factors that may contribute to developing psychological distress and other mental health symptoms.The disease characteristics of the current COVID-19 pandemic provoked a generalized climate of wariness and uncertainty, particularly among health professionals, due to a range of causes such as the rapid spread of COVID-19, the severity of symptoms it can cause in a segment of infected individuals, the lack of knowledge of the disease, and deaths among health professionals. Stress may also be caused by organizational factors, such as depletion of personal protection equipment, concerns about not being able to provide competent care if deployed to new area, concerns about rapidly changing information, lack of access to up-to-date information and communication, lack of specific drugs, the shortage of ventilators and intensive care unit beds necessary to care for the surge of critically ill patients, and significant change in their daily social and family life. Further risk factors have been identified, including feelings of being inadequately supported, concerns about health of self, fear of taking home infection to family members or others, and not having rapid access to testing through occupational health if needed, being isolated, feelings of uncertainty and social stigmatization, overwhelming workload, or insecure attachment. Additionally, we discussed positive social and organizational factors that contribute to enhance resilience in the face of the pandemic. There is a consensus in all the relevant literature that health care professionals are at an increased risk of high levels of stress, anxiety, depression, burnout, addiction and post-traumatic stress disorder, which could have long-term psychological implications.In the long run, this tragic health crisis should significantly enhance our understanding of the mental health risk factors among the health care professionals facing the COVID-19 pandemic. Reporting information such as this is essential to plan future prevention strategies. Protecting health care professionals is indeed an important component of public health measures to address large-scale health crisis. Thus, interventions to promote mental well-being in health care professionals exposed to COVID-19 need to be immediately implemented, and to strengthen prevention and response strategies by training health care professionals on mental help and crisis management.

Cystic fibrosis (CF) is the most frequent genetic disorder in the Caucasian population benefiting from systematic newborn screening tests. It is also the most frequent indication of prenatal and preimplantation genetic diagnosis for a single gene disorder. During the past thirty years, thanks in part to the evolution of diagnostic techniques, our knowledge on CFTR genetics and pathophysiological mechanisms involved in CF have significantly improved. With the implementation of newborn screening in France and in several countries, the diagnosis now often occurs in clinically asymptomatic infants and this has modified the criteria for CF diagnosis. Recently, guidelines for CF diagnosis have been reformulated in Europe and the US, in regard to sweat chloride usual values and disease terminology. This review describes the methods and molecular approaches that are used in routine practice or are being developed to detect CFTR protein dysfunction and to identify disease-causing CFTR variants. Ultimately, an optimal use of all these functional and genetic resources may improve patient care and therapeutic decision-making. © 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

Introduction La granulomatose eosinophilique avec polyangeite (GEPA) associe une vascularite des petits vaisseaux, un asthme a debut tardif et une hypereosinophilie sanguine et tissulaire. Malgre des progres recents dans la comprehension de la physiopathologie, les mecanismes conduisant a la maladie restent inconnus. L’objectif de cette etude etait d’etudier l’hypothese d’une contribution genetique grâce a l’analyse du sequencage complet d’exome d’une famille multiplex atteinte de GEPA, afin d’en extraire des genes candidats et de les etudier sur une cohorte de patients atteints de GEPA sporadique. Patients et methodes Nous avons realise un sequencage complet d’exome par Next Generation Sequencing (NGS) d’une famille multiplex atteinte de GEPA, le pere et un fils etant atteints selon les criteres de classification de l’ACR et la mere et une fille etant indemnes de toute affection. Un sequencage Sanger des genes candidats precedemment identifies a ensuite ete realise chez 119 patients atteints de GEPA sporadiques afin de rechercher une recurrence de variants dans ces genes au sein de la cohorte. Resultats L’analyse des donnees de sequencage basee sur l’hypothese d’une transmission autosomique dominante et sur l’etablissement de filtres selectionnant les variants tres rares ou rares dans la population generale et predits comme probablement deleteres par les outils de prediction bioinformatique a permis d’identifier 3 genes candidats : EPX, LCN2 et FLT3. Le sequencage Sanger des genes LCN2 et FLT3 chez les 119 patients avec une GEPA sporadique n’a pas mis en evidence de variants d’interet. En revanche, le sequencage du gene EPX a permis d’identifier 22 variants distincts chez 31 patients. Parmi ces 22 variants, 8 variants identifies chez 16 patients etaient classes comme benins et 5 variants chez 5 patients etaient classes comme de signification inconnue. Les patients avec variants de signification inconnue etaient exclus de l’etude comparative pour limiter les biais. Dix patients (8,4 %) presentaient donc un variant considere comme possiblement pathogene. Ces 10 patients etaient des hommes dans 60 % des cas, avec un âge median au diagnostic de 46 [IQR 42–51] ans. Comparativement aux patients avec GEPA sans mutation ou avec un variant benin (n = 104), les patients avec variant d’EPX potentiellement pathogene presentaient plus d’atteinte cardiaque [6/10 (60 %) versus 28/104 (27 %)], plus d’infiltrats pulmonaires [6/10 (60 %) versus 52/104 (50 %)], un chiffre maximal d’eosinophiles plus eleve (mediane a 9420/mm3 [IQR 5844–178925] versus 6000/mm3 [3500–11980]) mais moins de neuropathie peripherique [5/10 (50 %) versus 62/104 (59,6 %)], moins de purpura vasculaire [2/10 (20 %) versus 34/104 (32,7 %)], moins d’ANCA positifs [2/10 (20 %) versus 30/104 (29 %] et aucune atteinte renale alors qu’elle etait presente chez 8 (7,7 %) patients sans variant. Conclusion Pour la premiere fois, un sequencage complet d’exome d’une forme familiale de GEPA a permis d’identifier un gene candidat dont des variants predits deleteres ont ete retrouves chez 8,4 % des patients d’une cohorte de GEPA sporadique. Les patients porteurs d’un variant potentiellement pathogene presentaient un phenotype clinique plus « hypereosinophilique » que « vascularitique ». Des etudes fonctionnelles des variants affectant cette enzyme eosinophile peroxydase seront necessaires pour confirmer la contribution de ce gene dans la physiopathologie de la GEPA.

Germline mosaicism for a novel missense variant p.Thr645Met located in the SNF2-related ATP dependent helicase domain of CHD2 in 2 affected siblings with autism spectrum disorder.

Auriculocondylar syndrome and isolated question mark ear result from dysregulation of the endothelin 1-endothelin receptor type A signaling pathway. Animal models have highlighted the role of the transcription factor MEF2C as an effector of this pathway. We report heterozygous MEF2C loss-of-function as a possible cause of question mark ear associated with intellectual deficiency.

Duplication of the Xq28 region, involving MECP2 (dupMECP2), has been primarily described in males with severe developmental delay, spasticity, epilepsy, stereotyped movements and recurrent infections. Carrier mothers are usually asymptomatic with an extremely skewed X chromosome inactivation (XCI) pattern. We report a series of six novel symptomatic females carrying a de novo interstitial dupMECP2, and review the 14 symptomatic females reported to date, with the aim to further delineate their phenotype and give clues for genetic counselling. One patient was adopted and among the other 19 patients, seven (37%) had inherited their duplication from their mother, including three mildly (XCI: 70/30, 63/37, 100/0 in blood and random in saliva), one moderately (XCI: random) and three severely (XCI: uninformative and 88/12) affected patients. After combining our data with data from the literature, we could not show a correlation between XCI in the blood or duplication size and the severity of the phenotype, or explain the presence of a phenotype in these females. These findings confirm that an abnormal phenotype, even severe, can be a rare event in females born to asymptomatic carrier mothers, making genetic counselling difficult in couples at risk in terms of prognosis, in particular in prenatal cases.

Germline mosaicism for a novel missense variant p.Thr645Met located in the SNF2-related ATP dependent helicase domain of CHD2 in 2 affected siblings with autism spectrum disorder.

Rett syndrome (RTT) is a severe neurodevelopmental disease that affects approximately 1 in 10,000 live female births and is often caused by mutations in the X-linked gene encoding methyl-CpG-binding protein 2 (MECP2). Mutations in loci other than MECP2 have also been found in individuals that have been labeled as atypical RTT. Among them, a mutation in the gene forkhead box G1 (FOXG1) has been involved in the molecular aetiology of the congenital variant of RTT. The FOXG1 gene encodes a winged-helix transcriptional repressor essential for the development of the ventral telencephalon in embryonic forebrain. Later, FOXG1 continues to be expressed in neurogenetic zones of the postnatal brain. Although RTT affects quasi-exclusively girls, FOXG1 mutations have also been identified in male patients. As far as we know, about 12 point mutations and 13 cases with FOXG1 molecular abnormalities (including translocation, duplication and large deletion on the chromosome 14q12) have been described in the literature. Affected individuals with FOXG1 mutations have shown dysmorphic features and Rett-like clinical course, including normal perinatal period, postnatal microcephaly, seizures and severe mental retardation. Interestingly, the existing animal models of FOXG1 deficiency showed similar phenotype, suggesting that animal models may be a fascinating model to understand this human disease. Here, we describe the impacts of FOXG1 mutations and their associated phenotypes in human and mouse models.

Introduction La mucoviscidose est habituellement diagnostiquee dans les premieres annees de vie. Observations Nous rapportons trois cas familiaux de mucoviscidose diagnostiques a l’âge adulte. Le premier patient, âge de 39 ans, a consulte pour une infertilite par atresie des canaux deferents ; le diagnostic de mucoviscidose a ete retenu devant la positivite du test de la sueur et la presence de deux mutations du gene CFTR. La mere de ce patient presentait des surinfections bronchiques a repetition depuis l’enfance. Le test de la sueur etait normal, la mesure de la difference de potentiel nasal transepithelial etait evocatrice de la maladie et la recherche des 33 mutations les plus frequentes de CFTR ne retrouvait qu’une seule mutation. Le sequencage complet du gene CFTR qui a montre une seconde mutation, et affirme le diagnostic de mucoviscidose a 74 ans. L’enquete familiale a revele un cas de mucoviscidose pauci-symptomatique chez un frere du cas index. Conclusions Ces observations illustrent les difficultes du diagnostic des formes attenuees de mucoviscidose a l’âge adulte. Nous discutons les modalites du diagnostic ainsi que l’interet de ce diagnostic pour adapter les therapeutiques et pour le conseil genetique.

Mutations in the methyl-cytosine-phosphate-guanosine dinucleotide (CpG) binding protein 2 gene are identified in up to 90% of patients with classic Rett syndrome. However, the lack of methyl-CpG binding protein 2 mutations in a small group of classic Rett syndrome cases, and the low frequency of these mutations in atypical Rett syndrome patients, suggest that other gene defects may play a role in this disorder. One report described a patient with atypical Rett syndrome who presented with early epilepsy and a de novo translocation which disrupted the Netrin G1 gene. This study tested a sample of 91 female patients with a clinically heterogeneous phenotype ranging from encephalopathy with epilepsy to atypical Rett syndrome without epilepsy for mutations in the Netrin G1 gene, to evaluate its involvement in this condition. Nine sequence variations (including six novel variations) were identified, all of which were unlikely to be pathogenic. One was a novel C to G transversion, resulting in a p.Leu537Val amino-acid substitution in one patient. The same substitution was detected in the asymptomatic mother, suggesting an absence of biological significance. Our study suggests that Netrin G1 is not involved in atypical Rett syndrome or in unexplained encephalopathy with epilepsy, but in specific forms to be delineated better in the future.

Since the description of Rett syndrome, only a handful of epidemiologic studies based only on clinical investigation have been reported. Mutations in the MECP2 gene are associated with Rett syndrome and French laboratories have organized a clinical and molecular network to investigate the incidence of Rett syndrome in France including the results of molecular investigations. The present study, based on a large cohort of 424 patients with Rett syndrome, found that the incidence of this disease with a MECP2 mutation varied between 0.43 to 0.71 per 10,000 females. The total population of females aged 4-15 years in November 2004 in France was estimated to be 4,337,627. The data presented here indicate a prevalence of Rett syndrome of 0.558 per 10,000 females aged 4-15 years in France. The incidence of Rett syndrome is in accordance with other European epidemiologic studies based on clinical examination. Given that this is a minimum incidence because complete inventory was not possible, this study of patients with Rett syndrome reinforces the fact that the great majority of patients with Rett syndrome have a MECP2 mutation.

Loss-of-function mutations of the MECP2 gene at Xq28 are associated with Rett syndrome in females and with syndromic and nonsyndromic forms of mental retardation (MR) in males. By array comparative genomic hybridization (array-CGH), we identified a small duplication at Xq28 in a large family with a severe form of MR associated with progressive spasticity. Screening by real-time quantitation of 17 additional patients with MR who have similar phenotypes revealed three more duplications. The duplications in the four patients vary in size from 0.4 to 0.8 Mb and harbor several genes, which, for each duplication, include the MR-related L1CAM and MECP2 genes. The proximal breakpoints are located within a 250-kb region centromeric of L1CAM, whereas the distal breakpoints are located in a 300-kb interval telomeric of MECP2. The precise size and location of each duplication is different in the four patients. The duplications segregate with the disease in the families, and asymptomatic carrier females show complete skewing of X inactivation. Comparison of the clinical features in these patients and in a previously reported patient enables refinement of the genotype-phenotype correlation and strongly suggests that increased dosage of MECP2 results in the MR phenotype. Our findings demonstrate that, in humans, not only impaired or abolished gene function but also increased MeCP2 dosage causes a distinct phenotype. Moreover, duplication of the MECP2 region occurs frequently in male patients with a severe form of MR, which justifies quantitative screening of MECP2 in this group of patients.

Background: This study was conducted to determine whether the major nasal airway ion transport abnormalities in cystic fibrosis (that is, defective cAMP regulated chloride secretion and basal sodium hyperabsorption) are related to the clinical expression of cystic fibrosis and/or to the genotype. Methods: Nasal potential difference was measured in 79 adult patients with cystic fibrosis for whom clinical status, respiratory function, and CFTR genotype were determined. Results: In univariate and multivariate analysis, patients with pancreatic insufficiency were more likely to have low responses to low chloride (odds ratio (OR) 8.6 (95% CI 1.3 to 58.5), p = 0.03) and isoproterenol (OR 11.2 (95% CI 1.3 to 93.9), p = 0.03) solutions. Similarly, in univariate and multivariate analysis, patients with poor respiratory function (forced expiratory volume in 1 second

Cystic fibrosis (CF) is one of the most common lethal autosomal recessive disease among the Caucasian population. It is caused by defects in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene. More than 1000 different CF mutations have been described. This large heterogeneity of mutations could explain in part the great variability of clinical expression of the disease. However, the severity of the lung disease is very different among patients with similar CFTR genotype, even from the same family. These discrepancies in phenotypes within patients of the same genotype suggest the influence of nongenetic environmental factors and genetic modifiers outside the CF locus.

Resume Objectifs. – Repondre au projet d’enfant de femmes steriles ayant une mucoviscidose. Patientes et methodes. – Prise en charge multidisciplinaire de 20 patientes entre 1997 et 2001. L’indication dependait de l’etat pulmonaire et nutritionnel, des risques d’aggravation pendant la grossesse, des facteurs d’infertilite et du risque de mucoviscidose pour l’enfant a naitre. Les specificites des traitements d’aide medicale a la procreation sont decrites. Resultats. – Trois patientes sont venues pour une simple information, 17 ont ete adressees pour aide medicale a la procreation. Trois ont ete recusees, 2 differees et 12 traitees pour sterilite cervicale. Sept grossesses ont ete initiees, 3 patientes ont eu une fausse couche, 3 ont accouche a terme d’enfants sains et 1 grossesse est en cours. Il n’y a pas eu d’aggravation de la maladie a 36 mois chez les femmes ayant accouche. Discussion et conclusion. – Une aide medicale a la procreation peut etre proposee chez les femmes steriles ayant une forme moderee de mucoviscidose.

Ten percent of couples trying for a child fail to conceive. In approximately 50% of cases, infertility is due to the inability of the male partner to produce spermatozoa in sufficient numbers to effect conception. Over the past 5 years, molecular studies have suggested that interstitial microdeletions in Yq11 represent an etiological factor for male infertility. Y-microdeletions have been detected in 12% of non-obstructive azoospermia and 6% of severe oligozoospermia. In general, microdeletions were detected by separate multiplex-polymerase chain reaction (PCR) reactions using primer pairs for single tagged sites (STSs) of all three azoospermia factor (AZF) regions (AZFa, AZFb and AZFc). This review describes the molecular methods and laboratory guidelines for molecular diagnosis of Y-chromosomal microdeletions. The diagnostics of Y-chromosomal microdeletions should be performed in two steps: in any case, the routine diagnostic should include six STS loci, two STS loci localised in each AZF region, and once a deletion is detected, the analysis can be extended to STS loci known to cross the proximal and the distal borderlines of each AZF region. Other molecular techniques such as DGGE, Southern blot should be performed to detect partial deletions of gene copies or mosaicism. These different molecular approaches should allow explaining 10% of male infertility, to evaluate the risk to pass the defect onto their male offspring (by intracytoplasmic sperm injection) and improve the genetic counselling of couples undergoing micromanipulative assisted reproduction.

Objective: To determine the prevalence and clinical features of malnutrition and its relationship with the CFTR genotype in a cystic fibrosis (CF) adult population. Design: Cross-sectional study. Setting: Department of Pulmonology, Cochin Hospital, Paris, France. Subjects: 163 CF adults seen between 1997 and 1999. Results: Mean age was 28.8 y. Mean body mass index (BMI) was 19.1 kg/m2. Malnutrition (BMI

Background: Cystic fibrosis (CF) is caused by compound heterozygosity or homozygosity of CF transmembrane conductance regulator gene (CFTR) mutations. Phenotypic variability associated with certain mutations makes genetic counselling difficult, notably for R117H, whose disease phenotype varies from asymptomatic to classical CF. The high frequency of R117H observed in CF newborn screening has also introduced diagnostic dilemmas. The aim of this study was to evaluate the disease penetrance for R117H in order to improve clinical practice. Methods: The phenotypes in all individuals identified in France as compound heterozygous for R117H and F508del, the most frequent CF mutation, were described. The allelic prevalences of R117H (p R117H), on either intron 8 T5 or T7 background, and F508del (p F508del) were determined in the French population, to permit an evaluation of the penetrance of CF for the [R117H]+[F508del] genotype. Results: Clinical details were documented for 184 [R117H]+[F508del] individuals, including 72 newborns. The disease phenotype was predominantly mild; one child had classical CF, and three adults' severe pulmonary symptoms. In 5245 healthy adults, p F508del was 1.06%, p R117H;T7 0.27% and p R117H;T5 ,0.01%. The theoretical number of [R117H;T7]+[F508del] individuals in the French population was estimated at 3650, whereas only 112 were known with CF related symptoms (3.1%). The penetrance of classical CF for [R117H;T7]+[F508del] was estimated at 0.03% and that of severe CF in adulthood at 0.06%. Conclusions: These results suggest that R117H should be withdrawn from CF mutation panels used for screening programmes. The real impact of so-called disease mutations should be assessed before including them in newborn or preconceptional carrier screening programmes .

Cystic fibrosis is usually diagnosed during the first years of life. Diagnosis may be achieved in adults with milder forms of the disease at any age.We report the diagnosis of cystic fibrosis in three adults within the same family. A 39 yr old man, was diagnosed with congenital absence of the vas deferens; the diagnosis of cystic fibrosis was achieved based on a positive chloride sweat test and the identification of two mutations in the CFTR gene. His mother experienced repeated bronchial infections that began when she was 12 years old. The diagnosis of cystic fibrosis was considered at the age of 74 yr after her son was diagnosed with this disease. Sweat test showed normal chloride concentrations and cystic fibrosis was suspected based on elevated basal transepithelial nasal potential difference. Genetic testing for the 33 most frequent mutations in the CFTR gene showed only one mutation. A second rare mutation was identified by complete sequencing of the CFTR gene, confirming the diagnosis of cystic fibrosis. A third case of pauci-symptomatic cystic fibrosis was diagnosed in a brother of the index case.These observations illustrate the challenge of diagnosing milder forms of cystic fibrosis in adult subjects. The recognition of this diagnosis may lead to improvement in patient's care and to genetic counselling.

Background Rett syndrome is a severe neurodevelopmental disorder representing one of the most common genetic causes of mental retardation in girls. The classic form is caused by MECP2 mutations. In two patients affected by the congenital variant of Rett we have recently identified mutations in the FOXG1 gene encoding a brain specific transcriptional repressor, essential for early development of the telencephalon. Methods 60 MECP2/CDKL5 mutation negative European Rett patients (classic and variants), 43 patients with encephalopathy with early onset seizures, and four atypical Rett patients were analysed for mutations in FOXG1 . Results and conclusions Mutations have been identified in four patients, independently classified as congenital Rett variants from France, Spain and Latvia. Clinical data have been compared with the two previously reported patients with mutations in FOXG1 . In all cases hypotonia, irresponsiveness and irritability were present in the neonatal period. At birth, head circumference was normal while a deceleration of growth was recognised soon afterwards, leading to severe microcephaly. Motor development was severely impaired and voluntary hand use was absent. In contrast with classic Rett, patients showed poor eye contact. Typical stereotypic hand movements with hand washing and hand mouthing activities were present continuously. Some patients showed abnormal movements of the tongue and jerky movements of the limbs. Brain magnetic resonance imaging showed corpus callosum hypoplasia in most cases, while epilepsy was a variable sign. Scoliosis was present and severe in the older patients. Neurovegetative symptoms typical of Rett were frequently present.

Introduction Les lesions cutanees induites par l’eau sont rares et peuvent etre associees a des anomalies genetiques. L’association d’une keratodermie aquagenique au cours de la mucoviscidose a ete rapportee en 1974. Observations Nous rapportons l’observation d’une jeune fille âgee de 28 ans qui consultait pour une dermatose des mains et des pieds induite par le contact avec l’eau, evoluant depuis 1 an. Cette patiente presentait un antecedent de pneumonie a l’âge de 3 ans et une amygdalectomie a 18 ans en raison d’angines a repetition. Elle ne prenait aucun traitement. L’examen clinique mettait en evidence un epaississement cutane papillomateux, blanchâtre, asymptomatique, 1 a 2 minutes apres contact avec l’eau. La patiente signalait une tendance a l’hypohidrose sans intolerance a la chaleur. La patiente presente une brachymesophalangie des 5 es orteils. Nous posions le diagnostic de keratodermie aquagenique (KA) et une recherche de mucoviscidose associee etait realisee. Le test a la sueur remontrait des valeurs de chlore et de sodium dans les limites superieures de la normale. Le bilan pulmonaire et sinusien etait normal. La recherche des 32 mutations communes du gene CFTR (Abbott Molecular) etait negative. En revanche, le sequencage complet du gene CFTR identifiait une mutation faux-sens rare homozygote, c.2855T > C (p.Met952TThr) prealablement identifiee dans l’absence congenitale bilaterale des canaux deferents, ainsi qu’une large deletion heterozygote des exons 16 a 20 de CFTR (del14b-17b, c.2620-674_3367 + 198del9855), decrite en homozygotie ou heterozygotie composite avec une autre mutation en cas de forme severe de mucoviscidose. Un traitement symptomatique par injections intra-palmaire de toxine botulique a permis la regression de la symptomatologie avec un suivi de 6 mois. Discussion Cette observation confirme l’implication de mutations de CFTR dans la KA. La presence de ces mutations est probablement sous estimee en l’absence du sequencage complet du gene CFTR . La KA isolee pourrait ainsi etre incluse dans le spectre phenotypique des affections associees aux mutations de CFTR dont la forme la plus grave est representee par la mucoviscidose. Conclusion La mise en evidence de ces mutations est importante pour un conseil genetique optimal.

Introduction Les lesions cutanees induites par l’eau sont rares et peuvent etre associees a des anomalies genetiques. Observation Nous rapportons l’observation d’une jeune fille âgee de 28 ans qui consultait pour une dermatose des mains et des pieds induite par le contact avec l’eau, evoluant depuis 1 an. Cette patiente presentait un antecedent de pneumonie a l’âge de 3 ans et une amygdalectomie a 18 ans en raison d’angines a repetition. Elle ne prenait aucun traitement. L’examen clinique mettait en evidence un epaississement cutane papillomateux, blanchâtre, asymptomatique, 1 a 2 minutes apres contact avec l’eau. La patiente signalait une tendance a l’hypohidrose sans intolerance a la chaleur. La patiente presente une brachymesophalangie des 5 es orteils. Nous posions le diagnostic de keratodermie aquagenique (KA) et une recherche de mucoviscidose associee etait realisee. Le test a la sueur retrouvait des valeurs de chlore et de sodium dans les limites superieures de la normale. Le bilan pulmonaire et sinusien etait normal. Le sequencage de CFTR identifiait une mutation homozygote de type faux-sens, c.2855T>C (M952T) decrite habituellement dans l’absence congenitale bilaterale des canaux deferents, ainsi qu’une deletion heterozygote des exons 16 a 20 de CFTR (del14b-17b, c.2620-674_3367 + 198del9855), decrite en homozygotie ou heterozygotie composite avec une autre mutation en cas de forme severe de mucoviscidose. Un traitement symptomatique par injections intra-palmaire de toxine botulique a permis la regression de la symptomatologie avec un suivi de 6 mois. Discussion Cette observation confirme l’implication de mutations de CFTR dans la KA. La KA isolee pourrait ainsi etre incluse dans le spectre phenotypique des affections associees aux mutations de CFTR dont la forme la plus grave est representee par la mucoviscidose. Conclusion La mise en evidence de ces mutations est importante pour un conseil genetique optimal.

The CDKL5 gene has been implicated in infantile spasms and more recently in a Rett syndrome-like phenotype. We report a case of a young girl presenting generalized convulsions at 10 days of life. Subsequent mutation analysis by denaturing high-performance liquid chromatography of MECP2 and CDKL5 genes revealed heterozygosity for a c.47_48insAGG insertion in exon 1 of MECP2 and heterozygosity for a new nonsense mutation p.Q834X and a new missense variant p.V999M in the CDKL5 gene. Co-segregation analysis showed that the nonsense mutation was a de novo mutation and that the insertion and the missense variant were also found in the asymptomatic mother. In the absence of skewed X inactivation in the mother, it is likely that these last two variants are not pathogenic. Reverse transcription-polymerase chain reaction from lymphoblastoid cells of the patient showed only the transcript without the nonsense and missense variations suggesting decreased stability of mature mRNA by nonsense-mediated decay. These data also suggest an occurrence of the de novo mutation in maternal germ line cells. Moreover, this report reinforces the observation that the CDKL5 phenotype overlaps with Rett syndrome and that CDKL5 gene analysis is recommended in females with a seizure disorder commencing in the first weeks of life.

Cystic fibrosis (CF) is one of the most common lethal autosomal recessive disease among the Caucasian population. It is caused by defects in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene. More than 1000 different CF mutations have been described. This large heterogeneity of mutations could explain in part the great variability of clinical expression of the disease. However, the severity of the lung disease is very different among patients with similar CFTR genotype, even from the same family. These discrepancies in phenotypes within patients of the same genotype suggest the influence of nongenetic environmental factors and genetic modifiers outside the CF locus.

Ten percent of couples trying for a child fail to conceive. In approximately 50% of cases, infertility is due to the inability of the male partner to produce spermatozoa in sufficient numbers to effect conception. Over the past 5 years, molecular studies have suggested that interstitial microdeletions in Yq11 represent an etiological factor for male infertility. Y-microdeletions have been detected in 12% of non-obstructive azoospermia and 6% of severe oligozoospermia. In general, microdeletions were detected by separate multiplex-polymerase chain reaction (PCR) reactions using primer pairs for single tagged sites (STSs) of all three azoospermia factor (AZF) regions (AZFa, AZFb and AZFc). This review describes the molecular methods and laboratory guidelines for molecular diagnosis of Y-chromosomal microdeletions. The diagnostics of Y-chromosomal microdeletions should be performed in two steps: in any case, the routine diagnostic should include six STS loci, two STS loci localised in each AZF region, and once a deletion is detected, the analysis can be extended to STS loci known to cross the proximal and the distal borderlines of each AZF region. Other molecular techniques such as DGGE, Southern blot should be performed to detect partial deletions of gene copies or mosaicism. These different molecular approaches should allow explaining 10% of male infertility, to evaluate the risk to pass the defect onto their male offspring (by intracytoplasmic sperm injection) and improve the genetic counselling of couples undergoing micromanipulative assisted reproduction.

To treat cystic fibrosis women who failed to conceive.Multidisciplinary coordinated approach in 20 infertile women affected with cystic fibrosis. Advisability of pregnancy was based on the assessment of pulmonary and nutritional status, risks of maternal health deterioration, infertility factors, risk of cystic fibrosis in the offspring. Assisted reproductive techniques in moderately affected women are described.Three patients requested only information, three were discouraged, two are still evaluated, 12 were treated and three delivered healthy children. The pulmonary status of each patient remained unchanged 36 months after delivery, and all three children remain healthy.Assisted reproductive techniques are an option in moderately affected infertile cystic fibrosis women. Advisability and management of pregnancy should be provided by a coordinated team of healthcare professionals with knowledge and experience in cystic fibrosis.

Mental retardation (MR) is a frequent cause of serious handicap in children and young adults. It is defined as an overall intelligence quotient (IQ) lower than 70 associated with functional deficits in adaptive behaviour (such as daily living skills, social skills, and communication), with an onset before 18 years.1,2 Moderate to severe MR (IQ

Recent advances in human, bacterial and viral genome projects and the development of quantitative real-time reverse transcription-polymerase chain reaction methods offer the possibility of analysing a large number of gene transcripts. These molecular developments represent an important advancein the field of genetics, cancer, virology, bacteriology and hematology. A limiting step remains the isolation of high quality mRNA purified from biological samples. This review describes the different methods used to isolate mRNA from biological samples and to verify RNA integrity and gives precise details about RNA storage conditions.

Rett syndrome (RTT) is a severe progressive neurological disorder that affects almost exclusively females. The gene responsible for this disorder, MECP2, was recently identified by candidate gene strategy. Mutations were detected in 70-85% of RTT cases. We report here five novel frameshift mutations (named 345delC, 895del202, 989ins18del8, 996insAG and 1124del53) in exon 3 and 4 of the MECP2 gene. To avoid the missing of few small deletions in RTT patients using classical mutation screening approaches, we suggest that screening of the mutations in the MECP2 gene in RTT girls should include at least a large PCR to amplify exon 4 entirely.

Item does not contain fulltext Following the recent discovery that the methyl-CpG binding protein 2 (MECP2) gene located on Xq28 is involved in Rett syndrome (RTT), a wild spectrum of phenotypes, including mental handicap, has been shown to be associated with mutations in MECP2. These findings, with the compelling genetic evidence suggesting the presence in Xq28 of additional genes besides RabGDI1 and FMR2 involved in non-specific X-linked mental retardation (MRX), prompted us to investigate MECP2 in MRX families. Two novel mutations, not found in RTT, were identified. The first mutation, an E137G, was identified in the MRX16 family, and the second, R167W, was identified in a new mental retardation (MR) family shown to be linked to Xq28. In view of these data, we screened MECP2 in a cohort of 185 patients found negative for the expansions across the FRAXA CGG repeat and reported the identification of mutations in four sporadic cases of MR. One of the mutations, A140V, which we found in two patients, has been described previously, whereas the two others, P399L and R453Q, are novel mutations. In addition to the results demonstrating the involvement of MECP2 in MRX, this study shows that the frequency of mutations in MECP2 in the mentally retarded population screened for the fragile X syndrome is comparable to the frequency of the CGG expansions in FMR1. Therefore, implementation of systematic screening of MECP2 in MR patients should result in significant progress in the field of molecular diagnosis and genetic counseling of mental handicap.

X-linked mental retardation is a very common condition that affects approximately 1 in 600 males. Despite recent progress, in most cases the molecular defects underlying this disorder remain unknown. Recently, a study using the candidate gene approach demonstrated the presence of mutations in PAK3 (p21-activating kinase) associated with nonspecific mental retardation. PAK3 is a member of the larger family of PAK genes. PAK proteins have been implicated as critical downstream effectors that link Rho-GTPases to the actin cytoskeleton and to MAP kinase cascades, including the c-Jun amino-terminal kinase (JNK) and p38. We screened 12 MRX pedigrees that map to a large region overlying Xq21-q24. Mutation screening of the whole coding region of the PAK3 gene was performed by using a combination of denaturing gradient gel electrophoresis and direct sequencing. We have identified a novel missense mutation in exon 2 of PAK3 gene (R67C) in MRX47. This confirms the involvement of PAK3 in MRX following the report of a nonsense mutation recently reported in MRX30. In the MRX47 family, all affected males show moderate to severe mental retardation. No seizures, statural growth deficiency, or minor facial or other abnormal physical features were observed. This mutation R67C is located in a conserved polybasic domain (AA 66-68) of the protein that is predicted to play a major role in the GTPases binding and stimulation of Pak activity.

Congenital bilateal absence of the vas deferens (CBAVD) with obstructive azoospermia is a congenital reproductive disorder that affects one in 10000 male individuals. The observation that many men presenting with CBAVD have mutations in their CFTR genes had led to the proposal that CBAVD may be a primary genital form of cystic fibrosis. We report here one novel mutation located in exon 10 of the CFTR gene. This mutation, named D513G (A--G at position 1670), has been found in one of 83 patients with CBAVD from France, the analysis of exon 10 using a chemical clamp DGGE assay allowed us to identify three CF mutations AEF508 (37/166; 22%), AE1507 (1/166; 0/6%) and D513G (1/166; 0.6%), and two variants M470V and E528E (1716 GA). The novel D513G mutation has not been found in more than 200 non-CF chromosomes and in a sample of 300 CF chromosomes from French classical CF patients.