Bridging the gap in cardiac mass diagnosis:Advanced imaging,genetic associations,and biomarkers

In this editorial we comment on the article by Huffaker et al published in a recent issue of the World Journal of Clinical Cases.We focus on cardiac tumors linked to genetic syndromes and the differential diagnosis of cardiac masses.As cardiomyocytes lack the ability to actively divide,primary cardiac tumors are extremely rare across all ethnicities and age groups.Once they occur,these tumors are often associated with genetic mutations and,occasionally,genetic syndromes.This underscores the importance of considering genetic mutations and syndromes when encountering these cases.The more common growths in the heart are thrombi and vegetations,which can mimic tumors,further making the differential diagnosis challenging.Among the imaging techniques,contrast-enhanced cardiac magnetic resonance imaging has the highest sensitivity for differential diagnosis.To aid in the differential diagnosis of cardiac masses,especially thrombi,appropriate utilization of biomarkers(i.e.D-dimer level)may provide pivotal clinical implications.Employing a multidisciplinary approach that integrates personal history,epidemiological insights,imaging findings,genetic markers,and biomarkers is therefore critical in the diagnostic process of cardiac masses.

Genetic evaluation and testing for hereditary forms of cancer in the era of next-generation sequencing

The introduction of next-generation sequencing(NGS) technology in testing for hereditary cancer susceptibility allows testing of multiple cancer susceptibility genes simultaneously. While there are many potential benefits to utilizing this technology in the hereditary cancer clinic, including efficiency of time and cost, there are also important limitations that must be considered. The best panel for the given clinical situation should be selected to minimize the number of variants of unknown significance. The inclusion in panels of low penetrance or newly identified genes without specific actionability can be problematic for interpretation.Genetic counselors are an essential part of the hereditary cancer risk assessment team, helping the medical team select the most appropriate test and interpret the often complex results. Genetic counselors obtain an extended family history, counsel patients on the available tests and the potential implications of results for themselves and their family members(pre-test counseling), explain to patients the implications of the test results(post-test counseling), and assist in testing family members at risk.

Multidisciplinary management of patients diagnosed with von Hippel-Lindau disease: A practical review of the literature for clinicians

Objective:The aim of the current review is to summarize the available evidence to aid clinicians in the surveillance,treatment and follow-up of the different primary tumors developed by patients diagnosed with von Hippel-Lindau(VHL)syndrome.Methods:A non-systematic narrative review of original articles,meta-analyses,and random-ized trials was conducted,including articles in the pre-clinical setting to support relevant find-ings.Results:VHL disease is the most common rare hereditary disorder associated with clear cell renal cell carcinoma.Affected individuals inherit a germline mutation in one VHL allele,and any somatic event that disrupt the other allele can trigger mutations,chromosomal rearrange-ments,or epigenetic regulations leading to oncogenesis.From a clinical perspective,patients continuously develop multiple primary tumors.Conclusion:Because VHL is considered a rare disease,very limited evidence is available for diagnosis,surveillance,active treatment with local or systemic therapy and follow-up.

Genetic counseling, prenatal screening and diagnosis of Down syndrome in the second trimester in women of advanced maternal age： a prospective study

Background The incidence of autosomal trisomy in livebirths is strongly dependent on maternal age. Special consideration is given to the provision of prenatal screening and cytogenetic testing to women of advanced maternal age （AMA）. The aim of this study was to evaluate the effectiveness of second trimester prenatal screening and amniocentesis for Down syndrome （DS） and compare the trends of choice of screening and amniocentesis among AMA women. Methods A total of 5404 AMA patients with natural singleton pregnancy were recruited for this prospective study from January 2008 to December 2010. The gestational weeks were from 15 weeks to 20~6 weeks. The patients referred were grouped into a screening group （2107 cases） and an amniocentesis group （3297 cases） by their own decision. The prevalence of DS was compared between the two groups by chi-square test. Choice rates for each maternal age with trends were compared by regression analysis. Results There were 18 cases of fetal DS detected in the screening group with a prevalence of 8.54%o （18/2107）. Twenty- five cases of fetal DS were diagnosed in the amniocentesis group with a prevalence of 7,58%0 （25/3297）. No statistical difference was observed in the prevalence of DS between the screening and amniocentesis group （P=0.928）. The invasive testing rate for DS in the amniocentesis group was 5.54 times higher than that of the screening group （1/131.88 vs. 1/23.78）. With the increase of the maternal age, the choice of amniocentesis increased while the choice of the screening showed an opposite trend. The choice of the AMA women between the screening and amniocentesis was significantly age relevant （P=0.012）. Conclusions The second trimester serum screening age alone to screen for DS. We suggest educating screening and amniocentesis options. in combination with maternal age was more effective than maternal the patients by recommending AMA women be informed of both

Gene mutations and clinical phenotypes in Chinese children with Blau syndrome

The mutations of CARD15 gene and clinical features of Chinese patients with Blau syndrome were analyzed. We identified10 missense mutations, out of which five were new: R334 L, E383 D, R471 C, C495 R and D512 F. The rest of them, R334 W,R334Q, G481 D, M513 T and R587 C, have been reported previously. Among all the mutations, R334 W, R334 Q and C495 R had the highest frequency. Blau syndrome was found at early age after birth. It began with lepidic rash and symmetric polyarthritis and was phenotypically characterized by typical rash, arthritis, iridocyclitis and arteritis. Cardiac involvement was also found in Blau syndrome. In addition to nerve deafness, renal involvement, osteochondroma and central nervous system involvement were also found in our patients. Therefore, Chinese children with Blau syndrome have unique gene mutations and complicated clinical phenotypes. Pathologic examination and CARD15 mutation testing should be considered for diagnosis as early as possible for suspected patients.

Single nucleotide polymorphisms of the SCN5A gene in Han Chinese and their relation with Brugada syndrome

Background Mutations in the cardiac sodium channel gene (SCN5A) may lead to a broad spectrum of familial arrhythmias, including long QT syndrome (LQTS), idiopathic ventricular fibrillation (IVF), and isolated cardiac conduction diseases Recent studies have shown that polymorphisms in the SCN5A gene also play an important role in the manifestation of disorders involving cardiac excitability In this study, we investigated the polymorphisms of the SCN5A gene in Han Chinese and its relation to Brugada syndrome (BS) Methods Genomic DNA was isolated from 120 unrelated healthy volunteers and 48 unrelated Brugada syndrome patients by means of standard procedures All exons including the putative splicing sites of the SCN5A gene were amplified by PCR and sequenced directly or after subcloning using an ABI Prism 377 DNA sequencer Results A total of 5 single nucleotide polymorphisms (SNPs) were identified in the Han Chinese population, including 3 novel ones: G87A(A29A), 4245+82A>G, and G6174A The allele frequencies of each SNP in the Han Chinese population were as follows: G87A (A29A) 27 5%, A1673G (H558R) 10 4%, 4245+82A>G 32 8%, C5457T (D1819D) 41 3%, and G6174A 44 9% S1102Y and 10 other SNPs identified in other ethnic populations were not detected in this study There was no significant difference in the allele frequency of A1673G (H558R) between different ethnic populations (all P >0 5) On the other hand, the allele frequency of C5457T (D1819D) among Han Chinese was similar to its frequency among Japanese ( P >0 5), but higher than that among Americans ( P <0 005) The allele G1673 (R558) was over-represented in BS patients compared to controls ( P <0 005), but there was no significant difference in genotype frequencies at this locus There were also no differences in either the allele or genotype frequencies of the 4 other identified SNPs when comparing BS patients with healthy controls Conclusions The distribution of SCN5A SNPs may vary between different ethnicities The polymorphism of A1673G might be associated with BS and may contribute to a susceptibility to BS in Han Chinese

Association between peroxisome proliferator-activated receptor γ gene polymorphism and susceptibility to northwest dryness syndrome

OBJECTIVE:To investigate the relationship between gene polymorphism of peroxisome proliferator-activated receptor(PPAR) and susceptibility to northwest dryness syndrome(NDS).METHODS:The polymorphisms of 11 PPARl51, rs13γ7 gene oci rs10510418, rs1263353640,rs17036188, rs2921190, rs4135247, rs4135275,rs4135283, rs6768587, rs709156, and rs7615916 were detected in 249 patients with NDS and 260 patients with non-NDS(control group) by using Snapshot single-nucleotide polymorphism typing technology.RESULTS:All locus detections were in accordance with Hardy-Weinberg equilibrium test.Compared with the control group, rs2921190 genotype frequency showed statistical difference in the NDS group(P < 0.05).Two-two comparison result showed that CC genotype frequency in the NDS group was higher than that in the control group.CT and TT genotype distribution frequencies showed differences between the two groups.The rare allele frequency in the NDS group was lower than that of the control group(P < 0.01).Multi-factor logistic regression analysis showed that the age and genotype entered the regression equation.The subjects in the age bracket 30-55 and 45-45 were1.796 and 1.561 times likely, respectively, than those in other age brackets to contract NDS,.The patients with CC genotype was only 0.524 times likely than those with CT/TT genotype to suffer from NDS.CONCLUSION:PPARsm was correlated γw gene rs2921190 polymorphiith the susceptibility to NDS.