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Impact of Confinement in Patients under Long-Term Noninvasive Ventilation during the First Wave of the SARS-CoV-2 Pandemic: A Remarkable Resilience.

Respiration 2021 Jun 15:1-9. Epub 2021 Jun 15.

Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland.

Background: During the first wave of the SARS-CoV-2 pandemic in Switzerland, confinement was imposed to limit transmission and protect vulnerable persons. These measures may have had a negative impact on perceived quality of care and symptoms in patients with chronic disorders.

Objectives: To determine whether patients under long-term home noninvasive ventilation (LTHNIV) for chronic respiratory failure (CRF) were negatively affected by the 56-day confinement (March-April 2020). Read More

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Clinical Utility of Overlap Time for Incomplete Relaxation to Predict Cardiac Events in Heart Failure: Incomplete relaxation in heart failure.

J Card Fail 2021 Jun 12. Epub 2021 Jun 12.

Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, 2-50-1 Kuramoto, Tokushima, Japan.

Background: The overlap time of transmitral flow can be a novel marker of subclinical left ventricular (LV) dysfunction for predicting adverse events in heart failure (HF). We aimed to 1) investigate the role of overlap time of E-A wave in association with clinical parameters, and 2) evaluate whether the overlap time could add prognostic information with respect to other conventional clinical prognosticators in HF.

Methods: We prospectively evaluated 153 patients hospitalized with HF (mean age 68±15 years; 63% male). Read More

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Chronic Pelvic Pain in Women: A Review.

JAMA 2021 Jun;325(23):2381-2391

Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles.

Importance: Chronic pelvic pain (CPP) is a challenging condition that affects an estimated 26% of the world's female population. Chronic pelvic pain accounts for 40% of laparoscopies and 12% of hysterectomies in the US annually even though the origin of CPP is not gynecologic in 80% of patients. Both patients and clinicians are often frustrated by a perceived lack of treatments. Read More

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Undergraduate medical education amid COVID-19: a qualitative analysis of enablers and barriers to acquiring competencies in distant learning using focus groups.

Med Educ Online 2021 Dec;26(1):1940765

Department of General Paediatrics, Neonatology, and Paediatric Cardiology, Düsseldorf University Department (UKD), Heinrich-Heine-University, Düsseldorf, Germany.

Due to comprehensive social distancing measures related to the COVID-19 pandemic, medical faculties worldwide have made a virtue of necessity in resorting to online teaching. Medical faculties grapple with how to convey clinical competencies to students in this context. There is a need for research not only to map but also to explain the effect of these secondary measures on students' learning and mental wellbeing. Read More

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December 2021

Sarcomatous Meningioma: Diagnostic Pitfalls and the Utility of Molecular Testing.

J Neuropathol Exp Neurol 2021 Jun 12. Epub 2021 Jun 12.

Department of Pathology (C-HGL, PD, DAS, AP); Clinical Cancer Genomics Laboratory (PD), University of California, San Francisco, California, UUSA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CG); Institute of Neuropathology, University Hospital Düsseldorf and Medical Faculty, Heinrich Heine University, Düsseldorf, Germany (GR); Department of Pathology and Immunology, Washington University, St. Louis, Missouri, USA (SD); Department of Pathology, Sutter Medical Center, Sacramento (DC); Department of Neurological Surgery, University of California, San Francisco (AP), California, USA.

Anaplastic meningiomas can have a sarcomatous appearance on histology but true sarcomatous (metaplastic) differentiation is rare. These tumors follow an aggressive clinical course with recurrence and poor clinical outcomes. Due to significant overlap in morphology and immunohistochemical profiles, distinguishing between sarcomatous transformation of a meningioma and a true sarcoma can be challenging. Read More

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Identification of transdiagnostic psychiatric disorder subtypes using unsupervised learning.

Neuropsychopharmacology 2021 Jun 14. Epub 2021 Jun 14.

Max Planck Institute of Psychiatry, Munich, Germany.

Psychiatric disorders show heterogeneous symptoms and trajectories, with current nosology not accurately reflecting their molecular etiology and the variability and symptomatic overlap within and between diagnostic classes. This heterogeneity impedes timely and targeted treatment. Our study aimed to identify psychiatric patient clusters that share clinical and genetic features and may profit from similar therapies. Read More

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The other connective tissue disease-associated interstitial lung diseases: Sjogren's syndrome, mixed connective tissue disease, and systemic lupus erythematosus.

Curr Opin Pulm Med 2021 Jun 14. Epub 2021 Jun 14.

Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA.

Purpose Of Review: We review the clinical manifestations of three less common connective tissue disease (CTD)-associated interstitial lung diseases (ILDs): Sjogren's syndrome (SjS), mixed CTD (MCTD), and systemic lupus erythematosus (SLE).

Recent Findings: SjS is classically associated with lymphocytic interstitial pneumonia and cystic lung disease, but the most common type of ILD in Sjogren's patients is nonspecific interstitial pneumonia. ILD is prevalent in MCTD and associated with worse survival. Read More

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TCR repertoire diversity in Multiple Sclerosis: High-dimensional bioinformatics analysis of sequences from brain, cerebrospinal fluid and peripheral blood.

EBioMedicine 2021 Jun 10:103429. Epub 2021 Jun 10.

Dipartimento di Medicina Sperimentale e Clinica (DMSC), Laboratory of Neuroimmunology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy. Electronic address:

Background: T cells play a key role in the pathogenesis of multiple sclerosis (MS), a chronic, inflammatory, demyelinating disease of the central nervous system (CNS). Although several studies recently investigated the T-cell receptor (TCR) repertoire in cerebrospinal fluid (CSF) of MS patients by high-throughput sequencing (HTS), a deep analysis on repertoire similarities and differences among compartments is still missing.

Methods: We performed comprehensive bioinformatics on high-dimensional TCR Vβ sequencing data from published and unpublished MS and healthy donors (HD) studies. Read More

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Landscape and selection of vaccine epitopes in SARS-CoV-2.

Genome Med 2021 Jun 14;13(1):101. Epub 2021 Jun 14.

Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, CB# 7295, Chapel Hill, NC, 27599-7295, USA.

Background: Early in the pandemic, we designed a SARS-CoV-2 peptide vaccine containing epitope regions optimized for concurrent B cell, CD4 T cell, and CD8 T cell stimulation. The rationale for this design was to drive both humoral and cellular immunity with high specificity while avoiding undesired effects such as antibody-dependent enhancement (ADE).

Methods: We explored the set of computationally predicted SARS-CoV-2 HLA-I and HLA-II ligands, examining protein source, concurrent human/murine coverage, and population coverage. Read More

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A road map for identifying autism spectrum disorder: recognizing and evaluating characteristics that should raise red or "pink" flags to guide accurate differential diagnosis.

Clin Neuropsychol 2021 Jun 13:1-36. Epub 2021 Jun 13.

Department of Psychiatry and Education, Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA.

Given the high population prevalence of Autism Spectrum Disorder (ASD) and overlapping symptoms with medically complex groups, ASD is a common rule out diagnosis for neuropsychologists even when not identified in the referral or initial presenting concerns. This paper presents practical guidance to support neuropsychologists in their ability to accurately assess, diagnose, and/or rule out ASD, especially in patients with more subtle presentations. This paper combines clinical experience and empirical literature to highlight important assessment measures and related considerations, differential diagnostic considerations, common misconceptions about ASD and person/family characteristics, as well as variability in presentation and comorbidities that can obscure the diagnosis. Read More

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Stevens-Johnson syndrome and toxic epidermal necrolysis: a 10-year experience in a burns unit.

J Wound Care 2021 Jun;30(6):492-496

Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Halle, Germany.

Objective: Stevens-Johnson syndrome (SJS) and its more severe counterpart, toxic epidermal necrolysis (TEN), are skin hypersensitivity reactions defined by epidermal blistering and necrosis. The exact pathophysiology of SJS/TEN is yet to be deciphered, but a number of risk factors have been identified including adverse drug reactions. The diagnosis of SJS/TEN is made on a clinical basis, and treatment consists of supportive care and occasionally immunosuppressants, such as cyclosporin, high-dose intravenous immunoglobulins and/or corticosteroids. Read More

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Myositis autoantibodies in a racially diverse population of children with idiopathic inflammatory myopathies.

Pediatr Rheumatol Online J 2021 Jun 12;19(1):92. Epub 2021 Jun 12.

Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY, 10467, USA.

Background: Juvenile idiopathic inflammatory myopathies (JIIMs) is a group of autoimmune disorders, including juvenile dermatomyositis (JDM), juvenile polymyositis (JPM) and overlap myositis, that are characterized by proximal muscle weakness, elevated levels of serum muscle enzymes, and pathognomonic skin findings. While the exact etiology of JIIMs is unclear, the presence of myositis specific autoantibodies (MSAs) have been associated with certain clinical phenotypes, organ involvement and disease prognosis. To date, there have been few studies of the associations between MSA presence and patient ethnicity. Read More

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Anaplastic Features in Advanced Prostate Cancer With and Without DNA Damage Repair Mutations.

Clin Genitourin Cancer 2021 May 17. Epub 2021 May 17.

Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD. Electronic address:

Background: Anaplastic prostate cancer has a poor prognosis with limited treatment options. Seven clinical features of anaplastic prostate cancer have been prospectively identified. In this phase II clinical trial, we identified mutations, including DNA damage repair (DDR) mutations, in patients with metastatic castration-resistant prostate cancer (mCRPC) who were treated with durvalumab and olaparib and determined how many of them can be described as anaplastic, and we examined the overlap between anaplastic features and DDR mutations. Read More

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Low back pain.

Lancet 2021 Jun 8. Epub 2021 Jun 8.

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Neurology, Physical Medicine and Rehabilitation, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA.

Low back pain covers a spectrum of different types of pain (eg, nociceptive, neuropathic and nociplastic, or non-specific) that frequently overlap. The elements comprising the lumbar spine (eg, soft tissue, vertebrae, zygapophyseal and sacroiliac joints, intervertebral discs, and neurovascular structures) are prone to different stressors, and each of these, alone or in combination, can contribute to low back pain. Due to numerous factors related to low back pain, and the low specificity of imaging and diagnostic injections, diagnostic methods for this condition continue to be a subject of controversy. Read More

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Prevalence of acute dizziness and vertigo in cortical stroke.

Eur J Neurol 2021 Jun 11. Epub 2021 Jun 11.

Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, WC1N 3BG, UK.

Background: In posterior circulation stroke, vertigo can be a presenting feature. However, whether isolated hemispheric strokes present with vertigo is less clear, despite a few single case-reports in the literature. Here we, a) explored the prevalence of vertigo/dizziness in acute stroke and, b) considered the cortical distribution of these lesions in relation to both the known vestibular cortex and evolution of these symptoms. Read More

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External Validation Confirms Validity of a Simple Model to Predict Bowel Outcome After Traumatic Spinal Cord Injury.

Neurorehabil Neural Repair 2021 Jun 11:15459683211023191. Epub 2021 Jun 11.

Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Switzerland.

. The prediction of functional outcomes after spinal cord injury (SCI) is essential to plan the rehabilitation phase and the social reintegration. Recently, 2 models to predict independent and reliable bowel management 1 year after traumatic SCI have been derived and validated in 2 cohorts of patients included in the European Multicenter Study about Spinal Cord Injury (EMSCI). Read More

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Deep learning-based amyloid PET positivity classification model in the Alzheimer's disease continuum by using 2-[F]FDG PET.

EJNMMI Res 2021 Jun 10;11(1):56. Epub 2021 Jun 10.

Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.

Background: Considering the limited accessibility of amyloid position emission tomography (PET) in patients with dementia, we proposed a deep learning (DL)-based amyloid PET positivity classification model from PET images with 2-deoxy-2-[fluorine-18]fluoro-D-glucose (2-[F]FDG).

Methods: We used 2-[F]FDG PET datasets from the Alzheimer's Disease Neuroimaging Initiative and Korean Brain Aging Study for the Early diagnosis and prediction of Alzheimer's disease for model development. Moreover, we used an independent dataset from another hospital. Read More

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Cardiac sarcoidosis masquerading as arrhythmogenic right ventricular cardiomyopathy: a case report.

Eur Heart J Case Rep 2021 Mar 13;5(3):ytab072. Epub 2021 Mar 13.

Department of Advanced Heart Failure, Sands-Constellation Heart Institute, Rochester Regional Health, 1425 Portland Avenue, Rochester, NY 14621, USA.

Background: Cardiac sarcoidosis (CS) and arrhythmogenic right ventricular cardiomyopathy (ARVC) are rare causes of ventricular arrhythmias and are associated with sudden cardiac death. Differentiation between both is important for proper management.

Case Summary: We present a 56-year-old man with sudden cardiac arrest and was diagnosed to have ARVC based on cardiac magnetic resonance imaging (MRI). Read More

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Identification of Ten Mitosis Genes Associated with Tamoxifen Resistance in Breast Cancer.

Onco Targets Ther 2021 4;14:3611-3624. Epub 2021 Jun 4.

Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.

Background: Endocrine therapy is the backbone therapy in estrogen receptor α (ER)-positive breast cancer, and tamoxifen resistance is a great challenge for endocrine therapy. Tamoxifen-resistant and sensitive samples from the international public repository, the Gene Expression Omnibus (GEO) database, were used to identify therapeutic biomarkers associated with tamoxifen resistance.

Materials And Methods: In this study, integrated analysis was used to identify tamoxifen resistance-associated genes. Read More

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A Real World Study to Assess the Effectiveness of Switching to Once Daily Closed Triple Therapy from Mono/Dual Combination or Open Triple Therapy in Patients with Chronic Obstructive Pulmonary Disease.

Int J Chron Obstruct Pulmon Dis 2021 3;16:1555-1568. Epub 2021 Jun 3.

Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.

Objective: This real world study evaluated the effectiveness of switching to closed triple therapy from mono/dual combination or open triple therapy in patients with chronic obstructive pulmonary disease (COPD).

Methods: We conducted this retrospective study at a single medical center from December 2014 to September 2020. Patients with COPD who were stepped up to triple therapy were enrolled. Read More

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The One-Bone Forearm in Children: Surgical Technique and a Retrospective Review of Outcomes.

J Hand Surg Am 2021 Jun 7. Epub 2021 Jun 7.

Department of Orthopedic Surgery, Shriners Hospitals for Children, Philadelphia, PA.

Purpose: The purpose of this study was to describe a technique of end-to-end rigid fixation of the distal radius to the proximal ulna. The shortening and radioulnar overlap in this technique yield a high union rate, large corrections, and few complications.

Methods: This retrospective chart review from 2 centers was undertaken in 39 patients (40 forearms) who underwent one-bone forearm operations between 2005 and 2019. Read More

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Mapping the Cerebellar Cognitive Affective Syndrome in Patients with Chronic Cerebellar Strokes.

Cerebellum 2021 Jun 9. Epub 2021 Jun 9.

Neuropsychology Laboratory, Physiology Department, School of Medicine, National Autonomous University of Mexico, 04510, Mexico city, Mexico.

The cerebellar cognitive affective syndrome (CCAS) has been consistently described in patients with acute/subacute cerebellar injuries. However, studies with chronic patients have had controversial findings that have not been explored with new cerebellar-target tests, such as the CCAS scale (CCAS-S). The objective of this research is to prove and contrast the usefulness of the CCAS-S and the Montreal Cognitive Assessment (MoCA) test to evaluate cognitive/affective impairments in patients with chronic acquired cerebellar lesions, and to map the cerebellar areas whose lesions correlated with dysfunctions in these tests. Read More

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Network medicine links SARS-CoV-2/COVID-19 infection to brain microvascular injury and neuroinflammation in dementia-like cognitive impairment.

Alzheimers Res Ther 2021 06 9;13(1):110. Epub 2021 Jun 9.

Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.

Background: Dementia-like cognitive impairment is an increasingly reported complication of SARS-CoV-2 infection. However, the underlying mechanisms responsible for this complication remain unclear. A better understanding of causative processes by which COVID-19 may lead to cognitive impairment is essential for developing preventive and therapeutic interventions. Read More

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Automated Quantification of Choriocapillaris Lesion Area in Patients with Posterior Uveitis.

Am J Ophthalmol 2021 Jun 6. Epub 2021 Jun 6.

Department of Ophthalmology, University of Washington, Seattle, WA. Electronic address:

Purpose: To validate a custom algorithm for automated identification and quantification of clinically relevant inflammatory choriocapillaris (CC) lesions from en face swept source optical coherence tomography (SS-OCTA) images.

Design: observational case series METHODS: : Twenty eyes of 14 patients with posterior uveitis were imaged using the PLEX® Elite 9000. The machine-generated en face OCTA CC slabs were exported to MATLAB where a custom algorithm performed unsupervised lesion boundary delineation and area quantification. Read More

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Community pharmacist prescribing of antimicrobials: A systematic review from an antimicrobial stewardship perspective.

Can Pharm J (Ott) 2021 May-Jun;154(3):179-192. Epub 2021 Apr 8.

Public Health Ontario, Ontario.

Background: Pharmacist prescribing authority is expanding, while antimicrobial resistance is an increasing global concern. We sought to synthesize the evidence for antimicrobial prescribing by community pharmacists to identify opportunities to advance antimicrobial stewardship in this setting.

Methods: We conducted a systematic review to characterize the existing literature on community pharmacist prescribing of systemic antimicrobials. Read More

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Evaluation of Pain in the Pediatric Emergency Department and the Request of Analgesia.

Pediatr Emerg Care 2021 Jun 7. Epub 2021 Jun 7.

From the Department of Pediatric Emergency Medicine, CHU Sainte-Justine, Montreal, QC, Canada.

Objectives: To determine the acute pain level associated with request for analgesia by children and their parents in the pediatric emergency department (ED) when pain was assessed by verbal numeric scale (VNS), visual analog scale (VAS), and verbal rating scale (VRS).

Methods: A secondary analysis of a prospective cohort study using a sample of children aged 8 to 17 presenting to the ED with acute pain. Patients and their parents were asked to quantify the child's pain on the VNS, VAS, and VRS. Read More

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Coincident Kikuchi-Fujimoto's disease and adult-onset Still's disease: report of a patient from an uncommonly affected population and case-directed systematic review.

Clin Rheumatol 2021 Jun 7. Epub 2021 Jun 7.

Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.

Kikuchi-Fujimoto's disease (KFD) and adult-onset Still's disease (AOSD) are rare idiopathic inflammatory conditions of unknown etiology. Ten prior instances of KFD and AOSD occurring together have been reported in the medical literature. These overlaps, together with certain distinguishing clinical and laboratory characteristics in these co-occurrences, offer insight into the pathophysiology of both of these rare disorders. Read More

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Limited predictive value of illness perceptions for short-term poor recovery in musculoskeletal pain. A multi-center longitudinal study.

BMC Musculoskelet Disord 2021 Jun 7;22(1):522. Epub 2021 Jun 7.

Department of Health Sciences, VU University, Amsterdam, The Netherlands.

Background: Musculoskeletal pain (MSP) is recognized worldwide as a major cause of increased years lived with disability. In addition to known generic prognostic factors, illness perceptions (IPs) may have predictive value for poor recovery in MSP. We were interested in the added predictive value of baseline IPs, over and above the known generic prognostic factors, on clinical recovery from MSP. Read More

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Plasma Mucin-1 (CA15-3) Levels in Autosomal Dominant Tubulointerstitial Kidney Disease due to MUC1 Mutations.

Am J Nephrol 2021 Jun 7:1-10. Epub 2021 Jun 7.

Department of Paediatrics and Inherited Metabolic Disorders, Research Unit of Rare Diseases, First Faculty of Medicine, Charles University, Prague, Czechia.

Introduction: Patients with ADTKD-MUC1 have one allele producing normal mucin-1 (MUC1) and one allele producing mutant MUC1, which remains intracellular. We hypothesized that ADTKD-MUC1 patients, who have only 1 secretory-competent wild-type MUC1 allele, should exhibit decreased plasma mucin-1 (MUC1) levels. To test this hypothesis, we repurposed the serum CA15-3 assay used to measure MUC1 in breast cancer to measure plasma MUC1 levels in ADTKD-MUC1. Read More

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Omics Profiling of S2P Mutant Fibroblasts as a Mean to Unravel the Pathomechanism and Molecular Signatures of X-Linked Osteogenesis Imperfecta.

Front Genet 2021 21;12:662751. Epub 2021 May 21.

Connective Tissue Unit, Division of Metabolism and Children's Research Centre, University Children's Hospital, Zurich, Switzerland.

Osteogenesis imperfecta (OI) is an inherited skeletal dysplasia characterized by low bone density, bone fragility and recurrent fractures. The characterization of its heterogeneous genetic basis has allowed the identification of novel players in bone development. In 2016, we described the first X-linked recessive form of OI caused by hemizygous missense variants resulting in moderate to severe phenotypes. Read More

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