Thesis (M. Med. Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 55-63).

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Thesis (M.Med.Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 55-63). Also available in print.

No description available.

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 6 uppsatser.

Includes bibliographic references. / 1 v. (various foliations) : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Details the results of in vivo and in vitro studies into the effects of zinc deficiency, hypervitaminosis A, alcohol, nicotine and salicyclic acid, at the morphological and ultrastructural levels in the developing embryo. / Thesis (Ph.D.)--University of Adelaide, Dept. of Anatomy and Histology, 1992

This study was undertaken to determine the effect of inflammatory bowel disease (IBD), in general, and one of its manifestations, growth retardation, in particular, on the self-image of adolescents. The conceptualization of adolescent self-image as described by D. Offer (1981) was the basis for the study's framework. The psychological, social, sexual, familial and coping selves, further classified into 11 separate content areas, comprised the adolescent self-image. A descriptive-comparative design was used to describe the self-image of adolescents with IBD and to compare the similarities and differences in self-image among the IBD adolescents with and without growth retardation and their healthy peers. A convenience sampling method was used to obtain 24 IBD subjects between the ages of 12 and 20, eleven of whom had growth retardation. A normative sample of adolescents (N = 1385) was used by permission of D. Offer for purposes of comparison with the IBD subjects. Data were gathered using the Offer Self-image Questionnaire for adolescents. The adolescents with IBD did not differ remarkably from the norm in their perceptions of self although a tendency among the females to have concerns about their body image and sexual maturation was demonstrated. The IBD subgroup without growth retardation reported self-image perceptions that were superior to the norm and the growth retarded subgroup in almost every category. The IBD subgroup with growth retardation reported a disturbed self-image in a number of areas. The males revealed disturbances primarily in body image and secondarily in emotional harmony, and adaptability to stress in the immediate environment, family relations, and sexual maturation. The females revealed self-image disturbances in sexual maturation and body image. The findings of the study suggest that growth retardation in the IBD adolescent may have a negative effect on self-image. The findings may demonstrate a more notable and broader effect of growth retardation on self-image in the males with IBD than in the females. / Applied Science, Faculty of / Nursing, School of / Graduate

Parcela considerável de pacientes com distúrbios de crescimento não têm a causa de seus quadros clínicos estabelecida, incluindo aproximadamente 50% dos pacientes com diagnóstico clínico de síndrome de Silver−Russell (SRS) e 10-20% dos pacientes com síndrome de Beckwith-Wiedemann (BWS). O objetivo deste estudo foi investigar as causas genéticas e epigenéticas de distúrbios de crescimento, de etiologia desconhecida, numa contribuição para o entendimento de mecanismos que regulam o crescimento. O estudo compreendeu: (1) a investigação de microdesequilíbrios cromossômicos, por aCGH; (2) a análise do perfil de expressão alelo-específica de genes sujeitos a imprinting (IG), por pirossequenciamento (PSQ) ou sequenciamento de Sanger; (3) a investigação do padrão de metilação global em pacientes com restrição de crescimento, utilizando microarray de metilação. A casuística constituiu-se de 41 pacientes não aparentados, com distúrbios de crescimento, de etiologia desconhecida: (1) 25, com hipótese diagnóstica de SRS; (2) seis, com restrição de crescimento intrauterino e peso ao nascimento abaixo do 10º percentil, associados a outros sinais clínicos; (3) sete, com hipótese diagnóstica de BWS; e (4) três, com macrossomia pré-natal ou pós-natal, associada a outros sinais. A investigação de microdesequilíbrios cromossômicos foi realizada em 40 pacientes. Foram detectadas 58 variantes raras em 30/40 pacientes (75%): 40 foram consideradas provavelmente benignas (18 pacientes, 45%), 12, com efeito patogênico desconhecido (11 pacientes, 27,5%), duas, provavelmente patogênicas (um paciente, 2,5%) e quatro, patogênicas (três pacientes, 7,5%). Essas frequências são comparáveis àquelas descritas em estudos que investigaram CNV em grupos de pacientes com distúrbios de crescimento e outras alterações congênitas, incluindo SRS, e mostram a importância da investigação de microdesequilíbrios cromossômicos nesses pacientes. A diversidade dos microdesequilíbrios cromossômicos identificados é reflexo da heterogeneidade clínica das casuísticas. Neste estudo, muitos dos pacientes com hipótese diagnóstica de SRS e BWS apresentavam sinais clínicos atípicos, explicando a ausência neles das alterações (epi)genéticas que causam essas síndromes. A identificação de CNV características de outras síndromes reflete a sobreposição de sinais clínicos com BWS e SRS. A análise do perfil de expressão alelo-específica de IG foi realizada em um subgrupo de 18 pacientes com restrição de crescimento. Trinta IG com função em proliferação celular, crescimento fetal ou neurodesenvolvimento foram inicialmente selecionados. Após seleção de SNP transcritos com alta frequência na população, genotipagem de pacientes, genitores e indivíduos controle, determinação da expressão dos IG em sangue periférico e seu padrão de expressão (mono ou bialélico), 13 IG, expressos no sangue, tiveram a expressão alelo-específica avaliada, sete deles por PSQ e seis por sequenciamento de Sanger. Alterações no perfil de expressão de dois genes, de expressão normalmente paterna, foram detectadas em 4/18 pacientes (22%). Este estudo é o primeiro a utilizar pirossequenciamento e sequenciamento de Sanger na avaliação do perfil de expressão alelo-específica de IG, em pacientes com restrição de crescimento. Apesar de terem limitações, ambas as técnicas mostraram-se robustas e revelaram alterações de expressão alélica interessantes; entretanto, a relação dessas alterações com o quadro clínico dos pacientes permanece por esclarecer. A investigação da metilação global do DNA foi realizada em subgrupo de 21 pacientes com restrição de crescimento e em 24 indivíduos controle. Dois tipos de análise foram realizados: (1) análise diferencial de grupo e (2) análise diferencial individual. Na primeira análise, em que foi comparado o padrão de metilação do grupo de pacientes com quadro clínico sugestivo de SRS (n=16) com o do grupo controle (n=24), não houve indicação de hipo ou hipermetilação global no grupo SRS. Na segunda análise, foi comparado o padrão de metilação de cada um dos 21 pacientes com restrição de crescimento e dos 24 indivíduos controle, com o padrão de metilação do grupo controle. O número médio de CpG hipermetilados e de segmentos diferencialmente metilados (SDM) foi significativamente maior nos pacientes. Foram identificados 82 SDM hipermetilados, estando 57 associados a gene(s) (69,5%), em 16 pacientes, e 51 SDM hipometilados, 41 deles associados a gene(s) (80,4%), em 10 pacientes. A análise de ontologia genética dos 61 genes associados aos SDM hipo ou hipermetilados nos pacientes destacou genes que atuam no desenvolvimento e na morfogênese do sistema esquelético e de órgãos fetais, e na regulação da transcrição gênica e de processos metabólicos. Alterações de metilação em genes que atuam em processos de proliferação e diferenciação celulares e crescimento foram identificadas em 9/20 dos pacientes (45%), sugerindo implicação clínica. Não foi detectada alteração epigenética comum aos pacientes com diagnóstico clínico de SRS, explicável provavelmente pela heterogeneidade clínica. A investigação de metilação global, utilizando microarray, produziu novos dados que podem contribuir para a compreensão de mecanismos moleculares que influenciam o crescimento pré- e pós-natal. Na translocação aparentemente equilibrada - t(5;6)(q35.2;p22.3)dn, detectada em paciente com suspeita clínica de SRS, a interrupção de um gene, pela quebra no cromossomo 6, pode ser a causa do quadro clínico; alternativamente, a translocação pode ter impactado a regulação de genes de desenvolvimento localizados próximos aos pontos de quebra. A análise de expressão em sangue periférico mostrou que os níveis de cDNA do gene, interrompido pelo ponto de quebra da translocação, estavam reduzidos à metade. Além de sinais típicos da SRS, a paciente apresentava algumas características clínicas sugestivas de displasia cleidocraniana. Assim, a translocação t(5;6) pode ter alterado a interação de genes de desenvolvimento e seus elementos reguladores, levando à desregulação de sua expressão espaço-temporal, e resultando num fenótipo atípico, com características sobrepostas de mais de uma síndrome genética / A large number of patients with growth disorders do not have the cause of their clinical phenotype established, including about 50% of patients with Silver-Russell syndrome (SRS), and 10-20% of patients with Beckwith-Wiedemann syndrome (BWS). The aim of this study was to investigate the (epi)genetic causes of growth disorders of unknown etiology, in a contribution to the understanding of growth regulation. The study included: (1) the investigation of submicroscopic chromosomal imbalances, by aCGH, (2) the analysis of the allele-specific expression profile of imprinted genes (IG), by pyrosequencing (PSQ) or Sanger sequencing, in patients with growth restriction; (3) the investigation of global methylation pattern in patients with growth restriction, using methylation microarray. The cohort consisted of 41 unrelated patients with growth disorders: (1) 25, with the diagnostic hypothesis of SRS; (2) six, with intrauterine growth restriction and birth weight below the 10th centile, associated with other clinical signs; (3) seven, with the diagnostic hypothesis of BWS; and (4) three, with prenatal or postnatal macrosomia, associated with other clinical signs. Chromosomal microdeletions and microduplications were investigated in 40 patients. Fifty-eight rare variants were detected in 30/40 patients (75%): 40 were considered likely benign (18 patients, 45%), 12, of unknown pathogenic significance (11 patients, 27.5%), two, likely pathogenic (one patient, 2.5%), and four, pathogenic (three patients, 7.5%). These frequencies are similar to those described in studies investigating CNVs in groups of patients with growth disorders and other congenital abnormalities, including SRS, and show the importance of investigating chromosomal microimbalances in these patients. The diversity of CNVs identified can be attributed to the clinical heterogeneity of these cohorts. In this study, many of the patients, with the diagnostic hypothesis of SRS or BWS, had atypical clinical signs, thus explaining the absence of specific SRS/BWS (epi)genetic mutations. The identification of CNVs, known to be causative of other syndromes, reflected the overlapping of some of their clinical features with those of SRS and BWS. The analysis of IG allele-specific expression profile was performed in a subgroup of 18 patients with growth restriction. Thirty IGs were initially selected, based on their association with cell proliferation, fetal growth or neurodevelopment. Transcribed SNPs with high frequency in the general population were selected for the genotyping of patients, parents and control subjects, determination of IG expression in peripheral blood, and of the monoallelic or biallelic expression pattern. The allele-specific expression of 13 IGs expressed in blood was then investigated in patients (seven of them by PSQ and six by Sanger sequencing). Expression alterations of two normally paternally expressed genes were detected in 4/18 patients (22%). This study is the first to use pyrosequencing and Sanger sequencing in the evaluation of IG allele-specific expression profile, in patients with growth restriction. Despite the limitations, both techniques have proved to be robust, and revealed interesting alterations in allelic expression; however, the causal relationship of these alterations with the clinical phenotypes remained unclear. The investigation of the global DNA methylation was performed in a subgroup of 21 patients with growth restriction, and in 24 control subjects. Two types of analysis were performed: (1) group differential analysis, and (2) individual differential analysis. In the first analysis, the methylation pattern obtained for the group of patients with the diagnostic hypothesis of SRS (n=16) was compared to that of the control group (n=24); no bias towards DNA hypo or hypermethylation was detected in the SRS group. In the second analysis, the methylation patterns of each of the 21 patients with growth restriction, and each of the 24 control subjects were compared to the methylation pattern of the control group. The average numbers of hypermethylated CpGs and of differentially methylated segments (DMSs) were significantly higher in the patients. In total, 82 hypermethylated DMSs - 57 associated with gene(s) (69.5%), in 16 patients, and 51 hypomethylated DMSs - 41 associated with gene(s) (80.4%), in 10 patients, were identified. Gene ontology analysis of the 61 DMS-associated genes highlighted genes involved in development and morphogenesis of the skeletal system and fetal organs, and also in the regulation of gene transcription and metabolic processes. Methylation changes in genes involved with cellular proliferation and differentiation, and growth were identified in 9/20 patients (45%), suggesting clinical implications; an epigenetic mutation common to SRS patients was not detected, likely due to the clinical heterogeneity of the cohort. The data generated by this global methylation analysis, using microarray, might contribute to the understanding of molecular mechanisms in growth restriction. In an apparently balanced translocation -t(5;6)(q35.2;p22.3)dn, detected in a patient with the diagnostic hypothesis of SRS, a gene found to be disrupted by the chromosome 6 breakpoint might explain the phenotype; alternatively, the translocation might have impacted the regulation of developmental genes in the vicinity of breakpoints. Expression analysis showed a significant decrease in the disrupted gene cDNA levels in the patient\'s blood cells, as expected. In addition to the SRS typical signs, the patient presented clinical features suggestive of cleidocranial dysplasia. Thus, the translocation t(5;6) might have altered the interaction of developmental genes and regulatory elements, leading to misregulation of spatiotemporal gene expression, thus resulting in an atypical phenotype, with overlapping features of more than one genetic syndrome

Abstract not available

published_or_final_version / Paediatrics / Master / Master of Philosophy