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American Journal of Medical Genetics Part C: Seminars in Medical Genetics最新文献

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The Myhre Syndrome Foundation as a global modern support group: The business of rare 迈尔综合征基金会是一个全球性的现代支持团体:罕见病的生意
IF 2.8 3区 医学 Q2 GENETICS & HEREDITY Pub Date : 2024-10-01 DOI: 10.1002/ajmg.c.32104
Kate Wears, Angela E. Lin, Lois J. Starr

Advocacy support groups grow into national and international organizations, but they all begin with personal experiences. As the parents to a newly diagnosed two-year-old son with Myhre syndrome, my husband and I were overwhelmed with the journey ahead. Thanks to networking, primarily through social media, we located other families living with Myhre syndrome and were quickly immersed in the challenges and joy of this community. Myhre syndrome, caused by pathogenic missense variants in SMAD4, is a rare connective tissue disease characterized by short stature, hearing loss, neurodevelopmental challenges, and fibroproliferation. This personal essay, written with physician partners, describes the development of a global advocacy group for patients with Myhre syndrome. I have the honor of serving as the founding Executive Director and reflect proudly on the great strides that our marvelous support group has made. We empower the global community impacted by this rare condition by providing meaningful and accessible data, educational opportunities, and connections with others going through similar experiences. Utilizing the expertise of our Board of Directors and my corporate expertise, we discuss how we have been able to elevate our ultra-rare community into a broader, more comprehensive network.

宣传支持团体发展成为全国性和国际性组织,但它们都始于个人经历。我和丈夫刚被诊断出两岁的儿子患有迈尔综合征,作为孩子的父母,我们对未来的旅程感到不知所措。多亏了网络,主要是通过社交媒体,我们找到了其他患有迈尔综合征的家庭,并很快融入了这个充满挑战和欢乐的社区。迈尔综合征是由 SMAD4 的致病性错义变异引起的,是一种罕见的结缔组织疾病,以身材矮小、听力丧失、神经发育障碍和纤维增生为特征。这篇与医生合作伙伴共同撰写的个人文章介绍了迈尔综合征患者全球权益组织的发展情况。我有幸担任该组织的创始执行主任,并自豪地回顾了我们这个了不起的支持团体所取得的巨大进步。我们通过提供有意义、可访问的数据、教育机会以及与其他经历相似的人建立联系,增强受这种罕见疾病影响的全球社区的能力。利用我们董事会的专业知识和我在企业方面的专长,我们将讨论如何将我们这个极其罕见的社区提升为一个更广泛、更全面的网络。
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引用次数: 0
Perspectives and Insights Into Phenylketonuria: Patient Narratives About the Early Years Following Newborn Screening 对苯丙酮尿症的看法和见解:患者讲述新生儿筛查后的最初几年
IF 2.8 3区 医学 Q2 GENETICS & HEREDITY Pub Date : 2024-09-17 DOI: 10.1002/ajmg.c.32110
Brittany M. Holmes, Suzanne Hollander, Stephanie Sacharow

Newborn screening for Phenylketonuria (PKU) began in 1963, and since then knowledge and treatment recommendations have evolved. In the decades following newborn screening for PKU, individual and family experiences varied widely. We present narratives by people living with PKU during these years, including individuals actively following in PKU clinic and those who have been out of PKU clinic for many years. These stories describe different individual experiences, including diet discontinuation in childhood, changing treatment guidelines, and new treatments that have become available.

新生儿苯丙酮尿症(PKU)筛查始于 1963 年,从那时起,相关知识和治疗建议不断发展。在新生儿 PKU 筛查后的几十年里,个人和家庭的经历千差万别。我们介绍了这些年里 PKU 患者的经历,其中包括在 PKU 诊所积极接受治疗的患者和已经离开 PKU 诊所多年的患者。这些故事描述了不同的个人经历,包括儿童时期停止饮食、不断变化的治疗指南以及新出现的治疗方法。
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引用次数: 0
Ode to Fiona: The Face of Fortitude in FBXL4 Deficiency 菲奥娜颂歌:FBXL4 缺乏症患者的坚毅面孔
IF 2.8 3区 医学 Q2 GENETICS & HEREDITY Pub Date : 2024-09-17 DOI: 10.1002/ajmg.c.32115
Amanda Barone Pritchard
<p>There are some moments in medicine that stay with you forever—putting on your white coat as a medical student for the first time, experiencing the sorrow of disclosing a terminal diagnosis, and the joy of seeing a newborn in her mother's arms after delivery. One of those indelible moments for me is the moment Fiona took her last breath, and experiencing her mother's pain as if it were something tangible in the room.</p><p>I met Fiona when she was just 4 months old, when she was intubated and sedated in the PICU in the throes of influenza. I noticed how small she was; her little hands laid inert at her sides. She was more sick than typical, even for influenza, with a lactate level amongst the highest I had ever seen. I did not know what her diagnosis would be, but I worried it was not going to be good.</p><p>A few days after I met her, we had our answer for why Fiona was so ill. She had two pathogenic variants in <i>FBXL4</i>—consistent with <i>FBXL4</i>-related encephalomyopathic mitochondrial DNA depletion syndrome. We corralled the PICU team and her parents for a meeting. In an austere PICU conference room, we laid out the news. In retrospect, it was one of the last family meetings we would have without masks on. I struggled with the variability of the prognosis—I had cared for a 10-year-old with the condition, but the literature reports a median age of death of 2 years. Fiona's parents were devastated with the news—that combination of shock, sadness, and uncertainty laid out on their faces and in their words. Through their tears, they also expressed hope—they told us Fiona would be a fighter.</p><p>Fiona did indeed fight and impressed us all with the speed of her recovery. Within a few weeks, she was well enough to go home. Fiona was 5 months old, and it was March 2020.</p><p>Fiona's family's life changed right as the world changed amidst the COVID-19 pandemic. Our first follow-up visit was one of my first virtual visits. Instead of that sick, pale baby lying on a bed, I was on screen with a smiling baby at home in a bouncer. We chatted about her health and the unpredictability of the future. There were so many practical matters to consider which changed the way I thought about her care—was it worth risking exposure to COVID to send her to the lab? She would benefit from therapies, but would it be safe to have those providers in the home?</p><p>At our visit when Fiona was 6 months of age, some of my own fears about her prognosis were dispelled. She was rolling! She laughed and she babbled. She loved playing with her big siblings. Aside from some mild delays, I would not have had any idea she was affected with a mitochondrial disease. At 15 months she was trying to crawl, and sometimes saying “mama.” At each visit, I shared in Fiona's mother's joy at her progress.</p><p>In May 2021 things took a turn for the worse. Fiona was <i>sick</i>; the sickest she had been since the hospital stay when we met. A choking episode led to aspiration, respir
她告诉我,菲奥娜入院时出现了一些病毒性症状,并且已经停止了呼吸。医护人员给她做了心脏按压,她的血液循环恢复了,但即使使用呼吸机,她的情况也不稳定。我想进去看看她吗?挂断电话后,我打开淋浴,尽快穿好衣服。我抱了抱 7 个月大的女儿,她冲我笑了笑;她不知道我正在为别人的孩子心碎。走到汽车旁时,我湿漉漉的头发冻住了,我含着泪水,忐忑不安地驱车前往医院。我到了 PICU 菲奥娜的病房,意识到--哦--现在是她的时候了。我拥抱了她的父母,然后走到一旁。病房里挤满了医生、护士、菲奥娜和她的父母,但却安静祥和。躺在病床上的菲奥娜看起来很平静。她的金发几乎长到了肩膀,蓝眼睛紧闭着。在短短两年零三个月的时间里,她已经褪去了婴儿圆润的脸颊,变成了一个瘦小的蹒跚学步的孩子。儿童生活专家轻轻地弹着木吉他,唱着菲奥娜最喜欢的歌曲。我清楚地记得,当护士准备为菲奥娜拔掉呼吸机时,我听到了凯蒂-佩里(Katy Perry)的《烟花》(Firework)的歌词:"你可曾觉得,就像一个塑料袋,在风中飘荡,想要重新开始?我想到了菲奥娜的一生,想到了她是如何成为自己的烟花--为每一个遇见她的人带来火花和光芒。她被母亲抱在怀里,看起来就像要躺下小睡一会儿。我们都目睹了菲奥娜咽下最后一口气的过程。她停止了呼吸,她的母亲发出了一声至今仍在我灵魂深处回荡的哭喊--痛苦、绝望和深不可测的失落。那一刻,我意识到作为一名医生,当我成为一名母亲时,我身上的某些东西发生了改变。我本以为,当我为人父母后,我会为家庭提供更多实用的建议,也会有更多与孩子相处的 "实践 "经验。但我没想到的是,我与这份工作之间的情感关系发生了变化,而我从事这份工作已经很多年了。我曾经目睹过死亡,但失去孩子的真正恐惧对我来说从未如此真实。现在,我在收到噩耗的父母身上看到了自己的影子;在我照顾的孩子身上,我看到了与我女儿相似之处。同理心被赋予了全新的意义,而这是我在女儿出生后第一次抱她时才知道的。在我的女儿们不断成长并经历菲奥娜从未经历过的事情时,我经常想起菲奥娜。我想起了菲奥娜的母亲--她的失落和坚强--尤其是在那些寒冷而明亮的冬日。根据我的经验,遗传学家并不总是谈论为人父母会如何改变我们对待工作的方式。从我感觉到腹部第一次踢动的那一刻起,我就期待着女儿的美好未来。然而在工作中,我可能不得不去告诉另一个家庭,他们的孩子永远学不会走路或说话,或者他们的孩子最终会失明。现在,当我看到父母的悲痛时,这些对话的感觉完全不同了,我比以往任何时候都更为他们感到悲痛。我理解产后睡眠不足和荷尔蒙剧烈波动给日常生活带来的挑战,但有些母亲在新生儿重症监护室的椅子上睡在患病婴儿身边时,却经历了那段动荡的时光。当父母带着孩子去看无数次医生和接受治疗时,我看到了他们的坚韧和奉献精神。为人父母以及在照顾菲奥娜的过程中,我加深了对他们的同情。我不确定病人或他们的家人是否会注意到这种不同,但当我在一天工作结束后带着他们的情绪、恐惧和希望回家时,我注意到了这一点。艾米莉-圣约翰-曼德尔的《十一号车站》的电视改编版中有一句话一直让我记忆犹新。其中一个角色,一位医生,告诉另一位医生这个职业需要什么--"见证死亡的勇气就是这份工作,就是在那里的勇气"。有时,我发现作为遗传学家,我们可以提供改变生命的治疗方法,但其他时候,我们是见证这些家庭的人,见证他们的痛苦,也见证他们的欢乐。我很庆幸,作为一名医生和一位母亲,我能够见证菲奥娜的生命,见证她在短暂的生命中带来的欢乐和火花。
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引用次数: 0
Parent Narratives Provide Perspectives on the Experience of Care in Trisomy 18 家长讲述 18 三体综合征患者的护理经历
IF 2.8 3区 医学 Q2 GENETICS & HEREDITY Pub Date : 2024-09-11 DOI: 10.1002/ajmg.c.32114
Ryann Bierer, Janessa Mladucky, Rebecca Anderson, John C. Carey

Trisomy 18 syndrome, also known as Edwards syndrome, is the second most common autosomal chromosome syndrome after Down syndrome. Trisomy 18 is a serious medical disorder due to the increased occurrence of structural defects, the high neonatal and infant mortality, and the disabilities observed in older children. Interventions, including cardiac surgery, remain controversial, and the traditional approach is to pursue pure comfort care. While the medical challenges have been well-characterized, there are scant data on the parental views and perspective of the lived experience of rearing a child with trisomy 18. Knowledge of the parental viewpoints can help clinicians guide families through decision-making. Our aim was to identify parents' perspectives by analyzing a series of narratives. In this qualitative study, we collected 46 parent narratives at the 2015 and 2016 conferences of the Support Organization for Trisomy 18 & 13 (SOFT). The participants were asked to “Tell us a story about your experience.” Inductive content analysis and close reading were used to identify themes from the stories. Dedoose, a web-based application to analyze qualitative data, was used to code themes more systematically. Of the identified themes, the most common included Impact of trisomy 18 diagnosis and Surpassing expectations. Other themes included Support from professionals, A child, not a diagnosis, and Trust/lack of trust. We examined the voice and the perspectives of the parents in their challenges in caring for their children with this life-limiting condition. The exploration of the themes can ideally guide clinicians in their approach to the counseling and care of the child in a shared decision-making approach.

18 三体综合征又称爱德华兹综合征,是仅次于唐氏综合征的第二大常见常染色体综合征。18 三体综合征是一种严重的内科疾病,因为其结构缺陷的发生率较高,新生儿和婴儿死亡率较高,年长儿童还会出现残疾。包括心脏手术在内的干预措施仍存在争议,传统的方法是追求纯粹的舒适护理。虽然医疗方面的挑战已被充分描述,但有关养育 18 三体综合征患儿的父母观点和生活经历的数据却很少。了解父母的观点有助于临床医生指导家庭做出决策。我们的目的是通过分析一系列叙述来确定父母的观点。在这项定性研究中,我们收集了 46 位家长在 2015 年和 2016 年 "18 三体综合征& 13 支持组织"(SOFT)会议上的叙述。参与者被要求 "告诉我们一个关于你经历的故事"。我们采用归纳式内容分析和精读法来确定故事的主题。Dedoose 是一款用于分析定性数据的网络应用程序,用于更系统地对主题进行编码。在确定的主题中,最常见的包括 18 三体综合征诊断的影响和超越期望。其他主题包括来自专业人士的支持、一个孩子,而不是一个诊断,以及信任/缺乏信任。我们研究了父母在照顾患有这种限制性疾病的孩子时所面临的挑战,了解了他们的心声和观点。对这些主题的探讨可以理想地指导临床医生以共同决策的方式为患儿提供咨询和护理。
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引用次数: 0
First a Provider, Now a Patient: Receiving a Devastating Diagnosis Through the Patient Portal 先是医护人员,后是患者:通过患者门户网站接受毁灭性诊断
IF 2.8 3区 医学 Q2 GENETICS & HEREDITY Pub Date : 2024-09-11 DOI: 10.1002/ajmg.c.32113
Alexandra C. Keefe
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引用次数: 0
Perspectives and Insights Into Phenylketonuria: Provider Narratives About the Early Years Following Newborn Screening 对苯丙酮尿症的看法和见解:提供者讲述新生儿筛查后的最初几年。
IF 2.8 3区 医学 Q2 GENETICS & HEREDITY Pub Date : 2024-09-09 DOI: 10.1002/ajmg.c.32111
Suzanne Hollander, Harvey Levy, Fran Rohr, Susan Waisbren, Priscila Rincon, Ann Wessel, Stephanie Sacharow

The understanding of phenylketonuria (PKU), guidelines, and treatment landscape have evolved dramatically over the decades since newborn screen implementation. We capture this rich history from the stories and experiences of a multidisciplinary provider team from Boston Children's Hospital's PKU Clinic, who treated PKU from the early years of newborn screening and who worked together for over 40 years.

自新生儿筛查实施以来的几十年间,人们对苯丙酮尿症(PKU)的认识、指南和治疗方法都发生了巨大的变化。我们从波士顿儿童医院 PKU 诊所多学科医疗团队的故事和经验中捕捉到了这段丰富的历史,他们在新生儿筛查初期就开始治疗 PKU,并一起工作了 40 多年。
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引用次数: 0
Shattered Dreams: Reflections on Loss and Resilience 破碎的梦想关于失去和复原的思考》。
IF 2.8 3区 医学 Q2 GENETICS & HEREDITY Pub Date : 2024-09-05 DOI: 10.1002/ajmg.c.32112
Taylor Kerrins
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引用次数: 0
Significance of Variants of Uncertain Significance: The Human Cost of Genetic Uncertainty 意义不明的变异基因的意义:遗传不确定性的人类代价》。
IF 2.8 3区 医学 Q2 GENETICS & HEREDITY Pub Date : 2024-08-31 DOI: 10.1002/ajmg.c.32109
Damla Gonullu-Rotman

This piece narrates the journey of Maria (name of the mother has been altered to protect the family's privacy), a new mother confronting her newborn's unexpected diagnosis of very long chain acyl-CoA dehydrogenase (VLCAD) deficiency, despite undergoing proactive genetic carrier screening within a consanguineous marriage. It highlights the emotional and systemic challenges arising from the lack of diversity in genetic databases, which, in this case, failed to detect pathogenic variants in Maria and her husband. Maria's story sheds light on situations where a masked variant of uncertain significance (VUS) necessitates consultation with a trained genetics specialist and underscores the urgent need for a more equitable healthcare system.

这篇报道讲述了玛丽亚(为保护家庭隐私,母亲的姓名有改动)的心路历程。她是一位新手母亲,尽管在近亲结婚中接受了积极的基因携带者筛查,但她的新生儿还是被意外诊断为超长链酰基-CoA 脱氢酶(VLCAD)缺乏症。在这个案例中,基因数据库未能检测出玛丽亚及其丈夫的致病变体,这凸显了基因数据库缺乏多样性所带来的情感和系统性挑战。玛丽亚的故事揭示了被掩盖的不确定意义变异体(VUS)需要向训练有素的遗传学专家咨询的情况,并强调了建立一个更加公平的医疗保健系统的迫切需要。
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引用次数: 0
Circles 圆圈
IF 2.8 3区 医学 Q2 GENETICS & HEREDITY Pub Date : 2024-08-31 DOI: 10.1002/ajmg.c.32105
Victoria Mok Siu, Jennifer Michelle Siu
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引用次数: 0
Blonde hair, blue eyes 金发碧眼
IF 2.8 3区 医学 Q2 GENETICS & HEREDITY Pub Date : 2024-08-21 DOI: 10.1002/ajmg.c.32106
Elizabeth K. Baker MD
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引用次数: 0
期刊
American Journal of Medical Genetics Part C: Seminars in Medical Genetics
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