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Fulltext Genetic Variations Associated with Non-Syndromic Cleft Lip and Palate in Malays with Whole Exome Sequencing: Case Report and Gene Review

Nurul Syazana Mohamad Shah, Sarina Sulong, Wan Azman Wan Sulaiman, Ahmad Sukari Halim

Malaysian Journal of Human Genetics, 2020;1(1):35-44.
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Introduction: Exome sequencing technology which is part of Next Generation Sequencing (NGS) is known for detection of various disease mutations through commercially available platforms. Less reports in identifying genetic variation in non-syndromic cleft lip with or without cleft palate (NSCL/P) in Malaysia had embarked for discovery of susceptible genes to fill in the gaps with the healthcare delivery for a better treatment and management to the patients and family. Methods: Whole exome sequencing was carried out on two Malay NSCLP patients. Blood samples were withdrawn and intact DNA was extracted, fragmented, purified and hybridized using exome sequencing capture and sequenced with Agilent 2100 Bioanalyzer platform. Bioinformatic analyses were done and reviewed with GenBank and PubMed database. Variants were filtered based upon a high impact variant. Results: We have identified single nucleotide polymorphisms in 2 genes (PDE4DIP and PDE11A) and InDels frameshift mutations in 4 genes (PDE4DIP, LTBP4, MMP12 and MMP28). Our preliminary study presents the successful application of whole exome sequencing to elucidate the genetic basis of NSCLP in Malays. Conclusion: Mutations that have been identified would shed more light on the susceptible genes to non-syndromic clefts and further investigation shall be carried out to confirm.
Long-term outcome of free fibula osteocutaneous flap and massive allograft in the reconstruction of long bone defect

Halim AS, Chai SC, Wan Ismail WF, Wan Azman WS, Mat Saad AZ, Wan Z

J Plast Reconstr Aesthet Surg, 2015 Dec;68(12):1755-62.
PMID: 26420474 DOI: 10.1016/j.bjps.2015.08.013

Reconstruction of massive bone defects in bone tumors with allografts has been shown to have significant complications including infection, delayed or nonunion of allograft, and allograft fracture. Resection compounded with soft tissue defects requires skin coverage. A composite osteocutaneous free fibula offers an optimal solution where the allografts can be augmented mechanically and achieve biological incorporation. Following resection, the cutaneous component of the free osteocutaneous fibula flaps covers the massive soft tissue defect. In this retrospective study, the long-term outcome of 12 patients, who underwent single-stage limb reconstruction with massive allograft and free fibula osteocutaneous flaps instead of free fibula osteal flaps only, was evaluated. This study included 12 consecutive patients who had primary bone tumors and had follow-up for a minimum of 24 months. The mean age at the time of surgery was 19.8 years. A total of eight patients had primary malignant bone tumors (five osteosarcomas, two chondrosarcomas and one synovial sarcoma), and four patients had benign bone tumors (two giant-cell tumors, one aneurysmal bone cyst, and one neurofibromatosis). The mean follow-up for the 12 patients was 63 months (range 24-124 months). Out of the 10 patients, nine underwent lower-limb reconstruction and ambulated with partial weight bearing and full weight bearing at an average of 4.2 months and 8.2 months, respectively. In conclusion, augmentation of a massive allograft with free fibula osteocutaneous flap is an excellent alternative for reducing the long-term complication of massive allograft and concurrently addresses the soft tissue coverage.
Prognostic factors and survival rate of osteosarcoma: A single-institution study

Faisham WI, Mat Saad AZ, Alsaigh LN, Nor Azman MZ, Kamarul Imran M, Biswal BM, et al.

Asia Pac J Clin Oncol, 2017 Apr;13(2):e104-e110.
PMID: 25870979 DOI: 10.1111/ajco.12346

AIM: Osteosarcoma is a highly malignant primary bone tumor. The study aim to evaluate the prognostic factors influencing the survival rate in our center.
METHODS: This was a retrospective cohort study of all patients treated between January 2005 and December 2010.
RESULTS: We included 163 patients with an age range of 6-59 years (median = 19). The median follow-up was 47 months (range 36-84). The overall survival in patients who completed chemotherapy and surgery (n = 117) was 72% at 2 years and 44% at 5 years. Histologically, 99 (85%) had osteoblastic, 6 (5%) had chondroblastic and 3 (2.5%) had telangiectatic osteosarcoma. Limb salvage surgery was performed in 80 (49%) and 41 (25%) underwent amputation. However, 46 patients (28%) underwent no surgical intervention and incomplete chemotherapy. In total, 38/79 patients had a good chemotherapy response. There was a significantly better survival rate for limb salvage versus amputation. Independent prognostic factors for survival are compliance to treatment and presence of lung metastasis.
CONCLUSION: The overall survival of osteosarcoma patients was influenced by the presence of pulmonary metastases and compliance to treatment. Histological subtype, different chemotherapy regimens and histological necrosis after chemotherapy did not significantly influence survival. The patients who did not complete treatment had significantly poorer survival.

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