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Among neonatal cardiomyopathies, primary endocardial fibroelastosis (pEFE) remains a mysterious disease of the endomyocardium that is poorly genetically characterized, affecting 1/5000 live births and accounting for 25% of the entire pediatric dilated cardiomyopathy (DCM) with a devastating course and grave prognosis. To investigate the potential genetic contribution to pEFE, we performed integrative genomic analysis, using whole exome sequencing (WES) and RNA-seq in a female infant with confirmed pathological diagnosis of pEFE. Within regions of homozygosity in the proband genome, WES analysis revealed novel parent-transmitted homozygous mutations affecting three genes with known roles in cilia assembly or function. Among them, a novel homozygous variant [c.1943delA] of uncertain significance in ALMS1 was prioritized for functional genomic and mechanistic analysis. Loss of function mutations of ALMS1 have been implicated in Alstrom syndrome (AS) [OMIM 203800], a rare recessive ciliopathy that has been associated with cardiomyopathy. The variant of interest results in a frameshift introducing a premature stop codon. RNA-seq of the proband's dermal fibroblasts confirmed the impact of the novel ALMS1 variant on RNA-seq reads and revealed dysregulated cellular signaling and function, including the induction of epithelial mesenchymal transition (EMT) and activation of TGFβ signaling. ALMS1 loss enhanced cellular migration in patient fibroblasts as well as neonatal cardiac fibroblasts, while ALMS1-depleted cardiomyocytes exhibited enhanced proliferation activity. Herein, we present the unique pathological features of pEFE compared to DCM and utilize integrated genomic analysis to elucidate the molecular impact of a novel mutation in ALMS1 gene in an AS case. Our report provides insights into pEFE etiology and suggests, for the first time to our knowledge, ciliopathy as a potential underlying mechanism for this poorly understood and incurable form of neonatal cardiomyopathy. KEY MESSAGE: Primary endocardial fibroelastosis (pEFE) is a rare form of neonatal cardiomyopathy that occurs in 1/5000 live births with significant consequences but unknown etiology. Integrated genomics analysis (whole exome sequencing and RNA sequencing) elucidates novel genetic contribution to pEFE etiology. In this case, the cardiac manifestation in Alstrom syndrome is pEFE. To our knowledge, this report provides the first evidence linking ciliopathy to pEFE etiology. Infants with pEFE should be examined for syndromic features of Alstrom syndrome. Our findings lead to a better understanding of the molecular mechanisms of pEFE, paving the way to potential diagnostic and therapeutic applications.

BackgroundMales and females are known to have varied responses to medical interventions. Our study aimed to determine the effect of sex on surgical outcomes after pyloromyotomy.Materials and methodsUsing the Kids' Inpatient Database for the years 2003-2012, we performed a serial, cross-sectional analysis of a nationally representative sample of all patients aged

SUNDIALS is a suite of advanced computational codes for solving large-scale problems that can be modeled as a system of nonlinear algebraic equations, or as initial-value problems in ordinary differential or differential-algebraic equations. The basic versions of these codes are called KINSOL, CVODE, and IDA, respectively. The codes are written in ANSI standard C and are suitable for either serial or parallel machine environments. Common and notable features of these codes include inexact Newton-Krylov methods for solving large-scale nonlinear systems; linear multistep methods for time-dependent problems; a highly modular structure to allow incorporation of different preconditioning and/or linear solver methods; and clear interfaces allowing for users to provide their own data structures underneath the solvers. We describe the current capabilities of the codes, along with some of the algorithms and heuristics used to achieve efficiency and robustness. We also describe how the codes stem from previous and widely used Fortran 77 solvers, and how the codes have been augmented with forward and adjoint methods for carrying out first-order sensitivity analysis with respect to model parameters or initial conditions. Categories and Subject Descriptors: G.4 [Mathematical Software]; G.1.7 [Numerical Analysis]: Ordinary Differential Equations--Differential-algebraic equations; multistep and multivalue methods; stiff equations; G.1.5 [Numerical Analysis]: Roots of Nonlinear Equations--Iterative methods; convergence General Terms: Algorithms, Design Additional Key Words and Phrases: ODEs, DAEs, nonlinear systems, sensitivity analysis