scholarly journals A Comparative Study between Lateral Approach Alone and Combination of Medial and Lateral Approaches for Intra-Articular Calcaneal Fractures with Displaced Sustentaculum Fragment

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Naohiro Hio ◽  
Masanori Taki
Keyword(s):  
Comparative Study ◽  
Inclination Angle ◽  
Subtalar Joint ◽  
Lateral Approach ◽  
Joint Surface ◽  
Calcaneal Fractures ◽  
Significant Difference ◽  
The Mean ◽  
Type 3

Category: Hindfoot; Trauma Introduction/Purpose: In intra-articular calcaneal fractures, the sustentaculum fragment, which is the reference for reduction, often undergoes varus plantar flexion displacement and requires accurate reduction. Although the lateral approach is generally used as a surgical approach, it is considered that the use of the combination of medial and lateral approaches can achieve more accurate reduction. Here we report a comparative study of between the group with the lateral approach alone (L-group) and the group with the combination of the medial and lateral approaches (ML-group) for calcaneal fractures with displacement of sustentaculum fragment. Methods: L-group included 11 feet, six feet of which were categorized as Sanders classification type 2, four as type 3, one as type 4. ML-group included 14 feet, ten as type 2, two as type 3, two as type 4. In both groups, small incision such as sinus tarsi approach were used for lateral approach and screws and/or plates were used for fixation. We assessed Creighton-Nebraska scale, pre- and postoperative width and height of the calcaneal body, step of subtalar joint surface and inclination angle of the sustentaculum fragment. Results: The mean postoperative clinical evaluation for the L-group / ML-group was 90.5+-7.9 points / 87.2+-9.6 points respectively. The pre- and postoperative image assessments showed improvements in the mean width from 123.4+-15.3% to 110.3+-14.1% / 129.9+-23.1% to 109.9+-14.1%, in the mean height from 88.1+-5.2% to 98.1+-3.7% / 86.0+-9.6% to 95.4+-5.9%, in the step of subtalar joint surface from 9.0+-6.3mm to 0.9+-1.1mm / 10.0+-8.0mm to 0.7+-1.0mm, and in the inclination angle of sustentaculum fragment from 10.3+-5.1 ° to 5.5+-5.0 ° / 12.1+-7.5 ° to 0.5+-1.0 °, respectively. There was a significant difference between the two groups in the inclination angle of the sustentaculum fragment, but no significant difference was observed in the other assessments. Complications were more common with ML-group. Conclusion: Displacement of the sustentaculum fragment in calcaneal fractures can be more reduced accurately by using the combination of medial and lateral approaches, although there is no significant difference in clinical results.

scholarly journals Comparison of Shade of Ceramic with Three Different Zirconia Substructures using Spectrophotometer

2015 ◽  
Vol 16 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Syed Rashid Habib ◽  
Ibraheem F Al Shiddi
Keyword(s):  
Maximum Difference ◽  
Mean Values ◽  
Tukey Test ◽  
Ceramic Color ◽  
Significant Difference ◽  
Grand Rapids ◽  
All Ceramic ◽  
The Mean ◽  
Type 3

ABSTRACT Objective This study assessed how changing the Zirconia (Zr) substructure affected the color samples after they have been overlaid by the same shade of veneering ceramic. Materials and methods Three commercial Zr materials were tested in this study: Prettau® Zirconia (ZirKonZahn, Italy), Cercon (Dentsply, Germany) and InCoris ZI (Sirona, Germany). For each system, 15 disk-shaped specimens (10 × 1 mm) were fabricated. Three shades of A1, A2 and A3.5 of porcelain (IPS e.MaxCeram, IvoclarVivadent, USA) were used for layering the specimens. Five specimens from each type of Zr were layered with same shade of ceramic. Color measurements were recorderd by a spectrophotometer Color-Eye® 7000A (X-Rite, Grand Rapids, MI). Mean values of L, a, b color coordinates and ?E were recorded and comparisons were made. Results Differences in the ΔE were recorded for the same porcelain shade with different Zr substructures and affected the color of the specimens (p < 0.01, ANOVA). The maximum difference between the ΔE values for the A1, A2 and A3.5 shades with three types of Zr substructures was found to be 1.59, 1.69 and 1.45 respectively. Multiple comparisons of the ΔE with PostHoc Tukey test revealed a statistically significant difference (p < 0.05) between the three types of Zr, except between Type 2 Zr and Type 3 Zr for the Shade A1. The mean values of L, a, b and ΔE for the Prettau® Zirconia substructure were found to be the least among the three types. Conclusions The brand of Zr used influences the final color of the all ceramic Zr based restorations and this has clinical significance. How to cite this article Habib SR, Al Shiddi IF. Comparison of Shade of Ceramic with Three Different Zirconia Substructures using Spectrophotometer. J Contemp Dent Pract 2015;16(2): 135-140.

Randomized comparative study between extensile lateral and sinus tarsi approaches for the treatment of Sanders type 2 calcaneal fracture

2021 ◽  
pp. 1-8
Author(s):  
Chul Hyun Park ◽  
Hongfei Yan ◽  
Jeongjin Park
Keyword(s):  
Comparative Study ◽  
Subtalar Joint ◽  
Short Form ◽  
Operation Time ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Aofas Score ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach

Aims No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. Methods Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of movement (ROM), Böhler’s angle and calcaneal width, and posterior facet reduction. Results Although four patients (12.5%) in the ELA groups and none in the STA group experienced complications, the difference was not statistically significant (p = 0.113). VAS and AOFAS score were significantly better in the STA group than in the ELA group at six months (p = 0.017 and p = 0.021), but not at 12 months (p = 0.096 and p = 0.200) after surgery. The operation time was significantly shorter in the STA group than in the ELA group (p < 0.001). The subtalar joint ROM was significantly better in the STA group (p = 0.015). Assessment of the amount of postoperative reduction compared with the uninjured limb showed significant restoration of calcaneal width in the ELA group compared with that in the STA group (p < 0.001). Conclusion The ELA group showed higher frequency of wound complications than the STA group for Sanders type 2 calcaneal fractures even though this was not statistically significant.

scholarly journals Computed Tomography Analysis of the Ethmoid Roof: A Region at Risk in Endoscopic Sinus Injury

2019 ◽  
Vol 19 (2) ◽  
pp. 108-115
Author(s):  
Pra Urusopone
Keyword(s):  
Computed Tomography ◽  
Facial Bones ◽  
Significant Difference ◽  
The Mean ◽  
Type 3 ◽  
Tomography Analysis

Objective: To determine the olfactory fossa depth according to the Keros classification and determine the incidence of asymmetry in height and configuration of the ethmoid roof. Materials and Methods: Retrospective analysis of 75 coronal computed tomography studies of paranasal sinuses and facial bones were performed. Measurement of the depth of the lateral lamella, classification of the depth according to Keros type and determination of the asymmetries in the ethmoid roof depth and configuration were done. Results: The mean height of the lateral lamella cribiform plate (LLCP) was 2.15+1.29 mm. The cases were classified as 87.33% Keros type1 and 12.67 % as Keros type 2. No Keros type 3 was found .There was asymmetry in the LLCP height of 33.33% of cases and a configuration asymmetry in 8% of the cases. No significant difference between the mean height and distribution of Keros type between gender and laterality were also found. Conclusion: As regards the olfactory fossa depth, the Keros type 1 was most frequently found. Asymmetry in the depth and configuration were detected in 33.33 and 8% respectively. Risk of inadvertent intracranial entry through the lateral lamella among Thai may be lower than other studies with majority of cases classified as Keros type 2 or 3.

scholarly journals Repair Integrity and Functional Outcomes Between Knot-Tying and Knotless Suture-Bridge Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110024
Author(s):  
Koray Şahin ◽  
Fatih Şentürk ◽  
Mehmet Ersin ◽  
Ufuk Arzu ◽  
Mechmet Chodza ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Constant Score ◽  
Knot Tying ◽  
Suture Bridge ◽  
Significant Difference ◽  
The Mean ◽  
Group 2 ◽  
Cuff Repair ◽  
Group 1

Background: Knot-tying suture-bridge (SB) rotator cuff repair may compromise the vascularity of the repaired tendon, causing tendon strangulation and medial repair failure. The knotless SB repair technique has been proposed to overcome this possibility and decrease retear rates. Purpose: To compare clinical and structural outcomes and retear patterns between the knot-tying and knotless SB techniques. We hypothesized that the knotless technique would result in lower retear rates owing to the preservation of intratendinous vascularity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 104 patients with full-thickness rotator cuff tears were randomly and prospectively allocated to undergo knot-tying (group 1) or knotless (group 2) SB repair. Clinical outcome measures included range of motion, the visual analog scale (VAS) for pain, and the Constant score for function. Repair integrity was evaluated on magnetic resonance imaging scans using the Sugaya classification. Retears were also classified according to their pattern as type 1 (lateral) or type 2 (medial). Results: Overall, 88 patients (group 1: n = 42 [mean ± SD age, 54.3 ± 9.8 years]; group 2: n = 46 [mean ± SD age, 55.8 ± 8.2 years]) were included in the final analysis. The mean ± SD follow-up period was 25.4 ± 8.3 and 23.3 ± 7.2 months for groups 1 and 2, respectively. From preoperatively to postoperatively, the mean VAS pain score improved significantly in both groups (group 1: from 7.4 ± 1.7 to 1.0 ± 1.7; group 2: from 7.1 ± 1.9 to 1.3 ± 2.0; P < .0001 for both), as did the mean ± SD Constant score (group 1: from 51.7 ± 13.4 to 86.0 ± 11.5; group 2: from 49.4 ± 18.4 to 87.2 ± 14.8; P < .0001 for both). There was no significant difference between the groups for the postoperative VAS or Constant score. The retear rate was not significantly different between the groups (19.0% [8/42] in group 1 and 28.3% [13/46] in group 2; P > .05). There was a significant difference in the type 2 failure rate (75.0% [6/8] in group 1 and 23.1% [3/13] in group 2; P = .03). Conclusion: Both techniques showed excellent improvement and comparable clinical outcomes, and there was no significant difference in retear rates. Consistent with previously published data, the type 2 failure rate was significantly higher with the knot-tying technique. Registration: NCT03982108 ( ClinicalTrials.gov identifier).

A Comparative Study of Endoscopic Coblation Adenoidectomy and Regular Curettage Adenoidectomy in a Tertiary Care Hospital in Kerala

2021 ◽  
Vol 8 (41) ◽  
pp. 3559-3566
Author(s):  
Abdul Salam R. T. ◽  
Shahul Hameed A. ◽  
Meera Rajan
Keyword(s):  
Blood Loss ◽  
Comparative Study ◽  
Tertiary Care ◽  
Operation Time ◽  
Care Hospital ◽  
Adenoid Tissue ◽  
Significant Difference ◽  
Tube Function ◽  
Prospective Comparative Study ◽  
The Mean

BACKGROUND An ideal surgery to remove hypertrophied adenoid mass should be safe, with less bleeding and operation time along with post-operative improvement in the eustachian tubal ventilation and normal respiration. It should also have low morbidity and mortality. Among the various methods described for its removal, the two commonly used methods are conventional cold curettage method and coblation technique. The purpose of this study was to collate the safety and efficacy of endoscopic coblation adenoidectomy with the conventional curettage adenoidectomy. METHODS A prospective comparative study with fifty patients was studied who underwent adenoidectomy. Twenty five patients underwent endoscopy assisted coblation adenoidectomy and twenty five patients underwent regular adenoidectomy by curettage. RESULTS Patients who underwent coblation adenoidectomy showed better results during follow up in terms of completeness of removal. 80 % of children undergoing regular adenoidectomy by curettage method showed remnant adenoid tissue in the nasopharynx at the end of the procedure. But it was 6 % among the children undergoing endoscopic assisted coblation adenoidectomy. The mean duration of operation was higher for endoscopic assisted coblation adenoidectomy which was significant statistically. The mean blood loss was 30.36 ml in regular curettage adenoidectomy; 10.6 ml with endoscopic coblation adenoidectomy. The grading of pain was significantly lower in endoscopic assisted coblation adenoidectomy. There was no significant difference between two groups in terms of eustachian tube function after surgery. CONCLUSIONS Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of completeness of removal, reduced blood loss, and lower post-operative pain grade. KEYWORDS Coblation, Adenoidectomy, Curettage, Haemorrhage and Complications

A comparative study on the nursery culture of hatchery-reared sub-adult cupped oyster, Crassostrea iredalei (Faustino, 1932), in an earthen pond and a mangrove canal

2018 ◽  
Vol 26 (4) ◽  
pp. 217-222
Author(s):  
Premwadee Chueachat ◽  
Woraporn Tarangkoon ◽  
Suwat Tanyaros
Keyword(s):  
Growth Rate ◽  
Comparative Study ◽  
Condition Index ◽  
Daily Growth ◽  
Nursery Culture ◽  
Absolute Growth Rate ◽  
Significant Difference ◽  
Adult Oyster ◽  
Absolute Growth ◽  
The Mean

Abstract A comparative study on the nursery culture of the spat of the tropical oyster, Crassostrea iredalei, in an earthen pond and a mangrove canal was conducted over two months. The results revealed no differences in the absolute growth rate determined by shell width between the two culture sites (P < 0.05). Sub-adult oysters cultured in the mangrove canal showed a higher absolute growth rate in shell length and a higher daily growth rate than the oysters cultured in the earthen pond (P < 0.05). The mean survival rate of sub-adult oysters cultured in the earthen pond (99.8 ± 0.2%) was significantly higher than for those cultured in the mangrove canal (66.7 ± 31.4%). Decreased density from the loss of sub-adult oyster nursery culture in the mangrove canal led to higher growth performance than in the earthen pond. However, no difference was found for the fraction of oysters larger or smaller than 5 cm for the two culture sites (P < 0.05). A significant difference was noted in the Condition Index (CI) between the two culture sites (P < 0.05). The high primary productivity in mangroves is a major supporter of higher CI in sub-adult oysters cultured in mangrove canals versus in earthen ponds. Water exchange in the earthen pond to maintain calcium and magnesium concentrations resulted in no differences in the shell compressibility of sub-adult oysters compared with those cultured in the mangrove canal.

scholarly journals Evaluating the Subtalar Joint in Tibiotalocalcaneal Nail

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0040
Author(s):  
Megan Reilly ◽  
Kurosh Darvish ◽  
Soroush Assari ◽  
John Cole ◽  
Tyler Wilps ◽  
...  
Keyword(s):  
Surface Area ◽  
Subtalar Joint ◽  
Articular Surface ◽  
Joint Surface ◽  
Central Dome ◽  
Below The Knee ◽  
Joint Surfaces ◽  
Circular Surface ◽  
The Mean ◽  
Pass Through

Category: Hindfoot Introduction/Purpose: In tibiotalocalcaneal nails for arthrodesis, the path of the nail through the subtalar joint has not been well documented. Ideally, the defect caused by reaming and the nail does not pass through the joint surface so that the amount of bony contact between the talus and calcaneus is maintained in order to optimize fusion. Our hypothesis is that the TTC nail does not destroy a significant amount contact area between the talus and calcaneus. However, using larger diameter nails (which are inherently stronger) will have more of an effect on the contact surface. Methods: Five cadaveric below the knee specimens were obtained. The ankle was disarticulated on each specimen. Subsequently, a guidepin was drilled from the central dome of the talus down to the calcaneus. The 11 mm reamer was then passed over the guidepin through the calcaneus to simulate retrograde reaming of a TTC nail. Then, the subtalar joint was dissected open and the articular surface was documented in comparison with the area that was reamed out. Measurements were then made, using software that calculated two dimensional surface area to determine the percentage of actual subtalar joint area that was reamed out. The mean percentage of articular area that was removed with the reamer was then calculated. Results: Among the five specimens, in the calcaneus, the mean total articular area was 599mm2±113 and the mean drilled articular area was 21mm2±16. The percentage of the calcaneal articular surface that was removed with the reamer was 3.4%±1.9. In the talus, the mean total articular area was 782mm2±130 and the mean drilled articular area was 39mm2±18. The percentage of the talar articular surface that was removed with the reamer was 5.0%±2.3. Additionally, an 11 mm reamer makes a circular surface area of 95mm2, and the statistics above indicate that a significant portion of the reamed area is nonarticular, within the calcaneal sulcus or the talar sulcus. Conclusion: In a tibiotalocalcaneal nail the subtalar joint is typically incompletely visualized, however this anatomic study demonstrates that the 11 mm reamer eliminates about 3.4% of the calcaneal articular surface and about 5% of the talar articular surface. Therefore, the majority of the articular surface is left intact, which is ideal in optimizing arthrodesis outcomes. Furthermore, this study could extrapolate the effects of a larger nail on the availability of joint surface. It could also be used to argue for cartilage stripping of the affected joint surfaces in arthrodesis preparation, because the majority of the articular surface is, in fact, left intact.

scholarly journals Modified approach to the characterization of adrenal nodules using a standard abdominal magnetic resonance imaging protocol

2017 ◽  
Vol 50 (1) ◽  
pp. 19-25 ◽  
Author(s):  
António P. Matos ◽  
Richard C. Semelka ◽  
Vasco Herédia ◽  
Mamdoh AlObaidiy ◽  
Filipe Veloso Gomes ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Imaging Protocol ◽  
Intensity Index ◽  
Abdominal Magnetic Resonance Imaging ◽  
Phase Type ◽  
The Mean ◽  
Magnetic Resonance Imaging Protocol ◽  
Type 3

Abstract Objective: To describe a modified approach to the evaluation of adrenal nodules using a standard abdominal magnetic resonance imaging protocol. Materials and Methods: Our sample comprised 149 subjects (collectively presenting with 132 adenomas and 40 nonadenomas). The adrenal signal intensity index was calculated. Lesions were grouped by pattern of enhancement (PE), according to the phase during which the wash-in peaked: arterial phase (type 1 PE); portal venous phase (type 2 PE); and interstitial phase (type 3 PE). The relative and absolute wash-out values were calculated. To test for mean differences between adenomas and nonadenomas, Student's t-tests were used. Receiver operating characteristic curve analysis was also performed. Results: The mean adrenal signal intensity index was significantly higher for the adenomas than for the nonadenomas (p < 0.0001). Chemical shift imaging showed a sensitivity and specificity of 94.4% and 100%, respectively, for differentiating adenomas from nonadenomas. Of the adenomas, 47.6%, 48.5%, and 3.9%, respectively, exhibited type 1, 2, and 3 PEs. For the mean wash-in proportions, significant differences were found among the enhancement patterns. The wash-out calculations revealed a trend toward better lesion differentiation for lesions exhibiting a type 1 PE, showing a sensitivity and specificity of 71.4% and 80.0%, respectively, when the absolute values were referenced, as well as for lesions exhibiting a type 2 PE, showing a sensitivity and specificity of 68.0% and 100%, respectively, when the relative values were referenced. The calculated probability of a lipid-poor lesion that exhibited a type 3 PE being a nonadenoma was > 99%. Conclusion: Subgrouping dynamic enhancement patterns yields high diagnostic accuracy in differentiating adenomas from nonadenomas.

scholarly journals Serum Selenium Status in Patients with Type 2 Diabetes and Control Group

2016 ◽  
Vol 9 (5) ◽  
pp. 234
Author(s):  
Zahra Heidari ◽  
Zahra Sepehri ◽  
Aleme Doostdar
Keyword(s):  
Type 2 Diabetes ◽  
Serum Level ◽  
Control Group ◽  
Diabetic Patients ◽  
Diabetes Incidence ◽  
Serum Selenium ◽  
Type 2 Diabetic Patients ◽  
Significant Difference ◽  
The Mean

<p>In addition to known risk factors, the role of different micronutrients such as selenium in diabetes incidence has been proposed. Some previous studies have shown an association of selenium deficiency and type 2 diabetes mellitus, while other studies have not confirmed such a relationship. The aim of this study was to evaluate serum level of selenium in patients with Type 2 diabetes compared with the control group. This cross-sectional study was carried out on patients with type 2 diabetes in Zahedan, southeastern Iran. One hundred newly diagnosed type 2 diabetic patients were evaluated for serum selenium level. One hundred subjects from the general population who had normal fasting blood sugar levels were selected as the control group. The control group subjects were matched in pairs with each of patients on the basis of sex, age (± one year), and body mass index (±1). Serum level of selenium was determined by spectrometry method. Results were compared using t-test. The mean serum level of selenium in patients was 94.47±18.07 µg/L whereas in control group was 142.79±23.67 µg/L. The mean serum level of selenium was significantly different between the two groups (P&lt;0.001). Serum levels of selenium in diabetic patients with significant difference statistically were lower than the control group. In order to evaluate serum level of selenium in patients with diabetes, studies with larger sample size are required. Likewise, prospective studies along with selenium supplementation and investigating its effect on incidence of diabetes are accordingly needed.</p>

scholarly journals CNNM2-Related Disorders: Phenotype and Its Severity Were Associated With the Mode of Inheritance

2021 ◽  
Vol 9 ◽  
Author(s):  
Han Zhang ◽  
Ye Wu ◽  
Yuwu Jiang
Keyword(s):  
De Novo ◽  
Serum Magnesium ◽  
Brain Magnetic Resonance Imaging ◽  
Functional Studies ◽  
Pathogenic Variants ◽  
Significant Difference ◽  
Domain Variations ◽  
Type 3

CNNM2 (Cystathionine-β-synthase-pair Domain Divalent Metal Cation Transport Mediator 2) pathogenic variants have been reported to cause hypomagnesemia, epilepsy, and intellectual disability/developmental delay (ID/DD). We identified two new cases with CNNM2 novel de novo pathogenic variants, c.814T&gt;C and c.976G&gt;C. They both presented with infantile-onset epilepsy with DD and hypomagnesemia refractory to magnesium supplementation. To date, 21 cases with CNNM2-related disorders have been reported. We combined all 23 cases to analyze the features of CNNM2-related disorders. The phenotypes can be classified into three types: type 1, autosomal dominant (AD) inherited simple hypomagnesemia; type 2, AD inherited hypomagnesemia with epilepsy and ID/DD; and type 3, autosomal recessive (AR) inherited hypomagnesemia with epilepsy and ID/DD. All five type 1 cases had no epilepsy or ID/DD; they all had hypomagnesemia, and three of them presented with symptoms secondary to hypomagnesemia. Fifteen type 2 patients could have ID/DD and seizures, which can be controlled with antiseizure medications (ASMs); their variations clustered in the DUF21 domain of CNNM2. All three type 3 patients had seizures from 1 to 6 days after birth; the seizures were refractory, and 1/3 had status epilepticus; ID/DD in these AR-inherited cases was more severe than that of AD-inherited cases; they all had abnormalities of brain magnetic resonance imaging (MRI). Except for one patient whose serum magnesium was the lower limit of normal, others had definite hypomagnesemia. Hypomagnesemia could be improved after magnesium supplement but could not return to the normal level. Variations in the CBS2 domain may be related to lower serum magnesium. However, there was no significant difference in the level of serum magnesium among the patients with three different types of CNNM2-related disorders. The severity of different phenotypes was therefore not explained by decreased serum magnesium. We expanded the spectrum of CNNM2 variants and classified the phenotypes of CNNM2-related disorders into three types. We found that DUF21 domain variations were most associated with CNNM2-related central nervous system phenotypes, whereas hypomagnesemia was more pronounced in patients with CBS2 domain variations, and AR-inherited CNNM2-related disorders had the most severe phenotype. These results provide important clues for further functional studies of CNNM2 and provide basic foundations for more accurate genetic counseling.

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