Consensus Statement: Chromosomal Microarray Is a First-Tier Clinical Diagnostic Test for Individuals with Developmental Disabilities or Congenital Anomalies

Chromosomal microarray (CMA) is increasingly utilized for genetic testing of individuals with unexplained developmental delay/intellectual disability (DD/ID), autism spectrum disorders (ASD), or multiple congenital anomalies (MCA). Performing CMA and G-banded karyotyping on every patient substantially increases the total cost of genetic testing. The International Standard Cytogenomic Array (ISCA) Consortium held two international workshops and conducted a literature review of 33 studies, including 21,698 patients tested by CMA. We provide an evidence-based summary of clinical cytogenetic testing comparing CMA to G-banded karyotyping with respect to technical advantages and limitations, diagnostic yield for various types of chromosomal aberrations, and issues that affect test interpretation. CMA offers a much higher diagnostic yield (15%-20%) for genetic testing of individuals with unexplained DD/ID, ASD, or MCA than a G-banded karyotype (similar to 3%, excluding Down syndrome and other recognizable chromosomal syndromes), primarily because of its higher sensitivity for submicroscopic deletions and duplications. Truly balanced rearrangements and low-level mosaicism are generally not detectable by arrays, but these are relatively infrequent causes of abnormal phenotypes in this population (<1%). Available evidence strongly supports the use of CMA in place of G-banded karyotyping as the first-tier cytogenetic diagnostic test for patients with DD/ID, ASD, or MCA. G-banded karyotype analysis should be reserved for patients with obvious chromosomal syndromes (e.g., Down syndrome), a family history of chromosomal rearrangement, or a history of multiple miscarriages.

Electroweak precision constraints on the Lee-Wick standard model

We perform an analysis of the electroweak precision observables in the Lee-Wick Standard Model. The most stringent restrictions come from the S and T parameters that receive important tree level and one loop contributions. In general the model predicts a large positive S and a negative T. To reproduce the electroweak data, if all the Lee-Wick masses are of the same order, the Lee-Wick scale is of order 5 TeV. We show that it is possible to find some regions in the parameter space with a fermionic state as light as 2.4-3.5 TeV, at the price of rising all the other masses to be larger than 5-8 TeV. To obtain a light Higgs with such heavy resonances a fine-tuning of order a few per cent, at least, is needed. We also propose a simple extension of the model including a fourth generation of Standard Model fermions with their Lee-Wick partners. We show that in this case it is possible to pass the electroweak constraints with Lee-Wick fermionic masses of order 0.4-1.5 TeV and Lee-Wick gauge masses of order 3 TeV.