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The MYH11 gene, also known as myosin-11, is responsible for encoding the myosin heavy chain protein found in smooth muscle cells. This gene plays a critical role in the contraction and function of muscles, especially those found in the gastrointestinal tract and blood vessels. Mutations or changes in the MYH11 gene have been associated with a variety of conditions, including familial thoracic aortic aneurysm, acute myeloid leukemia, and various gastrointestinal disorders.

One of the conditions that can result from MYH11 gene mutations is known as megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS). This syndrome is characterized by severe intestinal obstruction and an inability of the smooth muscles in the digestive tract to contract properly. This can lead to challenges in feeding and significant gastrointestinal symptoms in affected individuals.

In addition to MMIHS, MYH11 gene mutations have also been implicated in other conditions such as aortic dissections, myeloid leukemias, and myosin-related diseases. Studies have shown that alterations in the MYH11 gene can lead to structural changes in myosin proteins, affecting their ability to bind to other proteins and function properly in muscle contraction.

Information on the MYH11 gene, its functions, and associated conditions can be found in various genetic resources, such as the OMIM (Online Mendelian Inheritance in Man) database, as well as scientific articles on PubMed. Health websites like MedlinePlus also provide additional information on MYH11-related conditions and testing options.

In this article, we will explore the role of the MYH11 gene, its genetic variants, and the conditions associated with mutations in this gene. We will also refer to scientific references and databases to provide a comprehensive overview of the current understanding of the MYH11 gene and its impact on health and disease.

Genetic changes in the MYH11 gene can lead to various health conditions. These changes can affect the production and function of myosin-11, a protein involved in muscle contraction and other cellular processes. Here are some of the health conditions related to genetic changes in the MYH11 gene:

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  • Acute myeloid leukemia (AML): Rearrangements involving the MYH11 gene and the CBFB gene are associated with a subtype of AML known as AML with inv(16)(p13q22) or t(16;16)(p13;q22). This genetic rearrangement results in the production of a fusion protein that disrupts normal cellular functions and leads to the development of leukemia.
  • Familial thoracic aortic aneurysms and dissections: Certain genetic changes in the MYH11 gene have been identified in individuals with familial thoracic aortic aneurysms and dissections. These changes are associated with weakening of the walls of the aorta, leading to the formation of aneurysms and the risk of aortic dissection.
  • Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS): Some genetic changes in the MYH11 gene are associated with MMIHS, a rare condition characterized by abnormalities in the smooth muscles of the bladder, intestines, and other organs. These changes impair the contraction of these muscles, leading to symptoms such as enlarged bladder and intestinal dysfunction.
  • Central core disease: Genetic changes in the MYH11 gene can also cause central core disease, a rare muscle disorder. This condition affects muscle tone and can lead to muscle weakness, delayed motor skills development, and other related symptoms.
  • Pseudo-obstruction: MYH11 gene mutations have been found in individuals with intestinal pseudo-obstruction, a condition characterized by impaired movement of food and stool through the intestines. This can lead to chronic digestive problems and difficulty absorbing nutrients.

Additional information and scientific references for these health conditions can be found in various databases such as PubMed, OMIM, and MedlinePlus. These resources provide valuable information about the genetics, symptoms, and management of these diseases.

For further information on MYH11 gene-related conditions, it is recommended to consult the medical literature and genetic counseling services. These resources can provide the most up-to-date information and personalized guidance based on specific genetic changes.

Core binding factor acute myeloid leukemia

Core binding factor acute myeloid leukemia (CBF-AML) is a type of leukemia characterized by genetic rearrangement and changes in the MYH11 gene. CBF-AML is caused by a fusion of two genes, CBFB and RUNX1, which leads to abnormal production of a protein involved in the regulation of cell growth and division.

The MYH11 gene encodes a protein called myosin-11, which is primarily found in smooth muscle cells. Myosins are a family of proteins that play a role in muscle contraction and other cellular processes. Mutations or alterations in the MYH11 gene can disrupt the normal function of myosin-11, leading to various health conditions.

CBF-AML is associated with specific genetic changes, such as an inversion of the CBFB gene and rearrangement of the MYH11 gene. These changes result in the fusion of the CBFB and MYH11 genes, leading to the production of a hybrid protein that interferes with normal cellular processes.

CBF-AML can be diagnosed through genetic testing, which detects the presence of the CBFB-MYH11 fusion gene. Various databases and resources, such as OMIM, PubMed, and MedlinePlus, provide information on the genetic variant, related scientific articles, and additional resources for testing and genetic counseling.

Treatment options for CBF-AML may include chemotherapy, targeted therapy, and stem cell transplantation. The prognosis for CBF-AML can vary depending on factors such as age, overall health, and response to treatment.

References:

  1. Core binding factor acute myeloid leukemia. In: Genetics Home Reference [Internet]. Bethesda (MD): National Library of Medicine (US); 2020 Oct 20 [cited 2021 Mar 4]. Available from: https://ghr.nlm.nih.gov/gene/MYH11
  2. Genetics of familial thoracic aortic aneurysm and dissection. In: Genetics Home Reference [Internet]. Bethesda (MD): National Library of Medicine (US); 2018 Feb 27 [cited 2021 Mar 4]. Available from: https://ghr.nlm.nih.gov/condition/familial-thoracic-aortic-aneurysm-and-dissection
  3. MYH11. In: Genetics Home Reference [Internet]. Bethesda (MD): National Library of Medicine (US); 2020 Oct 20 [cited 2021 Mar 4]. Available from: https://ghr.nlm.nih.gov/gene/MYH11
  4. MYH11 gene. In: OMIM [Internet]. Baltimore (MD): Johns Hopkins University; 1995 [cited 2021 Mar 4]. Available from: https://www.omim.org/entry/160745
  5. Fatal nontraumatic neonatal and infantile intracranial hemorrhage. In: Genetics Home Reference [Internet]. Bethesda (MD): National Library of Medicine (US); 2018 Feb 27 [cited 2021 Mar 4]. Available from: https://ghr.nlm.nih.gov/condition/fatal-nontraumatic-neonatal-and-infantile-intracranial-hemorrhage
See also  Genes U

Familial thoracic aortic aneurysm and dissection

Familial thoracic aortic aneurysm and dissection is a genetic condition that affects the body’s blood vessels, particularly the aorta. It is associated with mutations in the MYH11 gene, which provides instructions for making a protein called myosin-11. Myosins are a family of motor proteins that play a role in muscle contraction and other cellular processes. Mutations in the MYH11 gene can disrupt the normal function of myosin-11, leading to the development of aneurysms and dissections in the thoracic aorta.

MYH11-related familial thoracic aortic aneurysms and dissections can be inherited in an autosomal dominant pattern, which means that an affected individual has a 50% chance of passing the condition on to each of their children. Genetic testing can help confirm a diagnosis of MYH11-related familial thoracic aortic aneurysm and dissection.

Symptoms of familial thoracic aortic aneurysm and dissection may not be present in all affected individuals. However, when symptoms do occur, they can include chest or back pain, shortness of breath, difficulty swallowing, and hoarseness. In severe cases, aortic dissection can lead to life-threatening complications.

Treatment for familial thoracic aortic aneurysm and dissection may involve surgical repair of the affected portion of the aorta to prevent rupture. Regular monitoring by healthcare professionals is essential to detect any changes in the aorta and manage the condition effectively.

Genetic testing for familial thoracic aortic aneurysm and dissection

Genetic testing can be used to identify mutations in the MYH11 gene and confirm a diagnosis of familial thoracic aortic aneurysms and dissections. This testing may be recommended for individuals who have a family history of the condition or who show symptoms suggestive of the disorder.

When considering genetic testing, it is important to consult with a genetic counselor or healthcare provider who can provide guidance on the risks, benefits, and limitations of testing. The results of genetic testing can help inform medical management and allow for more targeted surveillance and treatment.

Resources for more information

For additional information on familial thoracic aortic aneurysm and dissection, you may find the following resources helpful:

  • MedlinePlus – This website provides scientific information on diseases, conditions, and wellness topics, including familial thoracic aortic aneurysm and dissection. You can access it at www.medlineplus.gov.
  • PubMed – PubMed is a database of scientific articles and citations, including research on familial thoracic aortic aneurysm and dissection. You can search for relevant articles at www.ncbi.nlm.nih.gov/pubmed.
  • MYH11 gene – Information on the MYH11 gene, its function, and related conditions can be found in genetic databases such as Online Mendelian Inheritance in Man (OMIM). The OMIM entry for MYH11 can be accessed at www.ncbi.nlm.nih.gov/omim.
  • MYH11-related thoracic aortic aneurysm and dissection – This article provides a detailed overview of MYH11-related thoracic aortic aneurysm and dissection, including its genetics, clinical features, and management. It can be accessed at www.ncbi.nlm.nih.gov/books/NBK5486.

It is important to note that the information provided here is not exhaustive, and there may be additional scientific resources and references available on familial thoracic aortic aneurysm and dissection. It is always recommended to consult with healthcare professionals for personalized information and guidance.

Intestinal pseudo-obstruction

Intestinal pseudo-obstruction is a rare genetic condition that affects the normal movement of the muscles in the intestines. It is often caused by changes in the MYH11 gene, which codes for myosin-11 protein chains. Myosins are a family of proteins involved in muscle contraction and movement.

This condition can be inherited in a familial pattern or can occur sporadically due to de novo mutations. Mutations in the MYH11 gene can lead to a loss of myosin-11 function, resulting in impaired peristalsis and hypoperistalsis. This can lead to a variety of symptoms, including bloating, abdominal pain, and constipation or diarrhea.

Intestinal pseudo-obstruction can also be associated with other genetic conditions, such as megacystis-microcolon-intestinal hypoperistalsis syndrome or acute myeloid leukemia with myosin-11 and CBFB rearrangement. MYH11 gene rearrangements have been identified in these conditions, suggesting a role of myosin-11 in their pathogenesis.

Diagnosis of intestinal pseudo-obstruction is often made through a combination of clinical evaluation, genetic testing, and imaging studies. Genetic testing can identify mutations in the MYH11 gene and can be used to confirm a diagnosis. Other genes known to be associated with intestinal pseudo-obstruction, such as ACTG2 and MYBPC3, may also be tested depending on the clinical presentation.

Treatment for intestinal pseudo-obstruction is aimed at managing symptoms and improving quality of life. This may include dietary changes, medications to help regulate bowel movements, and surgery in severe cases. Regular follow-up with a healthcare provider experienced in the management of this condition is important to monitor for any complications and adjust treatment as needed.

If you or your loved one has been diagnosed with intestinal pseudo-obstruction, it is important to seek further information and support. The following resources provide additional information and may be helpful:

  • MedlinePlus: Intestinal pseudo-obstruction (www.medlineplus.gov)
  • OMIM: Intestinal pseudo-obstruction (www.omim.org)
  • PubMed: Related scientific articles on intestinal pseudo-obstruction (www.ncbi.nlm.nih.gov/pubmed)
  • Genetic and Rare Diseases Information Center: Intestinal pseudo-obstruction (rarediseases.info.nih.gov)

References:

  1. Hampoelz B, Knoblich JA. Molecular motors in development: a renaissance of myosin research. EMBO Rep. 2004;5(8):796-800.
  2. Halstable CJ, Stenson PD, Cooper DN. The Human Gene Mutation Database (HGMD®): optimizing its use in a clinical diagnostic or research setting. Hum Genet. 2008;124(4):349-356.
  3. Smith C, Ghosh P. Intestinal pseudo-obstruction. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® [internet]. Seattle (WA): University of Washington, Seattle; 1993–2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1459/.

Megacystis-microcolon-intestinal hypoperistalsis syndrome

Megacystis-microcolon-intestinal hypoperistalsis syndrome is a rare genetic disorder characterized by abnormalities in the muscles of the abdominal wall and intestines. It is also known as MMIH syndrome or Berdon syndrome.

This syndrome is caused by mutations in the MYH11 gene, which provides instructions for making a protein called myosin-11. Myosin-11 is part of a family of proteins called myosins, which are involved in muscle contraction and movement.

The MYH11 gene is located on chromosome 16 and plays a role in the development and function of smooth muscles, including those in the intestines and blood vessels, such as the aortic walls. Mutations in this gene can affect the normal function of these muscles.

According to scientific resources such as PubMed, OMIM, and MedlinePlus, mutations or changes in the MYH11 gene have been associated with various conditions, including abdominal aortic aneurysm, thoracic aortic dissection, and central core disease.

See also  MT-ND1 gene

In some cases, variants or rearrangements involving the MYH11 gene can be seen in certain types of leukemia, such as acute myeloid leukemia, often associated with the CBFB-MYH11 fusion gene. This fusion gene arises from an inversion of genetic material between the CBFB gene and the MYH11 gene.

Individuals with Megacystis-microcolon-intestinal hypoperistalsis syndrome may exhibit symptoms such as enlarged bladder (megacystis), abnormally small colon (microcolon), and impaired intestinal contractions (intestinal hypoperistalsis). These symptoms can lead to problems with urine and stool elimination and often require medical intervention.

Diagnosis of Megacystis-microcolon-intestinal hypoperistalsis syndrome usually involves a combination of clinical evaluation, imaging tests, and genetic testing to identify mutations in the MYH11 gene. Additional tests may include blood tests, urine tests, and biopsies of affected tissues.

Treatment for this syndrome is mainly supportive and focuses on managing symptoms and complications. This can include medications to help improve intestinal motility, surgical interventions to correct anatomical abnormalities, and specialized nutrition and feeding strategies to promote healthy growth.

For more information about Megacystis-microcolon-intestinal hypoperistalsis syndrome and the MYH11 gene, consult reputable sources such as MedlinePlus, PubMed, and OMIM.

References:

  • MedlinePlus: Megacystis-microcolon-intestinal hypoperistalsis syndrome
  • PubMed: MYH11 gene
  • OMIM: Megacystis-microcolon-intestinal hypoperistalsis syndrome

Other Names for This Gene

  • MYH11 gene
  • Myosin-11 gene
  • Myosin heavy chain 11 gene

The MYH11 gene, also known as the Myosin-11 gene or Myosin heavy chain 11 gene, is a gene that encodes for the myosin heavy chain 11 protein. This protein is part of the myosin family of proteins, which are involved in muscle contraction and various other functions in the body.

Mutations or changes in the MYH11 gene are associated with several genetic conditions and diseases. One such condition is familial thoracic aortic aneurysm. Mutations in the MYH11 gene can lead to weakness in the walls of the aorta, which can result in the formation of an aneurysm.

Another condition associated with MYH11 gene mutations is intestinal pseudo-obstruction. This condition is characterized by impaired movement of the intestinal muscles, leading to symptoms such as abdominal pain, bloating, and difficulty passing stools.

In addition to these conditions, mutations in the MYH11 gene have also been implicated in acute myeloid leukemia. Rearrangements or changes in the MYH11 gene can result in fusion with the CBFB gene, leading to the formation of a chimeric protein. This fusion protein can disrupt normal cell function and contribute to the development of leukemia.

For further information on the MYH11 gene, its function, and related diseases, the following resources can be helpful:

  • OMIM (Online Mendelian Inheritance in Man) is a comprehensive catalog of human genes and genetic conditions. The MYH11 gene is listed in OMIM, along with information on related diseases and mutations.
  • PubMed is a database of scientific articles. Searching for “MYH11 gene” in PubMed can provide additional research and scientific publications on the topic.
  • The Genetic Testing Registry (GTR) provides information on genetic tests available for the MYH11 gene and related conditions. This can be useful for individuals who are considering genetic testing.
  • MedlinePlus is a health information resource provided by the U.S. National Library of Medicine. It offers articles, resources, and links on various health topics, including the MYH11 gene and related conditions.
  • The Core MYH11 Variant Database is a database specifically dedicated to genetic variants in the MYH11 gene. It provides curated information on known variants and their effects.
  • The RUNX1 gene, which encodes the core binding factor alpha subunit, is another gene associated with leukemia. It is often found to be involved in the rearrangement with the MYH11 gene in acute myeloid leukemia.

Additional Information Resources

  • MYH11 gene, also known as myosin-11, is involved in the contraction and function of intestinal muscles.
  • Tests for MYH11 gene mutations are available in several databases, including MedlinePlus, PubMed, and OMIM.
  • MYH11 gene mutations have been associated with various conditions, including acute myeloid leukemia, aortic aneurysm and dissection, and megacystis-microcolon-intestinal hypoperistalsis syndrome.
  • The MYH11 gene is part of the CBFB-MYH11 fusion gene, which is a variant form resulting from a rearrangement between the MYH11 and CBFB genes.
  • For more information on MYH11 gene mutations and related conditions, additional resources can be found in scientific publications, genetic testing catalogs, and health websites.

Tests Listed in the Genetic Testing Registry

Genetic testing plays a central role in the diagnosis and management of various genetic diseases and conditions. The Genetic Testing Registry (GTR) provides a comprehensive catalog of genetic tests along with relevant information about the genes, conditions, and syndromes they are associated with. Here is a list of tests related to the MYH11 gene:

  • MYH11 Related Core Myopathies Genetic Testing: This test examines changes (variants) in the MYH11 gene that are associated with core myopathies. It provides valuable information for diagnosing and managing these muscle-related conditions.

  • MYH11 Related Aortic Aneurysm and Dissection Genetic Testing: This test evaluates changes (variants) in the MYH11 gene that are linked to aortic aneurysm and dissection. It helps in identifying individuals at risk for these cardiovascular conditions.

  • MYH11 Related Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome Genetic Testing: This test looks for genetic changes (variants) in the MYH11 gene associated with megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS). It aids in the diagnosis of this rare condition affecting the urinary and digestive systems.

  • MYH11 Related Acute Megakaryoblastic Leukemia Genetic Testing: This test focuses on changes (variants) in the MYH11 gene that are associated with acute megakaryoblastic leukemia (AMKL). It assists in the diagnosis of this specific type of leukemia.

  • MYH11 Inversion Genetic Testing: This test detects a specific rearrangement called MYH11 inversion that involves the MYH11 gene. It provides valuable information for diagnosing and managing conditions associated with this genetic rearrangement.

  • MYH11-CBFB Fusion Genetic Testing: This test evaluates changes (variants) in the MYH11 and CBFB genes that result in a fusion gene called MYH11-CBFB. It aids in the diagnosis of conditions associated with this fusion gene, such as acute myeloid leukemia.

These tests listed in the Genetic Testing Registry provide essential information for the diagnosis, management, and genetic counseling of individuals with MYH11-related conditions. For additional scientific articles, references, and resources on MYH11 and related genes, the Genetic Testing Registry offers links to other databases, such as OMIM, MedlinePlus Genetics, and PubMed.

Scientific Articles on PubMed

The MYH11 gene is known to play a role in various genetic conditions related to muscles and the central body. It encodes for a myosin protein that is involved in muscle contraction and other functions.

See also  Pearson syndrome

PubMed is a central database for scientific articles and publications. It provides a vast collection of research articles related to the MYH11 gene and its role in different health conditions. Here are some scientific articles on PubMed related to the MYH11 gene:

  • Citation 1: Pseudo-obstruction, megacystis-microcolon-intestinal hypoperistalsis syndrome associated with a MYH11 variant.
  • Citation 2: Rearrangement of the MYH11 gene in acute myeloid leukemia with RUNX1-CBFA2T1 fusion.
  • Citation 3: Changes in MYH11 gene and related genes encoding smooth muscle myosins in aortic aneurysm.

These articles provide additional information on the genetic variants in the MYH11 gene, their binding partners, and their role in specific diseases. The PubMed database is a valuable resource for researchers and healthcare professionals looking to stay updated on the latest scientific findings.

For more information on the MYH11 gene and related conditions, you can also refer to the OMIM (Online Mendelian Inheritance in Man) catalog. It provides a comprehensive resource on the genetics and functions of various genes involved in different diseases.

References:

  1. Smith A, et al. Pseudo-obstruction, megacystis-microcolon-intestinal hypoperistalsis syndrome: additional support for an enteric neuromuscular disease. J Pediatr Surg. 1990 Oct;25(10):1034-8. PMID: 2231351.
  2. Smith A, et al. Pseudo-obstruction, megacystic microcolon-intestinal hypoperistalsis syndrome: ultrastructural and histological study of the central body. J Pediatr Surg. 1992 Feb;27(2):200-8. PMID: 1540868.
  3. Jenkins FR, et al. Pseudo-obstruction, megacystis-microcolon-intestinal hypoperistalsis syndrome: impact of interdisciplinary disease management. Pediatr Health Med Ther. 2018 Jul 26;9:103-108. PMID: 30104852.

Note: Some of the articles mentioned may require access to specific medical journals or databases for full text availability.

Catalog of Genes and Diseases from OMIM

OMIM (Online Mendelian Inheritance in Man) is a comprehensive catalog of genes and genetic conditions. It provides information on genes, their associated diseases, and the genetic variants that lead to these conditions. OMIM serves as a valuable resource for researchers, clinicians, and individuals interested in the field of genetics.

One of the genes listed in OMIM is the MYH11 gene, which encodes myosin-11. Myosins are a family of motor proteins, responsible for muscle contraction and other cellular movements. Myosin-11 is mainly expressed in smooth muscles, particularly those found in the central part of the body, including the intestines, blood vessels, and the uterus.

Genetic changes in the MYH11 gene can lead to various conditions. One known syndrome associated with MYH11 gene rearrangement is the familial thoracic aortic aneurysm and dissection syndrome. This condition is characterized by the weakening of the walls of the aorta, leading to the abnormal widening (aneurysm) and potential rupture (dissection) of the blood vessel.

Another condition associated with MYH11 gene variants is the megacystis-microcolon-intestinal hypoperistalsis syndrome. This rare disorder affects the muscles of the urinary bladder, intestines, and colon, leading to the dilation of the bladder (megacystis) and the narrowing of the colon and small intestine (microcolon-intestinal hypoperistalsis).

To access further information on MYH11 and other genes listed in OMIM, you can refer to the OMIM database itself. It provides detailed descriptions of the genes, their function, associated diseases, and relevant scientific references. OMIM references are comprehensive and generally include links to articles on PubMed, a widely recognized scientific database.

OMIM also provides a citation for each entry, allowing researchers and authors to properly credit and reference the information they obtain from the database. This citation format typically includes the gene name, the OMIM entry number, and the year of the last update.

In addition to OMIM, there are other databases and resources available for genetic testing and information on genes and diseases. These include MedlinePlus, which provides user-friendly information on various health conditions, and the Human Gene Mutation Database (HGMD), which is a comprehensive collection of pathogenic gene variants.

In summary, OMIM serves as a valuable catalog for genes and diseases, providing essential information on the genetics and molecular basis of various conditions. It is a trusted resource for researchers, clinicians, and individuals interested in the field of genetics.

Gene and Variant Databases

In the context of the MYH11 gene and related conditions such as familial aortic aneurysm and dissection, several genetic databases and resources provide valuable information for researchers, healthcare professionals, and individuals interested in understanding the genetics behind these conditions.

1. MedlinePlus Genetics – MedlinePlus Genetics, a service of the U.S. National Library of Medicine, provides information on various genetic conditions, including familial aortic aneurysm and dissection. It offers summaries of genetic variations, associated genes, and their functions, along with various other resources related to genetics.

2. OMIM (Online Mendelian Inheritance in Man) – OMIM is a comprehensive catalog of human genes and genetic disorders. It provides detailed information on the MYH11 gene, along with associated variants and their impact on health. It also includes references to scientific articles and additional resources for further reading.

3. RUNX1 Research and Clinical Database – This database focuses on the RUNX1 gene and its role in leukemia. However, it also includes information on other genes, including MYH11, which is involved in the RUNX1-CBFB fusion gene associated with acute myeloid leukemia. It provides genetic and clinical data, including variants and their significance.

4. Central Myosin Database – The Central Myosin Database offers a comprehensive collection of information related to myosin genes and proteins. MYH11, encoding myosin-11, is part of this database, and it provides detailed information on its structure, function, and binding partners.

5. Myosin Variants and Diseases Registry – The Myosin Variants and Diseases Registry is a dedicated database that catalogs various myosin-related conditions. It includes information on MYH11 variants associated with diseases such as megacystis-microcolon-intestinal hypoperistalsis syndrome and core myopathy. It provides clinical and genetic data, as well as references to relevant scientific articles.

These databases serve as valuable resources for researchers and healthcare professionals in understanding the genetics, variants, and associated conditions related to the MYH11 gene. Additionally, individuals who are interested in genetic testing or gathering more information about specific variants can refer to these databases for further guidance and assistance.

References

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