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Christensen KE, Deng L, Leung KY, Arning E, Bottiglieri T, Malysheva OV, Caudill MA, Krupenko NI, Greene ND, Jerome-Majewska L, MacKenzie RE, Rozen R. A novel mouse model for genetic variation in 10-formyltetrahydrofolate synthetase exhibits disturbed purine synthesis with impacts on pregnancy and embryonic development. Hum Mol Genet 2013; 22:3705-19. [PMID: 23704330 DOI: 10.1093/hmg/ddt223] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Genetic variants in one-carbon folate metabolism have been identified as risk factors for disease because they may impair the production or use of one-carbon folates required for nucleotide synthesis and methylation. p.R653Q (1958G>A) is a single-nucleotide polymorphism (SNP) in the 10-formyltetrahydrofolate (formylTHF) synthetase domain of the trifunctional enzyme MTHFD1; this domain produces the formylTHF which is required for the de novo synthesis of purines. Approximately 20% of Caucasians are homozygous for the Q allele. MTHFD1 p.R653Q has been proposed as a risk factor for neural tube defects (NTDs), congenital heart defects (CHDs) and pregnancy losses. We have generated a novel mouse model in which the MTHFD1 synthetase activity is inactivated without affecting protein expression or the other activities of this enzyme. Complete loss of synthetase activity (Mthfd1S(-/-)) is incompatible with life; embryos die shortly after 10.5 days gestation, and are developmentally delayed or abnormal. The proportion of 10-formylTHF in the plasma and liver of Mthfd1S(+/-) mice is reduced (P < 0.05), and de novo purine synthesis is impaired in Mthfd1S(+/-) mouse embryonic fibroblasts (MEFs, P < 0.005). Female Mthfd1S(+/-) mice had decreased neutrophil counts (P < 0.05) during pregnancy and increased incidence of developmental defects in embryos (P = 0.052). These findings suggest that synthetase deficiency may lead to pregnancy complications through decreased purine synthesis and reduced cellular proliferation. Additional investigation of the impact of synthetase polymorphisms on human pregnancy is warranted.
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Tse WC, Leung KY, Hung BKM. Trend of sex ratio at birth in a public hospital in Hong Kong from 2001 to 2010. Hong Kong Med J 2013; 19:305-10. [PMID: 23687211 DOI: 10.12809/hkmj133858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To identify factors affecting the sex ratio at birth. DESIGN Cross-sectional study. SETTING Obstetric department of a public hospital in Hong Kong. PARTICIPANTS All pregnant women delivered between 2001 and 2010. MAIN OUTCOME MEASURES Sex ratio at birth versus women's eligibility status, age, parity, number of miscarriages or terminations of pregnancy, and number of fetuses were analysed using the Chi squared test. Multivariate regression was used to determine the effects of multiple factors on the sex of the newborn. RESULTS A total of 54 039 cases were reviewed. The sex ratio at birth changed since 2003, and became unbalanced (>107 males per 100 females) since 2006 revealed by a significant increase in males per 100 females, from 106.6 in 2001-2005 to 111.4 in 2006-2010. From 2001 to 2010, the sex ratio at birth increased from being balanced to becoming unbalanced in eligible persons, and became more unbalanced in non-eligible persons. The ratio increased in eligible persons after having two children, but in non-eligible persons after having one child. The sex ratio at birth was unbalanced (1.095) in singleton pregnancies, but balanced (1.019) in multiple pregnancies. Based on logistic regression, the chance of a male baby being born increased with parity of 2 or above (odds ratio=1.1; P<0.001), non-eligible person status (odds ratio=1.05; P=0.034), and delivery in the period 2006-2010 (odds ratio=1.04; P=0.019). The ratio was not increased with advanced maternal age, the number of miscarriages/terminations of pregnancy, and number of fetuses. CONCLUSION Compared with 2001-2005, the sex ratio at birth became unbalanced in 2006-2010. An unbalanced ratio ensued in the latter period in both eligible and non-eligible persons, but to a greater extent and even after having one child in the latter group.
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Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Hernandez-Andrade E, Kalache K, Kingdom J, Kiserud T, Lee W, Lees C, Leung KY, Malinger G, Mari G, Prefumo F, Sepulveda W, Trudinger B. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:233-239. [PMID: 23371348 DOI: 10.1002/uog.12371] [Citation(s) in RCA: 282] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Leung KY, Kretzschmar MEE, Diekmann O. Dynamic concurrent partnership networks incorporating demography. Theor Popul Biol 2012; 82:229-39. [PMID: 22884770 DOI: 10.1016/j.tpb.2012.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/13/2012] [Accepted: 07/20/2012] [Indexed: 01/22/2023]
Abstract
We introduce a population model that incorporates From a mathematical point of view we deal with continuous-time Markov chains at the individual level, with the interaction between individuals captured by a global variable describing opportunities for new partnerships. We show that for large time a stationary distribution is attained and we deduce various statistical features of that distribution, with particular attention for concurrency, i.e. the overlap in time of multiple partnerships of one and the same individual. Our ultimate motivation is to model the spread of sexually transmitted infections in the population, for which the present paper serves as a prelude.
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An FP, Bai JZ, Balantekin AB, Band HR, Beavis D, Beriguete W, Bishai M, Blyth S, Boddy K, Brown RL, Cai B, Cao GF, Cao J, Carr R, Chan WT, Chang JF, Chang Y, Chasman C, Chen HS, Chen HY, Chen SJ, Chen SM, Chen XC, Chen XH, Chen XS, Chen Y, Chen YX, Cherwinka JJ, Chu MC, Cummings JP, Deng ZY, Ding YY, Diwan MV, Dong L, Draeger E, Du XF, Dwyer DA, Edwards WR, Ely SR, Fang SD, Fu JY, Fu ZW, Ge LQ, Ghazikhanian V, Gill RL, Goett J, Gonchar M, Gong GH, Gong H, Gornushkin YA, Greenler LS, Gu WQ, Guan MY, Guo XH, Hackenburg RW, Hahn RL, Hans S, He M, He Q, He WS, Heeger KM, Heng YK, Hinrichs P, Ho TH, Hor YK, Hsiung YB, Hu BZ, Hu T, Hu T, Huang HX, Huang HZ, Huang PW, Huang X, Huang XT, Huber P, Isvan Z, Jaffe DE, Jetter S, Ji XL, Ji XP, Jiang HJ, Jiang WQ, Jiao JB, Johnson RA, Kang L, Kettell SH, Kramer M, Kwan KK, Kwok MW, Kwok T, Lai CY, Lai WC, Lai WH, Lau K, Lebanowski L, Lee J, Lee MKP, Leitner R, Leung JKC, Leung KY, Lewis CA, Li B, Li F, Li GS, Li J, Li QJ, Li SF, Li WD, Li XB, Li XN, Li XQ, Li Y, Li ZB, Liang H, Liang J, Lin CJ, Lin GL, Lin SK, Lin SX, Lin YC, Ling JJ, Link JM, Littenberg L, Littlejohn BR, Liu BJ, Liu C, Liu DW, Liu H, Liu JC, Liu JL, Liu S, Liu X, Liu YB, Lu C, Lu HQ, Luk A, Luk KB, Luo T, Luo XL, Ma LH, Ma QM, Ma XB, Ma XY, Ma YQ, Mayes B, McDonald KT, McFarlane MC, McKeown RD, Meng Y, Mohapatra D, Morgan JE, Nakajima Y, Napolitano J, Naumov D, Nemchenok I, Newsom C, Ngai HY, Ngai WK, Nie YB, Ning Z, Ochoa-Ricoux JP, Oh D, Olshevski A, Pagac A, Patton S, Pearson C, Pec V, Peng JC, Piilonen LE, Pinsky L, Pun CSJ, Qi FZ, Qi M, Qian X, Raper N, Rosero R, Roskovec B, Ruan XC, Seilhan B, Shao BB, Shih K, Steiner H, Stoler P, Sun GX, Sun JL, Tam YH, Tanaka HK, Tang X, Themann H, Torun Y, Trentalange S, Tsai O, Tsang KV, Tsang RHM, Tull C, Viren B, Virostek S, Vorobel V, Wang CH, Wang LS, Wang LY, Wang LZ, Wang M, Wang NY, Wang RG, Wang T, Wang W, Wang X, Wang X, Wang YF, Wang Z, Wang Z, Wang ZM, Webber DM, Wei YD, Wen LJ, Wenman DL, Whisnant K, White CG, Whitehead L, Whitten CA, Wilhelmi J, Wise T, Wong HC, Wong HLH, Wong J, Worcester ET, Wu FF, Wu Q, Xia DM, Xiang ST, Xiao Q, Xing ZZ, Xu G, Xu J, Xu J, Xu JL, Xu W, Xu Y, Xue T, Yang CG, Yang L, Ye M, Yeh M, Yeh YS, Yip K, Young BL, Yu ZY, Zhan L, Zhang C, Zhang FH, Zhang JW, Zhang QM, Zhang K, Zhang QX, Zhang SH, Zhang YC, Zhang YH, Zhang YX, Zhang ZJ, Zhang ZP, Zhang ZY, Zhao J, Zhao QW, Zhao YB, Zheng L, Zhong WL, Zhou L, Zhou ZY, Zhuang HL, Zou JH. Observation of electron-antineutrino disappearance at Daya Bay. PHYSICAL REVIEW LETTERS 2012; 108:171803. [PMID: 22680853 DOI: 10.1103/physrevlett.108.171803] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Indexed: 05/23/2023]
Abstract
The Daya Bay Reactor Neutrino Experiment has measured a nonzero value for the neutrino mixing angle θ(13) with a significance of 5.2 standard deviations. Antineutrinos from six 2.9 GWth reactors were detected in six antineutrino detectors deployed in two near (flux-weighted baseline 470 m and 576 m) and one far (1648 m) underground experimental halls. With a 43,000 ton-GWth-day live-time exposure in 55 days, 10,416 (80,376) electron-antineutrino candidates were detected at the far hall (near halls). The ratio of the observed to expected number of antineutrinos at the far hall is R=0.940±0.011(stat.)±0.004(syst.). A rate-only analysis finds sin(2)2θ(13)=0.092±0.016(stat.)±0.005(syst.) in a three-neutrino framework.
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Yang F, Leung KY, Hou YW, Yuan Y, Tang MHY. Birth-weight prediction using three-dimensional sonographic fractional thigh volume at term in a Chinese population. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:425-433. [PMID: 21308831 DOI: 10.1002/uog.8945] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To develop and validate new birth-weight prediction models in Chinese pregnant women using fractional thigh volume. METHODS Healthy late third-trimester fetuses within 5 days of delivery were prospectively examined using two- (2D) and three- (3D) dimensional ultrasonography. Measurements were performed using 2D ultrasound for standard fetal biometry and 3D ultrasound for fractional thigh volume (TVol) and middle thigh circumference. The intraclass correlation coefficient (ICC) was used to analyze the inter- and intraobserver reliability of the 3D ultrasound measurements of 40 fetuses. Five birth-weight prediction models were developed using linear regression analysis, and these were compared with previously published models in a validation group. RESULTS Of the 290 fetuses studied, 100 were used in the development of prediction models and 190 in the validation of prediction models. The inter- and intraobserver variability for TVol and middle thigh circumference measurements was small (all ICCs ≥ 0.95). The prediction model using TVol, femur length (FL), abdominal circumference (AC) and biparietal diameter (BPD) provided the most precise birth-weight estimation, with a random error of 4.68% and R(2) of 0.825. It correctly predicted 69.5 and 95.3% of birth weights to within 5 and 10% of actual birth weight. By comparison, the Hadlock model with standard fetal biometry (BPD, head circumference, AC and FL) gave a random error of 6.41%. The percentage of birth-weight prediction within 5 and 10% of actual birth weight was 46.3 and 82.6%, respectively. CONCLUSION Consistent with studies on Caucasian populations, a new birth-weight prediction model based on fractional thigh volume, BPD, AC and FL, is reliable during the late third trimester in a Chinese population, and allows better prediction than does the Hadlock model.
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Tomlinson V, Gudmundsdottir K, Luong P, Leung KY, Knebel A, Basu S. JNK phosphorylates Yes-associated protein (YAP) to regulate apoptosis. Cell Death Dis 2011; 1:e29. [PMID: 21364637 PMCID: PMC3032333 DOI: 10.1038/cddis.2010.7] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Yes-associated protein (YAP) regulates DNA damage and chemosensitivity, as well as functioning as a pro-growth, cell size regulator. For both of its roles, regulation by phosphorylation is crucial. We undertook an in vitro screen to identify novel YAP kinases to discover new signaling pathways to better understand YAP's function. We identified JNK1 and JNK2 as robust YAP kinases, as well as mapped multiple sites of phosphorylation. Using inhibitors and siRNA, we showed that JNK specifically phosphorylates endogenous YAP in a number of cell types. We show that YAP protects keratinocytes from UV irradiation but promotes UV-induced apoptosis in a squamous cell carcinoma. We defined the mechanism for this dual role to be YAP's ability to bind and stabilize the pro-proliferative ΔNp63α isoform in a JNK-dependent manner. Our report indicates that an evaluation of the expression of the different isoforms of p63 and p73 is crucial in determining YAP's function.
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Yuan Y, Leung KY, Ouyang YS, Yang F, Tang MHY, Chau AKT, Dai Q. Simultaneous real-time imaging of four-chamber and left ventricular outflow tract views using xPlane imaging capability of a matrix array probe. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:302-309. [PMID: 21077157 DOI: 10.1002/uog.8883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To determine the feasibility and reliability of using xPlane imaging to examine simultaneously the four-chamber and left ventricular outflow tract (LVOT) views in real time, to assess rotation angles from the four-chamber view to the LVOT view, and to investigate factors affecting the angles. METHODS In 145 fetuses at 11-37 weeks' gestation, we visualized the four-chamber view in one of three cardiac positions: a subcostal view with the apex at the 3 or 9 o'clock position; an apical view with the apex at the 12 or 6 o'clock position; or a view with the fetal heart apex midway between these two positions. We then used the rotation function of xPlane imaging, using the four-chamber view as the reference plane, to visualize the LVOT view simultaneously in real time on the secondary image plane, on the right side of the split screen, by rotating a reference line from 0° with a rotation step of 5°. The rotation angle necessary for the first appearance of LVOT was recorded as the first rotation angle. The reference line was then rotated until the LVOT was just out of view, and this last rotation angle was recorded as the second rotation angle. The difference between these two angles was recorded as the angle span of the LVOT display. Reliability was assessed by intraclass correlation coefficient (ICC). RESULTS Of the 145 fetuses examined, 29 had cardiac defects. Using xPlane imaging, the LVOT was visualized successfully after 14 weeks in 95.1% of cases. The first and second rotation angles varied significantly with cardiac position (P < 0.001); when the fetal heart was examined using a subcostal approach with the apex at the 3 or 9 o'clock position, the first rotation angle was smaller than that at the apical view for normal hearts (20° vs. 50°, P < 0.001). There was also a significant difference for the second rotation angle and for the angle span, between fetuses with and without normal LVOT (P = 0.038 and 0.006, respectively). Regarding intra- and interobserver reliability for measurement of first and second rotation angles, the ICCs were high (range, 0.847-0.980). CONCLUSION Using xPlane imaging, it is feasible to examine simultaneously the four-chamber and LVOT views in real time, and measurement of the rotation angles between these two views is reproducible. The rotation angles depend on the position of the fetal heart, and the normality of the LVOT. Proposed algorithms for examination of the fetal heart with three-/four-dimensional ultrasonography may need to be adapted to optimize visualization of the standard planes.
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Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, Kalache K, Leung KY, Malinger G, Munoz H, Prefumo F, Toi A, Lee W. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:116-26. [PMID: 20842655 DOI: 10.1002/uog.8831] [Citation(s) in RCA: 605] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Cheong KB, Leung KY, Li TKT, Chan HY, Lee YP, Tang MHY. Comparison of inter- and intraobserver agreement and reliability between three different types of placental volume measurement technique (XI VOCAL, VOCAL and multiplanar) and validity in the in-vitro setting. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:210-217. [PMID: 20201116 DOI: 10.1002/uog.7609] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To compare XI VOCAL (eXtended Imaging Virtual Organ Computer-aided AnaLysis) for three-dimensional (3D) ultrasound volumetry of the placenta and of phantom objects with a rotational method using VOCAL and with the multiplanar method. METHODS We acquired 3D volume datasets from 32 fetuses at 11-14 weeks' gestation. Placental volume was calculated twice by each of two observers using XI VOCAL (with 5, 10, 15 and 20 slices), multiplanar (1-mm interval) and VOCAL (with 12 degrees, 18 degrees and 30 degrees rotation) methods. In addition, validity was assessed using the in-vitro setting with three phantom objects of known volume. RESULTS Both inter- and intraobserver reliabilities were very high for all three methods. There was no systematic bias between any two methods except between XI VOCAL (10 slices) and the multiplanar (1-mm interval) method, with a smaller volume using the former method. The limits of agreement were wide between any two of the three methods. In the in-vitro setting, there was a trend towards less valid measurements with the XI VOCAL technique and fewer slices. With the same number of steps, measurements made with VOCAL (12 degrees and 18 degrees) were more valid than were those made with XI VOCAL (15 and 10 slices, respectively). CONCLUSION XI VOCAL cannot be used interchangeably with VOCAL or multiplanar techniques in measuring placental volume at 11-14 weeks' gestation.
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Yang F, Leung KY, Lee YP, Chan HY, Tang MHY. Fetal biometry by an inexperienced operator using two- and three-dimensional ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:566-71. [PMID: 20183864 DOI: 10.1002/uog.7600] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To compare the reproducibility, accuracy and time required for fetal biometric measurements using two-dimensional (2D) and three-dimensional (3D) ultrasonography by an inexperienced operator. METHODS Fifty consecutive fetuses were evaluated at a gestational age of 17-34 weeks. For every fetus measurements-including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL)-were made by an inexperienced operator using 2D ultrasound and then saved 3D volumes. As a control, measurements were also made by an experienced operator using 2D ultrasonography alone. Each fetal biometric parameter was measured twice by each operator. All images were assessed by two experienced reviewers, blinded to the operator's identity, using a scoring system based on objective evaluation criteria. RESULTS The interobserver, intraobserver and inter- method variability for 2D ultrasonography by the experienced operator (2D-exp), and 2D and 3D ultrasonography by the inexperienced operator (2D-inexp and 3D-inexp) was small (all intraclass correlation coefficients > or = 0.991). A non-significantly higher proportion of fetal biometric measurements by 3D-inexp than 2D-inexp were within 1 mm of the measurements by 2D-exp. There were no differences in the mean image quality scores of fetal biometry between 2D-exp and 2D-inexp, 2D-exp and 3D-inexp. However, the quality score of AC images obtained by 3D-inexp was greater than that obtained by 2D-inexp (5.5 vs. 5.3, P = 0.018). The mean time required to measure BPD, HC, AC and FL was less for 3D-inexp than for 2D-inexp (67.2 vs. 97.0 s, 64.6 vs. 97.0 s, 60.1 vs. 81.5 s and 65.5 vs. 95.1 s, respectively; all P < 0.001), but was significantly greater than for 2D-exp, with corresponding figures of 24.3, 24.3, 27.9 and 27.2 s. CONCLUSION Fetal biometric measurements obtained by an inexperienced operator using both 2D and 3D ultrasound were reproducible and showed good agreement with those obtained by an experienced operator. The use of 3D ultrasound by an inexperienced operator allows faster measurements to be made than by 2D ultrasound and also seems to facilitate the acquisition of higher-quality images for measurement of AC.
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Chan K, Yam I, Leung KY, Tang M, Chan TK, Chan V. Detection of paternal alleles in maternal plasma for non-invasive prenatal diagnosis of beta-thalassemia: a feasibility study in southern Chinese. Eur J Obstet Gynecol Reprod Biol 2010; 150:28-33. [PMID: 20206431 DOI: 10.1016/j.ejogrb.2010.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 02/03/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate in maternal plasma, the efficacy of detecting the paternal beta-gene mutation and informative single nucleotide polymorphisms (SNPs) linked to the paternal-mutant or -normal allele in non-invasive prenatal diagnosis (NIPND). STUDY DESIGN In 20 at-risk pregnancies, using the allele-specific arrayed primer extension (AS-APEX) technology of the previously published "Thalassemia" array, cyanine-5-deoxycytosine triphosphate (Cy5-dCTP) was incorporated into the extended strands to matched PCR-amplified maternal plasma DNA templates, to detect both the paternal beta-gene mutation and informative paternal SNPs. RESULTS Sensitivity experiment showed that 5pg DNA as starting template gave detectable signals on the array. In 13 cases (65%), the paternal-derived beta-gene mutation and/or informative mutant-associated SNP were detected. A subsequent invasive procedure was required to determine if the fetus had a beta-thalassemia (thal) major or minor genotype. In 3 cases (15%), absence of the paternal mutant or mutant-associated SNP excluded a beta-thal major fetus; while in 4 cases (20%), this approach was non-discriminative as both parents carry the same mutation without any informative SNP. CONCLUSION This approach was useful in 16 out of 20 (80%) pregnancies at risk for beta-thal in southern Chinese.
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Leung KY, Cheong KB, Lee CP, Chan V, Lam YH, Tang M. Ultrasonographic prediction of homozygous alpha0-thalassemia using placental thickness, fetal cardiothoracic ratio and middle cerebral artery Doppler: alone or in combination? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:149-154. [PMID: 20047196 DOI: 10.1002/uog.7443] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare the predictive values of three ultrasonographic parameters: placental thickness (PT), fetal cardiothoracic ratio (CTR) and middle cerebral artery peak systolic velocity (MCA-PSV), alone or in combination, in pregnancies affected by homozygous alpha(0)-thalassemia at 12-20 weeks' gestation. METHODS Pregnant women at risk of carrying a fetus affected by homozygous alpha(0)-thalassemia were studied from 1995 to 2006 using serial ultrasonography at 12-15 weeks, 16-20 weeks and 30 weeks' gestation. We measured CTR and PT from 1995, and MCA-PSV as well from 1997. An invasive prenatal test was offered if cardiomegaly with or without placentomegaly was detected but the MCA-PSV results were used only retrospectively for analysis. RESULTS Of a total of 777 at-risk fetuses studied, 138 (17.8%) were affected by homozygous alpha(0)-thalassemia. At 12-15 weeks' gestation, 598 ultrasound examinations were performed. CTR was better than both PT and MCA-PSV in the prediction of affected pregnancies. The highest sensitivity (98.3%) was achieved by the combination of CTR and/or MCA-PSV at a false-positive rate of 15.8%. At 16-20 weeks' gestation, 410 ultrasound examinations were performed, 121 of which were at the patient's first visit and 289 of which were at a follow-up visit. Both CTR and MCA-PSV predicted the affected pregnancies equally well. The sensitivity of CTR was 100.0%, but the false-positive rate was 5.2%. In contrast, the false-positive rate of MCA-PSV alone was 1.4% and that of the combination of CTR and MCA-PSV was 0%, although their sensitivities were less than 65%. CONCLUSIONS The data suggest that adding MCA-PSV to CTR in the prediction of homozygous alpha(0)-thalassemia can increase the sensitivity at 12-15 weeks and decrease the false-positive rate at 16-20 weeks' gestation.
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Cheong KB, Leung KY, Chan HY, Lee YP, Yang F, Tang MHY. Comparison of inter- and intraobserver agreement between three types of fetal volume measurement technique (XI VOCAL, VOCAL and multiplanar). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:287-294. [PMID: 19248036 DOI: 10.1002/uog.6255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To compare the new XI VOCAL (eXtended Imaging Virtual Organ Computer-aided Analysis) for three-dimensional (3D) ultrasound measurement of fetal volume with the conventional multiplanar technique and a rotational method using VOCAL. METHODS We acquired 3D volume datasets from 30 fetuses at 11-14 weeks of gestation using a commercially available ultrasound system. Fetal volume was calculated using XI VOCAL (with 5, 10, 15 and 20 slices), multiplanar (1-mm interval) and VOCAL (with 12 degrees, 18 degrees and 30 degrees rotation) techniques. The level of agreement for interobserver and intraobserver variability was determined and evaluated for all methods and reliability was assessed. RESULTS Fetal volume measurements obtained using XI VOCAL (10 slices) showed good correlation with those obtained using VOCAL (18 degrees) (r = 0.940, P = 0.076; intraclass correlation coefficient (ICC), 0.962 (95% CI, 0.920-0.982), P = 0.182), and XI VOCAL (15 slices) showed good correlation with VOCAL (12 degrees ) (r = 0.961, P = 0.092; ICC, 0.979 (95% CI, 0.957-0.990), P = 0.190). The mean difference between paired measurements by the XI VOCAL (10 slices) and VOCAL (18 degrees ) methods was 1.00 mL, while that by the XI VOCAL (15 slices) and VOCAL (12 degrees) methods was 0.90 mL. 95% limits of agreement were - 2.80 to 4.80 between XI VOCAL (10 slices) and VOCAL (18 degrees) and - 1.90 to 3.70 between XI VOCAL (15 slices) and VOCAL (12 degrees). There was a small difference in the time required to complete the fetal volume measurement between XI VOCAL and VOCAL when a similar number of slices or rotational steps was used (P < 0.05), XI VOCAL taking less time. CONCLUSION XI VOCAL (with 10, 15 and 20 slices) can be used interchangeably with the multiplanar technique (1-mm interval) for the measurement of fetal volume. XI VOCAL (10 slices) and VOCAL (18 degrees) can be used interchangeably, as can XI VOCAL (15 slices) and VOCAL (12 degrees), for the measurement of fetal volume.
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Chan BC, Hui PW, Leung WC, Leung KY, Pun TC, Lee CP. Application of transcervical hysterofetoscopy and cord blood collection at first trimester termination of pregnancy for fetal abnormalities. Prenat Diagn 2008; 28:939-42. [PMID: 18792922 DOI: 10.1002/pd.2085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the applicability of hysterofetoscopy and cord blood collection at first trimester termination of pregnancy for fetal abnormalities. METHODS From 2004 to 2007, transcervical hysterofetoscopy was performed in seven patients at the same operation setting of surgical termination of pregnancy. The findings were compared with prenatal diagnosis. Feasibility of cord blood collection was also examined. RESULTS Out of these seven patients, six of them had prenatal ultrasound diagnosis of cystic hygroma. All of them had chromosomal abnormalities. Subcutaneous oedema was confirmed by hysterofetoscopy with good view. Another pregnancy was complicated by homozygous alpha thalassaemia and the diagnosis was confirmed by electrophoresis of fetal haemoglobin collected from umbilical cord vessel. Cord blood collection was also attempted in two other patients yielding fetal blood with minimal maternal contamination. CONCLUSION Transcervical hysterofetoscopy is a feasible tool in confirming external fetal structural abnormalities before surgical termination of pregnancy. It can be performed under either general anaesthesia or conscious sedation. Umbilical cord blood collection can facilitate confirmation of genetic diseases. It may also allow the potential of isolating fetal mesenchymal stem cell in first trimester.
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Abstract
Alpha-thalassaemia is one of the most common human genetic disorders. Couples in which both partners carry alpha(0)-thalassaemia traits have a 25% risk of having a fetus affected by homozygous alpha-thalassaemia or haemoglobin Bart's disease, with severe fetal anaemia in utero, hydrops fetalis, stillbirth or early neonatal death, as well as causing various maternal morbidities. This disorder is common in southeast Asia and southern China, and the expanding populations of southeast Asian immigrants in the US, Canada, UK and Europe mean that this disorder is no longer rare in these countries.
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Law KM, Leung KY, Tang MHY, Chau AKT. Prenatal two- and three-dimensional sonographic diagnosis of total anomalous pulmonary venous connection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:788-9. [PMID: 17663483 DOI: 10.1002/uog.4085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Lau SKP, Woo PCY, Fan RYY, Ma SSL, Hui WT, Au SY, Chan LL, Chan JYF, Lau ATK, Leung KY, Pun TCT, She HHL, Wong CY, Wong LLL, Yuen KY. Isolation of Laribacter hongkongensis, a novel bacterium associated with gastroenteritis, from drinking water reservoirs in Hong Kong. J Appl Microbiol 2007; 103:507-15. [PMID: 17714383 DOI: 10.1111/j.1365-2672.2006.03263.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Freshwater fish has been found to be the reservoir of Laribacter hongkongensis, a recently discovered bacterium associated with community-acquired gastroenteritis. However, little is known about the ecology of this bacterium in the aquatic environment. We carried out a surveillance study to investigate the presence of L. hongkongensis in water and freshwater fish from 10 drinking water reservoirs in Hong Kong. METHODS AND RESULTS Using membrane filtration, L. hongkongensis was isolated from the waters of six reservoirs, with numbers ranging from 1 to 12 CFU l(-1). Higher recovery rates were observed in summer and during days of higher water and ambient temperatures. Of 27 freshwater fish collected from the reservoirs, L. hongkongensis was recovered from the intestines of two fish, a Goldfish and a Nile tilapia. Overall, 35 different pulsed-field gel electrophoresis patterns are found among the 59 isolates recovered from water and the two isolates from freshwater fish. CONCLUSIONS The present report represents the first to demonstrate the presence of L. hongkongensis in natural water environments. SIGNIFICANCE AND IMPACT OF THE STUDY Although it is unlikely that treated, drinking water is an important source of L. hongkongensis-associated gastroenteritis, one should be aware of the possibility of other contaminated water as a source of human infection.
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Leung KY. Changing pattern of hysterectomies for benign conditions. Hong Kong Med J 2007; 13:176-7. [PMID: 17548904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
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Yin A, Ng EHY, Zhang X, He Y, Wu J, Leung KY. Correlation of maternal plasma total cell-free DNA and fetal DNA levels with short term outcome of first-trimester vaginal bleeding. Hum Reprod 2007; 22:1736-43. [PMID: 17416916 DOI: 10.1093/humrep/dem058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The current methods using sonographic parameters and/or maternal serum beta-HCG levels to predict spontaneous abortion are not satisfactory. The aim of this study was to determine whether maternal plasma fetal DNA and total DNA levels could be used to predict spontaneous abortion. METHODS We prospectively studied pregnant women who presented with vaginal bleeding in the first trimester of pregnancy, and those who had no vaginal bleeding (controls). DYS14 and the beta-globin gene were used to measure the maternal plasma levels of fetal and total DNA, respectively, by real-time PCR. RESULTS A total of 1114 women were studied. Both maternal plasma fetal and total DNA concentrations increased with gestation from 6 to 11.6 weeks in the controls. The multiple of medians (MoMs) of fetal and total DNA concentration in those who miscarried were significantly greater (P < 0.001) than in the normal controls by about 5- and 4-fold respectively. Using a cut-off value of 1.6 MoMs for total DNA to predict spontaneous abortion, the sensitivity was 98.2% and false positive rate was 4.7%. However, using a cut-off value of 1.8 MoMs for fetal DNA, the corresponding figures were 97% and 44.3%, respectively. CONCLUSIONS Both maternal plasma fetal and total DNA concentrations increased throughout the first trimester. Significantly high levels of fetal and total DNA were found in those who miscarried.
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Leung WC, Chan BCP, Ma G, Lam KW, Leung KY, Pun TC, Lao TT, Lee CP. Continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries after the study period: Was this the Hawthorne effect? Eur J Obstet Gynecol Reprod Biol 2007; 130:165-8. [PMID: 16567034 DOI: 10.1016/j.ejogrb.2006.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 12/19/2005] [Accepted: 02/08/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND The incidence of birth trauma and birth asphyxia related to instrumental deliveries in our obstetric unit was high (2.8%) in 1998-1999. A study was performed in 2000 to identify the risk factors. Unexpectedly, the incidence (0.6%) was reduced significantly during the study period. We attributed this phenomenon to the famous Hawthorne effect (tendency to improve performance because of awareness of being studied). OBJECTIVES The objectives were to study whether there is a continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries in the post-study period (2001-2003) and to investigate the presence of underlying confounding factors apart from the Hawthorne effect. METHOD To compare the hospital obstetric statistics among the pre-study period (1998-1999), the study period (2000) and the post-study period (2001-2003), in particular the incidence of birth trauma and birth asphyxia related to instrumental deliveries, the instrumental delivery rate, the overall Caesarean section rate, the Caesarean section rate for no progress of labour, the incidence of failed instrumental delivery, the incidence of attempted instrumental delivery in the operating theatre, and incidence of direct second-stage Caesarean sections. RESULTS The incidence of birth trauma and birth asphyxia related to instrumental deliveries (0.6%) during the study period (2000) was significantly lower than that (2.8%) during the pre-study period (1998-1999; RR 0.27, 95% CI 0.11-0.70). This phenomenon continued into the post-study period (2001-2003) when the incidence of 1.0% was similarly lower than that in the pre-study period (RR 0.35, 95% CI 0.20-0.64). The instrumental delivery rate decreased further in the post-study period (13.5%) compared with those in the study (16.6%) and pre-study (19.5%) periods (RR 0.81, 95% CI 0.75-0.89 and RR 0.69, 95% CI 0.65-0.74, respectively). There was a marked increase in the direct second-stage Caesarean section rate in the post-study period (7.1%) compared to those in the study (0.4%) and pre-study (0.7%) periods (RR 15.9, 95% CI 5.05-49.73 and RR 9.77, 95% CI 5.28-18.08, respectively). CONCLUSION A change in obstetric practice was identified that may explain the continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries in the post-study period.
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Wang LM, Leung KY, Tang M. Prenatal evaluation of facial clefts by three-dimensional extended imaging. Prenat Diagn 2007; 27:722-9. [PMID: 17533633 DOI: 10.1002/pd.1766] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine the prenatal diagnostic accuracy of two-dimensional ultrasound (2DUS) alone versus 2DUS in conjunction with three-dimensional ultrasonography (3DUS) including orthogonal display (OGD) and three-dimensional extended Imaging for cleft lip and primary palate. MATERIALS AND METHOD Fetuses being suspected of having a facial cleft by previous ultrasound examination or family history were examined sequentially with 2DUS and then 3DUS. RESULTS Of a total of 30 infants, 22 had cleft lip and nine also had cleft palate at birth. The use of 2DUS with or without 3DUS correctly identified all cases of cleft lips prenatally. However, the use of 2DUS in conjunction with 3DUS correctly identified more cleft primary palate than 2DUS alone (88.9% vs 22.2%, P < 0.01). Cleft primary palate was well demonstrated in both the multi-slice view (MSV) and OGD modes. In one case, a cleft palate was shown in the MSV mode but not in the Oblique view (OBV) mode. All the unaffected fetuses were reported as no cleft palate with the use of MSV mode. CONCLUSIONS Combined approach of 2DUS and 3DUS with both OGD and MSV modes significantly improved the prenatal detection rate for a cleft palate compared with 2DUS alone (88.9% vs 22.2%) without decreasing the specificity.
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Leung KY, Ngai CSW, Lee A, Chan HY, Leung WC, Lee CP, Tang MHY. The effects on maternal anxiety of two-dimensional versus two- plus three-/four-dimensional ultrasound in pregnancies at risk of fetal abnormalities: A randomized study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:249-54. [PMID: 16909403 DOI: 10.1002/uog.2844] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To test the hypothesis that the use of two-dimensional (2D) ultrasonography with three-dimensional/four-dimensional (3D/4D) ultrasonography can reduce anxiety to a greater extent in women at risk of having a fetus with congenital abnormalities than the use of 2D ultrasonography alone. METHODS A total of 124 women attending the prenatal diagnostic clinic of a teaching hospital were randomized into the intervention group (2D ultrasonography followed by 3D/4D ultrasonography) or control group (2D ultrasonography alone). The primary outcome was maternal anxiety levels, which were assessed by the Spielberger state-trait anxiety inventory. We measured the anxiety levels in all women at the first visit, at around 18 weeks' gestation (immediately after ultrasound examinations) and at 28 weeks' gestation. RESULTS A short-term reduction of the state-anxiety score (by around 2 points) from the first visit to after ultrasound examinations was observed in both the intervention group and the control group. Unexpectedly, a small increase in the state-anxiety score from the first visit to 28 weeks' gestation was observed in the intervention group but not in the control group, though there was no significant difference in the changes between the two groups. Repeated measures ANOVA (analysis of variance) also showed that there was no significant interaction effect between groups and time of assessment on the state-anxiety scores (F = 1.072 and P = 0.344). About 80% of women reported a better understanding that their baby was normal after viewing 3D rather than 2D images. CONCLUSION This randomized study indicates that the addition of 3D/4D ultrasound does not cause a significant reduction in maternal anxiety in pregnancies at risk of fetal abnormalities compared with conventional 2D ultrasound alone.
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Chen M, Leung KY, Lee CP, Tang MHY, Ho PC. Placental volume measured by three-dimensional ultrasound in the prediction of fetal alpha(0)-thalassemia: a preliminary report. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:166-72. [PMID: 16652395 DOI: 10.1002/uog.2721] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To evaluate the use of placental volume measured by three-dimensional (3D) ultrasound in predicting fetal homozygous alpha(0)-thalassemia (Hb-Bart's disease). METHODS From June 2002 to May 2004 singleton pregnancies at risk of alpha(0)-thalassemia and normal controls were studied prospectively at 9-12 weeks of gestation. Affected fetuses were suspected to have alpha(0)-thalassemia by two-dimensional (2D) ultrasound and confirmed by DNA analysis. Placental volume was measured on 3D ultrasound by a multiplanar technique. Intra- and interobserver agreement of measurements was assessed. The placental volume/crown-rump length quotient of the affected fetuses was compared with that of normal fetuses. RESULTS The final study group comprised 105 pregnancies; 43 were at risk of alpha(0)-thalassemia and 62 were normal controls. Eleven (10.5%) fetuses were affected by alpha(0)-thalassemia, all from the at-risk group, and the others were normal. Intra- and interobserver agreement of volume measurement by 3D ultrasound was relatively poor; this was reflected in the wide limits of agreement, which ranged from -10.82 to 40.86 mL. The mean +/- SD placental volume/crown-rump length quotient in affected pregnancies was larger than that in unaffected pregnancies (1.37 +/- 0.65 vs. 1.13 +/- 0.39), but this difference was not significant (P > 0.05). CONCLUSIONS Assessment of placental volume by 3D ultrasound does not seem to be superior to 2D ultrasound in the first-trimester prediction of alpha(0)-thalassemia.
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Leung KY, Liao C, Li QM, Ma SY, Tang MHY, Lee CP, Chan V, Lam YH. A new strategy for prenatal diagnosis of homozygous alpha(0)-thalassemia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:173-7. [PMID: 16652394 DOI: 10.1002/uog.2720] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVES We have shown previously that ultrasound examination performed by one experienced operator can be useful to exclude homozygous alpha(0)-thalassemia in a tertiary referral center. This study aimed to determine whether the technique was still applicable when performed by several operators and in different centers. METHODS At the Maternal and Neonatal Hospital of Guangzhou (MNH) and Tsan Yuk Hospital of Hong Kong (TYH), women at risk of homozygous alpha(0)-thalassemia were given the option of a non-invasive approach (using serial ultrasound examinations at 12-15, 16-20 and 25-30 weeks' gestation) to exclude an affected pregnancy. The fetal cardiothoracic ratio (CTR) was measured at each of these examinations and the placental thickness was measured at 12-15 weeks' gestation. The operators of MNH received training on the ultrasound examination techniques at TYH and the quality of the subsequent ultrasound examinations was checked regularly. The final diagnosis of homozygous alpha(0)-thalassemia was confirmed using an invasive test. RESULTS Of 832 at-risk pregnancies studied in the two hospitals, 168 (20.2%) were affected. The overall sensitivity and specificity of the non-invasive approach was 100% and 95.6%, respectively. At MNH, the need for an invasive test was reduced by 80.8%, and all the affected pregnancies were diagnosed before 24 weeks' gestation. The results achieved at MNH were comparable with those at TYH. The at-risk pregnancies including the affected ones presented at a more advanced gestational age at MNH. At each hospital, one affected pregnancy was missed at the 12-week scan but this was subsequently detected at the 15-18-week scan. CONCLUSIONS This non-invasive approach to exclude homozygous alpha(0)-thalassemia can be applicable when it is performed by several operators and in different centers.
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