Detection of fetal sex chromosome aneuploidy by massively parallel sequencing of maternal plasma DNA: initial experience in a Chinese hospital

OBJECTIVES

To evaluate the performance of a massively parallel sequencing (MPS)-based test in detecting fetal sex chromosome aneuploidy (SCA) and to present a comprehensive clinical counseling protocol for SCA-positive patients.

METHODS

This was a retrospective study in a large patient cohort of 5950 singleton pregnancies which underwent MPS-based testing as a prenatal screening test for trisomies 21, 18 and 13, with X and Y chromosomes as secondary findings, in Southwest Hospital in China. MPS-based SCA-positive women were offered the choice of knowing whether their SCA results were positive and those who did commenced a two-stage post-test clinical counseling protocol. In Stage 1, general information about SCA was given, and women were given the option of invasive testing for confirmation of findings; in Stage 2, those who had chosen to undergo invasive testing were informed about the specific SCA affecting their fetus and their management options.

RESULTS

Thirty-three cases were classified as SCA-positive by MPS-based testing. After Stage 1 of the two-stage post-test clinical counseling session, 33 (100%) of these pregnant women chose to know the screening test results, and 25 (75.76%) underwent an invasive diagnostic procedure and karyotype analysis, in one of whom karyotyping failed. In thirteen cases, karyotyping confirmed the MPS-based test results (two X0 cases, seven XXX cases, three XXY cases and one XYY case), giving a positive predictive value of 54.17% (13/24 cases confirmed by karyotyping). After post-test clinical counseling session Stage 2, seven women chose to terminate the pregnancy: one X0 case, two XXX cases, the three XXY cases and the single XYY case. Six women decided to continue with pregnancy: one X0 case and five XXX cases.

CONCLUSION

Our study showed the feasibility of clinical application of the MPS-based test in the non-invasive detection of fetal SCA. Together with a two-stage post-test clinical counseling protocol, it leads to a well-informed decision-making procedure.

The structure of the symptoms of major depression: exploratory and confirmatory factor analysis in depressed Han Chinese women

BACKGROUND

The symptoms of major depression (MD) are clinically diverse. Do they form coherent factors that might clarify the underlying nature of this important psychiatric syndrome?

METHOD

Symptoms at lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ⩾30 years with recurrent DSM-IV MD. Exploratory factor analysis (EFA) and confirmatoryfactor analysis (CFA) were performed in Mplus in random split-half samples.

RESULTS

The preliminary EFA results were consistently supported by the findings from CFA. Analyses of the nine DSM-IV MD symptomatic A criteria revealed two factors loading on: (i) general depressive symptoms; and (ii) guilt/suicidal ideation. Examining 14 disaggregated DSM-IV criteria revealed three factors reflecting: (i) weight/appetite disturbance; (ii) general depressive symptoms; and (iii) sleep disturbance. Using all symptoms (n = 27), we identified five factors that reflected: (i) weight/appetite symptoms; (ii) general retarded depressive symptoms; (iii) atypical vegetative symptoms; (iv) suicidality/hopelessness; and (v) symptoms of agitation and anxiety.

CONCLUSIONS

MD is a clinically complex syndrome with several underlying correlated symptom dimensions. In addition to a general depressive symptom factor, a complete picture must include factors reflecting typical/atypical vegetative symptoms, cognitive symptoms (hopelessness/suicidal ideation), and an agitated symptom factor characterized by anxiety, guilt, helplessness and irritability. Prior cross-cultural studies, factor analyses of MD in Western populations and empirical findings in this sample showing risk factor profiles similar to those seen in Western populations suggest that our results are likely to be broadly representative of the human depressive syndrome.

Changing patterns of basic household consumption in the Inner Mongolian grasslands: a case study of policy-oriented adoptive changes in the use of grasslands

Grassland ecosystems, as the basic natural resources in the Inner Mongolia Autonomous Region, are becoming increasingly sensitive to human intervention, leading to deterioration in fragile ecosystems. The goal of this study was to describe the restoration policy-oriented adoptive changes to basic household consumption patterns of food, fuel, and water, and their spatial distribution by grassland types in the region. Basic household consumption data were collected in the meadow steppe (Hulun Buir), typical steppe (Xilin Gol), and semi-desert steppe (Ordos) ecosystems using structured questionnaires administered to 209 herders and farmers. In 2010, the householders’ intake comprised a low amount of agri-crops, including staple foods, vegetables and fruit with a high amount of meat, which still dominated the patterns of food consumption. However, the number of households preferring this pattern is decreasing and higher amounts of agri-crop and lower amounts of meat consumption pattern is increasing. From 1995 to 2010, fuel consumption patterns changed from being dominated by bio-fuels (dung) to being dominated mainly by electricity and gas. However, bio-fuel remains a major energy source for daily life in the meadow steppe ecosystem. In all three surveyed grassland types, the use of coal, electricity and gas increased from 1995 to 2010. The source of domestic water in all three surveyed areas is from groundwater, with an increasing trend to use tap water from a public supply rather than from privately owned wells.

Cyclin-dependent kinase 1 inhibitor RO3306 promotes mitotic slippage in paclitaxel-treated HepG2 cells

Hepatocellular carcinoma (HCC) is the most common primary liver neoplasm and current systemic chemotherapy are mostly ineffective. Paclitaxel (PTX) has a clinically significant effect on many malignant tumors. Cells treated with PTX undergo reversible mitotic arrest and although high doses can cause side effects it may also induce apoptosis. We investigated the effect of a sequential combination of PTX and RO3306, a cyclin-dependent kinase 1 inhibitor, on the hepatocellular carcinoma HepG2 cell line. The sequential drug treatment protocol involved the addition of PTX (0.2 µmol/L) for 18 h followed by RO3306 (2 µmol/L) for a further 6 h. Cell viability and proliferation were measured using tetrazolium dye (MTT) and colony formation assay. Cell cycle profiles were established by flow cytometry. The expression level of protein was examined by immunoblotting. We observed a synergistic effect of PTX and RO3306 treatment on cell growth and proliferation as well as an increased proportion of cells in sub-G1 phase. Expression levels of cyclin B, cyclin E and phosphorylated Histone H3 demonstrated that RO3306 enhanced apoptosis in PTX treated cells by mitotic slippage. Our data suggested that the combination of PTX and RO3306 may be an effective therapeutic combination for the treatment of liver cancer.

Morphologic characteristics of atherosclerotic middle cerebral arteries on 3T high-resolution MRI

BACKGROUND AND PURPOSE

There are limited studies on the morphologic characteristics of MCA atherosclerotic stenosis. Our aim was to quantitatively assess the remodeling pattern and plaque distribution of atherosclerotic MCAs with 3T high-resolution MR imaging.

MATERIALS AND METHODS

Eighty-seven consecutive patients with symptomatic atherosclerotic stenoses at the M1 segment of the MCA on DSA (50%-99%) were enrolled. The remodeling index was calculated as the Vessel Area at Maximal Lumen Narrowing/Reference Vessel Area. A remodeling index ≥ 1.0 was defined as positive remodeling, and a remodeling index < 1.0, as negative remodeling. Plaque distribution at the maximal lumen narrowing site was classified on the basis of the involvement of the superior, inferior, dorsal, or ventral MCA wall.

RESULTS

Forty-three of 87 patients were excluded due to poor imaging quality (n = 8) or scan plane obliquity secondary to a tortuous M1 segment of the MCA or an MCA ostium lesion or angled lesion (n = 35). Of 44 patients in the final analysis, negative remodeling was found in 19 (43.2%) lesions, and positive remodeling, in 25 (56.8%) lesions. At maximal lumen narrowing sites, lesions with negative remodeling had less vessel area, wall area, and percentage of plaque burden (P < .0001) and a lower eccentricity index (P = .023), compared with lesions with positive remodeling. The plaque involved the superior and dorsal walls in 15 (34.1%) of 44 patients.

CONCLUSIONS

2D high-resolution MR imaging can help assess the remodeling pattern and plaque distribution of MCA stenosis, but the imaging and postprocessing protocol for remodeling assessment needs to be improved in the tortuous course of the MCA and in MCA ostium or angled lesions.

Energy, amino acid, and phosphorus digestibility of phytase transgenic corn for growing pigs

Three experiments were conducted to evaluate energy, AA, and P digestibility in a phytase transgenic corn (PTC) containing a phytase gene (phyA2) isolated from Aspergillus niger compared with a nontransgenic near-isoline conventional corn (CC) grown in the same environmental conditions for growing pigs. Experiment 1 was an energy balance experiment conducted to measure DE and ME in PTC and CC. Eighteen growing barrows (initial BW 25.8±0.3 kg) from 9 litters were allotted by BW and litter to 1 of 2 dietary treatments with 9 pigs per treatment in a randomized complete block design. Pigs were individually placed in metabolism cages and fed diets based on the 2 corns. The DE and ME in PTC (3,967 and 3,941 kcal/kg of DM, respectively) were greater (P<0.05) than those in CC (3,917 and 3,848 kcal/kg of DM, respectively). Experiment 2 was conducted to measure apparent ileal digestibility (AID) and standardized ileal digestibility (SID) values of CP and AA in the 2 corns. Eighteen growing barrows (initial BW 41.8±0.7 kg) were equipped with a T-cannula in the distal ileum. Pigs were placed in metabolism cages in a completely randomized design with 3 dietary treatments of 6 pigs each. An N-free diet was used to estimate basal endogenous losses of CP and AA. The AID and SID values for CP and all AA did not differ between the 2 corns. Experiment 3 was conducted to measure apparent total tract digestibility (ATTD) and standardized total tract digestibility (STTD) values of P in the 2 corns. Eighteen growing pigs (initial BW 30.5±0.5 kg) from 6 litters were placed in metabolism cages in a randomized complete block design with 3 dietary treatments of 6 pigs each based on BW and litter. Two diets were based on the 2 corns, and a P-free diet was used to measure endogenous P losses. The ATTD and STTD values of P were greater (P<0.05) in the PTC diet (71.4% and 76.9%, respectively) than those in the CC diet (27.6% and 33.4%, respectively). Pigs fed the PTC diet had a greater (P<0.05) P retention (70.7%) than those fed the CC diet (27.1%). It was concluded that PTC had a greater digestibility of energy and P than CC for growing pigs. As a consequence, if PTC replaces CC in a pig diet, the DE and ME in the diet will increase, and less inorganic P will need to be supplemented to the diet, and thus P excretion in manure will be decreased.

Evaluation of an isotope dilution liquid chromatography tandem mass spectrometry method for pharmaceuticals in fish

An isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was successfully developed and applied for analysis of 15 pharmaceuticals and 2 pharmaceutically active metabolites in fish tissues. This method relied on electrospray ionization (ESI), for which the influence of sample matrix on analyte ionization efficiencies remains a persistent challenge to environmental analysis. Statistically derived method detection limits (MDLs) for most analytes ranged from 1 to 10 ng/g, independent of sample matrix, and were as low as 0.04 ng/g for the most sensitive compounds in fillet tissue. MDLs for fish fillets were determined for both 10 μL and 100 μL injection volumes; however, results showed that detection limits did not scale linearly with injection volume. Direct comparison of spike recoveries from fish liver demonstrated that isotope dilution was superior to matrix-matched calibration in compensating for matrix interference. Spike recoveries for the isotope dilution approach generally ranged from 91 to 112%, independent of tissue (i.e., fillet or liver). The developed method was applied to examine target analytes in brown trout (Salmo trutta), collected upstream and downstream from a municipal effluent discharge to East Canyon Creek, Park City, UT, USA. Though no pharmaceuticals were detected in fish samples from the upstream location, 3 and 10 compounds (out of 17 target analytes) were detected in fish fillet and liver samples, respectively, from the downstream sampling site. Pharmaceuticals in fish fillets were observed at concentrations ranging from 0.14 to 12 ng/g, while levels were markedly higher in liver tissues (range: 0.27-600 ng/g).

Bacterial communities in sediments of the shallow Lake Dongping in China

AIMS

The purpose of this study was to discuss how the environmental inputs and anthropogenic activities impact bacterial communities in the sediments of a shallow, eutrophic and temperate freshwater lake.

METHODS AND RESULTS

Sediment cores were collected from Lake Dongping, located in Taian, Shandong, China. All samples were processed within 4 h of collection. Total nitrogen, total phosphorus (TP), total organic carbon, ammonium nitrogen and nitrate nitrogen content of samples were measured by Kjeldahl determination, sulphuric acid-perchloric acid digestion and molybdenum blue colorimetry, potassium dichromate titration, Nessler's reagent colorimetric and the phenol disulphonic acid colorimetric method, respectively. Seasonal and temporal diversity of sediment bacterial communities at six stations in Lake Dongping were investigated using molecular approaches (terminal restriction fragment length polymorphism and 16S rDNA clone libraries). Noticeable seasonal and temporal variations were observed in bacterial diversity and composition at all six stations. Sediment bacterial communities in Lake Dongping belonged to 16 phyla: Proteobacteria (including α-Proteobacteria, β-Proteobacteria, δ-Proteobacteria, ε-Proteobacteria, γ-Proteobacteria), Acidobacteria, Planctomycetes, Bacteroidetes, Firmicutes, Verrucomicrobia, Nitrospira, Chloroflexi, Gemmatimonadetes, Chlorobi, Cyanobacteria, Deferribacteres, Actinobacteria, OP8, Spirochaetes and OP11. Members of β-, δ- and γ-Proteobacterial sequences were predominant in 11 of 12 clone libraries derived from sediment samples. Sediment samples collected at stations 1 and 4 in July had the greatest bacterial diversity while those collected at station 2 in October had the least diversity. TP concentration was significantly correlated with the distribution of bacterial communities.

CONCLUSIONS

Our results suggested that different environmental nutrient inputs contribute to seasonal and temporal variations of chemical features and bacterial communities in sediments of Lake Dongping. TP concentration was significantly correlated with the distribution of bacterial communities.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study has an important implication for the optimization of integrated ecosystem assessment of shallow temperate freshwater lake and provides interesting information for the subsequent of the ecosystem.

Purification and characterization of an intracellular beta-glucosidase from the protoplast fusant of Aspergillus oryzae and Aspergillus niger

Protoplasts of Aspergillus oryzae 3.481 and Aspergillus niger 3.316 were prepared using cellulose and snail enzyme with 0.6 M NaCl as osmotic stabilizer. Protoplast fusion has been performed using 35% polyethylene glycol 4.000 with 0.01 mM CaCl2. The fused protoplasts have been regenerated on regeneration medium and fusants were selected for further studies. An intracellular beta-glucosidase (EC 3.2.1.21) was purified from the protoplast fusant of Aspergillus oryzae 3.481 and Aspergillus niger 3.316 and characterized. The enzyme was purified 138.85-fold by ammonium sulphate precipitation, DE-22 ion exchange and Sephadex G-150 gel filtration chromatography with a specific activity of 297.14 U/mg of protein. The molecular mass of the purified enzyme was determined to be about 125 kDa by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. The enzyme had an optimum pH of 5.4 and temperature of 65 degrees C, respectively. This enzyme showed relatively high stability against pH and temperature and was stable in the pH range of 3.0-6.6. Na+, K+, Ca2+, Mg2+ and EDTA completely inhibited the enzyme activity at a concentration of 10 mM. The enzyme activity was accelerated by Fe3+. The enzyme activity was strongly inhibited by glucose, the end product ofglucoside hydrolysis. The K(m) and V(max) values against salicin as substrate were 0.035 mM and 1.7215 micromol min(-1), respectively.

Arterial remodeling of advanced basilar atherosclerosis: a 3-tesla MRI study

BACKGROUND

There are limited studies on wall imaging of human basilar artery (BA). Our aim was to investigate remodeling mode of advanced BA atherosclerosis using 3-T MRI.

METHODS

Thirty-two consecutive symptomatic patients with atherosclerotic BA stenosis >or=70% were imaged with a 3-T magnetic resonance scanner. Proton density-weighted (PDW) cross-sectional images with submillimeter voxel size were obtained. The vessel area (VA) and lumen area (LA) at the maximal lumen narrowing (MLN) site and reference site were measured. Intraobserver and interobserver variability was determined by intraclass correlation coefficient (ICC). Wall area (WA) was estimated by VA - LA. Plaque size (PS) was estimated by WA at MLN site--reference WA. Percent plaque burden was calculated as (PS/VA at MLN site) x 100%. Remodeling index (RI) was the ratio of VA at MLN site to reference VA. RI >or=1.05 was defined as positive remodeling (PR) and RI <1.05 as non-PR.

RESULTS

Measurements of cross-sectional BA images were available in 30 of 32 patients. Intraobserver or interobserver variability was small, with ICC ranging from 0.955 to 0.996. The mean RI of the 30 patients was 1.2 +/- 0.4. PR was found in 19 (63.3%) patients and non-PR in 11 (36.7%) patients. Compared with the non-PR group, the PR group had greater PS (15.0 +/- 9.3 mm(2) vs 6.4 +/- 3.9 mm(2), p = 0.007) and greater percent plaque burden (50.5 +/- 9.9% vs 28.5 +/- 12.7%, p < 0.0001).

CONCLUSIONS

3-T high-resolution PDW imaging is a reproducible tool for measuring BA dimensions. In patients with advanced BA atherosclerosis, PR lesions are more frequently observed and contain larger plaques than non-PR lesions.

Wingspan experience at Beijing Tiantan Hospital: new insights into the mechanisms of procedural complication from viewing intraoperative transient ischemic attacks during awake stenting for vertebrobasilar stenosis

BACKGROUND AND AIM

Intracranial vertebrobasilar artery (VBA) stenosis portends a stroke and death rate of 8.5-22.8% annually despite medical therapy. Stenting has emerged as a treatment option but also carries substantial risk. Awake stenting under local anesthesia to minimize major procedural complication was investigated.

METHODS

Between January 2007 and December 2008, 43 of 46 consecutive patients with severe symptomatic intracranial VBA stenosis underwent elective angioplasty assisted with self-expanding Wingspan stent under local anesthesia at our institute. All data were collected prospectively.

RESULTS

All 43 patients tolerated the stenting procedure under local anesthesia well. Forty-two patients (97.7%) were stented successfully. Within 30 days, there were three periprocedural strokes, including thromboembolic infarct, pontine perforator infarct and intracranial hemorrhage, without fatality. In addition, five patients had intraoperative brainstem transient ischemic attacks (TIAs) seconds after the deployment of the stent delivery system across the tortuous VBA. The symptoms and signs included impaired consciousness (n=5), dysarthria (n=3), convulsion (n=2), conjugate horizontal gaze palsy (n=2), nystagmus (n=2) and pinpoint pupils (n=1). There was angiographic evidence of VBA straightening without thromboembolism. The TIAs resolved within minutes of prompt removal of the delivery catheter.

CONCLUSIONS

VBA stenting under local anesthesia is feasible with a 7% periprocedural stroke risk. Awake stenting allows timely detection of intraoperative TIAs. The mechanism of intraoperative TIA appears to be stent delivery system induced VBA straightening and distortion of its vascular tree. A devastating stroke may ensue if the TIA is not detected and distortion of VBA perforators is not reversed promptly.

Do patients with basilar or vertebral artery stenosis have a higher stroke incidence poststenting?

BACKGROUND AND AIM

Posterior circulation stenosis may be a risk factor associated with stroke after intracranial stenting as compared with anterior circulation stenosis. Our aim was to test our hypothesis that there was no difference in clinical outcome poststenting between patients with severe stenosis of the basilar artery (BA) and intracranial vertebral artery (VA).

METHODS

Using the Cox proportional hazards regression model adjusted for prespecified factors (qualifying event, and timing of stenting after the qualifying event), we compared primary endpoint (ischemic stroke in the vertebrobasilar territory, including any stroke or death within 30 days of stenting) between patients with severe symptomatic atherosclerotic BA and VA stenosis who underwent elective stenting in our prospective database. Analysis was by intention-to-treat principle.

RESULTS

Primary endpoint event occurred in 13 (18.8%) of 69 patients with BA stenosis during a mean 23.4 months (9 within 30 days and 4 afterward) and 3 (4.3%) of 70 patients with VA stenosis during a mean 26.4 months (2 within 30 days and 1 afterward). Patients with BA stenosis had a significantly higher risk of the primary endpoint (adjusted HR=4.87, 95% CI 1.37 to 17.29; p=0.014) or any stroke or death within 30 days of stenting (adjusted HR=5.13, 95% CI 1.10 to 23.96; p=0.038) than those with VA stenosis.

CONCLUSION

A significantly higher stroke risk poststenting exists in patients with severe BA stenosis than those with VA stenosis. The discrepancy in clinical outcome after stenting between patients with BA and VA stenosis should be considered in clinical practice and stenting trials.

Hepatitis B virus subgenotype C2 is the most prevalent subgenotype in northeast China

The geographical distribution of hepatitis B virus (HBV) subgenotypes and their clinical implications in patients with acute and chronic hepatitis B in the Heilung-kiang province of northeast China were investigated. Nested PCR and multiplex PCR were performed with genotype-specific primers and with subgenotype-specific primers to identify genotypes and subgenotypes from serum samples of 412 HBV infections including 69 with acute self-limited hepatitis (ASH) and 343 with chronic hepatitis (CH). A total of 361 samples were genotyped and 304 were further subgenotyped. The most common HBV genotype was C (93.63%, 338/361), with subgenotype group C2 (83.73%, 283/338) predominating. Genotype B was also found and subgenotype B2 predominated within this genotype. Out of 69 infected patients with ASH, 48 were identified as genotype C and all belonged to subgenotype C2. Of 343 infected patients with CH, 313 were genotyped and 256 were subgenotyped; amongst these, C2 (91.80%, 235/256), B2 (7.42%, 19/256) and mixed subgenotypes B2 and C2 (0.78%, 2/256) were found. In HBV subgenotype C2 infections, ASH had a higher ratio of women than CH patients. These results show that HBV subgenotypes C2 and B2 were found in Heilung-kiang province of northeast China. In ASH and CH groups, the distributions of subgenotypes were coincident with C2, the predominant subgenotype. Analysis of the association between subgenotype and the outcomes of HBV infection was inconclusive in our study.

Long-term outcome of tandem stenting for stenoses of the intracranial vertebrobasilar artery and vertebral ostium

BACKGROUND AND PURPOSE

Patients with symptomatic atherosclerotic stenosis of the intracranial vertebrobasilar artery (VBA) have a poor prognosis, and those with coexistent intracranial and extracranial stenoses have worse outcomes despite medical therapy. Our aim was to study the long-term outcome of patients with symptomatic atherosclerotic tandem stenoses at the intracranial VBA and the vertebral artery ostium (VAO) after elective stent placement.

MATERIALS AND METHODS

Ten consecutive patients (mean age, 65.3 years) with this condition underwent elective stent placement at our institution between September 2001 and December 2007. Technical success was defined as stent placement of both VAO and intracranial VBA stenoses with complete stent coverage of the lesions, residual stenosis of < or = 30%, and good antegrade blood flow. The study end point was a composite of any stroke or death within 30 days and ischemic stroke in the VBA territory after 30 days.

RESULTS

Technical success was obtained in 9 of 10 patients without any stroke or death within 30 days. During a median follow-up duration of 32 months, 1 patient had a fatal ischemic stroke in the VBA territory at 4 months, and the other 9 patients were free from stroke recurrence. Thus, the annual stroke rate in VBA territory (including any stroke or death within 30 days) was 3.8%.

CONCLUSIONS

This pilot study shows that elective stent placement for patients with symptomatic atherosclerotic tandem stenoses at the intracranial VBA and VAO has an acceptable long-term outcome and may be considered as an alternative to medical therapy.