Human calmodulin-like protein is an epithelial-specific protein regulated during keratinocyte differentiation

Human calmodulin-like protein (CLP) is a calcium-binding protein down-regulated in a cell culture model of mammary tumorigenesis as well as in a majority of breast cancers in vivo. CLP down-regulation may be a result of the poorly differentiated state of these cell lines and tumors, or CLP expression may be incompatible with the uncontrolled cell growth associated with tumorigenesis. To learn more about CLP expression and regulation, we determined the distribution of CLP in various human tissues by immunohistochemistry. CLP was expressed exclusively in the epithelium of the tissues surveyed and was most abundant in thyroid, breast, prostate, kidney, and skin. CLP expression appears to increase in stratified epithelium during differentiation, as illustrated in the skin where CLP staining intensified from the basal through the spinous to the granular layers. Using a normal human keratinocyte culture model, we examined CLP expression in response to various agents known to affect keratinocyte differentiation. Agents that inhibit (epidermal growth factor, EGF) or permit (keratinocyte growth factor) terminal differentiation correspondingly regulate CLP expression. Factors modulating the EGF receptor signaling pathway were particularly potent in regulating CLP expression. CLP expression correlated with an agent's ability to promote terminal differentiation regardless of the agent's effect on keratinocyte proliferation. These studies show that CLP expression is coordinately regulated by, and may be involved in, the program of terminal differentiation in human keratinocytes and, likely, other differentiating epithelial cell types.

Reference intervals for thyroid hormones in pregnant Chinese women

OBJECTIVE

To establish gestation-related reference intervals for thyroid hormones in a Chinese population.

MATERIALS AND METHODS

A prospective study with 343 healthy pregnant women (5-41 weeks) and 63 non-pregnant controls. Thyroid stimulating hormone (TSH), free thyroxine (T4) and tri-iodothyronine (T3) (and human chorionic gonadotrophin) were measured by immunoassays. The median, 2.5th and 97.5th percentiles at 4-week intervals were calculated. Data were also analysed for significant trends using ANOVA.

RESULTS

Free T3 decreased during pregnancy, whereas free T4 initially increased, peaking between 9-13 weeks and then decreased, the decline becoming significant by week 21. TSH mirrored changes in free T4.

CONCLUSION

The gestation-related reference intervals for thyroid hormones should alleviate the misinterpretation of thyroid function in pregnancy.

The predictive value of serum 1,5-anhydro-D-glucitol in pregnancies at increased risk of gestational diabetes mellitus and gestational impaired glucose tolerance

The objective of the study was to determine the efficacy of 1,5-anhydro-D-glucitol (1,5 AG) for the prediction of gestational diabetes and gestational impaired glucose tolerance (GIGT). One hundred and eighty-five pregnant women with epidemiological risk factors of gestational diabetes or GIGT underwent 75 g oral glucose tolerance test and plasma 1,5 AG assay at 26 to 28 weeks of gestation. There was no significant difference in plasma 1,5 AG either before or after an oral glucose load. The area under the receiver operator characteristic curve for 1,5 AG was only 0.485 which implies that 1,5 AG is a poor predictor of GIGT or gestational diabetes.

Are thyroid hormones or hCG responsible for hyperemesis gravidarum? A matched paired study in pregnant Chinese women

OBJECTIVE

To determine the relative importance of thyroid hormones and human chorionic gonadotropin in the etiology of hyperemesis gravidarum.

DESIGN

A prospective study comparing the hormonal status in women with hyperemesis gravidarum (5-18 weeks), with healthy pregnant controls, matched for gestational age. Sensitive thyroid stimulating hormone, free thyroxine, free triiodothyronine and total beta human chorionic gonadotropin were measured by immunoassays. The hormone results for hyperemesis gravidarum group (n=58) were compared with pregnant control women (n=58) using the Mann Whitney test. Stepwise logistic regression analysis was performed to determine which variables were significantly associated with hyperemesis gravidarum and to estimate the probability of each woman having hyperemesis gravidarum. The strength of the resulting association was tested by generating a receiver operating characteristic curve for predicting hyperemesis gravidarum using these probabilities.

RESULTS

Maternal age and all hormones were significantly different between the hyperemetic and control groups. However, logistic regression analysis demonstrated that only maternal age, free thyroxine and thyroid stimulating hormone were significant independent variables. The area beneath the receiver operating characteristic curve for prediction of hyperemesis gravidarum was 0.84.

CONCLUSION

Human chorionic gonadotropin is not independently involved in the etiology of hyperemesis gravidarum but may be indirectly involved by its ability to stimulate the thyroid. Differences in maternal age and thyroid function are highly discriminatory with regard to hyperemesis gravidarum.

The tumor-sensitive calmodulin-like protein is a specific light chain of human unconventional myosin X

Human calmodulin-like protein (CLP) is an epithelial-specific Ca(2+)-binding protein whose expression is strongly down-regulated in cancers. Like calmodulin, CLP is thought to regulate cellular processes via Ca(2+)-dependent interactions with specific target proteins. Using gel overlays, we identified a approximately 210-kDa protein binding specifically and in a Ca(2+)-dependent manner to CLP, but not to calmodulin. Yeast two-hybrid screening yielded a CLP-interacting clone encoding the three light chain binding IQ motifs of human "unconventional" myosin X. Pull-down experiments showed CLP binding to the IQ domain to be direct and Ca(2+)-dependent. CLP interacted strongly with IQ motif 3 (K(d) approximately 0.5 nm) as determined by surface plasmon resonance. Epitope-tagged myosin X was localized preferentially at the cell periphery in MCF-7 cells, and CLP colocalized with myosin X in these cells. Myosin X was able to coprecipitate CLP and, to a lesser extent, calmodulin from transfected COS-1 cells, indicating that CLP is a specific light chain of myosin X in vivo. Because unconventional myosins participate in cellular processes ranging from membrane trafficking to signaling and cell motility, myosin X is an attractive CLP target. Altered myosin X regulation in (tumor) cells lacking CLP may have as yet unknown consequences for cell growth and differentiation.

Birth of twins using in vitro matured oocytes and cryopreserved semen from a male with carcinoma of the penis

Semen cryopreserved from a male prior to treatment for carcinoma of the penis was used for intra-cytoplasmic sperm injection (ICSI) of in vitro matured (IVM) oocytes, resulting in the birth of healthy, non-identical twin girls.

Complications of laparoscopic surgery for benign ovarian cysts

STUDY OBJECTIVE

To assess complications of laparoscopic surgery in the management of ovarian cysts.

DESIGN

Prospective observational study (Canadian Task Force classification II-2).

SETTING

University-affiliated hospital.

PATIENTS

Consecutive patients (513) undergoing laparoscopic surgery for ovarian cysts not suspected to be malignant.

INTERVENTION

Laparoscopic surgery.

MEASUREMENTS AND MAIN RESULTS

A total of 587 ovarian cysts were removed from 513 women. Conversion to laparotomy was necessary in five cases (<1%). Mean +/- SD cyst diameter was 5.5+/-2.9 cm, with endometriomas (44. 5%) and dermoids (24.3%) being the two most common pathologies; 6.6% were functional. Mean +/- SD operating time was 69+/-31 minutes, and hospital stay and postoperative convalescence was 2.6+/-1.5 and 14.3 +/-9.6 days, respectively. The overall complication rate was 13.3%. Major complications occurred in three patients (0.6%): one small bowel injury and two ureter injuries. Cannula site complications were five inferior epigastric vessel injuries and four incisional hernias at the 10-mm lateral port site.

CONCLUSION

Laparoscopic ovarian surgery was associated with 13.3% complications, with 0.6% being major. Careful patient selection and proper surgical training are critical to ensure safe performance of laparoscopy.

Evaluation of glucose intolerance in pregnancy using biochemical markers of fetal hyperinsulinemia

We aimed to evaluate gestational impaired glucose tolerance (GIGT) in untreated patients using umbilical cord blood insulin and connecting peptide (C-peptide) concentrations to indicate fetal hyperinsulinemia. A 75 g, 2-hour oral glucose tolerance test, evaluated using WHO criteria, was performed in 722 antenatal patients. Cord C-peptide (p = 0.001) and insulin (p = 0.008) concentrations were significantly higher in patients with GIGT in comparison to those with normal glucose tolerance. The WHO test failed to identify abnormal C-peptide concentrations (p = 0.057), but did identify abnormal insulin concentrations (p = 0.006) and cases where either or both were raised (p = 0.002), with a low Youden's index (range 8.1-11.3) in all 3 cases. A significant biochemical difference exists in patients with GIGT. The WHO criteria for GIGT predict abnormal biochemical outcomes, but they do so poorly.

The incidence of pregnancy-induced hypertension among patients with carbohydrate intolerance

OBJECTIVE

To determine the association between pregnancy-induced hypertension (PIH) and carbohydrate intolerance in pregnancy.

METHODS

Data on singleton pregnancies were retrieved from the obstetric database of University Hospital, Kuala Lumpur. Gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM) were defined according to the World Health Organization criteria. Established diabetes mellitus (EDM) was defined as diabetes mellitus diagnosed prior to pregnancy. PIH was diagnosed according to the criteria of the International Society for the Study of Hypertension in Pregnancy. Maternal characteristics were compared between groups using analysis of variance (ANOVA) and incidence counts using the chi-squared test. Logistic regression analysis using the presence of PIH as the response variable was used to study the association among GDM, GIGT, EDM, and PIH, controlling for maternal factors.

MAIN OUTCOME MEASURES

To determine the incidence of PIH among patients with glucose intolerance and the independent risk factors for the development of PIH.

RESULTS

There were 24,290 singleton pregnancies retrieved from the database. Both the prevalence of carbohydrate intolerance and the incidence of PIH differed among the three principal ethnic groups (p < 0.0001). There was a significant association between PIH and both a higher maternal age (OR = 1.04, p < 0.0001) and a higher maternal body mass index (BMI) at delivery (OR = 1.14 per unit increment, p < 0.0001). After adjusting for maternal age, BMI, parity, and ethnic origin, using logistic regression, there was a significant residual risk of PIH among individuals with GIGT, GDM, or EDM.

CONCLUSIONS

Patients with carbohydrate intolerance of varying severity are at increased risk of developing PIH. Our findings lend credence to the theory that carbohydrate intolerance and PIH share a common etiology.

Diurnal variation in excretion of N-acetyl-beta-glucosaminidase during pregnancy: implications for the prediction of pre-eclampsia

Significant differences in urinary excretion of N-acetyl-beta-glycosaminidase (NAG) were observed between nulliparous and multiparous patients and between fasted and nonfasted individuals. No significant difference was observed between patients with normal and those with abnormal glucose tolerance. Multiple regression analysis confirmed that the significant independent determinants of NAG/creatinine ratio were age, parity, gestation and fasting state. Significant diurnal variation in urinary NAG/Cr ratio was observed, the highest levels being recorded in early morning fasting specimens, falling in each postprandial specimen and beginning to rise again by midnight. The urinary NAG/Cr ratio is influenced by fasting, parity, gestation and age. More consistent results for prediction of pre-eclampsia are therefore likely to be obtained using fasting (early morning) urine specimens and adjusting cut-off criteria for the other factors.

A survey of pregnant women's attitude towards breech delivery and external cephalic version

A structured interview survey was carried out in 150 women who came for their first antenatal visit in a university hospital in Hong Kong between June and July 1998. Their opinions and perceptions of fetal and maternal safeties on different modes of delivery for both cephalic and breech presentation, and external cephalic version (ECV) were surveyed. Their decisions on the management of term breech-presenting pregnancy were examined. Most women (92%) preferred vaginal delivery to Caesarean delivery (CS) in case of cephalic presentation, mainly because it was a natural way of parturition. They perceived that vaginal delivery was safer than CS for both mothers and babies, but the reverse was true for breech presentation. About 82% chose ECV as the first choice of managing breech presentation, mainly because a successful version allowed a natural way of delivery. Only 2% of women considered ECV ineffective, and 13.3% and 18.7% considered it not safe for mothers and fetuses respectively. Therefore, ECV should be an available option in all obstetric units. Adequate counselling and explanation would improve the acceptance of ECV.

Determinants of umbilical cord arterial 8-iso-prostaglandin F2alpha concentrations

OBJECTIVE

To determine the concentration of 8-isoPGF(2alpha) in cord blood as a measure of oxidative stress during labour, and to compare them with other established parameters of in vivo lipid peroxidation and with the acid-base status of the newborn.

METHOD

Umbilical cord arterial and venous blood samples were collected from 81 singleton term deliveries for determination of 8-isoPGF(2alpha), malondialdehyde and organic hydroperoxides. In addition, metabolites derived from the oxidative metabolism of purines during hypoxia-reoxygenation and routine cord blood of oxygen saturation, pH, pO2, pCO2, HCO3 and base excess were measured.

RESULTS

Arterial concentrations of 8-isoPGF(2alpha) were significantly higher in cases with fetal distress, tight nuchal cord (P < 0.001), the umbilical coiling index, and male sex (P < 0.05) (R2 = 0.48). No correlation was found with any parameter of acid-base status. In arterial and venous blood the concentrations of organic hydroperoxides and hypoxanthine significantly correlated with the fetal nuchal cord (P < 0.001) (R2 = 0.26 and 0.16, respectively).

CONCLUSION

Our findings indicate that 8-isoPGF2(alpha) in cord arterial blood is a suitable parameter to quantify a possible oxidative stress in the fetus during labour. Measurements of the F2-isoprostane concentrations in cord blood at labour provide a clinically useful method to assess the perinatal outcome.

The 'right kind' of pain: talking about symptoms in outpatient oncology consultations

Despite improvements in cancer management over the past 25 years, unrelieved symptoms continue to be reported. Little is known about how patients' problems and concerns are communicated to professionals during oncology treatment. This qualitative study investigates the process of communication between cancer patients and oncologists during consultations in outpatient clinics of a regional teaching hospital. Data were collected by nonparticipant observation and audiotaping consultations. Analyses were by qualitative content analysis and conversation analysis. An objectives, strategies and tactics model was applied to organize the findings. Seventy-four consultations between cancer patients and 15 doctors were observed and audiotaped. Pain talk is defined and identified as a substantial topic, occurring in 39 out of 74 consultations. Doctor-initiated questions are the predominant discourse feature and are prominent not only in initiating discussions but also in directing further talk (e.g. over three-quarters of doctor-initiated questions are in a closed form which focus narrowly on limited physical aspects of patients' pain). This limited information exchange is used alongside other communication tactics to identify the 'right kind' of pain that may benefit from cancer therapy and to truncate talk of problems perceived to be outside of this specialist remit. Although individualized, holistic care is the expressed philosophy of the clinic, our data show that doctors tightly control the agenda to focus narrowly on pain which was amenable to radiotherapy, chemotherapy, surgery or hormone manipulation. Inadequate exploration of patients' pain is likely to be detrimental to symptom control.

Color ultrasonography: a useful technique in the identification of nuchal cord during labor

OBJECTIVE

To compare the accuracy of intrapartum ultrasound with and without color Doppler for identification of nuchal cord displacement during labor.

METHODS

180 normal pregnant women, admitted in labor, or for induction to labor, were examined independently by two researchers, using either conventional real-time gray-scale imaging or color Doppler imaging. A repeat examination was performed by the other researcher using the other ultrasound modality. Nuchal cord displacement was classified as either negative, definite or suspicious. Nuchal cord at birth was classified as either tight or loose.

RESULTS

Sixty-two (34%) cases examined using the two ultrasound imaging modalities presented with nuchal cord at delivery. The sensitivity of color Doppler was 96.8%. The accuracy of color Doppler in detecting nuchal cord during labor was significantly better (P < 0.05) than gray-scale imaging alone. The results of a restricted sequential t-test analysis of 53 un-tied pairs showed an overall preference in favor of color Doppler assessment: statistical significance (P < 0.01) was reached after 41 un-tied pairs.

CONCLUSIONS

The tight and loose nuchal cord could not be distinguished by ultrasound. Color Doppler imaging can provide useful additional information to gray-scale imaging in the detection of nuchal cord displacement during labor.

Effect of external cephalic version at term on fetal circulation

OBJECTIVE

We sought to investigate the subclinical effect of external cephalic version on fetal circulation.

STUDY DESIGN

A prospective observational study was conducted on 136 subjects who had external cephalic version at or beyond 36 weeks of gestation without clinical complication. Doppler ultrasonographic studies of the umbilical and middle cerebral circulations were performed before and after the external cephalic version. The following Doppler indexes were measured: (1) the pulsatility index of the umbilical artery, which represents disturbance of placental circulation, and (2) the pulsatility index of the fetal middle cerebral artery, which represents fetal response. The Wilcoxon signed rank test was used for all statistical analyses.

RESULTS

There was no significant difference in pulsatility index of the umbilical artery before and after external cephalic version (P =.674). There was a statistically significant reduction in the pulsatility index of the middle cerebral artery after external cephalic version (P =.043), and this difference existed only among multiparous women (P =.029), among those in whom the external cephalic version was considered to be difficult (P =.038), and when the placenta was posteriorly located (P =.028). The reduction in pulsatility index was not related to whether the external cephalic version was successful. In all cases the Doppler indexes remained within the normal ranges, and there were no associated fetal complications.

CONCLUSION

External cephalic version was not associated with any significant disturbance of placental resistance to blood flow. Conversely, external cephalic version was associated with a significant reduction in the pulsatility index of the middle cerebral circulation, especially among the multiparous women, after a difficult procedure or in those with a posterior placenta. This probably represents a normal fetal physiologic response to manipulation of the fetal head.

Outcome of labour after successful external cephalic version at term complicated by isolated transient fetal bradycardia

OBJECTIVES

To investigate factors associated with the occurrence of transient fetal bradycardia after external cephalic version, and labour outcome after isolated transient fetal bradycardia.

DESIGN

Cohort study.

SETTING

Teaching hospital with a policy of offering external cephalic version for breech presentation at or beyond 36 weeks of gestation.

POPULATION

Four hundred and twenty-nine external cephalic versions performed over a 5-year period.

METHODS

Between group differences were compared with the unpaired t test or the chi2 test. Logistic regression analysis was performed to exclude confounding effects.

MAIN OUTCOME MEASURES

Incidence of caesarean section for fetal distress.

RESULTS

Transient fetal bradycardia occurred in 8.4% of external cephalic versions, and was associated with a successful version (OR 16.45, P < 0.001), a difficult procedure (OR 3.70, P = 0.001), and nulliparity (OR 2.83, P = 0.007). The incidence of intrapartum caesarean section for fetal distress was 16.7% in pregnancies with transient fetal bradycardia, compared with 7.9% in those without (OR 2.34, 95% CI 0.81, 6.71).

CONCLUSIONS

Transient fetal bradycardia after external cephalic version may be associated with a higher risk of intrapartum caesarean section for fetal distress.

Effect of labour and delivery on plasma hepatic enzymes in the newborn

OBJECTIVE

To study the relationship between cord blood hepatic enzymes and obstetric and neonatal outcome in a Chinese population.

MATERIALS AND METHODS

The study group consisted of 288 low-risk Chinese women with singleton term pregnancies. The following enzymes were assayed in cord blood: lactate dehydrogenase (LDH), glutamyl transferase (GGT), aspartate aminotransferase (AST) and alanine transferase (ALT). These were correlated to maternal and neonatal characteristics.

RESULTS

A strong correlation was noted between cord blood AST and LDH (R = 0.582, p < 0.01), which was absent amongst those infants delivered by elective cesarean section. LDH, AST and ALT were negatively correlated with cord arterial pH and base excess (BE). GGT was inversely related only to gestational age (R = -0.18, p < 0.01). Both LDH and AST were weakly correlated with the duration of the first and second stages of labour. LDH was most closely linked to arterial pH, whereas AST was related to both arterial BE and duration of the second stage.

CONCLUSIONS

The reference values are comparable to those published for Caucasian populations. There are moderate elevations in LDH and AST associated with the onset of labour and changes in acid-base status.

A comparison of three ultrasound estimates of intrapartum oligohydramnios for prediction of fetal hypoxia-reperfusion injury

A prospective observational study assessed the predictive value of three techniques for amniotic fluid volume assessment on umbilical cord arterial lipid peroxide levels and acid-base balance. Women with singleton, term, cephalic presentation, and an initially normal fetal heart rate tracing were recruited. All pregnancies had the largest vertical pocket (LVP), two diameter pocket (2phi), and amniotic fluid index (AFI) assessments before and after amniotomy and cord arterial acid-base and lipid peroxide determinations at delivery. In 171 cases with confirmed cord arterial samples, malondialdehyde (MDA), organic hydroperoxide (OHP), pH and base excess (BE) were examined in relationship to intrapartum LVP, 2phi and AFI before and after amniotomy. Improvements in correlation between the estimates of amniotic fluid volume and outcome measures were observed 30 min after amniotomy, particularly with lipid peroxide measurements. Examination of scatter-plots using Lowess regression suggested that the correlation was only valid in cases of oligohydramnios but that the cutoff values recommended in the literature for defining oligohydramnios were not appropriate in our population sample. We suggest that oligohydramnios should be defined as an AFI < 8 cm or LVP < 4 cm. We concur with the recommendation of < 15 cm2 for the 2phi measurement.

Prediction of cervical response to prostaglandin E2 using fetal fibronectin

BACKGROUND

To determine whether presence of fetal fibronectin in cervico-vaginal secretions at term will predict the cervical response to prostaglandin E2 (PGE2) pessaries and successful induction of labor amongst subjects with unfavorable cervices.

METHODS

Cervico-vaginal secretion was tested for the presence of fetal fibronectin prior to cervical ripening with PGE2 pessaries in women with a singleton term or post-term pregnancy undergoing induction of labor. The total number of PGE2 pessaries, interval from induction to labor and induction to delivery, latent phase and active phase of labor and cesarean section rate were compared.

RESULTS

Women with fetal fibronectin in their cervico-vaginal secretion had better cervical response to PGE2 pessaries and required fewer doses for induction of labor and they took a shorter time interval from induction to delivery. They tend to have a lower cesarean section rate but the figures did not reach statistical significance.

CONCLUSIONS

The presence of fetal fibronectin from cervico-vaginal secretions in subjects with a Bishop score <5 is predictive of a favorable response to induction by prostaglandin pessary

Calcium and low-dose aspirin prophylaxis in women at high risk of pregnancy-induced hypertension

OBJECTIVE

The objectives of the study were to confirm the validity of using oscillometric measurement of MAP in the left lateral position to identify those at high risk for developing pregnancy-induced hypertension (PIH), and to assess and compare the efficacy of prophylaxis with low-dose aspirin or calcium supplementation in high-risk patients.

STUDY DESIGN

A prospective study in pregnancy; 500 normotensive, primigravid Chinese women were recruited in the second trimester of pregnancy on the basis of 80 mm Hg > or = MAP < 106 mm Hg in the antenatal clinic. They were then screened by Dinamap in a research setting, measuring MAP in the left lateral position after rest and using a cutoff value of 60 mm Hg for inclusion in the randomized study. Randomization was divided into three groups: control, low-dose aspirin, and calcium supplementation. After delivery, patients were classified as either having remained normotensive or having developed PIH, with or without proteinuria.

RESULTS

The incidence of both proteinuric and nonproteinuric PIH was significantly lower in patients screened out as low risk than in those selected as high risk using a critical value of 60 mm Hg for left lateral MAP (p < 0.05). The incidence of proteinuric PIH was significantly lower in patients given low-dose aspirin than in the control group (p < 0.05). However, the confidence intervals for the effect were wide, comparable with aspirin having no effect or leading to a 16-fold reduction in the risk of preeclampsia. For those given calcium supplementation, the reduction was not significant. There was no significant difference in the incidence of nonproteinuric PIH between the control group and the two groups receiving prophylaxis.

CONCLUSION

Oscillometric measurement of second-trimester left lateral MAP is a valid predictor of proteinuric PIH. Low-dose aspirin may offer a degree of protection from proteinuric PIH in these high-risk women. Calcium supplementation was not shown to significantly reduce the incidence of PIH.

Fetus papyraceous: an unusual cause of obstructed labour

Fetus papyraceous is a relatively rare complication in twin pregnancy. The occurrence of fetus papyraceous is frequently associated with perinatal morbidity in the other twin, making antenatal diagnosis of this condition desirable. Ultrasound detection is not always possible due to anatomical position and technical difficulties. A case of fetus papyraceous, found during Caesarean section for obstructed labour is reported and the implications of antenatal detection are discussed.

Loss of immunoreactivity for human calmodulin-like protein is an early event in breast cancer development

Cell proliferation requires calmodulin, a protein that regulates calcium-dependent enzymes involved in signal transduction pathways in eukaryotic cells. Calmodulin-like protein (CLP) is found in certain epithelial cell types, including normal breast epithelium, and, although it closely resembles calmodulin in amino acid sequence, CLP interacts with different proteins than does calmodulin. The observation that CLP mRNA expression is dramatically reduced in transformed breast epithelial cells led to two hypotheses: (1) CLP helps to maintain the differentiated state in epithelial cells; and (2) downregulation of CLP accompanies malignant transformation of breast epithelial cells. The objective of this study was to determine if the expression of CLP in human breast cancer specimens is reduced in comparison to its expression in normal breast tissue. Eighty human breast cancer biopsy specimens were analyzed immunohistochemically for CLP expression by using a polyclonal rabbit antihuman CLP antibody. CLP expression was reduced in 79% to 88% of the invasive ductal carcinoma and lobular carcinoma specimens and in a similar fraction of the ductal carcinoma in-situ specimens, compared with normal breast specimens. None of the breast cancer specimens showed an increase in CLP expression. These findings support the hypotheses that CLP behaves as a functional tumor suppressor protein and is downregulated early in breast cancer progression.

Maternal serum screening for Down syndrome in a teaching hospital in Hong Kong

OBJECTIVE

To study prospectively the use of maternal serum alpha-fetoprotein (AFP) and total beta-human chorionic gonadotropin (hCG) concentrations for screening of Down syndrome in Hong Kong.

METHODS

AFP and total beta-hCG were measured in serum samples from 1638 singleton Chinese pregnancies at 14-22 weeks of gestation, recruited over a twelve-month period. Gestational ages were determined by ultrasonographic parameters measured at the same visit as the test for all cases. The gestational-age-specific and weight-adjusted medians for serum AFP and total beta-hCG were calculated. Risk for fetal Down syndrome (FDS) was derived by mathematical modeling of the medians together with maternal age. Amniocenteses were offered to women with a calculated FDS risk of 1:270 or greater.

RESULTS

The gestational-age-specific and weight-adjusted medians for maternal serum AFP were similar to previous studies while that of total beta-hCG were higher. A total of 101 patients (6.1%) were classified as being high risk for FDS, including 3.4% (48/1394) of those younger than 35 years of age and 21.7% (53/244) of those who were 35 or above. There were 4 cases of Down syndrome, 1 case of Tumer syndrome and 1 of Edward syndrome. Three out of the four cases of Down syndrome were screened positive, corresponding to a detection rate of FDS of 75%. A case of Tumer syndrome was also screened positive. A case of trisomy 18 was found to have very low levels of AFP [0.262 multiple of median (MoM)] and total beta-hCG (0.115 MoM).

CONCLUSIONS

Maternal serum screening using double biochemical markers (AFP and total beta-hCG) in combination with gestational dating by ultrasonography is effective in the detection of fetal Down syndrome and possibly other chromosomal disorders in Chinese pregnant women.