Apoptosis in fetal nucleated erythrocytes circulating in maternal blood

The purpose of this study was to determine if apoptosis occurs in fetal cells that have crossed into the maternal circulation, which would potentially explain the difference between the number of intact fetal cells and the amount of fetal DNA detectable in maternal plasma. We flow-sorted fetal nucleated erythrocytes (FNRBCs) using antibody to the gamma chain of fetal haemoglobin and confirmed them to be fetal in origin by FISH analysis using chromosome-specific probes. Fetal cells were then analysed microscopically for the presence of terminal UdTP nuclear end labelling (TUNEL) staining. Apoptotic change was observed in 42.7% of fetal NRBCs (106/246) and 3.5% of maternal cells (29/818). Results of this study indicate that a significant number of fetal cells in maternal blood are undergoing apoptosis at the time of sampling. Apoptosis may be one mechanism by which fetal cells are cleared by the maternal circulation.

Pattern analysis for ultrasound anomalies in fetuses with normal karyotype

Two hundred cases of double or multiple anomalies (up to five in the same fetus) out of 828 karyotypically normal fetuses with at least one ultrasound finding were enrolled in the present study. One hundred and sixty patterns belonging to 200 fetuses were found. Then, we included in the final analysis only those double or triple patterns of anomalies with frequency more then 1. Thus, 123 cases and 83 patterns were analyzed. A double pattern was intended as any combination of ultrasound findings present in the same fetus. Exact Chi-square test was used to evaluate the specificity of the association of the most frequent patterns. The association of patterns was expressed as ratio between observed and expected frequency (O/E) ratio. Pattern analysis was used as statistical tool to calculate the number of possible associations of ultrasound finding. Anomalies of fluid distribution, as well as Central Nervous System malformations, and facial malformations were among the most significant associations. Among the triple patterns, Cleft Lip + Cleft Palate + Holoprosencephaly showed the highest degree of association. Antenatal diagnosis of ultrasound finding can benefits by considering the present results.

Premature infants respond to early-onset and late-onset sepsis with leukocyte activation

OBJECTIVE

Leukocyte differentiation antigens are expressed on the cell membrane during activation. The purpose of this study was to evaluate leukocyte activation in premature neonates with sepsis. Paired blood samples from the same individual while sick and while convalescent were examined to quantify the expression of leukocyte antigens in these clinical states.

METHODS

Mononuclear blood cells from 21 premature infants (24 to 30 weeks' gestation) were analyzed. The "sick" samples were drawn at the time of workup for sepsis; "convalescent" samples were drawn 20 days later. Samples were incubated with monoclonal antibodies to the lymphocyte antigens CD3, CD19, CD25, CD26, CD71, and CD69 and neutrophil antigens CD11b, CD11c, CD13, CD15, CD33, and CD66b. The cells were lysed, fixed, and analyzed by flow cytometry.

RESULTS

Twenty-one infants enrolled in the study had multiple sepsis evaluations and had more than one sample available for a paired observation. CD33, CD66b, and CD19 levels were significantly elevated in both the presumed sepsis and culture-proven sepsis groups when compared with the samples drawn from those same patients when healthy. Expression of CD33 and expression of CD66b were correlated, and in a multivariate analysis the elevation of antigen expression was predictive of sepsis.

CONCLUSIONS

Leukocytes from preterm newborn infants respond to infection with an increased expression of CD19, CD33, and CD66b on their cell surfaces.

A bromodomain protein, MCAP, associates with mitotic chromosomes and affects G(2)-to-M transition

We describe a novel nuclear factor called mitotic chromosome-associated protein (MCAP), which belongs to the poorly understood BET subgroup of the bromodomain superfamily. Expression of the 200-kDa MCAP was linked to cell division, as it was induced by growth stimulation and repressed by growth inhibition. The most notable feature of MCAP was its association with chromosomes during mitosis, observed at a time when the majority of nuclear regulatory factors were released into the cytoplasm, coinciding with global cessation of transcription. Indicative of its predominant interaction with euchromatin, MCAP localized on mitotic chromosomes with exquisite specificity: (i) MCAP-chromosome association became evident subsequent to the initiation of histone H3 phosphorylation and early chromosomal condensation; and (ii) MCAP was absent from centromeres, the sites of heterochromatin. Supporting a role for MCAP in G(2)/M transition, microinjection of anti-MCAP antibody into HeLa cell nuclei completely inhibited the entry into mitosis, without abrogating the ongoing DNA replication. These results suggest that MCAP plays a role in a process governing chromosomal dynamics during mitosis.

Amniotic fluid index and labor length of pregnancies induced beyond 41 weeks of gestation with unfavorable cervix

We evaluated if the response to prostaglandin E2 (PGE2) induction, in pregnancies completing 41 gestational weeks, is correlated to amniotic fluid index (AFI) values. A follow-up was performed from the time of the induction to the time of delivery of 63 pregnancies resulting in a spontaneous delivery showing unfavorable cervical examination at 41 weeks of gestation. This was induced by means of intracervical administration of PGE2 gel (Dinoprostone 0.5 mg). If the cervix was still unfavorable after 12 h, another gel administration followed. The number of PGE2 administration and AFI were both used as variables to correlate the time remaining before the delivery and the probability of delivery (Kaplan-Meier and Cox algorithms). Gestational age, parity, neonatal weight, and APGAR 5' were used as covariates. A cut-off of AFI > 6 better discriminates two groups regarding the probability of delivery at paired hours from the beginning of the induction. A statistically significant difference was demonstrated in only those patients which did not deliver within 12 h (44 cases). Multivariate analysis (Cox regression) yielded an adjusted odds ratio associated to the probability of delivery of 0.47 (0.23-0.95, 95% CI, p value = 0.0354) for AFI < or = 6 vs. AFI > 6.

Sonographic imaging of the distal phalanx

OBJECTIVE

To investigate the potential role of ultrasonography (US) with very high frequency transducers in assessing distal phalanx involvement in some rheumatic diseases.

METHODS

We performed sonographic evaluation with an Esaote AU-4 Idea (Esaote Biomedica, Genoa, Italy) equipped with a 13-MHz linear transducer. The images were obtained in asymptomatic healthy subjects and representative patients with psoriatic arthritis, osteoarthritis of the distal interphalangeal joint (Heberden's nodes), erosive osteoarthritis, gout, rheumatoid arthritis, systemic sclerosis, and posttraumatic synovial cyst.

RESULTS

US with very high frequency transducers allowed a careful identification of the following anatomic details: joint space, extensor and flexor tendons, bone margin, periarticular and peritendinous soft tissues, nail, and blood vessels. Several pathological changes were depicted in different rheumatic disorders. These included joint space widening, tendon sheath widening, dislocation of the joint surfaces, irregularity of the bone margin, and urate and calcium deposits within periarticular soft tissues.

CONCLUSIONS

Very high frequency US is able to depict the anatomic substrate of distal phalanx involvement in several rheumatic diseases, adding useful information to clinical examination of the hand.

Fetal sonographic findings: analysis of the most frequent patterns and their specificity of association

A major goal of obstetric sonography is the detection of patterns of anomalies in order to make a diagnosis, or to determine which pregnant women should be offered invasive testing. Previous studies have analyzed patterns from the perspective of a specific anomaly and its associations, e.g., increased nuchal translucency measurement and structural heart disease. In this study we applied the technique of cluster analysis to a population data set that consisted of fetuses with at least two sonographically detectable anomalies. The specificity of association of the most frequent patterns found in our population was evaluated by means of the ratio of the observed number of fetuses with the findings (O) over the expected number of such fetuses (E). The observation that different patterns aggregate in a relatively small number of clusters was then evaluated by means of cluster analysis for binary data. Results show that several patterns can be considered in nonrandom associations, based on the O/E ratio. Most of these patterns are well known to clinicians but validate this new approach. As cluster analysis is applied to antenatal sonographic data sets, new patterns of associations of anomalies may be detected.

The BFRF1 gene of Epstein-Barr virus encodes a novel protein

Computer analysis of the Epstein-Barr virus (EBV) genome indicates there are approximately 100 open reading frames (ORFs). Thus far about 30 EBV genes divided into the categories latent and lytic have been identified. The BamHI F region of EBV is abundantly transcribed during lytic replication. This region is highly conserved among herpesviruses, thus suggesting that some common function could be retained in the ORFs encompassed within this viral fragment. To identify putative novel proteins and possible new markers for viral replication, we focused our attention on the first rightward ORF in the BamHI F region (BFRF1). Histidine and glutathione S-transferase-tagged BFRF1 fusion proteins were synthesized to produce a mouse monoclonal antibody (MAb). Analysis of human sera revealed a high seroprevalence of antibodies to BFRF1 in patients affected by nasopharyngeal carcinoma or Burkitt's lymphoma, whereas no humoral response to BFRF1 could be detected among healthy donors. An anti-BFRF1 MAb recognizes a doublet migrating at 37 to 38 kDa in cells extracts from EBV-infected cell lines following lytic cycle activation and in an EBV-negative cell line (DG75) transfected with a plasmid expressing the BFRF1 gene. Northern blot analysis allowed the detection of a major transcript of 3.7 kb highly expressed in EBV-positive lytic cycle-induced cell lines. Treatment with inhibitors of viral DNA polymerase, such as phosphonoacetic acid and acyclovir, reduced but did not abolish the transcription of BFRF1, thus indicating that BFRF1 can be classified as an early gene. Cell fractionation experiments, as well as immunolocalization by immunofluorescence microscopy, immunohistochemistry, and immunoelectron microscopy, showed that BFRF1 is localized on the plasma membrane and nuclear compartments of the cells and is a structural component of the viral particle. Identification of BFRF1 provides a new marker with which to monitor EBV infection and might help us better understand the biology of the virus.

Fetal nucleated erythrocyte recovery: fluorescence activated cell sorting-based positive selection using anti-gamma globin versus magnetic activated cell sorting using anti-CD45 depletion and anti-gamma globin positive selection

BACKGROUND

Fluorescence activated cell sorting (FACS)-based anti-gamma (gamma) positive selection and magnetic activated cell sorting (MACS)-based anti-CD45 depletion followed by anti-gamma positive staining have been two of the most frequently used methods to isolate fetal cells from maternal blood. To date, there has been no direct comparison of fetal cell recovery by these two methods. This study was designed to address this issue.

METHODS

Fluorescence in situ hybridization (FISH) was performed on nucleated anti-gamma positive cells using X and Y probes. Twenty-four maternal blood samples were obtained immediately after elective termination of pregnancy to ensure a detectable number of fetal cells.

RESULTS

The yield and purity of fetal nucleated erythrocytes (FNRBCs) was statistically higher in FACS sorted samples (P < 0.01). The specificity of staining for FNRBCs was statistically higher in MACS sorted samples (P < 0.01).

CONCLUSIONS

The data from this study demonstrate that both techniques have benefits and limitations. FACS has the advantage of having higher yield, higher purity, higher FISH efficiency and ease in microscope analysis, and MACS has the advantage of having higher specificity and less cell loss during FISH.

Residual glutaraldehyde levels in fiberoptic endoscopes: measurement and implications for patient toxicity

Most gastroenterology societies recommend glutaraldehyde for fiberoptic endoscope disinfection. However, glutaraldehyde toxicity has been suspected in patients examined with endoscopes disinfected with this compound. The aim of our study was to determine the residual levels of glutaraldehyde in fiberoptic endoscopes after either manual or automatic disinfection and to evaluate the extent of toxicity. Furthermore, the procedures for disinfection currently performed by the department were compared with the new French guidelines. We used both manual and automatic disinfection procedures and flushed sterile distilled water through the lumens of endoscopes before use. Residual glutaraldehyde levels were determined using liquid chromatography coupled to spectrophotometric detection. In a total of 92 measurements it was found that residual glutaraldehyde levels were higher and more variable after manual disinfection (< 0.2-159.5 mg/L) than after automatic disinfection (< 0.2-6.3 mg/L). We conclude that local procedures for disinfection need to be improved to conform to the new French guidelines. Since thresholds for the toxic dose of glutaraldehyde and international norms for levels of residual glutaraldehyde in equipment have not been defined, additional studies combining accurate measurements in fiberoptic endoscopes and clinical observations of endoscopy patients will be required to draw more definitive conclusions.

Amniotic fluid volume and onset of labor in physiological pregnancy

We measure, by means of ultrasound, the amniotic fluid volume (expressed as maximal vertical pocket or MVP) in 646 normal pregnancies at the 39th gestational week. Our aim is to evaluate the possible correlation between MVP and onset of the labor. In a 2-week follow-up, the onset of the labor is considered the "event" variable in a time-dependent statistical analysis. Univariate analysis (Kaplan-Meier algorithm) describes a different trend in predicting the onset of labor when a stratification of MVP < 50 and > or = 50 mm was performed (chi2 = 7.91 p < 0.0049 with 1 df, Breslow-Gehan test). The first category was comprised of 496 fetuses with a median (min-max) MVP of 39 mm (25-49), the second category of 150 fetuses with a MVP of 57 mm (50-100). The results suggest that lower levels of MVP are associated to a higher percentage of the onset of labor. Furthermore, in our measurement, performed at the 39th gestational week, the correlation with the events is higher within the 40th gestational week. In fact, at 7 days from the amniotic fluid measurement, the onset of labor and the subsequent delivery is observed in 80.65 and 73.00% of the cases when they are stratified according to MVP < 50 and > or = 50 mm. At the end of the follow-up, instead, the percentage of "events" is similar, 88.10 and 86.67%, respectively. Adjustment for covariates (Cox analysis), as well as maternal age, neonatal weight, and obstetrics history, show an odds ratio (95% C.I.) of 2.08 (1.61-2.69) for MVP, using the above cutoff level. In physiological pregnancy, lower levels of amniotic fluid at term correlated to a higher probability of the onset of labor.

Synovitis of small joints: sonographic guided diagnostic and therapeutic approach

OBJECTIVE

The aim of this pictorial essay is to describe the sonographic guided approach to investigation and local injection therapy of a small joint in a patient with psoriatic arthritis (PA).

METHODS

Sonographic pictures are obtained using a high frequency ultrasonography apparatus equipped with a 13-MHz transducer.

RESULTS

Ultrasonography allows a careful morphostructural assessment of soft tissue involvement in PA patients. Sonographic findings include joint cavity widening, capsular thickening, synovial proliferation, synovial fluid changes, tendon sheath widening. Ultrasound guided placement of the needle within the joint and injection of corticosteroid under sonographic control can be easily performed.

CONCLUSIONS

High frequency ultrasonography is a quick and safe procedure that allows a useful diagnostic and therapeutic approach in patients with arthritis of small joints.

Latent class analysis applied to patterns of fetal sonographic abnormalities: definition of phenotypes associated with aneuploidy

The aim of the present study was to generate different latent variables that classify the major chromosome aneuploidies using frequency and patterns of fetal sonographic abnormalities in a large database. A total of 1867 fetuses with sonographic abnormalities recorded in a database at New England Medical Center from January 1995 to March 1998 were available for the statistical analysis. Included within this group were 61 aneuploid fetuses, including 11 with 45,X, 30 with trisomy 21, 14 with trisomy 18 and 6 with trisomy 13, 40 structural malformations and/or sonographic markers were detected in these 61 aneuploid fetuses. The ability of malformations and sonographic markers to generate different groups of phenotypes was evaluated by means of latent class analysis, using the 61 affected cases. Four different classes were generated with the hypothetical assumption that each of them could satisfactorily identify a respective fetal aneuploidy represented in the study group. Among 40 fetal malformations and/or sonographic markers, the most important findings in generating specific karyotypic groups were cystic hygroma (class 1), duodenal atresia (class 2), holoprosencephaly (class 3) and omphalocele (class 4), respectively. Accuracy of the classification was 72 per cent for Turner syndrome (class 1), 74 per cent for Down syndrome (classes 1 and 2), 88 per cent for trisomy 13 (class 3) and 93 per cent for trisomy 18. The frequency of associated malformations detected sonographically can help to define a phenotype that is likely to be representative of a specific aneuploidy. Before the definitive karyotype is available or, in cases in which patients refuse an invasive prenatal diagnostic procedure, this may improve antenatal clinical management.

Evaluation of intrauterine growth pattern of twins by linear discriminant analysis of the values of biparietal diameter, femur length and abdominal circumference1

In a cross-sectional study, the intrauterine growth pattern of 32 twins was compared to that of 205 singletons by analysis of the coefficients of the equations of biparietal diameter (BPD), femur length (FL) and abdominal circumference (AC). Lower values were observed in twins from the 20th week. BPD and AC curves showed a progressively diverging pattern, and yielded different coefficients of equations. AC showed the highest discriminant capacity followed by BPD and FL. Combined values of the two series solved by discriminant function output produced an overlapping of 58%. Based on our data, nomograms of growth of singletons should not be used for twins.

Stability of reconstituted solutions of ceftazidime for injections: an HPLC and CE approach

The stability of aqueous reconstituted ceftazidime injection vials containing ceftazidime pentahydrate blended with anhydrous sodium carbonate was investigated in different storage conditions (4 degrees C and 10 degrees C for 7 days in a refrigerator, 20 and 30 degrees C for 24 h) with validated HPLC and (micellar) CE methods. Stability indicating data were obtained for ceftazidime and two degradation products: pyridine and the delta2-ceftazidime isomer. Other degradation products were also identified (the complementarity of the two used experimental procedures was useful in such exercise) and characterized by their UV spectra and retention times. Stability data (7 days at 4 degrees C in a refrigerator and 18 h at room temperature) resulted in agreements with the manufacturers prescription and point out the need of a strict temperature control of the refrigerator's compartment used to store the reconstituted solution.

Improvement of fetal cell recovery from maternal blood: suitable density gradient for FACS separation

OBJECTIVE

To improve the recovery of fetal nucleated erythrocytes (NRBCs) from maternal blood for noninvasive prenatal genetic diagnosis.

METHODS

Blood samples were obtained from 10 women at 8-22 weeks of gestation. Samples were split and mononuclear cells were isolated using 1.083 and 1.090 g/ml of Percoll solution. Flow sorting with antibody to fetal hemoglobin and fluorescence in situ hybridization (FISH) analysis were used to evaluate the number of fetal cells recovered.

RESULTS

In samples separated with the 1.090 density gradient, the yield of true gamma-hemoglobin-positive cells (median 21.0, range 2.2-303.8) was 1.9 times higher than that in the 1.083 density (median 11.1, range 1.1-87.5), although it took 2. 1-fold longer time to flow sort the gamma-hemoglobin-positive cells. In 7 out of 10 cases, the number of gamma-hemoglobin-positive cells recovered from the 1.090 density gradient was 3 times or greater than that from 1.083 gradient. After FISH analysis, we detected a median of 13.3 (range 2.2-98.8) fetal NRBCs per 10-ml maternal blood in the 1.090 density gradient, whereas a median of 11.0 fetal NRBCs were detected in the 1.083 gradient (range 1.1-35.0). The number of fetal NRBCs in the 1.090 density was significantly higher than that in the 1.083.

CONCLUSION

Increased Percoll density results in improved fetal cell recovery in fresh posttermination maternal samples. The increased yield of fetal cells using this gradient may permit better noninvasive detection of fetal chromosome as well as DNA abnormalities in maternal blood.

Is the new TNM (1997) the best system for predicting prognosis?

In 1997, the U.I.C.C. (International Union against Cancer) modified the previous TNM stage grouping published in 1987. In the present study, TANIS and TNM '97 systems were compared in order to evaluate their prognostic ability. Data from 164 patients affected by primary squamous cell carcinoma cancers of the oral cavity (n=100) and oropharynx (n=64) were analyzed by means of survival analyses. Both systems showed a significant correlation with survival rate. TANIS yielded better results in association with the survival rate as compared with TNM '97.

Sonographic imaging of normal and osteoarthritic cartilage

OBJECTIVES

This study was undertaken to describe representative sonographic features of normal and osteoarthritic cartilage.

METHODS

Sonographic evaluation was performed with real-time ultrasound equipment, using 7.5-, 10-, 13-, 15-, and 20-MHz transducers. Normal and osteoarthritic cartilage has been studied in healthy subjects and in patients with osteoarthritis.

RESULTS

Ultrasonography allows a safe, quick, and careful evaluation of both normal and osteoarthritic cartilage. A spectrum of images ranging from loss of cartilage transparency to marked narrowing of the cartilage layer can be depicted clearly in patients with osteoarthritis. Loss of clarity of the cartilaginous band and loss of the normal sharpness of the synovial space-cartilage interface are the earlier features of cartilage damage.

CONCLUSIONS

Although the value of ultrasonography in the evaluation of articular cartilage remains to be determined, this imaging method can be regarded as a useful bedside procedure for initial diagnostic screening of osteoarthritic femoral condylar cartilage.

Morphologic characteristics of initial lymphatics of the healthy and diseased human gingiva

Investigation was performed on healthy and inflamed human gingivae. In the healthy mucosa lymphatic vessels generally appeared as flattened channels with a reduced lumen. Only in very inflamed tissue were some more evident vessels with a distended wall detectable. Ultrastructurally, most of the vessels had the characteristics of capillaries and they were delimited by a thin and irregular endothelial wall with large intercellular spaces. These observations indicate that in the gingival tissues, which are continuously exposed to inflammatory agents and need a really efficient draining system, the pathway of interstitial exudation and cell migration may include both the lymphatic vessel system and the intercellular spaces of the permeable junctional epithelium.