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Parobek CM, Shanahan MA, Burnett BA, Dadoun SE, Adams AD. Limited Role of MSAFP Screening for Prenatal Omphalocele Detection. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39189734 DOI: 10.1002/jum.16562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/09/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVES Although serum screening for aneuploidies has become less prevalent, maternal-serum alpha-fetoprotein (MSAFP) screening for body-wall defects remains widespread. We explored whether MSAFP screening is associated with earlier omphalocele detection than ultrasound alone. METHODS This is a retrospective cohort study of prenatally detected omphalocele cases at our center from 2007 to 2023. We explored the association between MSAFP screening, gestational age at omphalocele detection, and clinical outcomes. RESULTS Among 101 pregnancies with prenatally diagnosed omphalocele, 27 (26.7%) had MSAFP screening. The median gestational age at MSAFP screening was 17 weeks 4 days. Of those who received MSAFP screening, 11 (41%) had values ≥2.5 multiples of the median (MoM) and 16 (59%) were not elevated. MSAFP results did not correlate with omphalocele size and were not associated with prenatal or postnatal outcomes. MSAFP screening did not result in earlier suspicion for or confirmation of omphalocele (P = .97 and P = .87, respectively). In contrast, first-trimester ultrasound screening was associated with earlier suspicion for and confirmation of omphalocele (P < .01 and P = .01, respectively). There were no clinical or demographic differences between those who received MSAFP screening and those who did not (including body mass index or commute distance to an urban center). CONCLUSION MSAFP screening is not associated with earlier omphalocele detection. Furthermore, in pregnancies with prenatally diagnosed omphalocele, the results of MSAFP screening are not predictive of clinical outcomes.
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Affiliation(s)
- Christian M Parobek
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew A Shanahan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Brian A Burnett
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Simon E Dadoun
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - April D Adams
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
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2
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Messerlian G, Strickland SW, Willbur J, Vaughan C, Koenig S, Wright T, Palomaki GE. Use of Maternal Race and Weight Provides Equitable Performance in Serum Screening for Open Neural Tube Defects. Clin Chem 2024; 70:948-956. [PMID: 38965696 DOI: 10.1093/clinchem/hvae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/18/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Maternal serum alpha-fetoprotein (AFP) levels are used in screening for open neural tube defects (ONTD). Historical reports show that AFP levels and maternal weights are higher in self-reported Black than White individuals, but recent reports question the need to account for these variables in screening. Our study compares screening performance with and without accounting for race. METHODS Retrospective analysis was performed on deidentified prenatal screening records including maternal weight and self-reported race of White or Black. Gestational age-specific medians and weight-adjusted multiples of the median levels were calculated separately for each group and using a race-agnostic analysis. Outcome measures included the proportion of screen-positive results. RESULTS Records for analysis (n = 13 316) had an ultrasound confirmed gestational age between 15 and 21 completed weeks, singleton pregnancy, and self-reported race. Race was Black for 26.3%. AFP levels for pregnancies in Black individuals were higher than in White individuals: 6% to 11% depending on gestational age. Race-specific gestational age and maternal weight analyses resulted in similar screen-positive rates for self-reported White and Black individuals at 0.74% vs 1.00%, respectively (P = 0.14). However, use of race-agnostic analyses resulted in a screen-positive rate that was 2.4 times higher in Black than White individuals (P < 0.001). CONCLUSION These data show that the historical method of accounting for maternal race and weight in prenatal screening for ONTD provides equitable performance. Using a race-agnostic methodology results in an increased screen-positive rate and a disproportionate rate of required follow-up care for individuals who self-identify as Black.
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Affiliation(s)
- Geralyn Messerlian
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, United States
- Department of Obstetrics and Gynecology, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, United States
| | | | - Jordan Willbur
- Women's Health and Genetics, Labcorp, Research Triangle Park, NC, United States
| | - Christine Vaughan
- Women's Health and Genetics, Labcorp, Research Triangle Park, NC, United States
| | - Shelby Koenig
- Women's Health and Genetics, Labcorp, Research Triangle Park, NC, United States
| | - Taylor Wright
- Women's Health and Genetics, Labcorp, Research Triangle Park, NC, United States
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, RI, United States
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3
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Yiming C, Chen Y, Sun L, Li L, Ning W. The importance of the trisomy 21 local cutoff value evaluation for prenatal screening in the second trimester of pregnancy. Lab Med 2023; 54:603-607. [PMID: 37053168 DOI: 10.1093/labmed/lmad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE The aim of this work was to compare different local cutoff values (LCV) and inline cutoff values (ICV) in pregnant women in the second trimester at high risk for carrying fetuses with trisomy 21. METHODS This retrospective cohort study analyzed prenatal screening outcomes in pregnant women (n = 311,561). The receiver operating characteristic curve was used to evaluate the diagnostic significance of the trisomy 21 risk value, alpha-fetoprotein, and free beta human chorionic gonadotropin multiple of the median for predicting trisomy 21 risk. The cutoff value corresponding to the maximal Youden index was taken as the LCV. The screening efficiency of both cutoff values was compared. RESULTS The LCV cutoff value was lower than the ICV cutoff value (1/643 vs 1/270). The sensitivity increased by 19.80%, the positive predictive value decreased by 0.20%, and the false-positive rate increased by 6.50%. CONCLUSION The LCV should be used to determine trisomy 21 risk, which can increase the detection rate of trisomy 21 in the second trimester.
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Affiliation(s)
- Chen Yiming
- Departments of Prenatal Diagnosis and Screening Center, Zhejiang Chinese Medical University, Hangzhou, China
- Department of the Fourth School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yijie Chen
- Department of the Fourth School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, China
| | - Long Sun
- Clinical
Laboratory, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, China
| | - Liyao Li
- Departments of Prenatal Diagnosis and Screening Center, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenwen Ning
- Department of the Fourth School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, China
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4
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Huang TJ, Chen CP, Lin CJ, Wu FT, Chen SW, Lai ST, Chen ZJ. The correlation with abnormal fetal outcome and a high level of amniotic fluid alpha-fetoprotein in mid-trimester. Taiwan J Obstet Gynecol 2023; 62:863-868. [PMID: 38008506 DOI: 10.1016/j.tjog.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE To evaluate the correlation of high levels [>2.0 multiples of median (MoM)] of amniotic fluid alpha-fetoprotein (AFAFP) in midtrimester with abnormal fetal outcome. MATERIALS AND METHODS We retrospectively studied 6245 pregnant women with singleton pregnancy who had undergone amniocentesis between 15 and 27 weeks' gestation at Mackay Memorial Hospital between January 2014 and June 2020. Fifty-five cases had high AFAFP levels (>2.0 MoM). We investigated the abnormal fetal outcomes. RESULTS Among the fifty-five cases with high AFAFP levels (>2.0 MoM), thirty (54.5%) had fetal chromosomal abnormalities, major structural abnormalities, and/or adverse obstetric events. Eight cases (14.5%) had chromosomal abnormalities including trisomy 21 (3 cases), trisomy 18 (3 cases), mosaic trisomy 18 (1 cases), and mosaic ring 13 (1 case). Seventeen cases (30.9%) had major structural abnormalities including abdominal wall defect (6 cases) and central nervous system (5 cases), gastrointestinal tract (3 cases), cardiovascular (2 cases), and genitourinary tract (2 cases) abnormalities. Fifteen cases (27%) had adverse obstetric events, including preterm delivery (5 cases), intrauterine fetal demise (4 cases), small for gestational age (4 cases), preeclampsia (4 cases), gestational diabetes mellitus (2 cases), gestational hypertension (1 case), preterm prelabor rupture of membrane (1 case), prolonged labor (1 case), and preterm uterine contraction (1 case). CONCLUSION A high AFAFP level (>2.0 MoM) in midtrimester can be associated with abnormal fetal outcome, including chromosomal abnormalities, major structural abnormalities, and adverse obstetric events. Women with a prenatal diagnosis of high AFAFP levels (>2.0 MoM) should be alerted of the possibility of abnormal fetal outcomes, and further detailed genetic studies and serial sonographic examinations are recommended.
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Affiliation(s)
- Tian-Jeau Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Chen-Ju Lin
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fang-Tzu Wu
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shin-Wen Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shih-Ting Lai
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Zhi-Jun Chen
- Institute of Science and Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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5
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Ma C, Jin Y, Wang Y, Xu H, Zhang J. Beyond liver cancer, more application scenarios for alpha-fetoprotein in clinical practice. Front Oncol 2023; 13:1231420. [PMID: 37781207 PMCID: PMC10540843 DOI: 10.3389/fonc.2023.1231420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Alpha-fetoprotein (AFP) is a commonly used clinical biomarker. Before 1970, the two-way agar diffusion method was mainly used, and the specificity of AFP in the diagnosis of primary liver cancer was satisfactory. However, its positivity rate was not very high. The diagnostic value of AFP is changing with the evolution of detection methods. Here, we performed a literature search to identify English-language publications. The search was performed from January 2015 to April 2023 using the PubMed database and the following terms in [Titles/Abstracts]: alpha-fetoprotein, clinical practice, detection, etc. The references of retrieved articles were also screened to broaden the search. Studies referring to liver cancer and AFP detection methods were excluded. In this review, several clinical application scenarios for AFP were systematically reviewed, and its potential detection value in the future was discussed.
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Affiliation(s)
- Chenyu Ma
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yuexinzi Jin
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yuhan Wang
- Center of Smart Laboratory and Molecular Medicine, School of Medicine, Chongqing University, Chongqing, China
| | - Huaguo Xu
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jiexin Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Burns RN, Kolarova T, Katz R, Ma K, Delaney S. In Reply. Obstet Gynecol 2023; 141:1229. [PMID: 37486655 DOI: 10.1097/aog.0000000000005207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Affiliation(s)
- R Nicholas Burns
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
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7
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Janik K, Smith GM, Krynska B. Identification of Neurocan and Phosphacan as Early Biomarkers for Open Neural Tube Defects. Cells 2023; 12:1084. [PMID: 37048157 PMCID: PMC10093370 DOI: 10.3390/cells12071084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/29/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
Open neural tube defects (NTDs) such as myelomeningocele (MMC) are debilitating and the most common congenital defects of the central nervous system. Despite their apparent clinical importance, the existing early prenatal diagnostic options for these defects remain limited. Using a well-accepted retinoic-acid-induced model of MMC established in fetal rats, we discovered that neurocan and phosphacan, the secreted chondroitin sulfate proteoglycans of the developing nervous system, are released into the amniotic fluid (AF) of fetal rats displaying spinal cord defects. In contrast to normal controls, elevated AF levels of neurocan and phosphacan were detected in MMC fetuses early in gestation and continued to increase during MMC progression, reaching the highest level in near-term fetuses. The molecular forms of neurocan and phosphacan identified in the AF of MMC fetuses and those found in MMC spinal cords were qualitatively similar. In summary, this is the first report demonstrating the presence of neurocan and phosphacan in the AF of MMC fetuses. The identification of elevated levels of neurocan and phosphacan in the AF of MMC fetuses provides two prospective biomarkers with the potential for early prenatal diagnosis of open NTDs.
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Affiliation(s)
- Karolina Janik
- Shriners Hospitals Pediatric Research Center, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
- Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - George M. Smith
- Shriners Hospitals Pediatric Research Center, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
- Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Barbara Krynska
- Shriners Hospitals Pediatric Research Center, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
- Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
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8
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Burns RN, Kolarova T, Katz R, Ma K, Delaney S. Reconsidering Race Adjustment in Prenatal Alpha-Fetoprotein Screening. Obstet Gynecol 2023; 141:438-444. [PMID: 36735409 DOI: 10.1097/aog.0000000000005045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/07/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Black racial designation is the only race for which adjustment is recommended for maternal prenatal serum alpha-fetoprotein (AFP) screening. The objective of this study is to reevaluate the relationship between maternal race and maternal serum AFP values in prenatal analyte screening. METHODS This was a single-center retrospective analysis of patients who underwent prenatal analyte screening between January 2007 and December 2020. Nomograms for raw maternal serum AFP values by gestational age were created and compared between patients identified as "Black" and "non-Black" on the laboratory requisition. Multivariable linear regression models were created to evaluate the relationship among gestational age, maternal weight, and maternal race on maternal serum AFP levels. The new models were compared with the laboratory-derived calculations, which used historically determined race adjustments. RESULTS A total of 43,997 patients underwent analyte screening, and 27,710 patients had complete data for analysis. Of these, 6% were identified as Black. Black patients had laboratory blood draws at a mean gestational age of 123 days, compared with 120 days in non-Black patients ( P <.001), and had higher maternal weight (mean 170 vs 161 lbs, P <.001). Nomograms for raw maternal serum AFP values did not differ between Black and non-Black patients ( P =.065). When adjusted for gestational age and maternal weight, no difference in maternal serum AFP values was identified between Black and non-Black individuals ( P =.81). CONCLUSION No difference in maternal serum AFP values was identified between Black and non-Black pregnant individuals when adjusted by maternal weight and gestational age at blood draw. These findings suggest that routine race-based adjustment of maternal serum AFP screening should be discontinued.
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Affiliation(s)
- R Nicholas Burns
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
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9
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Gerami R, Agahi T, Barkhordari S, Kargar J. Evaluation of sensitivity and accuracy of maternal serum alpha fetoprotein to the diagnosis of open spina bifida in comparison with sonographic findings of open spina bifida and Chiari II malformation in pregnant women. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
NTD is one of the most important problems of the nervous system and the second fetal anomaly that is associated with high mortality and morbidity. Therefore, its prenatal diagnosis is very important. AFP has a high false positive, which reduces its diagnostic value, so the discovery of ultrasound findings in OSB is very important and can replace AFP testing.
Results
4 patients with positive OSB were detected and their diagnosis was confirmed during pathological follow-up (100% diagnostic accuracy) and the rest of the patients with high AFP (51 patients) were negative for OSB. Therefore, the diagnostic accuracy of AFP during statistical analysis was about 7%, which is a very low value.
Conclusion
According to the results of this study, IT, BS, BSOB, BS/BSOB ultrasound criteria in the first screening and decreased BPD and ventriculomegaly in the second screening ultrasound in OSB diagnosis have a higher diagnostic value than the AFP laboratory level. It should pay more attention to MS-AFP results in OSB screening.
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10
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Wang Y, Ma L, Jia S, Liu D, Gu H, Wei X, Ma W, Luo W, Bai Y, Wang W, Yuan Z. Serum exosomal coronin 1A and dynamin 2 as neural tube defect biomarkers. J Mol Med (Berl) 2022; 100:1307-1319. [PMID: 35915349 PMCID: PMC9402777 DOI: 10.1007/s00109-022-02236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
Abstract No highly specific and sensitive biomarkers have been identified for early diagnosis of neural tube defects (NTDs). In this study, we used proteomics to identify novel proteins specific for NTDs. Our findings revealed three proteins showing differential expression during fetal development. In a rat model of NTDs, we used western blotting to quantify proteins in maternal serum exosomes on gestational days E18, E16, E14, and E12, in serum on E18 and E12, in neural tubes on E18 and E12, and in fetal neural exosomes on E18. The expression of coronin 1A and dynamin 2 was exosome-specific and associated with spina bifida aperta embryogenesis. Furthermore, coronin 1A and dynamin 2 were significantly downregulated in maternal serum exosomes (E12–E18), neural tubes, and fetal neural exosomes. Although downregulation was also observed in serum, the difference was not significant. Differentially expressed proteins were further analyzed in the serum exosomes of pregnant women during gestational weeks 12–40 using enzyme-linked immunosorbent assays. The findings revealed that coronin 1A and dynamin 2 showed potential diagnostic efficacy during gestational weeks 12–40, particularly during early gestation (12–18 weeks). Therefore, these two targets are used as candidate NTD screening and diagnostic biomarkers during early gestation. Key messages We used proteomics to identify novel proteins specific for NTDs. CORO1A and DNM2 showed exosome-specific expression and were associated with SBA. CORO1A and DNM2 were downregulated in maternal serum exosomes and FNEs. CORO1A and DNM2 showed good diagnostic efficacy for NTDs during early gestation. These two targets may have applications as NTD screening and diagnostic biomarkers.
Supplementary information The online version contains supplementary material available at 10.1007/s00109-022-02236-w.
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Affiliation(s)
- Yanfu Wang
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China.,Department of Pediatric Surgery, Neonatal Surgery, Shengjing Hospital, China Medical University, Shenyang, People's Republic of China
| | - Ling Ma
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China.,Department of Pathophysiology, College of Basic Medical Science, China Medical University, Shenyang, People's Republic of China
| | - Shanshan Jia
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China
| | - Dan Liu
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China
| | - Hui Gu
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China
| | - Xiaowei Wei
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China
| | - Wei Ma
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China
| | - Wenting Luo
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China
| | - Yuzuo Bai
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China
| | - Weilin Wang
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China
| | - Zhengwei Yuan
- Department of Pediatric Surgery, Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People's Republic of China.
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Peng P, Peng X, Jiao X, Chen N. A unique Levey-Jennings control chart used for internal quality control in human papillomavirus detection. Virol J 2022; 19:125. [PMID: 35902957 PMCID: PMC9331565 DOI: 10.1186/s12985-022-01861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/23/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to provide an updated estimate of the prevalences of different types of human papillomavirus (HPV) in females in Chaoshan District and to establish an internal quality control (IQC) method for excluding false-positive results in HPV detection by using the Levey-Jennings control chart. METHOD HPV types were detected in 23,762 cervical samples by using PCR membrane hybridization. The means and standard deviations (SDs) of the positive rates were calculated, the Levey-Jennings chart was plotted, and the rules for "out of control" and "warning" were established. A set of standardized IQC for HPV DNA tests was developed based on the values and Levey-Jennings charts. RESULT In 466 batches, the positive rate exceeded the 1 + 2SD rule 24 times, but there was no consecutive exceedance, which was considered "in control". When the positive rate exceeded the 1 + 3SD rule 8 times with consecutive exceedance, it was considered "out of control". Further examination revealed that detections showing "out of control" had an undesirable random error, indicating that contamination may occur due to improper operation. CONCLUSION This unique Levey-Jennings control chart is a practical method for eliminating false-positive results in HPV DNA detection and should be widely applicable in molecular diagnostic laboratories.
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Affiliation(s)
- Peiyi Peng
- Shantou University Medical College, Shantou, Guangdong, China
| | - Xuehong Peng
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaoyang Jiao
- Shantou University Medical College, Shantou, Guangdong, China
| | - Nuan Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
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Chen Y, Wang X, Chen Y, Ning W, Chen L, Yin Y, Zhang W, Lian J, Wang H. Construction and predictive value of risk models of maternal serum alpha-fetoprotein variants and fetal open neural tube defects. Exp Biol Med (Maywood) 2022; 247:822-831. [PMID: 35238224 PMCID: PMC9160932 DOI: 10.1177/15353702221080458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
The correlation of maternal serum alpha-fetoprotein (AFP) variants (AFP-L2, AFP-L3), free beta-human chorionic gonadotropin (free β-hCG), and open neural tube defects (ONTDs) during the second trimester, and the screening efficiency of different risk models remain indistinct. We conducted a retrospective case-control study, and studied 57 pregnant women with ONTD fetuses and 569 pregnant women with normal fetuses. The receiver operating characteristic curve method indicated the best cutoff value and area under the curve (AUC). The predictive value of ONTD risk models by free β-hCG, AFP, AFP-L2, and AFP-L3 was investigated via integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Compared to the control group, AFP, AFP-L2, and AFP-L3 levels were significantly higher, while free β-hCG level was significantly lower in the study group. The triple-index model of free β-hCG + AFP-L2 + AFP-L3 and the dual-index model of AFP-L2 + AFP-L3 showed the best predictive values, respectively (AUC = 0.905; AUC = 0.885). The order of the single-index model AUCs was AFP-L3 > AFP-L2 > AFP > free β-hCG. The negative predictive value, false positive rate, and negative likelihood ratio of AFP-L2, AFP-L3 alone, or combined with free β- hCG were better than those of AFP alone; however, the positive likelihood ratio was the opposite. The replacement of AFP by AFP-L2 or AFP-L3 combined with free β-hCG increased the IDI and NRI for predicting ONTD. The top five DCAs were AFP-L2 + free β-hCG, free β-hCG, AFP-L3, AFP + free β-hCG, and AFP. Indicators of maternal serum free β-hCG, AFP-L2, and AFP-L3 in the second trimester exhibited high sensitivity and specificity screening for ONTD fetuses. Risk models constructed using AFP-L2 + AFP-L3 and AFP-L2 + AFP-L3 + free β-hCG demonstrated better screening efficiency.
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Affiliation(s)
- Yiming Chen
- Department of Prenatal Diagnosis and
Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health
Care Hospital), Hangzhou 310008, China
| | - Xue Wang
- Department of Reproduction Center,
Xuzhou Maternity and Child Health Care Hospital, Xuzhou 221010, China
| | - Yijie Chen
- Department of the Fourth School of
Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - WenWen Ning
- Department of the Fourth School of
Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Lei Chen
- Department of Ultrasound, Hangzhou
Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou
310008, China
| | - Yixuan Yin
- Department of Prenatal Diagnosis and
Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health
Care Hospital), Hangzhou 310008, China
| | - Wen Zhang
- Department of Prenatal Diagnosis and
Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health
Care Hospital), Hangzhou 310008, China
| | - Jiejing Lian
- Department of Prenatal Diagnosis and
Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health
Care Hospital), Hangzhou 310008, China
| | - Hao Wang
- Department of Prenatal Diagnosis and
Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health
Care Hospital), Hangzhou 310008, China
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13
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Erol SA, Tanacan A, Firat Oguz E, Anuk AT, Goncu Ayhan S, Neselioglu S, Sahin D. A comparison of the maternal levels of serum proprotein convertase subtilisin/kexin type 9 in pregnant women with the complication of fetal open neural tube defects. Congenit Anom (Kyoto) 2021; 61:169-176. [PMID: 34128273 DOI: 10.1111/cga.12432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/08/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
It was aimed to evaluate the levels of maternal serum proprotein convertase subtilisin/kexin type 9 (PCSK9) in pregnant women with a fetus diagnosed with open neural tube defects (NTDs). This case-control study included 38 pregnant women carrying fetuses with open NTDs and 44 age-matched, pregnant women with no specified risk factors. Comparisons were made of the groups in respect of demographic and clinical data and PCSK9 levels. To examine the performance of PCSK9 levels in the prediction of fetal open NTDs, receiver operating characteristic (ROC) curve analysis was used. In the first and second trimesters, PCSK9 levels were determined to be lower in the NTD group than in the control group (p = 0.010 and p = 0.015, respectively). In the first trimester, the lower PCSK9 levels in the NTD group were not statistically significant (p = 0.575). In the second trimester, the ROC curve value with the best balance of sensitivity/specificity for PCSK9 was 71.9 ng/ml (84.6% sensitivity, 51.7% specificity) and in the first and second trimester combined, 74.4 ng/ml (81.6% sensitivity, 45.5% specificity) (p = 0.015, p = 0.036, respectively). PCSK9 may be involved in the etiopathogenesis of open NTDs at the critical steps of fetal neuronal differentiation. Although it has limitations, PCSK9 may be used as an additional biomarker for the screening of NTDs.
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Affiliation(s)
- Seyit Ahmet Erol
- Department of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Esra Firat Oguz
- Department of Clinical Biochemistry, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ali Taner Anuk
- Department of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Sule Goncu Ayhan
- Department of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Salim Neselioglu
- Department of Clinical Biochemistry, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey.,Yildirim Beyazit University, Ankara, Turkey
| | - Dilek Sahin
- Department of Perinatology, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
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14
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Huang J, Chu X, Chen Y. Correlation and diagnostic value of maternal serum alpha-fetoprotein level, predelivery age and body mass with gestational diabetes mellitus. Gynecol Endocrinol 2021; 37:83-87. [PMID: 32292079 DOI: 10.1080/09513590.2020.1751112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
To investigate the correlation and diagnostic value of maternal serum alpha-fetoprotein (MSAFP) level, predelivery age and body mass with gestational diabetes mellitus (GDM) at 9 ∼ 13 + 6 weeks (early pregnancy) and 15 ∼ 20 + 6 weeks (middle pregnancy). 486 normal and 1290 GDM women were examined for serum pregnancy-associated plasma protein A (PAPP-A), MSAFP, free β-subunit of human chorionic gonadotropin (free β-hCG) and nuchal transparency (NT) levels. Binary logistic regression analysis was used to analyze the risk factors and calculate the Odds ratio (OR) of each relevant variable. In GDM group, the predelivery age, body mass in early pregnancy and middle pregnancy were statistically higher than that in control group. The level of MSAFP in GDM group was 0.97(0.54-1.86) MOM, higher than that in control group 0.92 (0.51-1.78), (z = 3.159, p = .002). Area under curve (AUC) of MSAFP, age and body mass to GDM was 0.549, 0.645 and 0.625, respectively. The level of MSAFP, predelivery age and body mass are associated with GDM, which may be helpful for the prediction of GDM in late pregnant women. However, PAPP-A, NT and free β-hCG during pregnancy have no predicting value for GDM.
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Affiliation(s)
- Jianxia Huang
- Department of Obstetrics, Nanjing Medical University, Affiliated Hangzhou Hospital (Hangzhou First People's Hospital, Hangzhou Women's Hospital), Hangzhou, Zhejiang, China
| | - Xuelian Chu
- Prenatal Screening Laboratory, Maternal and Child Health Hospital, Yuhang, Hangzhou, Zhejiang, China
| | - Yiming Chen
- Department of Prenatal diagnosis and screening center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, China
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15
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Chen Y, Wang X, Li L, Lu S, Zhang Z. New cut-off values for screening of trisomy 21, 18 and open neural tube defects (ONTD) during the second trimester in pregnant women with advanced maternal age. BMC Pregnancy Childbirth 2020; 20:776. [PMID: 33317474 PMCID: PMC7734716 DOI: 10.1186/s12884-020-03464-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background To determine whether advanced maternal age (AMA) causes changes in the maternal serum markers of Trisomy 21, 18 and open neural tube defects (ONTD) during the second trimester of pregnancy. Our research aims to develop new cut-off values for AMA in order to reduce the need for further invasive testing. Methods This retrospective cohort study involved 12,739 pregnant women with AMA and 197,101 pregnant women with non-AMA. We then compared the two groups with respect to the positive rate and positive predictive value (PPV) of Trisomy 21, 18 and ONTD. Pregnant women with Trisomy 21, 18 and ONTD were diagnosed by karyotyping the amniotic fluid and by ultrasound diagnosis. Results Compared to the non-AMA group, the multiple of the median (MOM) of free beta- human chorionic gonadotropin (free β-hCG), alpha-fetoprotein (AFP), and the risk value forTrisomy 21, were significantly higher in the AMA group (all P < 0.001). The positive rates of Trisomy 21, 18, and ONTD in the AMA group were significantly higher than those in the control group (all P < 0.001). In the AMA group, the PPVs for Trisomy 21 and other deformities were significantly higher (all P < 0.001), although the PPVs for Trisomy 18 and ONTD were similar to those of the non-AMA group. The area under the curve (AUC) values for the AMA group were higher than the non-AMA group, based on free β-hCG MoM, AFP MoM, and the risk value of Trisomy 21. The cut-off value for the risk value of Trisomy 21 was 1/172 for the AMA, group and 1/780 for the non-AMA group. Conclusions The positive rates for Trisomy 21, 18 and ONTD, and the PPV for Trisomy 21 and other deformities were significantly higher in the AMA group. It is essential for pregnant women with AMA to be tested using appropriate cut-off values of serum markers screening for Trisomy 21 during the second trimester of pregnancy to improve the efficacy of prenatal screening and reduce the need for further invasive testing.
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Affiliation(s)
- Yiming Chen
- Department of Prenatal Diagnosis and Screening Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), No. 369, kunpeng Road, Shangcheng District, Hangzhou Zhejiang, 310008, China.
| | - Xue Wang
- Nanjing Medical University, Nanjing Jiangsu, 210029, China
| | - Liyao Li
- Department of Prenatal Diagnosis and Screening Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), No. 369, kunpeng Road, Shangcheng District, Hangzhou Zhejiang, 310008, China
| | - Sha Lu
- Department of Prenatal Diagnosis and Screening Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), No. 369, kunpeng Road, Shangcheng District, Hangzhou Zhejiang, 310008, China
| | - Zhifen Zhang
- Nanjing Medical University, Nanjing Jiangsu, 210029, China.
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16
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Dong N, Gu H, Liu D, Wei X, Ma W, Ma L, Liu Y, Wang Y, Jia S, Huang J, Wang C, He X, Huang T, He Y, Zhang Q, An D, Bai Y, Yuan Z. Complement factors and alpha-fetoprotein as biomarkers for noninvasive prenatal diagnosis of neural tube defects. Ann N Y Acad Sci 2020; 1478:75-91. [PMID: 32761624 DOI: 10.1111/nyas.14443] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/30/2020] [Accepted: 06/29/2020] [Indexed: 12/23/2022]
Abstract
Neural tube defects (NTDs) are serious congenital malformations. In this study, we aimed to identify more specific and sensitive maternal serum biomarkers for noninvasive NTD screenings. We collected serum from 37 pregnant women carrying fetuses with NTDs and 38 pregnant women carrying normal fetuses. Isobaric tags for relative and absolute quantitation were conducted for differential proteomic analysis, and an enzyme-linked immunosorbent assay was used to validate the results. We then used a support vector machine (SVM) classifier to establish a disease prediction model for NTD diagnosis. We identified 113 differentially expressed proteins; of these, 23 were either up- or downregulated 1.5-fold or more, including five complement proteins (C1QA, C1S, C1R, C9, and C3); C3 and C9 were downregulated significantly in NTD groups. The accuracy rate of the SVM model of the complement factors (including C1QA, C1S, and C3) was 62.5%, with 60% sensitivity and 67% specificity, while the accuracy rate of the SVM model of alpha-fetoprotein (AFP, an established biomarker for NTDs) was 62.5%, with 75% sensitivity and 50% specificity. Combination of the complement factor and AFP data resulted in the SVM model accuracy of 75%, and receiver operating characteristic curve analysis showed 75% sensitivity and 75% specificity. These data suggest that a disease prediction model based on combined complement factor and AFP data could serve as a more accurate method of noninvasive prenatal NTD diagnosis.
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Affiliation(s)
- Naixuan Dong
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China.,School of Sino-Dutch Biomedical & Information Engineering, Northeastern University, Shenyang, China
| | - Hui Gu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Dan Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xiaowei Wei
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Wei Ma
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Ling Ma
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yusi Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yanfu Wang
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Shanshan Jia
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Jieting Huang
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Chenfei Wang
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xuan He
- School of Sino-Dutch Biomedical & Information Engineering, Northeastern University, Shenyang, China
| | - Tianchu Huang
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yiwen He
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Qiang Zhang
- Second Respiratory Department, Shengjing Hospital, China Medical University, Shenyang, China
| | - Dong An
- Pediatric Department, The First Hospital of China Medical University, Shenyang, China
| | - Yuzuo Bai
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Zhengwei Yuan
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
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17
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Weng B, Xu YL, Ying J, Yang HK, Su L, Yang YM, Chen M. A novel use for Levey-Jennings charts in prenatal molecular diagnosis. BMC Med Genomics 2020; 13:109. [PMID: 32736662 PMCID: PMC7395379 DOI: 10.1186/s12920-020-00758-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background The goal of this study was to determine whether Levey-Jennings charts, which are widely used in clinical laboratories, can be used to create standardized internal quality controls (IQCs) for prenatal molecular diagnosis. Methods Aneuploid amniocyte lines with trisomy 13, 21, and 18, and 47,XXY were established by transfection with SV40LTag-pcDNA3.1(−)and combined at different ratios to generate aneuploidy chimeric quality-control cell mixtures A to H. These quality-control cells were then used to calculate the \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{\mathrm{X}} $$\end{document}X¯ ±3 SD values to develop standardized IQCs for methods used for the prenatal diagnosis of aneuploidies such as FISH. Results Methods for constructing aneuploid amniocyte lines were developed and a set of quality-control cells (A-H) were prepared. The \documentclass[12pt]{minimal}
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\begin{document}$$ \overline{\mathrm{X}} $$\end{document}X¯ ±3 SD values of these quality-control cells for trisomy 13 and 21 were 10.2 ± 1.7, 10.2 ± 3.4, and 10.2 ± 5.1, and 90.3 ± 2.3, 90.3 ± 4.6, and 90.3 ± 6.9, respectively. Based on the values and Levey-Jennings charts, a set of standardized IQCs for prenatal diagnosis such as FISH were established. Conclusions This method resolves the problems of a shortage of quality-control materials and a lack of quality-control charts in prenatal molecular diagnosis such as NIPT, NGS, aCGH/SNP, PCR, and FISH. Levey-Jennings chart-based IQCs for prenatal diagnosis such as FISH can be used to easily monitor whether IQC results are within acceptable limits, and then infer whether the diagnostic results for clinical samples are reliable. We expect that this standardized IQC will be useful for a wide range of molecular diagnostic laboratories.
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Affiliation(s)
- Binghuan Weng
- The Key Laboratory of Reproductive Genetics, Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, Zhejiang, China.
| | - Ya-Li Xu
- Department of Clinical Laboratory Research, Shulan Hospital, Zhejiang University, 848 Dongxin Road, Hangzhou, 310006, Zhejiang, China
| | - Jun Ying
- Department of Clinical Laboratory Research, Shulan Hospital, Zhejiang University, 848 Dongxin Road, Hangzhou, 310006, Zhejiang, China
| | - Hao-Kun Yang
- The Key Laboratory of Reproductive Genetics, Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, Zhejiang, China
| | - Lan Su
- The Key Laboratory of Reproductive Genetics, Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, Zhejiang, China
| | - Yan-Mei Yang
- The Key Laboratory of Reproductive Genetics, Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, Zhejiang, China
| | - Min Chen
- The Key Laboratory of Reproductive Genetics, Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, Zhejiang, China
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