Chalcone inhibits the proliferation of human breast cancer cell by blocking cell cycle progression and inducing apoptosis

Chalcones are discussed to represent cancer preventive food components in a human diet that is rich in fruits and vegetables. In this study, we examined chalcone (1,3-diphenyl-2-propenone) for its effect on proliferation in human breast cancer cell lines, MCF-7 and MDA-MB-231. The results showed that chalcone inhibited the proliferation of MCF-7 and MDA-MB-231 by inducing apoptosis and blocking cell cycle progression in the G2/M phase. Immunoblot assay showed that chalcone significantly decreased the expression of cyclin B1, cyclin A and Cdc2 protein, as well as increased the expression of p21 and p27 in a p53-independent manner, contributing to cell cycle arrest. An enhancement in Fas/APO-1 and its two form ligands, membrane-bound Fas ligand (mFasL) and soluble Fas ligand (sFasL), was responsible for the apoptotic effect induced by chalcone. In addition, chalcone also triggered the mitochondrial apoptotic signaling by increasing the amount of Bax and Bak and reducing the level of Bcl-2 and Bcl-X(L), and subsequently activated caspase-9 in MCF-7 and MDA-MB-231 cells. Taken together, our study suggests that the blockade of cell cycle progression and initiation of cell apoptotic system may participate in the antiproliferative activity of chalcone in human breast cancer cells.

The antiproliferative activity of prodelphinidin B-2 3′-O-gallate from green tea leaf is through cell cycle arrest and Fas-mediated apoptotic pathway in A549 cells

Prodelphinidin B-2 3'-O-gallate, a proanthocyanidin gallate isolated from green tea leaf, was investigated for its anti-proliferative activity in human non-small cell lung cancer A549 cells. The results showed that prodelphinidin B-2 3'-O-gallate inhibited the proliferation of A549 cells with no detectable toxic effects on normal WI-38 cells as measured by the XTT assay. Flow cytometric analysis showed that prodelphinidin B-2 3'-O-gallate blocked cell cycle progression in the G0/G1 phase. In addition, prodelphinidin B-2 3'-O-gallate effectively induced A549 cell apoptosis as determined by assessing the nucleosome level in cytoplasm. Enzyme-linked immunosorbent assay showed that the G0/G1 phase arrest is due to p53-independent induction of p21/WAF1. An enhancement in Fas/APO-1 and its two form ligands, membrane-bound Fas ligand (mFasL) and soluble Fas ligand (sFasL), might be responsible for the apoptotic effect induced by prodelphinidin B-2 3'-O-gallate. We suggested that prodelphinidin B-2 3'-O-gallate's activities might be potentially contribute to its overall chemopreventive effects against lung cancer, and can possibly be considered for future therapeutic application.

Expression of DAZL protein in the human corpus luteum

The DAZL gene and its homologues are required for the development of male and female germ cells in different species. However, their role in other aspects of human reproduction is not known. We have generated a polyclonal antibody to the DAZL protein and developed a sensitive standard curve quantitative-competitive-RT-PCR assay to characterize the expression of DAZL in the human corpus luteum (CL). DAZL transcripts are expressed in the CL, but the concentrations decreased with advancing luteal phase. In accordance with the mRNA data, DAZL protein was most abundant in the early phase CL. Immunohistochemical staining showed DAZL protein in the cytoplasm of granulosa-luteal cells. The distinct expression pattern of DAZL protein in the human CL may play an important role in the regulation of luteal function.

Expression patterns and transcript concentrations of the autosomal DAZL gene in testes of azoospermic men

The DAZ (Deleted in AZoospermia) gene cluster on the Y chromosome is a strong candidate for the azoospermia factor. The DAZ gene was derived from an autosomal homologue, DAZL (DAZ-Like). This study was designed to assess the functional role of DAZL in human spermatogenesis. The expression patterns and mRNA transcript levels of DAZL in the testes of 17 azoospermic men were therefore examined by immunohistochemical staining and quantitative competitive reverse transcription-polymerase chain reaction. DAZL protein was expressed in the cytoplasm of primary spermatocytes and weakly in spermatogonia. It was detected in the testicular tissues of all subjects with germ cells present. The copy number of the DAZL transcript in normal spermatogenesis (n = 4), hypospermatogenesis or maturation arrest (n = 6), and Sertoli cell-only syndrome (n = 7) ranged from 1.22 x 10(6) to 1.63 x 10(6) per ng of RNA, 1.19 x 10(5) to 2.82 x 10(5) per ng of RNA and 2.83 x 10(4) to 1.23 x 10(5) per ng of RNA respectively. DAZL transcripts were lower in men with spermatogenic failure, and a significant difference was found between the three groups (P < 0.0001). This study suggests that DAZL may play an important role in the human spermatogenic processes of both mitosis and meiosis.

Elastic properties of tendon measured by two different approaches

Elastic properties of tendon were assessed by two different approaches. Six fresh bovine Achilles tendon specimens were used. The first approach directly measured Young's modulus along the transverse direction (E(perpendicular)) and the longitudinal direction (E(parallel)), using a cyclic compression-relaxation method. Young's moduli were derived based on the measured strain and stress values. The ratio of E(parallel): E(perpendicular) at smaller strains was around 4 and decreased to 0.6 approximately 1.1 at larger strains. The second approach assumed that tendons are transversely isotropic. Three observable second-order elastic stiffness constants (c(11), c(13) and c(33)) were obtained by sound speed measurements along various propagation directions. The measured elastic stiffness constants were also correlated with results from the first approach. It was shown that the transverse isotropy assumption was valid at small strains. However, a significant discrepancy existed between the two approaches. The discrepancy was primarily due to viscoelasticity associated with the first approach.

AZFa candidate gene deletions in Taiwanese patients with spermatogenic failure

BACKGROUND AND PURPOSE

Deletions of the azoospermia factor subregion a (AZFa) genes in proximal Yq11 are not frequently reported. The majority of AZFa deletions are thought to be associated with more severe testicular phenotypes, such as Sertoli cell-only syndrome. There is a lack of data on AZFa gene deletions in East Asian populations. In this study, we investigated the deletion status of AZFa genes in Taiwanese men with spermatogenic failure.

METHODS

One hundred and eighty-three consecutive men with severe oligozoospermia or non-obstructive azoospermia were enrolled in this study. Genomic DNA was extracted from peripheral blood samples and polymerase chain reaction (PCR) was performed using primers specific to four AZFa genes: AZFaT1, DFFRY, DBY, and UTY. Sequence-tagged site markers (sY740, sY630, sY86, sY85, sY87, sY709, and sY88) were used to define the position of deletions. One hundred and twenty fertile men with normal spermatogenesis were enrolled as controls.

RESULTS

Of the 183 patients, two showed single AZFa gene deletions, resulting in an overall frequency of 1.1%. One of these two patients had DFFRY deletion and the other had DBY deletion; their testicular phenotypes were Sertoli cell-only syndrome and hypospermatogenesis, respectively. Neither patient had deletions extending from AZFa through AZFb or AZFc.

CONCLUSION

Our results suggest that AZFa gene deletion is infrequent in Taiwanese patients with severe oligozoospermia or non-obstructive azoospermia.

An effective strategy of using molecular testing to screen mentally retarded individuals for fragile X syndrome

Fragile X syndrome (FXS) is the most common form of familial mental retardation (MR). It is caused by the expansion of the CGG repeat in the FMR1 gene on the X chromosome. To date, FXS is not treatable, but can be prevented by prenatal genetic examination. Identifying women who carry a full mutation or premutation FMR1 gene is thus very important, and can be done by tracing family members of FXS subjects. However, most of the FXS subjects in Taiwan as well as those in many other countries have not been identified. In this study the authors attempt to develop reliable and inexpensive tests suitable for a large-scale screen of subjects with MR for FXS. Together with their previous study, a total of 311 male and 160 female subjects with MR were screened with nonradioactive Southern blot assay using mixed deoxyribonucleic acid from three subjects of the same sex. From these subjects, nine male subjects and one female FXS subject were diagnosed. All male subjects were also screened with nonradioactive polymerase chain reaction (PCR). These nine male FXS subjects were also detected on the basis of PCR amplification failure. No false-negative results were discerned. The PCR procedure was simplified further by combining it with an analysis of a blood spot on filter paper, which is a much simpler and cheaper method for sample collection and DNA preparation. This method was then used to screen 104 boys with MR. Two of them were suspected, and later confirmed with Southern blot assay, as subjects with FXS. This study suggests that simple PCR combined with blood spot analysis could be a reliable, inexpensive test that is feasible for a large-scale screening of male subjects with MR for FXS. However, Southern blot assay with mixed deoxyribonucleic acid is appropriate for screening female subjects. Based on this strategy, most FXS subjects could be identified easily for further management.

Magnetic-activated cell sorting (MACS) significantly decreases the hybridization efficiency of fluorescencein situ hybridization (FISH)

Fetal cells were enriched from maternal blood using density gradient centrifugation of Histopaque followed by magnetic-activated cell sorting (MACS) to select CD71-positive cells. For each specimen, cells partially purified by Histopaque were split into equal portions, and each portion was subjected to purification by MACS in parallel. Cells before and after MACS were subjected to dual-color fluorescence in situ hybridization (FISH) analysis with X- and Y-chromosome-specific probes. We found that the hybridization rates were decreased by approximately 10% after MACS based on duplicated analysis for each sample.

Y-chromosome microdeletion and its effect on reproductive decisions in taiwanese patients presenting with nonobstructive azoospermia

OBJECTIVES

To investigate the position, extent, and frequency of Y chromosome microdeletions in Taiwanese patients presenting with nonobstructive azoospermia, and to investigate the effect of microdeletions on reproductive decisions.

METHODS

We studied 176 consecutive men with azoospermia in our urology clinic. Polymerase chain reaction tests were performed in 94 patients with nonobstructive azoospermia, and a series of 27 sequence-tagged sites (STSs) mapped within intervals 5 and 6 of Yq11 was selected for analysis. Clinical genetics counseling was provided to couples with microdeletions, and these couples made their own choices about further treatment modalities.

RESULTS

Among 94 patients screened for microdeletion, 11 (11.7%) showed microdeletions of one or more STSs. One had a deletion confined to the azoospermia factor b (AZFb) region (encompassing the RBM gene). Two were found to have deletions of both the AZFb and AZFc regions. Eight patients had deletions in the AZFc region (encompassing the DAZ gene). Five had deletions distal to the DAZ gene family. One had multiple, noncontiguous deletions. In 8 patients with testicular histology available, a lack of genotype/phenotype correlation was noted. Of the 11 couples with deletions, 3 thought microdeletion was a serious defect and opted for an artificial insemination of donor or adoption, 5 chose intracytoplasmic sperm injection, and the other 3 decided to undergo treatment with Chinese medicinal herbs.

CONCLUSIONS

The most commonly deleted region in the Taiwanese population is AZFc. The genes implicated in Taiwanese spermatogenesis defects are the DAZ and RBM gene families. Twenty-seven percent of couples with microdeletions deferred assisted reproductive technologies because of concern about their underlying genetic defects.

Prenatal diagnosis of alobar holoprosencephaly by two-dimensional and three-dimensional ultrasound

The aim of this study is to evaluate the sonographic characteristics of alobar holoprosencephaly (AH) in utero. Seventeen cases were diagnosed at 16-30 weeks' gestation by two-dimensional and three-dimensional ultrasound from October 1994 to December 1998. In this series, the prenatal prevalence was 1 out of 415 and the detection rate of AH by prenatal ultrasound was 100%. Eleven cases (64.7%) had concurrent facial anomalies. Cleft lip and hypotelorism were the most common associated facial anomalies (72.7%). Two cases (11.8%) were twin pregnancy with one fetus affected. We present one of the largest series in the literature and compare it with previous reports. From this series, we concluded that: (1) intracranial findings, including monoventricle, fused thalami, and the absence of midline structures, were reliable sonographic characteristics for prenatal diagnosis; (2) cleft lip and hypotelorism seemed to be more common associated facial malformations than cyclopia or cebocephaly with AH; and (3) although three-dimensional ultrasound did not change the diagnosis of AH made by two-dimensional ultrasound in this series, three-dimensional ultrasound does assist in defining the severity and extent of AH.

EEG--a valuable tool in early diagnosis of Angelman syndrome

Angelman Syndrome (happy puppet syndrome) is one of the genetic diseases causing developmental delay in children. Late diagnosis used to be the rule because of delayed appearance of disease markers such as craniofacial dysmorphism, ataxia, unprovoked laughter and seizure. However, reports have described characteristic EEG changes such as 2-3 Hz large amplitude slow wave paroxysms which appear early and are quite specific to the syndrome. With EEG aid, we made very early diagnosis in a 9 month-old young infant. And we would like to advocate the use of EEG study in cryptogenic psychomotor retardation in children.

Strain measurements of rabbit Achilles tendons by ultrasound

Axial components of tendons' transverse strain fields were successfully measured in vitro by ultrasound. Achilles tendons of New Zealand white rabbits were used. Tendon inflammation was simulated by artificially inducing ischemia. Strain measurements were also correlated with conventional B-mode sonograms and histological micrographs. Results showed that strain measurements had reasonable agreement with histological examinations and provided better tissue differentiation than conventional B-mode imaging. For a given tendon, the strain values corresponding to different tissue layers were easily differentiated with an elastographic contrast-to-noise ratio ranging from 17 to 43 dB. Such differences, however, were not always present in the sonograms. Therefore, ultrasonic strain imaging may be a useful tool for assessing tendon disorders during the rehabilitation process.

Nucleated red blood cells in maternal blood during pregnancy

OBJECTIVE

To assess the frequencies of nucleated red blood cells (RBCs) in maternal blood during different stages of gestation and postpartum.

METHODS

Peripheral venous blood samples were collected longitudinally from 38 pregnant women from the first trimester to 3 months postpartum. Nucleated RBCs were isolated by using a triple-density gradient with Histopaque (Sigma Diagnostics, St. Louis, MO) and identified by Kleihauser-Betke acid stain.

RESULTS

The number of nucleated RBCs steadily increased from 3.9 (standard error 0.6) per 10(7) nucleated cells in early gestation (6-10 weeks) to 112.0 (standard error 7.5) per 10(7) nucleated cells near term and decreased rapidly after delivery. The number of nucleated RBCs was not related to the gender of the fetus or the ABO blood type compatibility between the mother and fetus.

CONCLUSION

The number of nucleated RBCs in the maternal blood increase progressively throughout pregnancy, with some variation from subject to subject.

Pilot fragile X screening in normal population of Taiwan

Fragile X syndrome (FXS) is the most common hereditary form of mental retardation. Molecular analysis of the FMR1 gene has now been applied to diagnosis and carrier detection. Because treatment is not feasible, prevention of FXS by prenatal diagnosis of carrier women early during pregnancy is important. The aim of this pilot study was to ascertain the prevalence of mutant FMR1 gene in normal population of Taiwan and to evaluate the efficacy of a betaine-based polymerase chain reaction (PCR) and nonradioactive Southern blot assays. The DNA was randomly and anonymously collected from 100 women and 100 men. The results showed 62% of the women were heterozygous for the CGG-repeat size in FMR1 gene. One of 300 X chromosomes in this study showed premutation, with 95 CGG repeats. All other chromosomes have CGG repeats ranging from 19 to 52, with eight chromosomes (3%) having more than 40 CGG repeats. The most prevalent allele has 29 repeats (48.1%), followed by 30 (24.0%) and 36 (9.5%), respectively. The results of this study reconfirmed previous reports that the prevalent FMR1 CGG repeat alleles in Chinese population are different from that of other populations. However, the prevalence of premutation gene seems to be comparable among them. The betaine-based PCR could minimize the intrinsic problem of preferential amplification and may reliably determine the different allele repeats in heterozygous females. This nonradioactive Southern blot protocol is safe, efficient, and inexpensive. However, further technical improvement may be needed to be more cost-effective for a wide screening of all pregnant women.

Detection of fetal cells with common chromosomal aneuploidies in maternal blood

This study was designed to address the feasibility of detection of fetal cells with chromosome abnormalities in maternal blood. Peripheral venous blood samples were collected from 150 pregnant women 1 day to 8 weeks before invasive examinations (amniocentesis, chorionic villus sampling, or fetal blood sampling). Fetal nucleated red blood cells were isolated by using a triple-density gradient followed by magnetic-activated cell sorting to select CD71 cells. Fluorescence in situ hybridization (FISH) with probes specific for chromosomes X, Y, 13, 18, and 21 was used to detect fetal cells from aneuploid pregnancies. The hybridization efficiency was greater than 98% for each probe in normal controls, and approximately 20% of all cells failed to hybridize after magnetic-activated cell sorting. Of the 10 aneuploid pregnancies identified with invasive procedures, trisomic fetal cells were identified in eight. The frequency of fetal cells in the sorted specimens ranged from 0 to 223 per 10,000 maternal nucleated cells. Although the aneuploid fetal cells could be successfully detected in eight of 10 patients in the current study, the existence of some limiting factors, such as scarcity of fetal cells and poor hybridization efficiency of FISH, raises questions about its clinical suitability for routine use.

Unusual chromosome 9 variant with an extra G-dark and C-negative segment in the short arm, proximal to the centromere: a case study

Polymorphic variation of constitutive heterochromatin in human chromosomes is commonly seen in clinical cytogenetic analyses. Normal variant can be confirmed with C-banding and are generally considered clinically insignificant. However, it may be a concern if an unusual variant chromosome is detected in a prenatal specimen. We report an unusual chromosome 9 variant with an extra G-dark and C-negative segment in the short arm, proximal to the centromere. This chromosome 9 variant has been previously reported in only nine independent families. Whether this is a rare variant or an underestimation requires further evaluation. Of note is that all probands so far reported in the literature are clinically normal.

Frequencies of fetal nucleated red blood cells in maternal blood during different stages of gestation

Nucleated red blood cells (NRBCs) isolated by a triple density gradient from 100 ml peripheral blood samples of 100 pregnant women and 30 women postpartum were subjected to morphological analysis and PCR quantitation. The number of NRBCs steadily increased from 5.3 (frequency: 2.4 x 10(-7)) in early gestation to 98.2 (frequency: 4.2 x 10(-6)) near term. The number of male cells increased from 6 (frequency: 2.7 x 10(-7)) in early gestation to a peak of 31 (frequency: 1.48 x 10(-6)) in the second trimester, and slightly decreased to 27 (frequency: 1.31 x 10(-6)) near term. Both NRBCs and male fetal cells rapidly disappeared after delivery. The result implies that a significant proportion of NRBCs in maternal blood are of fetal origin before 24 weeks of gestation while in late gestation the majority of NRBCs may be of maternal origin.

Coamplification of the ZFX and ZFY genes for sex identification in preimplantation embryos

Knowledge of the sex of an embryo may be particularly useful for couples who have a high risk of producing offspring with inherited genetic disorders. We present a rapid and reliable nested polymerase chain reaction strategy to simultaneously amplify the ZFX and ZFY genes at the single cell level. Forty single blastomeres isolated from six triploid preembryos were subjected to coamplification of ZFX and ZFY genes. The results obtained from the preembryo were consistent with the assigned genotype. The amplification rate was 80% for ZFX and 84% for ZFY. Our strategy can be applied to preimplantation diagnosis of single gene disorders, and is especially useful for preimplantation diagnosis and prevention of X-linked diseases in in vitro fertilization programs.

Application of natural and amplification-created restriction sites in prenatal and preimplantation diagnosis of beta-thalassemia

We attempted the strategy of natural and amplification-created restriction sites for early prenatal and preimplantation diagnosis of Chinese beta-thalassemia. Mutagenesis primers were designed for 11 mutations reported for the Chinese population. The diagnosis was established after polymerase chain reaction and digestion of products by specific enzymes. The results were confirmed by direct sequencing of enzymatically amplified double-stranded DNA. The beta-globin gene was amplified from triploid embryos and isolated blastomeres using mismatched primers. The mutant and normal alleles can be distinguished clearly by this new method. Early prenatal diagnosis was successfully achieved in 9 cases. The beta-globin gene was successfully amplified from single blastomeres and tripronuclear embryos with mismatched primers. Natural and amplification-created restriction sites are a reliable method for rapid prenatal diagnosis of beta-thalassemia. Furthermore, the strategy provides a possible approach for the preimplantation diagnosis of beta-thalassemia.

Detection of Y-chromosome sequences in patients with X-chromosome abnormalities

The polymerase chain reaction was used to test 18 adults and eight fetuses with numerical or structural X-chromosome abnormalities for the presence of nine Y-specific loci. Y-chromosomal DNA was detectable in one adult patient with X-chromosome mosaicism. This study and previous reports provide evidence to support further screening of patients with X-chromosome abnormalities for the presence of Y-chromosomal DNA sequences. Long-term follow-up of patients with Y-chromosomal sequences is required to determine the risk of gonadal neoplasms and other abnormal phenotypes.

Detection of Y-chromosomal DNA with marker chromosomes in Turner's syndrome

Patients with clinical features of Turner's syndrome may have a 45,X/46,X + mar or 46,X + mar karyotype. It is estimated that phenotypic females or intersexuals with a Y chromosome and gonadal dysgenesis have a 20% risk of developing gonadoblastoma, so it is crucial to know whether Turner's syndrome patients have a Y chromosome. We studied the chromosomal make-up of four patients with Turner's syndrome using the polymerase chain reaction (PCR). Nine Y-chromosomal loci including four loci (PABY, SRY, ZFY, DYS14) on the short arm, one loci (DYZ3) on the centromere, and four loci (DYS132, DYS1, DYZ1, DYZ2) on the long arm were amplified to determine the origin of marker chromosomes. Three patients were identified as having Y chromosome DNA. Patient 1 contained the presumed gonadoblastoma locus (DYS132) and a prophylactic gonadectomy was carried out. DNA extracted from dysgenetic gonads did not show Y chromosome DNA. A rapid, highly sensitive and isotope-free method for detection of abnormal Y chromosomes in Turner's syndrome patients has been developed. Chromosome in situ hybridization analysis is required to confirm the PCR results, to provide further evidence for molecular organization of these marker chromosomes.

Prenatal ultrasonographic diagnosis of congenital megalourethra

Congenital megalourethra is a rare genital anomaly characterized by dilatation of the penile urethra without evidence of distal obstruction. Reports of the prenatal diagnosis of this condition in the literature are limited. We present a case of congenital megalourethra with obstructive uropathy from the posterior urethra diagnosed prenatally at 18 weeks of gestation. 'Prune-belly'-like features, colonic malrotation, and imperforate anus were also found on autopsy.

Spontaneous resolution of fetal mediastinal cystic hygroma

We present a case of prenatally diagnosed mediastinal cystic hygroma with spontaneous resolution. To our knowledge, this is only the second case report of mediastinal cystic hygroma diagnosed prenatally, and the first one with spontaneous resolution perinatally. Our case shows that, in the absence of hydrops fetalis, mediastinal cystic hygroma in a fetus with normal karyotype can be associated with a normal outcome. Therefore we recommend fetal karyotyping, a careful search for other anomalies and close sonographic follow-up in such cases.

Prenatal diagnosis of recurrence of short rib-polydactyly syndrome

We describe a nonconsanguineous couple whose 3 successive pregnancies, including one pair of twins, led to the birth of 4 infants with short rib-polydactyly syndrome (SRPS). Flat face, hypoplastic thorax, short limbs and ribs, polydactyly, absence of penis, and death after birth were noted in the first affected male baby. The affected female twins were detected prenatally by ultrasonography and had the same characteristics, but milder than the previous one. Serial measurements of the thoracic circumference and the 4 limbs were obtained by ultrasound, and showed progressively decreased ratio of thoracic to abdominal circumference and shortness of the limbs. The last male baby also had a similar but variable expression in prenatal ultrasonography.

Carrier screening and prenatal diagnosis for alpha-thalassemia with biphasic polymerase chain reaction

Alpha-thalassemia is the most common single gene disorder in Taiwan and Southeast China. The majority of alpha-thalassemic mutations in this area are alpha-thalassemia 1. Homozygous alpha-thalassemia 1 has been recognized as the most important cause of hydrops fetalis. To investigate the incidence of alpha-thalassemia 1 mutations and to characterize its molecular defects, cord blood electrophoresis was performed on 2,000 newborns, of which 99 (5%) cases were found to have hemoglobin (Hb) Bart's levels > 3.0%. A methodology using biphasic polymerase chain reaction (PCR) with nesting primers was developed to characterize the alpha-thalassemia 1 Southeast Asia type (SEA) deletion in the cases with detectable Hb Bart's levels. The SEA deletion was found in 92 (93%) of 99 cases. Prenatal screening was performed on couples with abnormal hematologic indices, and PCR was used to detect couples heterozygous for SEA deletion. Prenatal diagnosis was performed in 21 cases, and four cases were found to have a homozygous SEA deletion. This strategy can be applied to couples who need prenatal genetic counseling for alpha-thalassemia major in this area.

Prenatal diagnosis of dicephalic conjoined twins: report of a case

Dicephalus is one of the rarest types of conjoined twins. In such cases, the twins are usually stillborn or die shortly after birth. Termination of the pregnancy is recommended if conjoined twins are diagnosed early in the second trimester. A case of dicephalic conjoined twins with cystic hygroma diagnosed prenatally by ultrasound at 16 weeks' gestation is presented. The ultrasonographic findings, management and pathology are discussed.

Amplification of beta-globin gene from single blastomeres

Prenatal diagnosis of beta-thalassemia can be performed by chorionic villus sampling as early as the ninth gestational week, and early amniocentesis within 12 weeks of gestation. Selective abortion or termination should be suggested if the fetus is affected. With polymerase chain reaction (PCR) and micromanipulation techniques, the preimplantation diagnosis of beta-thalassemia has become possible. A total of 60 single blastomeres were collected and equally divided at random into two groups. Eight DNA primers (A to H) were designed for 15 mutations of beta-thalassemia in Chinese people. Two beta-globin gene fragments (602 bp and 423 bp) were amplified by PCR through two sequential reactions with two sets of primers (A+B and C+D, E+F and G+H), respectively. The amplified products were confirmed by Southern blotting with DNA probes hybridization. The amplification rates were 54% (16/30) and 60% (18/30), respectively. All of the positive and negative controls showed the presence or absence of amplification, respectively. Our study provides a possible approach for the preimplantation diagnosis of beta-thalassemia.

X chromosome mosaicism in patients with recurrent abortion or premature ovarian failure

X chromosome mosaicism is usually associated with abnormal sexual development and reproductive performance, such as recurrent spontaneous abortion, primary or secondary amenorrhea, infertility, and premature ovarian failure. However, there is a paucity of literature which discusses these relationships. From July 1988 to December 1992, a total of 105 couples with a history of recurrent spontaneous abortion from a genetic counseling clinic and 61 women with a history of premature ovarian failure followed up in reproductive endocrinology clinics were assembled, and chromosomal analysis of peripheral blood lymphocytes was carried out. X chromosome mosaicism was found in six individuals (2.9%) out of the 105 couples with recurrent spontaneous abortion, and in five (8.2%) out of 61 women with premature ovarian failure. The karyotypes were 45,X/46,XX/47,XXX in five cases, 45,X/46,X in four cases, and 46,XX/47,XXX in two cases. The cases of complex X chromosome mosaicism (45,X/46,XX/47,XXX) presented recurrent spontaneous abortion in four cases and premature ovarian failure in one case. The cases of mosaic Turner's syndrome (45,X/46,XX) presented premature ovarian failure in three cases and recurrent spontaneous abortion in one case. The two cases of mosaic triple-X syndrome (46,XX/47,XXX) presented with premature ovarian failure and recurrent spontaneous abortion, respectively. However, the ratio of mosaic cell lines does not correlate well with the phenotypic manifestations in our cases. Our preliminary data suggest that chromosomal analysis should be done routinely in every couple with recurrent spontaneous abortion and in women with premature ovarian failure. The reproductive performance of X chromosome mosaicism is highly variable and difficult to define.(ABSTRACT TRUNCATED AT 250 WORDS)

Dicentric isochromosome X with premature ovarian failure: report of two cases

Two cases of dicentric isochromosome X, dic (Xp-), with premature ovarian failure are presented. The karyotype of case 1 is 46,X,dic(X)(qter-->p22::p22-->qter), and of case 2 is 45,X (77.5%)/46,X,dic(X)(qter-->p22::p22-->qter) (22.5%). An abnormal menstrual history including delayed menarche and secondary amenorrhea occurring at under 30 years of age was noted. Hormonal profiles revealed elevated levels of serum gonadotropins and decreased levels of estrogens. Gross appearance did not present an obvious picture of Turner's syndrome, except for short stature, poor development of secondary sexual characteristics and infertility. The possible mechanisms of dicentric isochromosome X are the breakage and reunion between either sister chromatid (isodicentric) or homologous chromosomes (homodicentric) which occur during meiosis of the germ cells in case 1 and mitosis after zygote formation in case 2.

Successful management of a pregnancy with maternal phenylketonuria: report of a case

Maternal phenylketonuria (PKU) is associated with significant complications such as mental retardation, microcephaly and congenital heart defects in nonphenylketonuric offspring. Dietary control with a low phenylalanine diet during the gestation period is effective in improving perinatal outcome in these cases. We present the case of a 27-year-old woman with classical features of PKU who had previously given birth to three babies, all of whom died of congenital heart disease. A low phenylalanine diet was started one month prior to the pregnancy and satisfactory fetal outcome was achieved.

Neonatal screening for alpha-thalassemia in southern Taiwan

Screening peripheral or cord blood from newborn infants has been used for early detection of alpha-thalassemia conditions. The level of hemoglobin Bart's (Hb Bart's) in the blood correlates with the degree of alpha-gene deletion. Hence, the degree of gene deletion in an alpha-thalassemia carrier state can be estimated. Two thousand cord blood samples collected from the Tainan area were screened with cellulose acetate membrane electrophoresis for Hb Bart's. Ninety-nine of the 2,000 samples (4.95%) were positive for Hb Bart's. Concentrations of Hb Bart's varied from 3.2% to 30.7%. Of the 99 cases with Hb Bart's, 22 had Hb Bart's levels of 3.0% to 9.9%; 54 had Hb Bart's levels of 10.0% to 19.9%; and 23 had Hb Bart's levels of 20% to 40%. Routine cord blood screening by hemoglobin electrophoresis is recommended.

The effect of third-trimester glycemic control on maternal and perinatal morbidities in pregestational diabetes mellitus

From May 1974 to March 1989, 48 cases of pregestational diabetes mellitus treated during the third trimester of pregnancy at the Obstetric Clinic of the National Taiwan University Hospital had complete maternal-fetal chart, and were enrolled into this retrospective review. Of these cases, 28 were class B, 13 were class C and seven were class D-R. The maternal complications and perinatal morbidities of each class were reviewed. The mean fasting, postprandial plasma glucose concentrations and the mean excursion of plasma glucose levels were calculated for statistical analysis. Among the maternal complications, urinary tract infections and preterm labor were significantly associated with mean fasting plasma glucose concentrations. Among perinatal morbidities, neonatal respiratory distress and metabolic problems (including neonatal hyperbilirubinemia, symptomatic hypoglycemia, hypocalcemia and polycythemia) were significantly associated with mean plasma fasting glucose concentrations, and perinatal asphyxia was associated with a mean excursion of plasma glucose levels. In view of the paucity of knowledge about the etiology of complications in diabetic pregnancies, it is necessary to conduct a prospective multi-center study with well-characterized morbidities to search for the role of glycemic control in obstetric and perinatal complications.

Clinical validation of two equations in antenatal prediction of Chinese fetal weight by ultrasonography

The purpose of this series is to prospectively validate the Chinese equations for predicting fetal weight developed in a previous study. A total of 640 Chinese fetuses were examined antenatally for biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) by real-time ultrasonography within two days of delivery. The results showed the actual birth weight (BW) to be highly correlated with the estimated body weight for both the equation using BPD and AC (EBW1) (r = 0.888, p less than 0.0001) and the equation using BPD, AC and FL (EBW2) (r = 0.890, p less than 0.0001). Our results demonstrate that the Chinese equations developed by Hsieh et al are a better fit for Chinese fetuses than the foreign equations are. Also, the two Chinese equations predict fetal weight well between 2,000 g and 4,000 g, but further modification is needed in cases where the BW is less than 2,000 g or greater than 4,000 g.

Doppler velocimetry of intraplacental fetal arteries

Doppler velocimetry of the umbilical and intraplacental fetal arteries was studied by color flow mapping in 39 normal pregnancies. The systolic-diastolic ratio (S/D) and pulsatility index of the intraplacental fetal artery downstream to the umbilical artery decreased significantly with advancing gestational age, and its S/Ds were persistently lower than those of the umbilical artery. The difference in the S/D between the umbilical artery and its intraplacental downstream branches decreased with advancing gestational age and approached zero as the pregnancy progressed to term. We conclude that intraplacental fetal arteries, possibly fetal arteries in main stem villi, can be imaged by color flow mapping and that there is a significant "resistance gradient" between the intraplacental fetal artery and the umbilical artery. Intraplacental fetal artery velocimetry using color flow mapping may give further insights into the umbilical-placental circulation.

Glucose gradients of maternal vein-umbilical vein and umbilical vein-umbilical artery in normally grown and growth-retarded fetuses

The present study was designed to investigate the roles of maternal-fetal glucose transport and fetal glucose utilization in the regulation of fetal growth. Maternal venous blood, umbilical arterial and venous blood were sampled simultaneously in 60 full-term appropriate-for gestational age (AGA) fetuses and 48 small-for-gestational-age (SGA) fetuses. The cases were divided into four groups: group 1 consisted of 35 AGA fetuses, group 2 consisted of 25 AGA fetuses, group 3 consisted of 25 SGA fetuses, and group 4 consisted of 22 SGA fetuses. The mothers of group 1 and 3 were given 2.5% glucose in 0.9% normal saline and those of groups 2 and 4 by cesarean section received normal saline or Ringer's lactate at least one hour prior to delivery of the fetus SGA fetuses were found to have hypoglycaemia of umbilical venous blood, increased (maternal vein-umbilical vein) MV-UV and decreased UV-UA (umbilical vein-umbilical artery) glucose gradients, all of which disappeared after maternal glucose supplementation. However, hypoinsulinemia and lower insulin/glucose ratio in SGA fetuses persisted either with or without maternal parenteral glucose infusion. Increased MV-UV and decreased UV-UA glucose gradients suggests placental dysfunction and poor glucose utilization in SGA fetuses. The lower fetal insulin/glucose ratio may imply pancreatic dysfunction in SGA fetuses, which did not respond to glucose challenge from the maternal side. It seems that in SGA fetuses, placental dysfunction interferes with maternal-fetal transfer with resulting fetal hypoglycemia; on the other hand, pancreatic dysfunction leads to poor glucose utilization and retarded intrauterine growth. However, the mechanism that primarily accounts for pancreatic dysfunction in these fetuses remains to be resolved.

The antenatal blood gas and acid-base status of normal fetuses and hydropic fetuses with Bart hemoglobinopathy

Funipuncture offers direct access to the fetal circulation. The blood gas and acid-base status of the fetus can be studied, and fetal hypoxia and acidosis can be diagnosed directly. To establish normal ranges of fetal blood gas and acid-base status, we analyzed umbilical venous blood samples obtained by funipuncture from 62 normal fetuses (20-35 weeks). These fetuses were studied because of suspected fetal diseases and were subsequently proved to be normal by the fetal blood examinations. Umbilical vein pH and pO2 decreased whereas pCO2 and bicarbonate increased with gestational age. The umbilical vein base excess did not correlate with gestational duration, but oxygen saturation tended to decrease with gestational age. Twenty hydropic fetuses with Bart hemoglobinopathy were also studied; they were found to be more acidotic, hypoxic, and hypercarbic than normal fetuses.

Clinical analysis of infants of diabetic mothers

The clinical spectra of 82 infants of diabetic mothers (IDMs) encountered in the past 15 years are presented. The perinatal mortality rate was 6.1%, The observed morbidities of the 78 live-born IDMs were: large for gestational age, 35.9%; prematurity, 12.8%; small for gestational age, 12.8%; respiratory distress, 17.9%; low Apgar score, 6.4%; nerve injury, 2.6%; hypoglycemia, 10.3%; hyperbilirubinemia, 28.2%; polycythemia, 12.8%; hypocalcemia, 5.1%; hypertrophic cardiomyopathy, 3.8%. Furthermore, 15.9% (13/82) of these infants suffered from congenital malformation, a rate nearly 10 times higher than that of the general neonatal population born in this hospital. In comparing sugar control during organogenesis, the mothers who had malformed infants had significantly higher fasting plasma glucose level than the mothers who had normal infants (P less than 0.05). Since tight control of maternal diabetes is mandatory to reduce the prevalence of mortality and malformation of the IDMs, we suggest that there is an urgent need to improve health education and supervision before and during pregnancy in all diabetic women.