Quantification of the placental epigenetic signature of the SERPINB5 gene in maternal plasma of pregnancies complicated by small for gestational age

INTRODUCTION

To investigate the association between pregnancies with small for gestational age (SGA) neonates and the concentration of cell-free fetal DNA or cell-free total DNA in maternal plasma during the first and second trimesters using tissue-specific epigenetic characteristics of the SERPINB5 gene.

METHODS

A nested case-control study was conducted with maternal plasma collected at 11 to 26 gestational weeks from 51 women with SGA neonates and 102 controls. We performed a real-time quantitative methylation-specific PCR to quantify concentrations of unmethylated-SERPINB5 (U-SERPINB5) as a cell-free fetal DNA marker and methylated-SERPINB5 (M-SERPINB5) as a cell-free total DNA marker.

RESULTS

A positive correlation was observed between U-SERPINB5 and M-SERPINB5 concentrations in both control (r = 0.363, p < 0.001) and SGA groups (r = 0.548, p < 0.001). Moreover, the concentration of U-SERPINB5 or M-SERPINB5 was significantly positive correlated with gestational age at sampling in both controls (U-SERPINB5: r = 0.397, p < 0.001; M-SERPINB5: r = 0.275, p = 0.005) and SGA (U-SERPINB5: r = 0.274, p = 0.052; M-SERPINB5: r = 0.439, p = 0.001). However, the concentration of U-SERPINB5 or M-SERPINB5 was not correlated with birthweight. At 11-14 weeks, U-SERPINB5 and M-SERPINB5 concentrations in SGA did not differ significantly from those of controls. There were also no statistically significant differences in the concentrations of U-SERPINB5 and M-SERPINB5 between SGA and controls at 15-26 weeks of gestation.

DISCUSSION

Our findings suggest that U-SERPINB5 and M-SERPINB5 concentrations in maternal plasma during early pregnancy are not associated with pregnancies who delivered SGA neonates.

Unusual maternal uniparental isodisomic x chromosome mosaicism with asymmetric y chromosomal rearrangement

Infertile men with azoospermia commonly have associated microdeletions in the azoospermia factor (AZF) region of the Y chromosome, sex chromosome mosaicism, or sex chromosome rearrangements. In this study, we describe an unusual 46,XX and 45,X mosaicism with a rare Y chromosome rearrangement in a phenotypically normal male patient. The patient's karyotype was 46,XX[50]/45,X[25]/46,X,der(Y)(pter→q11.222::p11.2→pter)[25]. The derivative Y chromosome had a deletion at Yq11.222 and was duplicated at Yp11.2. Two copies of the SRY gene were confirmed by fluorescence in situ hybridization analysis, and complete deletion of the AZFb and AZFc regions was shown by multiplex-PCR for microdeletion analysis. Both X chromosomes of the predominant mosaic cell line (46,XX) were isodisomic and derived from the maternal gamete, as determined by examination of short tandem repeat markers. We postulate that the derivative Y chromosome might have been generated during paternal meiosis or early embryogenesis. Also, we suggest that the very rare mosaicism of isodisomic X chromosomes might be formed during maternal meiosis II or during postzygotic division derived from the 46,X,der(Y)/ 45,X lineage because of the instability of the derivative Y chromosome. To our knowledge, this is the first confirmatory study to verify the origin of a sex chromosome mosaicism with a Y chromosome rearrangement.

A case of an anomalous hypertrophied muscle band in the left ventricle

A hypertrophied muscle band (HMB) in the left ventricle (LV), which can be misinterpreted as apical hypertrophic cardiomyopathy, is a rare echocardiographic finding in a patient with normal LV wall thickness. Not only are symptoms produced, but changes in the electrocardiogram (ECG) are limited to the repolarization phase and show no progression even in a large HMB. Hence, we report a case of a 25-year-old woman who visited a local medical clinic due to epigastric discomfort in January 2007. The 24-hour Holter ECG showed multiple premature ventricular complexes. An HMB (3.23 × 10.8 cm) was observed on two-dimensional echocardiography that ran toward the interventricular septum (IVS) across the LV and divided the LV into apical and basal cavities at the apical one-third of the LV. Although LV wall thickness showed normal range, flow acceleration was observed between the HMB and IVS and revealed dagger-shaped with a high pressure gradient up to 30 mmHg in continuous wave Doppler examination. Circumferential band-like myocardial hypertrophy was observed at the LV apex on cardiac magnetic resonance imaging. Myocardial thinning and prominent trabeculae were present from the proximal to distal HMB. However, contractility was normal at the myocardial thinning site, regional wall motion abnormality was not observed in cine images. Focal fatty accumulation was evident at the base of the HMB. Coronary angiography revealed no significant stenosis, whereas left ventriculography showed septation at the apical one-third of the LV. The patient was discharged without any medication.

Hypoxia inducible factor-1α gene polymorphisms in Korean patients with pre-eclampsia

BACKGROUND

Placental hypoxia has been implicated in the pathogenesis of pre-eclampsia. Hypoxia inducible factor-1α (HIF-1α) is activated by low oxygen tension and is a key regulator of genes involved in the cellular responses to hypoxia.

AIM

We determined whether maternal blood c.1722C>T (Pro582Ser) and c.1790G>A (Ala588Thr) polymorphisms in exon 12 of the HIF-1α gene are associated with pre-eclampsia.

SUBJECTS AND METHODS

Subjects included 163 pre-eclamptic patients (48 mild and 115 severe preeclampsia) and 194 healthy pregnant women. Polymorphisms were genotyped by PCR and direct DNA sequencing.

RESULTS

There were no significant differences in genotype or allele frequencies of the c.1772C>T and c.1790G>A polymorphisms of the HIF-1α gene among the study groups. Moreover, subgroup analysis according to pre-eclampsia severity revealed no significant differences in genotype or allele frequencies of the HIF-1α c.1772C>T and c.1790G>A polymorphism in mild pre-eclamptic compared to severe pre-eclamptic group. In addition, there were no significant differences in the frequencies of 3 haplotypes (C-G,-G, T-G, and C-A) between the control and pre-eclamptic groups.

CONCLUSIONS

Our results suggest that the HIF-1α gene polymorphisms are not associated with the development of pre-eclampsia in the studied Korean women population.

Comparison between measured and calculated length of side branch ostium in coronary bifurcation lesions with intravascular ultrasound

PURPOSE

Accurate evaluation of side branch (SB) ostium could be critical to the treatment of bifurcation lesions. We compared measured and calculated values of side branch ostial length (SBOL) in coronary bifurcation lesions with intravascular ultrasound (IVUS).

MATERIALS AND METHODS

Pre-intervention and post-intervention IVUS was performed in 113 patients who underwent stent implantation of bifurcation lesions. For the IVUS longitudinal reconstruction of the bifurcation lesions, SBOL, SB diameter, and the angle between the distal portion of the main vessel (MV) and SB were directly measured. In addition, SBOL was calculated as: SB diameter/ sin (angle between distal MV and SB). The relationship between measured and calculated SBOL was then evaluated.

RESULTS

The angled between the distal MV and SB were 57.3±12.4° at pre-intervention and 59.4±12.6° at post-intervention. The mean measured and calculated SBOL values were 2.91±0.86 mm and 3.06±0.77 mm at pre-intervention and 2.79±0.82 mm and 2.92±0.69 mm at post-intervention, respectively. Differences between measured and calculated SBOL were 0.15±0.44 mm at pre-intervention and 0.13±0.41 mm at post-intervention. We found that calculated SBOL was correlated with measured SBOL (pre-intervention r=0.863, p<0.001; post-intervention r=0.868, p<0.001).

CONCLUSION

There was a good correlation between measured and calculated SBOLs of the bifurcation lesions in IVUS longitudinal reconstruction. SBOL in the bifurcation lesions can therefore be estimated using the SB diameter and the angle between distal MV and SB.

Clinical outcomes of infrapopliteal angioplasty in patients with critical limb ischemia

Background and Objectives

With recent advances in equipment and techniques, infrapopliteal angioplasty has shown results that are comparable to those of surgical bypass in patients with critical limb ischemia (CLI). In this study, we evaluated the efficacy and the feasibility of infrapopliteal angioplasty in patients with CLI.

Subjects and Methods

Between March 2002 and May 2008, infrapopliteal angioplasty was performed on 118 limbs of 101 patients (79 males; mean age 66 years) with CLI (Rutherford category 4, 5 or 6). Freedom from reintervention, limb salvage, and overall survival were analyzed.

Results

The median follow-up duration was 30 months. Initial technical and clinical success rates were 69.5% and 83.1%, respectively. No major complication requiring surgical intervention developed after angioplasty. Among 82 limbs with initial technical success, the rate of freedom from any reintervention at 2 years was 70.7% and that from limb salvage was 97.6%. Young age and Rutherford category 6 at initial presentation were independent predictors associated with poor 2 year primary patency in these patients with CLI. Overall survival at 1 year was 86.4% and that at 2 years 76.3%. A history of cerebrovascular accident was an independent predictor associated with poor 2 year survival in these patients.

Conclusion

Infrapopliteal angioplasty as a primary choice of treatment in CLI patients showed favorable clinical outcomes and feasibility.

Impact of multivessel coronary disease with chronic total occlusion on one-year mortality in patients with acute myocardial infarction

BACKGROUND AND OBJECTIVES

The impact of multivessel coronary disease (MVD) with chronic total occlusion (CTO) on one-year mortality in patients with acute myocardial infarction (AMI) is not clearly known. We investigated the impact of MVD with concurrent CTO lesion on one-year mortality in patients with AMI.

SUBJECTS AND METHODS

We studied 1008 consecutive patients who underwent coronary angiography between November 2005 and December 2008 with a diagnosis of AMI.

RESULTS

Among 1008 patients, 432 patients (43%) had MVD, and 88 patients (8.7%) had CTO lesion. The one-year overall mortality was higher in patients with MVD than in patients with single vessel disease (SVD) (10.2% vs. 5.9%, p=0.012). However, the one-year overall mortality was not significantly higher in patients with CTO lesion than in patients without that lesion (12.5% vs. 7.3%, p=0.080). In multivariate analysis, independent predictors of one-year overall mortality were age older than 65 years {hazard ratio (HR) 2.41, 95% confidence interval (CI): 1.43 to 4.08}, Killip class ≥III (HR 3.59, 95% CI: 2.24 to 5.77), ST-elevation myocardial infarction (HR 2.45, 95% CI: 1.49 to 4.05) and MVD (HR 1.76, 95% CI: 1.07 to 2.89).

CONCLUSION

Patients with MVD showed higher one-year mortality than patients with SVD. However, the presence of CTO was not an independent predictor of one-year mortality in this study that included patients with successfully revascularized CTO lesion.

Prognostic value of standard electrocardiographic parameters for predicting major adverse cardiac events after acute myocardial infarction

BACKGROUND

The prognostic value of electrocardiographic (ECG) variables in predicting major adverse cardiac events (MACEs) after acute myocardial infarction (AMI) in the era of modern therapy is unclear. This study was conducted to evaluate the prognostic significance of ECG parameters in predicting 1-year MACEs for AMI patients.

METHODS

Between January 2006 and January 2008, 529 AMI patients were included. ECG variables were analyzed from the ECG taken on discharge day. The 1-year MACEs were defined as death, nonfatal MI, and revascularization including repeat percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Mean follow-up duration was 360 ± 119 days.

RESULTS

Of these patients, 497 (94%) patients provided complete follow-up data (355 males; 67 ± 12 years old). The rate of 1-year MACEs was 16%. In univariate analysis, heart rate, corrected QT interval, left ventricular (LV) hypertrophy, voltage (SV(1) + RV(5) ), lateral ST-depression (V(5-6) or I, aVL), pathologic Q wave (V(1-4) , V(5-6) ), ST-elevation (V(1-4) , V(5-6) or I, aVL), and T-wave inversion (V(1-4) , V(5-6) , or I, aVL) had a significant association with 1-year MACEs. In the Cox regression hazard model, lateral ST-depression (hazard ratio [HR] 2.260, 95% confidence interval [CI] 1.204 to 4.241, P = 0.011) and corrected QT interval (HR 1.007, 95% CI 1.002 to 1.011, P = 0.004) were independent predictors of 1-year MACEs. After adjustment for all risk variables, lateral ST-depression (HR 3.781, 95% CI 1.047 to 13.656, P = 0.042) was the only ECG variable that independently predicted 1-year MACEs.

CONCLUSION

Lateral ST-depression on discharge day ECG is an independent predictor of 1-year MACEs after AMI.

The impact of circadian variation on 12-month mortality in patients with acute myocardial infarction

BACKGROUND AND OBJECTIVES

Although circadian variation in the onset of acute myocardial infarction (AMI) has been reported in a number of studies, not much is known about the impact of circadian variation on 12-month mortality. The aim of this study was to investigate the impact of circadian variation on 12-month mortality in patients with AMI.

SUBJECTS AND METHODS

Eight hundred ninety two patients (mean age 67±12; 66.1% men) with AMI who visited Kyungpook National University Hospital from November 2005 to December 2007 were included in this study. Patients were divided into groups based on four 6-hours intervals: overnight (00:00-05:59); morning (06:00-11:59); afternoon (12:00-17:59) and evening (18:00-23:59).

RESULTS

Kaplan-Meier survival curves showed 12-month mortality rates of 9.6%, 9.1%, 12.1%, and 16.7% in the overnight, morning, afternoon, evening-onset groups, respectively (p=0.012). Compared with the morning-onset AMI group, the serum creatinine levels (p=0.002), frequency of Killip class ≥3 (p=0.004), and prescription rate of diuretics (p=0.011) were significantly higher in the evening-onset AMI group, while the left ventricular ejection fraction (p=0.012) was significantly lower. The proportion of patients who arrived in the emergency room during routine duty hours was significantly lower in evening-onset groups irrespective of the presence or absence of ST-segment elevation (p<0.001). According to univariate analysis, the 12-month mortality rate in the evening group was significantly higher compared to the morning group (hazard ratio 1.998, 95% confidence interval 1.196 to 3.338, p=0.008).

CONCLUSION

Patients with evening-onset AMI had poorer baseline clinical characteristics, and this might affect the circadian impact on 12-month mortality. Further studies are needed to clarify the role of circadian variation on the long-term outcome of AMI.

Examining the relationship between triggering activities and the circadian distribution of acute aortic dissection

BACKGROUND AND OBJECTIVES

There are limited data examining triggering activities and circadian distribution at the onset of acute aortic dissection (AAD) in the context of diagnostic and anatomical classification. The aim of this study was to further investigate this relationship between triggering activities and circadian distribution at the onset of AAD according to diagnostic and anatomic classification.

SUBJECTS AND METHODS

A total of 166 patients with AAD admitted to Kyungpook National University Hospital between July 2001 and June 2009 were included. To assess the influence of diagnostic and anatomical classification, we categorized the patients into intramural hematoma (IMH) group (n=67)/non-IMH group (n=99) and Stanford type A (AAD-A, n=94)/type B (AAD-B, n=72). To evaluate circadian distribution, the day was divided into four 6-hour periods: night (00-06 hours), morning (06-12 hours), afternoon (12-18 hours), and evening (18-00 hours).

RESULTS

Most (72%) AAD episodes were related to physical (53%) and mental activities (19%), with about one-third occurring during the afternoon, and only 12% occurring at night. No differences in triggering activities or circadian distribution were observed among the groups. Waking hours including morning, afternoon, and evening correlated with triggering activities (p=0.003). These relationships were observed for the non-IMH (p=0.008) and AAD-B (p=0.003) cases. The remaining categories had similar relationships, but did not reach statistical significance.

CONCLUSION

Our findings suggest differences in the relationship between triggering activities and the circadian distribution of the onset of AAD according to diagnostic and anatomical classification.

Electrocardiography patterns and the role of the electrocardiography score for risk stratification in acute pulmonary embolism

Background and Objectives

Data on the usefulness of a combination of different electrocardiography (ECG) abnormalities in risk stratification of patients with acute pulmonary embolism (PE) are limited. We thus investigated 12-lead ECG patterns in acute PE to evaluate the role of the ECG score in risk stratification of patients with acute PE.

Subjects and Methods

One hundred twenty-five consecutive patients (63±14 years, 56 men) with acute PE who were admitted to Kyungpook National University Hospital between November 2001 and January 2008 were included. We analyzed ECG patterns and calculated the ECG score in all patients. We evaluated right ventricular systolic pressure (RVSP) (n=75) and RV hypokinesia (n=80) using echocardiography for risk stratification of acute PE patients.

Results

Among several ECG findings, sinus tachycardia and inverted T waves in V_1-4 (39%) were observed most frequently. The mean ECG score and RVSP were 7.36±6.32 and 49±21 mmHg, respectively. The ECG score correlated with RVSP (r=0.277, p=0.016). The patients were divided into two groups {high ECG-score group (n=38): ECG score >12 and low ECG-score group (n=87): ECG score ≤12} based on the ECG score, with the maximum area under the curve. RV hypokinesia was observed more frequently in the high ECG-score group than in the low ECG-score group (p=0.006). Multivariate analysis revealed that a high ECG score was an independent predictor of high RVSP and RV hypokinesia.

Conclusion

Sinus tachycardia and inverted T waves in V_1-4 were commonly observed in acute PE. Moreover, the ECG score is a useful tool in risk stratification of patients with acute PE.

A case of coronary artery dissection after aortic replacement in acute type a aortic dissection

A 59-year-old woman was transferred to our institution with a diagnosis of acute type A aortic dissection. During aortic replacement surgery, the dissection had not extended to the orifice of the left coronary artery. However, ST segment elevation was observed on an electrocardiogram monitor immediately postoperatively. An emergent coronary angiogram showed almost complete collapse of the lumen of the left coronary artery due to pulsatile compression of the false lumen, which was caused by extension of the aortic dissection. Percutaneous coronary intervention (PCI) was performed with placement of stents in the left anterior descending artery (LAD) and left circumflex artery. Coronary angiography and intravascular ultrasound performed 45-days after PCI showed significant instent restenosis (ISR) at the proximal portion of the LAD and residual coronary artery dissection of the diagonal branch. Repeat balloon angioplasty was performed at the site of the ISR. A follow-up coronary angiogram 8-months after the PCI showed no evidence of ISR.

Gender differences among korean patients with coronary spasm

BACKGROUND AND OBJECTIVES

The gender differences among Korean patients with coronary spasm have not been defined. We thus determined the gender differences among Korean patients with coronary spasm.

SUBJECTS AND METHODS

Patients with chest pain and/or syncope who were admitted to Kyungpook National University Hospital between January 2001 and August 2008 were included. Provocation of coronary vasospasm with intracoronary ergonovine maleate was performed when baseline coronary angiography showed no significant stenosis or there was a strong clinical suspicion of coronary spasm. The clinical characteristics were analyzed from 104 consecutive patients (56+/-9 years of age; 21 females) who were diagnosed with coronary spasm.

RESULTS

Female patients were younger (52+/-7 vs. 57+/-10 years, p=0.046) with lower rates of smoking and alcohol consumption histories than male patients (19% vs. 65%, p<0.001; and 43% vs. 89%, p<0.001, respectively). The other clinical characteristics were not significantly different, except for the triglyceride levels.

CONCLUSION

The majority of patients with coronary spasm were males who were smokers and alcohol consumers. The female patients had lower rates of smoking and alcohol consumption, and they were younger than the male patients. Further studies are needed to investigate the relevance of gender differences in the pathogenesis of coronary spasm.

Prognosis and natural history of drug-related bradycardia

Background and Objectives

The prognosis and natural history of bradycardia related to drugs such as beta-blockers and non-dihydropyridine calcium channel blockers are not well known.

Subjects and Methods

We retrospectively analyzed 38 consecutive patients (age 69±11, 21 women) with drug-related bradycardia (DRB) between March 2005 and September 2007. A drug-associated etiology for the bradycardia was established based on the medical history and patient response to drug discontinuation. The mean follow-up duration was 18±8 months.

Results

The initial electrocardiogram (ECG) showed sinus bradycardia (heart rate ≤40/min) in 13 patients, sinus bradycardia with junctional escape beats in 18 patients, and third-degree atrioventricular (AV) block in seven patients. Drug discontinuation was followed by resolution of bradycardia in 60% of patients (n=23). Among them, five (17.8%) patients resumed taking the culprit medication after discharge and none developed bradycardia again. Bradycardia persisted in 10 (26.3%) patients despite drug withdrawal, and a permanent pacemaker was implanted in seven of them. Third-degree AV block, QRS width, and bradycardia requiring temporary transvenous pacing were significantly associated with the bradycardia caused by drugs.

Conclusion

Beta-blockers were the most common drugs associated with DRB. However, in one quarter of the cases the DRB was not associated with drugs; in these patients permanent pacemaker implantation should be considered.

Teratogen risk counselling by internet: A prospective cohort study

Although the internet may play a role in providing proper teratogen-risk counselling for pregnant women, the experience with this type of service has not been reported. We aimed to compare the pregnancy outcome of women counselled by the internet to women that received typically in-clinic teratogen risk counselling in the clinic. In a prospective cohort design, 1,011 patients were counselled in the clinic and 235 patients were counselled via the internet. Teratogen risk counselling was provided according with the information obtained from medical literature and specialised software. Information about pregnancy outcome (delivery, spontaneous abortion, or termination of pregnancy and major malformations) was obtained from 903 (89.3%) patients from the clinic group and 141 (60%) from the internet group. The amount of alcohol, cigarettes smoked, and millirads of X-ray were greater ( p < 0.05) in patients counselled by internet than in clinic. The rate of deliveries, ongoing pregnancies, pregnancy terminations, and spontaneous abortions were similar between clinic and internet (chi2 = 1.32; p = 0.7). Of 498 babies born to mothers counselled in the clinic, major malformations were identified in 3.6%. Of 67 babies born to mothers counselled by internet, major malformations were present in 1.5% ( p = 0.6). Teratogen-risk counselling by internet and clinic seems to have a similar efficacy in pregnancy outcome.

Prenatal multivitamins containing folic acid do not decrease prevalence of depression among pregnant women

Several studies have reported an association between depression and folic acid deficiency. We investigated whether intake of prenatal multivitamins containing folic acid (MVandFA) was associated with decreased rates of depression among pregnant women. A questionnaire was given to 1,314 low-risk pregnant women. Of them, 1,277 (97.2%) women completed the questionnaire. The overall prevalence of depression was 8.1%. Of 652 participants who did not take MVandFA, 9.4% had depression, whereas 6.9% of 624 women who had MVandFA had depression (p = 0.11). In a multivariate logistic regression analysis, family history of depression (adjusted OR 3.7; 95% CI 1.9-7.3) and premenstrual syndrome (adjusted OR 3.0, 95% CI 1.8-4.8) were identified as risk factors for depression during pregnancy. In conclusion, intake of MVandFA was not associated with lower rates of depression during pregnancy whereas family history of depression and personal history of premenstrual syndrome were significant risk factors.

Pregnancy outcome after exposure to oral contraceptives during the periconceptional period

To evaluate whether periconceptional exposure to oral contraceptives (OCs) increased adverse pregnancy outcomes, 136 pregnant women taking OCs within the periconceptional period were identified at the Korean Motherisk Program. Of them, 120 pregnant women accepted to participate in their study and were followed up until completion of the pregnancy. A control group of 240 age- and gravidity-matched pregnant women exposed to non-teratogen drugs for at least 1 month before pregnancy was also included. The median gestational age at delivery was 39.1 (27.0-41.0) weeks in the exposed group and 39.3 (27.4-42.0) weeks in the control group (P = 0.19). In the exposed group, 7.1% of babies were born with low birth weight versus 2.6% in the control group (P = 0.068). The number of preterm deliveries or babies born large for gestational age did not differ between the two groups. In the exposed group, the rate of birth defects was 3.2% (n = 3/99) versus 3.6% (n = 7/193) in the control group (P = 1.0). There were 15 women who took high doses of progesterone (emergency contraception) and no adverse fetal outcomes were observed. In conclusion, periconceptional exposure to OCs does not appear to increase the risk for adverse pregnancy outcomes.

Clinical manifestations of arrhythmogenic right ventricular cardiomyopathy in Korean patients

BACKGROUND

The clinical manifestations of the Korean patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) are not well known.

METHODS

The clinical data of Korean patients who met the Task Force Criteria for ARVC were analyzed.

RESULTS

Thirty-seven patients (41.2+/-14.8 years old, 19 males) were diagnosed with ARVC. The commonest presenting symptoms were palpitations (30%), syncope/presyncope (30%) and no symptoms (30%). Four patients had a family history of premature sudden death or ARVC. Most patients with no symptoms were evaluated due to ECG abnormalities or asymptomatic ventricular arrhythmias. Ventricular tachycardia, ventricular fibrillation and frequent premature ventricular contractions only were observed in 35%, 5% and 24%, respectively. Wall motion abnormalities of the right and left ventricles were detected in 92% and 41%, respectively. Fatty or fibrofatty infiltration was observed in 26 of the 32 (81%) patients who underwent an endomyocardial biopsy. Two patients had signs of heart failure. Two patients with syncope/presyncope were diagnosed with vasovagal syncope and another was due to side effects from a medication. Most of the patients with ventricular arrhythmias were treated with beta-blockers and/or amiodarone. Implantable cardioverter-defibrillators (ICDs) were implanted in 3 patients. During a mean follow-up of 27.4+/-26.5 months no syncope or sudden death developed except for in one patient with an ICD who suffered from recurrent shocks due to ventricular fibrillation.

CONCLUSIONS

ARVC may be an important cause of syncope, ventricular arrhythmias, and ECG and wall motion abnormalities of the ventricles in Koreans. The Korean patients with ARVC exhibited various clinical manifestations.

Prevalence of the Brugada-type ECG recorded from higher intercostal spaces in healthy Korean males

BACKGROUND

Electrocardiograms (ECGs) recorded from the higher intercostal spaces (ICSs) are reported to be helpful for the diagnosis of Brugada syndrome (BS). However, the prevalence of Brugada-type ECG changes recorded from the higher ICSs is unknown in the healthy Korean population.

METHODS AND RESULTS

A total of 225 healthy Korean male subjects with a mean age of 44+/-13 (20-69) years with no syncope or family history of sudden death were enrolled in the present study. ECGs were taken from 4th, 3rd, and 2nd ICSs and examined for Brugada-type ECG changes. There were none on the routine 12-lead ECGs, but 3 (1.3%) of the 225 subjects had a Brugada-type ECG recorded from the higher ICSs and 1 of them had a Brugada-type ECG recorded at both the 2nd and 3rd ICSs. The prevalence of the Brugada-type ECG was 1.3% at the 3rd ICS, 0.4% at the 2nd ICS. All were type 2.

CONCLUSION

Some healthy Korean males with normal routine ECGs show Brugada-type 2 changes on ECGs recorded from higher ICSs.

Mesenchymal progenitor cells in the human umbilical cord

Mesenchymal progenitor or stem cells (MPCs) isolated from fetal blood, liver, and bone marrow are a population of multipotential cells that can proliferate and differentiate into multiple mesodermal tissues including bone, cartilage, muscle, ligament, tendon, fat, and stroma. The objective of this study was to isolate and characterize MPCs in the human umbilical cord. The suspensions of endothelial and subendothelial cells in cord vein were collected and cultured in M199 supplemented with 10% fetal bovine serum (FBS). Of 50 umbilical cord samples, 3 had numerous fibroblastoid cells morphologically distinguishable from endothelial cells. Fibroblastic cells displayed lack of expression of vWF, Flk-1, and PECAM-1, indicating the endothelial cell-specific marker. To investigate the differentiation potentials, the cells were cultured in adipogenic or osteogenic medium for 2 weeks. Fibroblast-like cells treated with adipogenic supplementation showed Oil red O-positive staining and expressed adipsin, FABP4, LPL, and PPARgamma2 genes by reverse transcriptase polymerase chain reaction (RT-PCR). In osteogenic differentiation, alkaline phosphatase activity and calcium accumulation were detected. RT-PCR studies determined that Cx43, osteopontin, and Runx2 genes were expressed in the osteogenic cultures. Among three cell lines cultured continuously for passage 10, two had normal karyotypes; however, one retained a karyotype of mos 46,XY[19]/47,XY,+mar[3]. These observations suggest that MPCs are present in human umbilical cord and possess several typical traits of MPCs.

Prenatal diagnosis of a familial complex chromosomal rearrangement involving chromosomes 5, 10, 16 and 18

We report one case of a familial complex chromosomal rearrangement (CCR) involving four different chromosomes 5, 10, 16 and 18. The CCR was detected prenatally at 20 weeks' gestation because of advanced maternal age and history of recurrent miscarriages. Cytogenetic analysis of cultured amniotic fluid cells with GTG banding showed a 46,XX,t(5;16;10;18)(q13;q22;q11.2;q21) karyotype. Parental cytogenetic study revealed that the mother has the same CCR. RBG banding, high resolution banding and fluorescence in situ hybridization (FISH) were used to characterize further and confirm the conventional banding data. No physical abnormalities were shown in the targeted fetal ultrasonography examination. The parents decided to continue the pregnancy. The child is now 2 years old and has neither congenital anomalies nor evidence of delayed psychomotor development. The fetal targeted ultrasound and FISH analysis helped us reassure fetal status.

Increased chromosome X, Y, and 18 nondisjunction in sperm from infertile patients that were identified as normal by strict morphology: implication for intracytoplasmic sperm injection

OBJECTIVE

To determine the incidence of nondisjunction for chromosomes X, Y, and 18 using fluorescence in situ hybridization (FISH) on morphologically normal sperm from infertile men who are candidates for ICSI.

DESIGN

After standard hematoxylin staining, sperm with normal morphology were identified using Kruger's strict morphology criteria. The location of each normal-appearing sperm was recorded using an electronic microstage locator. Slides were subsequently subjected to FISH for detection of chromosomes X, Y, and 18 (control probe). Nuclei were relocated and analyzed under the fluorescent microscope.

SETTING

University-affiliated IVF and intracytoplasmic sperm injection program.

PATIENT(S)

Men classified as infertile on the basis of abnormal strict morphology (<4% by Kruger's criteria). For controls, normal fertile men (n=6) were also analyzed.

INTERVENTION(S)

Semen smears were obtained retrospectively from infertile (n=8) and fertile (n=6) men.

MAIN OUTCOME MEASURE(S)

Ploidy of each cell was determined according to the number of signals detected for each probe.

RESULT(S)

Approximately 100-150 morphologically normal sperm were identified and located in each case. Subsequent FISH analysis of these normal sperm showed aneuploidy to range from 1.8% to 5.5% in the infertile group as compared with 0 to 2.6% among the control fertile group. Statistically significant differences in the incidence of aneuploidy for the sex chromosomes as well as for all three (X, Y, and 18) chromosomes was observed.

CONCLUSION(S)

Although 95% to 98% of the sperm were found to be normal for X, Y, and 18, our findings show that infertile couples undergoing ICSI are likely to be at an increased risk for having a genetically abnormal conceptus as compared with the fertile controls. These results demonstrate that normal morphology is not an absolute indicator for the selection of genetically normal sperm. Hence, observed pregnancy failures among ICSI patients may in part be due to the selection of aneuploid sperm.

Frequencies of fetal chromosomal abnormalities at prenatal diagnosis: 10 years experiences in a single institution

We present frequencies of fetal chromosomal abnormalities in 4,907 prenatal cytogenetic examinations at Samsung Cheil Hospital from 1988 to 1997 for 10 yr duration. Prenatal karyotypes were undertaken in 3,913 amniotic fluid samples, 800 chorionic villi samples, and 194 percutaneous umbilical blood samples. The frequency of fetal abnormal karyotypes was 3.1% (150 cases). Numerical chromosome abnormalities were 87 cases (1.8%) and structural aberrations of chromosomes were 63 cases (1.3%). In the numerical chromosomal abnormalities, the frequency of trisomy 21 was by far the highest (36 cases), followed by trisomy 18 in 22 cases and sex chromosome aneuploidies in 19 cases. In the structural chromosomal aberrations, 5 cases had the inversions in chromosome 2, 7, 17, and Y. Chromosomal deletions in 6 cases and additions in 4 cases were analysed. Of the remaining 47 translocation in abnormal fetuses, reciprocal translocation was in 26 cases and Robertsonian translocation in 21 cases. Among them, 41 cases were balanced translocation and 6 were unbalanced. Thirty five cases of translocation were inherited from one of the parents. Four had de novo chromosome rearrangements, and 8 cases were unknown.

Tetralogy of Fallot in the fetus: findings at targeted sonography

OBJECTIVES

To evaluate the findings of tetralogy of Fallot in various fetal sonographic views.

METHODS

We reviewed the fetal sonograms and medical records of 20 fetuses with prenatal diagnosis of tetralogy of Fallot. We analyzed the indications for targeted sonography, the abnormalities seen in various sonographic views, the postnatal echocardiographic and angiographic findings and autopsy findings.

RESULTS

The most common indication for targeted sonography was an abnormal (n = 12) or inadequate (n = 3) finding on sonographic screening in which the abnormality was most frequently found on the three-vessel view (n = 9). The key pathological features of tetralogy of Fallot were uniformly demonstrated in the ventricular outflow tract, three-vessel and short-axis views. The ductus arteriosus was small in 70% of cases and not identifiable in the remaining fetuses. In three of six fetuses with no identifiable ductus, the ductus was shown to be absent at autopsy. The direction of ductal flow was variable.

CONCLUSION

The key features of tetralogy of Fallot were always demonstrable in the ventricular outflow tract, three-vessel and short-axis views. The most common reason for referral was the abnormal three-vessel view.

Retroactive DNA analysis for sex determination and dystrophin gene by polymerase chain reaction with archived cytogenetic slides

We describe a rapid and efficient diagnostic method for sex determination and the dystrophin gene by the polymerase chain reaction (PCR) using archived cytogenetic slides. Archived cytogenetic slides stored for about 4 years at room temperature were used. To confirm whether DNA analysis is possible using the archived cytogenetic slides, we extracted the DNA from the slides and amplified the Y centromeric region (DYZ3), the X centromeric region (DXZ1) and the exon 46 of the dystrophin gene. Of the 50 cases, 24 were peripheral bloods, 13 were amniotic fluid cells, 5 were chorionic villus samplings and 8 were cord bloods. The PCR related sex determination in 22 females and 28 males, showed 100% concordance with the results of chromosome analysis, and all cases showed positive band for the exon 46 of the dystrophin gene. Of the 50 cases of the archived cytogenetic slides, we were fortunate enough to obtain the fresh blood sample from one fetus whose karyotype showed 45,X[34]/46,X,+mar[145] to compare the results of the gDNA with that from archived cytogenetic slide. To confirm whether the marker chromosome was derived from Y chromosome, we studied the six loci (PABY, SRY, RPS4Y (SY16, 17), ZFY, DYS14) on the short arm, one locus (DYZ3) on the centromere and one locus (DYZ1) on the long arm. Of the 8 loci studies, all PCR related Y chromosome showed positive band from both gDNA obtained from cord blood and archived cytogenetic slides. We could conclude from the above results that the marker chromosome was derived from the Y chromosome. We believe our experiment is rapid and efficient for studies of over 10 independent loci from a single slide which has been kept in storage for up to 4 years and that archival Giemsa-stained cytogenetic slide repositories represent valuable DNA resources for clinical and forensic studies.

Unusual fate of vesicoallantoic cyst with non-visualization of fetal urinary bladder in a case of patent urachus

We present the sonographic findings of a fetus with a vesicoallantoic cyst. The cyst was first identified at 17 weeks of gestation; it was associated with an omphalocele, and disappeared spontaneously at 29 weeks. The fetal urinary bladder was not visualized thereafter. An omphalocele and exstrophia of the urachus were found at birth and repaired. Non-visualization of the fetal urinary bladder suggested rupture of the covering membrane of the omphalocele and allantois during fetal life. A defect in the wall of the omphalocele supported our hypothesis.

Three-vessel view of the fetal upper mediastinum: an easy means of detecting abnormalities of the ventricular outflow tracts and great arteries during obstetric screening

The three-vessel view is a transverse view of the fetal upper mediastinum is as simple to obtain as the four-chamber view. It demonstrates the main pulmonary artery, ascending aorta and superior vena cava in cross- or oblique sections. The purposes of this study were to describe the normal anatomy of the three-vessel view and to analyze what anatomical changes would occur in this view when there are lesions of the ventricular outflow tracts and/or great arteries. Sonograms of 29 fetuses with lesions involving the ventricular outflow tracts and/or great arteries were reviewed. Three-vessel views were evaluated in terms of vessel size, number, arrangement and alignment. Twenty-eight of 29 fetuses showed an abnormal three-vessel view that included abnormal vessel size (n = 12), abnormal alignment (n = 8), abnormal arrangement (n = 7) and abnormal vessel number (n = 3). The vessel size was abnormal in obstructive lesions of the right (n = 4) or the left (n = 8) side of the heart. An abnormal alignment was seen in tetralogy of Fallot (n = 6) and double-outlet right ventricle (n = 2) that showed anterior displacement of the aorta. An abnormal arrangement was seen in complete (n = 4) and corrected (n = 1) transposition, double-outlet right ventricle (n = 1) and pulmonary atresia with ventricular septal defect (n = 1). Only two vessels were seen in truncus arteriosus (n = 1). Four vessels were seen in persistent left superior vena cava (n = 2). A fetus with pulmonary atresia and intact ventricular septum showed a normal three-vessel view. In conclusion, most of the lesions involving the ventricular outflow tracts and/or great arteries showed an abnormal three-vessel view.

Identification of cytochrome P450 2E1 in rat brain

We have isolated cDNA fragments that were originated from P450 2E1 in rat brain by PCR analysis. Their size matched up to what we expected based on the reported sequence of rat liver P450 2E1 mRNA. Internal structure of the longest first-round PCR products were investigated by Southern blot analysis and "nested" PCR. Their results confirmed that PCR products actually originated from P450 2E1 mRNA in rat brain. RT-PCR was also carried out using P450 2E1 specific primers and the size of the product was exactly as we expected for P450 2E1. These experimental evidences should clarify the presence of P450 2E1 in rat brain.