Gene transfer to the embryo: strategies for the delivery and expression of proteins at 48 to 56 hours postfertilization

BACKGROUND/PURPOSE

Although gene and protein transfer may potentiate the cure of genetic disease, current strategies involving fetal gene therapy remain nonfocal and confounded by the lack of imaging techniques and in vivo markers for precise gene transfer.

METHODS

Fourteen white Leghorn chick eggs were incubated for 48 to 56 hours postfertilization until they reached stages 11 to 16, about 3 mm in size. In 7 chick embryos, a glass needle was placed at the midbrain/hindbrain level and 1 x 10(7) pfu of an adenovirus containing the green fluorescent protein (GFP) reporter gene was injected into the lateral head. In another 7 chicken embryos, colored agarose beads coated with Sonic hedgehog (Shh) protein were implanted at the level of the hindbrain under direct microscopy. The eggs were then sealed, incubated at 37 degrees C for 24 hours, and reimaged using fluorescent microscopy and confocal laser microscopy.

RESULTS

At 24 hours postinjection, all embryos were alive and were imaged in vivo. Fluorescent microscopic imaging showed green fluorescence in the region of the injection site in all the embryos. In embryos that underwent bead placement, the beads were visualized under microscopy in the lateral hindbrain of all embryos, and the presence of the Shh protein was confirmed using fluorescein isothiocyanate (FITC)-conjugated secondary antibody.

CONCLUSIONS

This study shows that embryonic 3-mm chick embryos survive adenoviral transduction or agarose bead implantation in a focal manner in vivo and that this delivery results in production of imageable levels of protein. This may be used in mammalian systems, including humans, to introduce genes and proteins.

Subtotal hysterectomy for uterine rupture

OBJECTIVE

The aim of this paper was to stratify patients with uterine rupture in extremis (with hypotension, change in vital organ function, and altered mental status) and evaluate outcome for patients undergoing subtotal hysterectomy (STH) vs. uterine repair (UR).

METHODS

Of 39667 hospital deliveries between 1993 and 1998 at a university hospital, 367 presented with uterine rupture. Of these, 96 presented in extremis and had an irregularly torn uterus found at operation. Charts were retrospectively reviewed to stratify patient population with uterine rupture and their outcome. Results were analyzed using Fisher's exact test.

RESULTS

Patients with uterine rupture were 31-35 years old, para> or =3, had received no antenatal care, and presented with rupture in the lower uterine segment. Sixty-one patients underwent STH while 35 underwent UR. The groups were similar with respect to patient age, parity, cause of rupture, and clinical condition at the time of evaluation (P=0.2). The operative time for STH was significantly less than UR, 35 min vs. 75 min (P<0.01). Maternal mortality was significantly higher in patients undergoing UR vs. STH, 46% vs. 20% (P=0.01). Maternal morbidity occurred in 30% of patients undergoing STH vs. 50% in patients undergoing UR (P=0.01). The time to discharge was significantly less in patients undergoing STH compared to UR, 14.5 days vs. 27 days (P<0.01).

CONCLUSIONS

Patients with uterine rupture in extremis tend to be young, multiparous, receive no antenatal care, and have uterine rupture of the lower segment. STH significantly lowered operative time, morbidity, time to discharge, and mortality than UR in patients in extremis with uterine rupture.

Outcome of labor following previous cesarean section

Four hundred fifty-one patients who had had previous lower segment cesarean section were studied for subsequent pregnancy outcome at the University Teaching Hospital, Lusaka, Zambia. Of 319 who were allowed to go into labor, 63% succeeded in delivering vaginally, while 37% had to undergo repeat intrapartum cesarean delivery. No maternal death occurred. Scar dehiscence occurred in one case only. Parturition in otherwise obstetrically normal patients seems to be safe, and the trial of labor approach is desirable as it results in a lower number of repeat cesarean deliveries.

Obstetric problems in the adolescent Zambian mother studied at the University Teaching Hospital, Lusaka

The Obstetric performance of teenage primigravida aged 12-15 years was studied retrospectively and analysed in the local population attending the University Teaching Hospital, Lusaka. The leading Obstetric complications were cephalo-pelvic disproportion (3.6%) and acute toxeamia (2.2%). The caesarean section rate (7.5%) and operative vaginal delivery rate (11%) were both high. There was one maternal death due to Obstetric shock. The rates for prematurity (154/1,000), still births (30.8/1000), and neonatal death (101.9/1,000) were increased. Perinatal mortality rate was 123/1,000. The incidence of pregnancy between 12-15 years was 1.2%. Overall incidence of teenage pregnancy (12-19 years) was 22.5% and parity of 5 was observed at the age of 18 and 19. The study concluded that early teenage pregnancy carried obstetrical risks and was associated with a high perinatal loss.

Role of cervical cytology in gynaecological practice

Exfoliative cytopathology is a potent tool for the early detection and thereby eradication of cervical cancer and reducing mortality for many others. Besides, it has a vital role to play in diagnosis and therapy of infections specially trichomoniasis for which it gives a permanent record. The simplicity and rapidity of the technique is the greatest advantage for screening a wider group of population and thus guide us toward further diagnostic procedures.

Criminal abortions as seen in the University Teaching Hospital, Lusaka

Every year a large number of patients who are spontaneously aborting are admitted to the Gynaecological ward of the University Teaching Hospital (Lusaka) at various clinical stages of septic, incomplete, inevitable or threatened abortion. An undetermined number of these patients are induced outside the hospital. Analysis of data revealed that 60% of admissions in the gynaecological admission ward are abortions and a number of them present with features of sepsis. In a 4 year study period there were 15 maternal deaths as a result of septic/criminal abortions. Various methods are used to procure criminal abortions; out of which a case of a patient who used a knitting needle to procure abortion is presented.

Obstetrical performance in elderly Zambian parturients

The Obstetrical performance of elderly parturients (aged 40 and above) who delivered at the University Teaching Hospital, Lusaka during 1979 and 1980, has been analysed. There were 39,109 deliveries in the two years period, out of which 391 mothers were of 40 years or above, giving an incidence of 1.0%. There were 32 mothers above the age of 45, an incidence of 0.08%. Analysis of these mothers revealed that 87.2% of them were grand multipara with maximum parity of 16. Incidence of breech, toxaemia, malpresentation and multiple pregnancy were observed in the series but there was no maternal death recorded in the present study. History of abortion in previous pregnancies ranging from 1 to 5 was noted in 43 cases. Operative deliveries were noted in 22% cases, out of which 13% were delivered by caesarean section and 9% had to undergo operative vaginal interference. In the foetal outcome, high rates of prematurity (71/1,000) and perinatal death (138/1,000) were noted. Relations of birth weights, age and parity of mothers with preventable factors are discussed.

Advanced abdominal pregnancy

Two cases of advanced abdominal pregnancy have been reviewed and two live babies have been delivered. Emphasis has been given to suggestive clinical features which may help in the pre-operative diagnosis of this rare condition.