Prenatal microarray analysis as second-tier diagnostic test: single-center prospective study

OBJECTIVE

To evaluate the usefulness of chromosome microarrays as a second-tier test in prenatal genetic testing.

METHODS

We prospectively analyzed 75 high-risk pregnancies undergoing invasive prenatal genetic testing in which the karyotype either was normal or had findings other than a common non-mosaic autosomal aneuploidy.

RESULTS

Chromosomal microarray analysis (CMA) was performed successfully in all cases. Pathological copy-number variations (CNVs) explaining the phenotypes were found in 11 cases (14.7%). Four cases were detected with an unbalanced translocation. In three of these cases, subsequent genetic analysis demonstrated that a parent was an unknown carrier of a balanced translocation. Among the 67 cases with normal karyo-types, submicroscopic rearrangements with pathological significance were detected in five (7.5%) and CNVs of unclear significance were detected in one (1.5%). CMA was able to discriminate correctly between true mosaicism and confined or pseudomosaicism in all six mosaic cases.

CONCLUSION

CMA is a valuable second-tier test in high-risk pregnancies for which identification or further delineation of genetic aberrations is important. Its higher resolution results in a higher detection rate of aberrant cases, with a clear clinical benefit for estimation of risk of recurrence.

[Occurrence and control of the Clostridium perfringens type A associated diarrhea of the suckling pigs with special consideration of the immunoprophylaxis]

OBJECTIVE

Clostridium (C.) perfringens type A is often associated with diarrhoea in suckling piglets. The impact of the alpha (α) and beta (β)2 toxins on the pathogenesis of the disease has not been conclusively answered. Previously, autologous vaccines were used to control this disease. The aim of our investigation was the classification of C. perfringens strains and the quantitative determination of the α and β2 toxins during the production of autologous vaccines. The efficacy of a commercial vaccine against the C. perfringens type A associated diarrhoea was tested using an animal intoxication model.

MATERIAL AND METHODS

A total of 1,434 C. perfringens strains from piglets with diarrhoea were classified using a multiplex PCR in the first part of the examination. In parallel, the α and β2 toxin content was determined quantitatively using ELISA tests. In the second part of the study 18 gilts were vaccinated twice in the last third of gestation to evaluate the α and β2 toxoid containing C.perfringens type A vaccine (Clostriporc A, IDT Biologika GmbH).

RESULTS

Of the C. perfringens strains which were found, 87.9% were type A ( cpa , cpb2 ), 6.3% type A ( cpa ), and 5.8% type C ( cpa , cpb , cpb2 ). Low to middle a toxin-producing strains often strongly expressed the β2 toxin. The vaccination led to the production of antibodies against the α and β2 toxins, which were transferred to the offspring by colostrum. Piglets were significantly protected (p<0.05) by the antibodies after having been challenged with an α and β2-containing supernatant of a heterologous C. perfringens type A strain.

CONCLUSION AND CLINICAL RELEVANCE

These results underline the importance of α and β2 toxin producing C.perfringens type A strains in diarrhoea in suckling piglets. Using the intoxication model, this vaccine showed significant protective effects against the α and β2 toxins.

Changes in quality of life of patients with lymphedema after lymphatic vessel transplantation

There are multiple treatment options for patients with chronic lymphedema, and one successful approach is lymph vessel transplantation. As quality of life assessments are frequently not utilized in standard treatment regimes, we investigated the change in quality of life for patients with chronic lymphedema (total = 212) who had undergone lymphatic vessel transplantation and conservative therapy for at least 6 months prior to operation. Quality of life was assessed by a modified standard questionnaire examining the physiological and psychological status of the patients. Results document a significant improvement in quality of life and underscore success of autologous lymphatic vessel transplantation as a therapy for lymphedema.

Isolation and characterization of circulating tumor cells from patients with localized and metastatic prostate cancer

Rare circulating tumor cells (CTCs) are present in the blood of patients with metastatic epithelial cancers but have been difficult to measure routinely. We report a quantitative automated imaging system for analysis of prostate CTCs, taking advantage of prostate-specific antigen (PSA), a unique prostate tumor-associated marker. The specificity of PSA staining enabled optimization of criteria for baseline image intensity, morphometric measurements, and integration of multiple signals in a three-dimensional microfluidic device. In a pilot analysis, we detected CTCs in prostate cancer patients with localized disease, before surgical tumor removal in 8 of 19 (42%) patients (range, 38 to 222 CTCs per milliliter). For 6 of the 8 patients with preoperative CTCs, a precipitous postoperative decline (<24 hours) suggests a short half-life for CTCs in the blood circulation. Other patients had persistent CTCs for up to 3 months after prostate removal, suggesting early but transient disseminated tumor deposits. In patients with metastatic prostate cancer, CTCs were detected in 23 of 36 (64%) cases (range, 14 to 5000 CTCs per milliliter). In previously untreated patients followed longitudinally, the numbers of CTCs declined after the initiation of effective therapy. The prostate cancer-specific TMPRSS2-ERG fusion was detectable in RNA extracted from CTCs from 9 of 20 (45%) patients with metastatic disease, and dual staining of captured CTCs for PSA and the cell division marker Ki67 indicated a broad range for the proportion of proliferating cells among CTCs. This method for analysis of CTCs will facilitate the application of noninvasive tumor sampling to direct targeted therapies in advanced prostate cancer and warrants the initiation of long-term clinical studies to test the importance of CTCs in invasive localized disease.

Structure of the Sec23p/24p and Sec13p/31p complexes of COPII

COPII-coated vesicles carry proteins from the endoplasmic reticulum to the Golgi complex. This vesicular transport can be reconstituted by using three cytosolic components containing five proteins: the small GTPase Sar1p, the Sec23p/24p complex, and the Sec13p/Sec31p complex. We have used a combination of biochemistry and electron microscopy to investigate the molecular organization and structure of Sec23p/24p and Sec13p/31p complexes. The three-dimensional reconstruction of Sec23p/24p reveals that it has a bone-shaped structure, (17 nm in length), composed of two similar globular domains, one corresponding to Sec23p and the other to Sec24p. Sec13p/31p is a heterotetramer composed of two copies of Sec13p and two copies of Sec31p. It has an elongated shape, is 28-30 nm in length, and contains five consecutive globular domains linked by relatively flexible joints. Putting together the architecture of these Sec complexes with the interactions between their subunits and the appearance of the coat in COPII-coated vesicles, we present a model for COPII coat organization.

Investigation of the efficacy of a genetically-stabile live Salmonella typhimurium vaccine for use in swine

Hybrid swine (Landrace x Pietrain) aged 3-4 weeks were immunized twice at an interval of 3 weeks solely by the oral route and by the oral/parenteral route to evaluate the efficacy of a live S. Typhimurium vaccine. In each experiment a control group was run without vaccination. The animals were challenged at the age of 8-10 weeks by oral test infection with a labelled S. Typhimurium DT 104 strain. An ELISA was used to establish the presence of antibodies to S. Typhimurium in serum samples, coupled with clinical investigation. The presence of the challenge strain in the ileal and caecal mucosa and in the ileocolic lymph nodes was investigated quantitatively using the Koch plating method to determine the degree of colonization of those organs at the time of slaughter. The clinical course of disease was used to assess the success of vaccination. However, it was not possible to trigger, in a reproducible manner, clinical signs of disease in unvaccinated animals through infection. The vaccinated animals had a significantly lower (p < 0.05) colonization of the ileal and caecal mucosa than the unvaccinated animals. This was also seen to a lesser degree for the ileocolic lymph nodes.

[Effects of prepartum infusion solutions on glucose and bilirubin metabolism of mother and child in the prepartum and postpartum period]

BACKGROUND

Administration of glucose 5% infusion is regularly used in obstetrics. The purpose of the study was to investigate the effects of glucose as compared to xylose and electrolyte solutions on parameters of maternal and fetal glucose and bilirubin metabolism during labour and after delivery.

PATIENTS AND METHODS

53 pregnant women (> or = 37 weeks of gestation, uncomplicated pregnancies) were randomised by entering the delivery ward. Under labour either glucose 5%, xylose 5% or electrolyte infusions were administered. Maternal serum glucose, serum osmolarity, insulin and glucagon were analysed before administration and 20 minutes after delivery. In the newborn blood osmolarity and serum glucose levels were analysed in the umbilical cord directly after birth and in capillary blood samplings 2 hours after birth.

RESULTS

Maternal blood glucose levels 20 min. post partum were significantly different (p < 0.05). Maternal insulin and glucagon concentrations 20 min. pp showed similar trends with glucose levels but were not significantly different. Glucose levels in the umbilical cord were significantly higher in the glucose than in the electrolyte group, but not higher than in the Xylit group. In contrast, the glucose-levels in the newborns after 2 h were significantly higher in the glucose group compared with both other groups. No significant differences were observed in bilirubin levels. Osmolarity in the umbilical cord between groups differed significantly.

CONCLUSIONS AND DISCUSSION

In conclusion, the administration of different solutions showed a distinct influence on the maternal and neonatal glucose metabolism. A significant impact on the bilirubin levels could not be shown in this study.

Psychosocial effects of enhanced external counterpulsation in the angina patient: a second study

Enhanced external counterpulsation (EECP) is a noninvasive technique that has shown promise in the treatment of ischemic coronary artery disease. Patients undergoing EECP were tested for alterations in psychosocial state associated with treatment. Overall perception of health and quality of life improved with EECP. There was also significant improvement in levels of depression, anxiety, and somatization but no change in levels of anger or hostility. On most measures, change was more significant for subjects who showed objective evidence of resolution of ischemia. Given the known predictive relationship between depression and mortality from cardiac disease, the improvement in depression scores through EECP indicates a finding of potential importance that may warrant further study in future research.

Alexander disease: diagnosis with MR imaging

BACKGROUND AND PURPOSE

To date, the demonstration of Rosenthal fibers on brain biopsy or autopsy specimens is considered a prerequisite for a definitive diagnosis of Alexander disease. We initiated a multiinstitutional survey of MR abnormalities in both presumed and confirmed cases of Alexander disease to assess the possibility of an MR-based diagnosis.

METHODS

MR imaging studies in three patients with an autopsy-based diagnosis of Alexander disease were analyzed to define MR criteria for the diagnosis. These criteria were then applied to 217 children with leukoencephalopathy of unknown origin.

RESULTS

Five MR imaging criteria were defined: extensive cerebral white matter changes with frontal predominance, a periventricular rim with high signal on T1-weighted images and low signal on T2-weighted images, abnormalities of basal ganglia and thalami, brain stem abnormalities, and contrast enhancement of particular gray and white matter structures. Four of the five criteria had to be met for an MR imaging-based diagnosis. In a retrospective analysis of the MR studies of the 217 patients, 19 were found who fulfilled these criteria. No other essentially new MR abnormalities were found in these patients. In four of the 19 patients, subsequent histologic confirmation was obtained. The clinical symptomatology was the same in the patients with and without histologic confirmation and correlated well with the MR abnormalities. MR abnormalities were in close agreement with the known histopathologic findings of Alexander disease.

CONCLUSION

The defined criteria are sufficient for an in vivo MR imaging diagnosis of Alexander disease; only in atypical cases is a brain biopsy still necessary for a definitive diagnosis.