DNAJB1-PRKACA fusion protein-regulated LINC00473 promotes tumor growth and alters mitochondrial fitness in fibrolamellar carcinoma

Fibrolamellar carcinoma (FLC) is a rare liver cancer that disproportionately affects adolescents and young adults. Currently, no standard of care is available and there remains a dire need for new therapeutics. Most patients harbor the fusion oncogene DNAJB1-PRKACA (DP fusion), but clinical inhibitors are not yet developed and it is critical to identify downstream mediators of FLC pathogenesis. Here, we identify long noncoding RNA LINC00473 among the most highly upregulated genes in FLC tumors and determine that it is strongly suppressed by RNAi-mediated inhibition of the DP fusion in FLC tumor epithelial cells. We show by loss- and gain-of-function studies that LINC00473 suppresses apoptosis, increases the expression of FLC marker genes, and promotes FLC growth in cell-based and in vivo disease models. Mechanistically, LINC00473 plays an important role in promoting glycolysis and altering mitochondrial activity. Specifically, LINC00473 knockdown leads to increased spare respiratory capacity, which indicates mitochondrial fitness. Overall, we propose that LINC00473 could be a viable target for this devastating disease.

Impact of Antenatal SARS-CoV-2 Exposure on SARS-CoV-2 Neutralization Potency

A pregnancy booster dose significantly reduces the risk and severity of COVID-19, and it is widely recommended. A prospective cohort study was conducted to compare the transplacental passage of maternal antibodies from vaccination or infection during three trimesters against both the vaccine-targeted Wuhan strain and the Omicron strain of SARS-CoV-2. Maternal-infant dyads from vaccinated mothers were collected between 6 June 2022 and 20 September 2022. We analyzed 38 maternal-infant dyads from mothers who had been infected with COVID-19 and 37 from mothers without any previous infection. Pregnant women who received their last COVID-19 vaccine dose in the third trimester exhibited the highest anti-spike protein antibody levels and neutralizing potency against both the Wuhan strain and Omicron BA.2 variant in their maternal and cord plasma. Both second- and third-trimester vaccination could lead to a higher level of neutralization against the Wuhan and Omicron strains. COVID-19 infection had a negative effect on the transplacental transfer ratio of SARS-CoV-2 antibodies. A booster dose during the second or third trimester is encouraged for the maximum transplacental transfer of humoral protection against COVID-19 for infants.

Transplacental passage of nirmatrelvir in pregnant women with COVID-19

The transplacental passage of nirmatrelvir in pregnant women with COVID‐19 is limited and reinforces the safety of using Paxlovid in pregnancy.

Upregulation of miR-20b-5p inhibits trophoblast invasion by blocking autophagy in recurrent miscarriage

Recurrent miscarriage is defined as more than three pregnancy failures occurring before 20 weeks of gestation. Poor differentiation of the endometrial stroma or defective trophoblast cell invasion at the maternal-fetal interface leads to recurrent miscarriages. Several miRNAs, including miR-20b-5p, are aberrantly regulated in recurrent miscarriages; however, the underlying molecular mechanisms remain unclear. Primary cilia are antenna-like organelles that coordinate signaling during development and differentiation. Defective primary cilia formation leads to complications, such as recurrent miscarriage or preeclampsia. Here, we demonstrated that miR-20b-5p inhibited trophoblast cell invasion by blocking primary cilia formation. Mechanistically, miR-20b-5p targeted and inhibited ATG16L1 and ATG7 expression, thereby blocking autophagy. Defective autophagy reduced primary cilia formation and stopped ERK activation, which is a crucial signaling pathway for trophoblast invasion. Aspirin is used to prevent recurrent miscarriages in clinical settings. Treatment with aspirin inhibited miR-20b-5p levels, thus restoring primary cilia formation and trophoblast invasion. Thus, our findings uncovered the molecular mechanism by which miR-20b-5p suppressed primary cilia formation and trophoblast invasion by reducing the expression of ATG16L1 and ATG7. Moreover, we found that the defective phenotypes could be rescued by aspirin in recurrent miscarriages.

Clinical outcomes of nirmatrelvir-ritonavir use in pregnant women during the Omicron wave of the coronavirus disease 2019 pandemic

BACKGROUND

Paxlovid is an oral drug composed of nirmatrelvir and ritonavir that has been demonstrated to be effective in decreasing the risk of severe coronavirus disease 2019 (COVID-19). Here, we report the use of paxlovid in pregnant women with COVID-19.

METHODS

Pregnant women attending a tertiary referral hospital in Taiwan from 29 April to 30 July 2022 were enrolled in the study. We compared baseline characteristics, clinical manifestations, and adverse events between paxlovid-treated women and those without paxlovid use. Maternal and neonatal outcomes were analysed in women who delivered during the study period.

RESULTS

A total of 30 paxlovid-treated pregnant women and 55 women without paxlovid use were included in the analysis. The mean duration of COVID-19-associated symptoms in the paxlovid-treated women was shorter than that in the control group (10.10 days versus 15.59 days, p = 0.04). No severe adverse events due to paxlovid use were observed. Dysgeusia and diarrhoea were the most common adverse effects. Thirteen paxlovid-treated and 28 untreated women delivered during the study period. More pregnant women in the paxlovid group who delivered during the study period underwent caesarean delivery compared to the group without antiviral treatment (10 of 13 [76.92%] versus 12 of 28 [42.86%], p = 0.042), and insignificantly more newborns were born small for gestational age in the paxlovid group compared to the control group (3 of 13 [23.08%] versus 1 of 28 [3.57%], p = 0.086).

CONCLUSION

Our study showed that paxlovid was effective and safe for pregnant women during the Omicron wave of the COVID-19 pandemic. A higher proportion of caesarean delivery rates was observed among paxlovid-treated women. Long-term follow-up of pregnant women exposed to paxlovid and their offspring is needed.

Setting up a specialized maternity unit in a tertiary hospital: An oasis for pregnant women with COVID-19 during the pandemic

OBJECTIVE

The COVID-19 pandemic has had an enormous impact on society and the medical environment in Taiwan in 2022. As pregnant women with COVID-19 are at higher risk for multiple complications, Taiwan needs a COVID-19 specialized maternity unit to improve the quality of maternal and neonatal care.

MATERIALS AND METHODS

We share our experience with specialized maternity unit for pregnant women with COVID-19 at the National Cheng Kung University Hospital, where we can have careful evaluation, safe birth, and comprehensive postpartum care.

RESULTS

Our COVID-19 specialized maternity unit enrolled 253 pregnant women with COVID-19, 90 (35.6%) pregnant women were admitted to the specialized maternity unit, and 71 (28.1%) pregnant women gave birth during hospitalization in two months. All pregnant women recovery well and real-time polymerase chain reaction tests on all infants were negative for COVID-19.

CONCLUSION

A specialized maternity unit can provide pregnant women with a safe birth environment, immediate maternity care, and high medical quality. It can also help health workers in non-specialized maternity units deal with COVID-19-related psychological stress. Therefore, setting up one specialized maternity unit in the city during the pandemic should be guardedly considered.

Nipsnap1-A regulatory factor required for long-term maintenance of non-shivering thermogenesis

OBJECTIVE

The activation of non-shivering thermogenesis (NST) has strong potential to combat obesity and metabolic disease. The activation of NST however is extremely temporal and the mechanisms surrounding how the benefits of NST are sustained once fully activated, remain unexplored. The objective of this study is to investigate the role of 4-Nitrophenylphosphatase Domain and Non-Neuronal SNAP25-Like 1 (Nipsnap1) in NST maintenance, which is a critical regulator identified in this study.

METHODS

The expression of Nipsnap1 was profiled by immunoblotting and RT-qPCR. We generated Nipsnap1 knockout mice (N1-KO) and investigated the function of Nipsnap1 in NST maintenance and whole-body metabolism using whole body respirometry analyses. We evaluate the metabolic regulatory role of Nipsnap1 using cellular and mitochondrial respiration assay.

RESULTS

Here, we show Nipsnap1 as a critical regulator of long-term thermogenic maintenance in brown adipose tissue (BAT). Nipsnap1 localizes to the mitochondrial matrix and increases its transcript and protein levels in response to both chronic cold and β3 adrenergic signaling. We demonstrated that these mice are unable to sustain activated energy expenditure and have significantly lower body temperature in the face of an extended cold challenge. Furthermore, when mice are exposed to the pharmacological β3 agonist CL 316, 243, the N1-KO mice exhibit significant hyperphagia and altered energy balance. Mechanistically, we demonstrate that Nipsnap1 integrates with lipid metabolism and BAT-specific ablation of Nipsnap1 leads to severe defects in beta-oxidation capacity when exposed to a cold environmental challenge.

CONCLUSION

Our findings identify Nipsnap1 as a potent regulator of long-term NST maintenance in BAT.

Ado-Mediated Depletion of Taurine Impairs Mitochondrial Respiratory Capacity and Alters the Chromatin Landscape of Inguinal Adipose Tissue

Non-shivering thermogenesis (NST) has strong potential to combat obesity; however, a safe molecular approach to activate this process has not yet been identified. The sulfur amino acid taurine has the ability to safely activate NST and confer protection against obesity and metabolic disease in both mice and humans, but the mechanism of this action is unknown. In this study, we discover that a suite of taurine biosynthetic enzymes, especially that of cysteamine dioxygenase (ADO), significantly increases in response to β3 adrenergic signaling in inguinal adipose tissue (IWAT) in order to increase intracellular concentrations of taurine. We further show that ADO is critical for thermogenic mitochondrial respiratory function as its ablation in adipocytes significantly reduces taurine levels, which leads to declines in mitochondrial oxygen consumption rates. Finally, we demonstrate via assay for transposase-accessible chromatin with sequencing (ATAC-seq) that taurine supplementation in beige adipocytes has the ability to remodel the chromatin landscape to increase the chromatin accessibility and transcription of genes, such as glucose-6-phosphate isomerase 1 (Gpi1), which are critical for NST. Taken together, our studies highlight a potential mechanism for taurine in the activation of NST that can be leveraged toward the treatment of obesity and metabolic disease.

Nipsnap1 – A Novel Thermogenic Regulator

Objectives

We aim to discover molecular treatment options to combat obesity by studying a process known as non-shivering thermogenesis (NST). The major objective is to determine if Nipsnap1 can regulate NST in brown adipose tissue (BAT) and evaluate its potential for obesity treatment.

Methods

1. Identification of Nipsnap1 and loss-of-function study•Unbiased proteomic analysis is performed on BAT isolated mitochondria samples from 6-week-old mice exposed to cold to activate NST (n = 3). •siRNA-mediated knockdown of Nipsnap1 is performed on primary brown adipocytes isolated from mice. Seahorse Bioanalyzer is used for Mitochondria Respiration Test. •Thermogenic tissue-specific Nipsnap1 knockout mice (N1-KO) are generated by crossing floxed Nipsnap1 (N1-Flox) transgenic mice with UCP1-Cre mice.

2. Role of Nipsnap1 in thermogenesis•Phenotypical studies in vivo are performed on 6-week-old N1-KO and N1-Flox mice (n = 8). Mice are acclimated in 30°C followed by cold exposure in 4°C for ten days. Rectal temperature is measured. •N1-KO mice metabolism level and locomotive movement are monitored by the Sable Promethion Metabolic Cage system (n = 8).

Results

Nipsnap1 displays potent thermogenic properties. By unbiased proteomic analysis, we identify Nipsnap1, which is highly induced when NST is activated and strongly correlates with the NST key protein Uncoupling Protein 1 (UCP1). Nipsnap1 ablation in primary brown adipocytes reveals significant reductions in thermogenic adipose function. siNipsnap1 causes complete ablation of UCP1 protein levels. Moreover, it causes a 50% reduction (P < 0.001) of mitochondrial oxidative capacity and a 40% reduction (P < 0.05) of glycolytic capacity in cells. Nipsnap1 KO mice have impaired NST and reduced energy expenditure in vivo. Under prolonged cold exposure (day 7–10), N1-KO mice exhibit significant defects (day 10, P < 0.05) to maintain body temperature by NST. We demonstrated that the N1-KO mice had a 10% (P < 0.01) reduction in energy expenditure during the active night period after prolonged cold (day 5–8) treatment compared to controls.

Conclusions

Nipsnap1 plays an essential role in regulating NST. Targeting Nipsnap1 to increase energy expenditure at the molecular level will provide new insights into developing a safe and effective method to combat obesity and metabolic disease.

Funding Sources

Agency: NIH; Institute: NIDDK.

Aspirin facilitates trophoblast invasion and epithelial-mesenchymal transition by regulating the miR-200-ZEB1 axis in preeclampsia

Preeclampsia is a severe gestational hypertensive disorder that occurs after 20 weeks' of gestation. It involves several maternal systems, such as cardiovascular, renal, coagulatory systems, and poses a major threat to the maternal and fetal health. Recent clinical evidence showed that aspirin is an effective preventative treatment for reducing the incidence of premature preeclampsia among high-risk pregnant women, however, the mechanism of drug action is not clear. miR-200 family has been shown to be associated with preeclampsia and upregulated in the plasma and placenta of preeclamptic patients. Here we revealed that miR-200 family inhibited trophoblast invasion and epithelial-mesenchymal transition (EMT) process by stimulating epithelial marker expression (E-cadherin and ZO-1) and repressing mesenchymal marker expression (ZEB1 and TGFβ1). Similarly, EMT markers in the placenta of preeclamptic patients showed higher E-cadherin and lower ZEB1 and TGF-β1 protein expression. Moreover, aspirin was shown to suppress miR-200 family and these miR-200 family-mediated cell functions, including cell invasion and EMT changes, were completely reversed. In conclusion, this study demonstrates the effect of miR-200 family on trophoblast invasion and EMT. For the first time, aspirin was shown to fully reverse miR-200-mediated trophoblast biology and act through the network signaling of TGF-β1/ZEB1/miR-200. These results provide a plausible mechanism explaining aspirin's effect on preeclampsia prevention and a therapeutic target for disease intervention.

Convolutional Neural Network-Based Humerus Segmentation and Application to Bone Mineral Density Estimation from Chest X-ray Images of Critical Infants

Measuring bone mineral density (BMD) is important for surveying osteopenia in premature infants. However, the clinical availability of dual-energy X-ray absorptiometry (DEXA) for standard BMD measurement is very limited, and it is not a practical technique for critically premature infants. Developing alternative approaches for DEXA might improve clinical care for bone health. This study aimed to measure the BMD of premature infants via routine chest X-rays in the intensive care unit. A convolutional neural network (CNN) for humeral segmentation and quantification of BMD with calibration phantoms (QRM-DEXA) and soft tissue correction were developed. There were 210 X-rays of premature infants evaluated by this system, with an average Dice similarity coefficient value of 97.81% for humeral segmentation. The estimated humerus BMDs (g/cm³; mean ± standard) were 0.32 ± 0.06, 0.37 ± 0.06, and 0.32 ± 0.09, respectively, for the upper, middle, and bottom parts of the left humerus for the enrolled infants. To our knowledge, this is the first pilot study to apply a CNN model to humerus segmentation and to measure BMD in preterm infants. These preliminary results may accelerate the progress of BMD research in critical medicine and assist with nutritional care in premature infants.

NLRP7 Is Involved in the Differentiation of the Decidual Macrophages

Macrophage polarization, regulated appropriately, may play important roles in successful pregnancy. In the face of the vital roles of decidua macrophages in pregnancy, it is insufficient to recognize the trigger of macrophage differentiation and polarization. We aimed to explore the link between the NLRP7 gene and macrophage polarization in human deciduas. Here, we enrolled the endometrial tissues from eight pregnant women in the first trimester. We found that NLRP7 was abundant in endometrial tissues and that NLRP7 was expressed in decidual macrophages of the first-trimester pregnancy. NLRP7 was predominately expressed in the decidual M2 macrophages, as compared with the M1 macrophages. Furthermore, our results suggest that NLRP7 is associated with decidual macrophage differentiation. NLRP7 over-expression suppresses the expression of M1 markers and enhances the expression of the M2 markers. Considering that NLRP7 relates to decidualization and macrophage differentiation, we propose that NLRP7 is a primate-specific multitasking gene to maintain endometrial hemostasis and reproductive success. This finding may pave the way for therapies of pathological pregnancies.

Fetuin-A Inhibits Placental Cell Growth and Ciliogenesis in Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a type of unbalanced glucose tolerance that occurs during pregnancy, which affects approximately 10% of pregnancies worldwide. Fetuin-A is associated with insulin resistance, and the concentration of circulating fetuin-A increases in women with GDM, however, the role of fetuin-A in the placenta remains unclear. In this study, we enrolled placental samples from twenty pregnant women with GDM and twenty non-GDM pregnant women and found that the abundance of fetuin-A was upregulated in terms of mRNA and protein levels. Fetuin-A inhibited placental cell growth by inducing apoptosis and inhibiting S phase entry. Irregular alignment of mitotic chromosomes and aberrant mitotic spindle poles were observed. In addition, centrosome amplification was induced by fetuin-A treatment, and these amplified centrosomes nucleated microtubules with disorganized microtubule arrays in placental cells. Furthermore, fetuin-A inhibited autophagy, and thus blocked the growth of the primary cilium, a cellular antenna that regulates placenta development and differentiation. Thus, our study uncovered the novel function of fetuin-A in regulating placental cell growth and ciliogenesis.

Changes in the number and causes of maternal deaths after the introduction of pregnancy checkbox on the death certificate in Taiwan

OBJECTIVE

To examine changes in the number and causes of maternal deaths after the introduction of pregnancy checkbox on the death certificate in January 2014 in Taiwan.

MATERIALS AND METHODS

We first used the cause-of-death (COD) mortality data for years 2010 through 2017 to examine the number of deaths by item of pregnancy checkbox. We then compared the distribution of the causes of maternal deaths before and after the introduction of pregnancy checkbox.

RESULTS

Between 2014 and 2017, 111 women died, for whom the certifiers indicated the following in the pregnancy checkbox items: 2 (pregnant at the time of death; n = 10), 3 (died within 42 days after the termination of pregnancy; n = 64), and 4 (died between 43 days and 1 year after the termination of pregnancy; n = 37). However, in only 61 of the 111 deaths, the certifiers reported pregnancy or delivery-related diagnosis in the COD section of the death certificate-5 each for items 2 and 4 and 51 for item 3. The number of maternal deaths was 55 in 2010-2013; this number increased to 82 in 2014-2017. A decline in the percentage of maternal deaths from obstetric hemorrhage was noted from 38% (21/55) in 2010-2013 to 21% (17/82) in 2014-2017.

CONCLUSION

The number of maternal deaths increased, and the distribution of causes of maternal deaths changed after the introduction of pregnancy checkbox. Additional studies are required to examine the possible misclassification of pregnancy-associated deaths indicated in the pregnancy checkbox.

Elevated miR-200a and miR-141 inhibit endocrine gland-derived vascular endothelial growth factor expression and ciliogenesis in preeclampsia

KEY POINTS

Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) is a critical factor that facilitates trophoblast invasion in placenta. Plasma miR-141 and miR-200a levels were elevated, while EG-VEGF was decreased in peripheral blood and placenta of preeclamptic patients. Furthermore, numbers of cilia in the placenta from preeclamptic women were significantly decreased. Elevated miR-141 and miR-200a inhibited the expression of EG-VEGF, downstream extracellular signal-regulated kinase (ERK)/matrix metalloproteinase 9 signalling and cilia formation, thus leading to defective trophoblast invasion. The growth of the primary cilium, which transduced ERK signalling upon EG-VEGF induction for proper trophoblast invasion, was also inhibited by miR-141 and miR-200a upregulation.

ABSTRACT

Preeclampsia is a severe gestational complication, and inadequate trophoblast invasion during placental development is an important pathoaetiology. Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) is a critical factor that facilitates trophoblast invasion in placenta. By binding to the primary cilium, EG-VEGF initiates the signalling cascade for proper embryo implantation and placental development. The miR-200 family was predicted to target the EG-VEGF 5'-untranslated region, and its specific binding site was confirmed using a dual luciferase and a co-transfection assay. In the peripheral blood and placenta of preeclamptic patients, EG-VEGF showed significantly lower expression, whereas plasma miR-141 and miR-200a had higher expression compared with the controls. The biological significance of miR-141 and miR-200a was verified using an overexpression method in a trophoblast cell line (HTR-8/SVneo). Elevated miR-141 and miR-200a inhibited the expression of EG-VEGF, matrix metalloproteinase 9 (MMP9) and downstream extracellular signal-regulated kinase (ERK) signalling, thus leading to defective trophoblast invasion. Additionally, the growth of the primary cilium, which transduces ERK/MMP9 signalling upon EG-VEGF induction, was inhibited by miR-141 and miR-200a upregulation. Furthermore, the number of cilia in the human placenta of preeclamptic women was significantly decreased compared to normal placenta. In conclusion, the study uncovers the clinical correlations among the miR-200 family, EG-VEGF and the primary cilium in preeclampsia and the underlying molecular mechanisms. The results indicate that miR-141 and miR-200a directly targeted EG-VEGF, suppressed primary cilia formation and inhibited trophoblast invasion. Thus, miR-141 and miR-200a could be explored as promising miRNA biomarkers and therapeutic targets in preeclampsia.

Assessment of the blood flow in kidneys of growth-restricted fetuses using quantitative three-dimensional power Doppler ultrasound

OBJECTIVE

Fetuses with fetal growth restrictions have higher perinatal mortality rates than fetuses without fetal growth restrictions. Vascularization of the fetal kidney is crucial to fetal growth. Hence, we assessed blood flow and vascularization of fetal kidneys in non-growth-restricted as well as growth-restricted fetuses using quantitative three-dimensional power Doppler ultrasound.

MATERIALS AND METHODS

We undertook a prospective study to evaluate the vascular indices of fetal kidneys; i.e., the vascularization index, flow index and vascularization-flow index, in growth-restricted and non-growth-restricted fetuses using three-dimensional power Doppler ultrasound and quantitative three-dimensional histogram analysis. All fetuses from 20 to 40 weeks of gestation were singletons with a normal pregnancy and were followed up to delivery.

RESULTS

In total, 209 fetuses without fetal growth restriction and 50 fetuses with fetal growth restriction were included. Our results showed the fetal renal vascularization index, flow index, and vascularization-flow index evaluated by three-dimensional power Doppler ultrasound can differentiate fetuses with fetal growth restriction from fetuses without fetal growth restriction.

CONCLUSION

The fetal renal vascularization index, flow index, and vascularization-flow index measured by three-dimensional power Doppler ultrasound can be applied to prenatally detect fetal growth restriction. Our data support assessment of the fetal renal vascularization index, flow index, and vascularization-flow index using three-dimensional power Doppler ultrasound as a useful test for detecting fetuses with fetal growth restriction.

miR-346 and miR-582-3p-regulated EG-VEGF expression and trophoblast invasion via matrix metalloproteinases 2 and 9

Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) is an important regulator for embryo implantation and placental development, and is clinically associated with several obstetric disorders related to insufficient or inappropriate trophoblast invasion, such as recurrent abortion, preeclampsia, and intrauterine fetal growth restriction. This study was performed to identify the microRNAs targeting EG-VEGF, and evaluate the regulatory effect on trophoblast biology. miR-346 and miR-582-3p were initially identified via bioinformatic tools, and their specific binding sites on the EG-VEGF 3'UTR were further confirmed using dual luciferase and a co-transfection assays. miR-346 and miR-582-3p were demonstrated not only to suppress EG-VEGF expression, but also inhibit trophoblast invasion and migration in the JAR and HTR-8/SVneo cell lines. We further evaluated the effect of microRNAs in HTR-8/SVneo cells coexpressing EG-VEGF and miR-346 or miR-582-3p on matrix metalloproteinase (MMP 2 and MMP 9) and the tissue inhibitors of metalloproteinase (TIMP 1 and TIMP 2) using RT-PCR, western blotting and gelatin zymography. TIMP 1 and TIMP 2 were not affected by the two microRNAs, whereas the expressions and activities of MMP 2 and MMP 9 were significantly downregulated, which in turn inhibited the invasion ability of trophoblasts. In conclusion, miR-346 and miR-582-3p regulate EG-VEGF-induced trophoblast invasion through repressing MMP 2 and MMP 9, and may become novel diagnostic biomarkers or therapeutic targets for EG-VEGF-related obstetric disorders. © 2016 BioFactors, 43(2):210-219, 2017.

Prenatal diagnosis of fetal gastroschisis using three-dimensional ultrasound: comparison between the 20th and 21st centuries

OBJECTIVE

In order to compare the trends and improvements of prenatal diagnosis of gastroschisis, we herein retrospectively reviewed our cases of fetal gastroschisis detected by three-dimensional ultrasound (3D US) between the two centuries.

MATERIALS AND METHODS

We reviewed our computer database of prenatal diagnosis on gastroschisis in National Cheng Kung University Hospital from October 1994 to November 2011. All the fetuses were initially scanned by two-dimensional (2D) US to locate the region of interest (ROI). Then, the 3D probe was used to scan all the ROI systematically and mechanically, and all the images were stored on laser discs for further 3D visualization and reconstruction. To compare the characteristics at prenatal diagnosis of gastroschisis between the 20th and 21st centuries in our hospital, the Chi-square test and Student t test were used. The p values less than 0.05 and 0.1 were considered statistically significant.

RESULTS

In total, 26 fetuses with gastroschisis were depicted by 3D US in utero (10 cases were diagnosed in the 20th century and 16 cases in the 21st century). The ranges of gestational age at prenatal diagnosis of gastroschisis by 3D US in the 20th century were between 14 and 34 weeks (mean: 21.6 weeks) and between 14 and 33 weeks (mean: 21.9 weeks) in the 21st century. Moreover, seven cases (70%) were diagnosed before the third trimester in the 20th century, whereas 13 cases (81%) were diagnosed before the third trimester in the 21st century.

CONCLUSION

Although without statistical significance, higher prenatal diagnosis rate before the third trimester in the 21st century was noted. The improvement of 3D US has remarkable advantages in adding novel visual depiction of a 3D lesion of a 3D fetus in 3D US after reconstruction and thus assists substantially in prenatal diagnosis, genetic consultation, and perinatal management of gastroschisis.

Prenatal diagnosis of fetal congenital cystic adenomatoid malformation of the lung using three-dimensional ultrasound: comparison between the 20th and 21st centuries

OBJECTIVE

Congenital cystic adenomatoid malformation of the lung (CCAML) is one of the most common lung lesions diagnosed prenatally. In order to compare the trends and improvements of prenatal diagnosis of CCAML, we herein retrospectively reviewed our cases of fetal CCAML detected by three-dimensional ultrasound (3-D US) between two centuries.

MATERIALS AND METHODS

We reviewed our computer database of prenatal diagnosis of CCAML in National Cheng Kung University Hospital from October 1994 to November 2011. All of the fetuses were initially scanned by two-dimensional (2-D) US to locate the region-of-interest (ROI). Then, the 3-D probe was used to scan all of the ROI systematically and mechanically, and the images were stored in the laser discs for further 3-D visualization and reconstruction. To compare the characteristics at prenatal diagnosis of CCAML between the 20th and 21st centuries in our hospital, Chi-square tests were undertaken. A p value <0.05 was considered as statistically significant.

RESULTS

In total, 58 fetuses with CCAML were depicted by 3-D US in utero (12 cases were diagnosed in the 20th century and 46 cases in the 21st century). The ranges of gestational age at prenatal diagnosis of CCAML by 3-D US in the 20th century were between 15 and 36 weeks (mean=24 weeks), and were between 16 and 31 weeks (mean=22 weeks) in the 21st century. Moreover, nine cases (75%) were diagnosed at the second trimester in the 20th century, whereas 44 cases (96%) were diagnosed at the second trimester in the 21st century.

CONCLUSION

The advancement of 3-D US has remarkable advantages in adding novel visual depiction of a 3-D lesion of a 3-D fetus in 3-D US after reconstruction, and thus assists substantially in the prenatal diagnosis and genetic consultation of CCAML. Furthermore, the trend analysis in this series showed a significantly earlier gestational age at prenatal diagnosis of CCAML in the 21st century than that in the 20th century.

Registration-based segmentation of three-dimensional ultrasound images for quantitative measurement of fetal craniofacial structure

Segmentation of a fetal head from three-dimensional (3-D) ultrasound images is a critical step in the quantitative measurement of fetal craniofacial structure. However, two main issues complicate segmentation, including fuzzy boundaries and large variations in pose and shape among different ultrasound images. In this article, we propose a new registration-based method for automatically segmenting the fetal head from 3-D ultrasound images. The proposed method first detects the eyes based on Gabor features to identify the pose of the fetus image. Then, a reference model, which is constructed from a fetal phantom and contains prior knowledge of head shape, is aligned to the image via feature-based registration. Finally, 3-D snake deformation is utilized to improve the boundary fitness between the model and image. Four clinically useful parameters including inter-orbital diameter (IOD), bilateral orbital diameter (BOD), occipital frontal diameter (OFD) and bilateral parietal diameter (BPD) are measured based on the results of the eye detection and head segmentation. Ultrasound volumes from 11 subjects were used for validation of the method accuracy. Experimental results showed that the proposed method was able to overcome the aforementioned difficulties and achieve good agreement between automatic and manual measurements.

Soft tissue volume of upper arm in predicting small-for-gestational-age fetuses using three-dimensional ultrasound

PURPOSE

To assess the value of fetal soft tissue volume (STV) of the upper arm in predicting small-for-gestational-age (SGA) fetuses using three-dimensional (3D) ultrasound (US).

METHODS

We used 3D US to test the accuracy of fetal STV of the upper arm measurement in predicting SGA in a prospective cross-sectional study.

RESULTS

Fetal STV of the upper arm assessed by 3D US can differentiate SGA fetuses from appropriate-for-gestational-age (AGA) fetuses. Using the 5th percentile as the cutoff, the sensitivity of fetal upper arm STV in predicting SGA fetuses was 84.1%, specificity, 93.4%, positive predictive value, 71.1%, negative predictive value, 96.8%, and overall accuracy, 91.9%. In addition, the diagnostic accuracy of fetal arm STV was better than that of the biparietal diameter, abdominal circumference, and femur length.

CONCLUSION

Fetal STV of upper arm assessment by 3D US is a novel method to predict SGA fetuses.

Thanatophoric dysplasia: role of 3-dimensional sonography

PURPOSE

Fetal thanatophoric dysplasia (TD) is a lethal skeletal dysplasia. Therefore, antenatal diagnosis of TD is mandatory in routine obstetrical care. However, because TD is relatively rare, prenatal detection is not an easy task. In the past, 2-dimensional (2D) sonography had been applied as the mainstay of prenatal diagnosis of TD. In this series, we report our work of detecting TD using 3-dimensional (3D) sonography.

METHODS

We reviewed our computer database of prenatal diagnosis of TD in National Cheng Kung University Hospital from May 1995 to June 2006. All the cases were scanned using 2D and 3D sonography. In total, 9 cases of fetal TD were diagnosed.

RESULTS

3D sonography can detect fetal TD and provide additional vivid illustration after various modes of reconstruction that 2D sonography cannot afford.

CONCLUSION

3D sonography may contribute significantly to the detection of TD in utero and provide a novel visual depiction of this defect after reconstruction. Thus, 3D sonography may assist substantially in prenatal diagnosis as well as consultation.

Predicting fetal growth restriction with renal volume using 3-D ultrasound: efficacy evaluation

Early detection and management of fetal growth restriction (FGR) is very important in prenatal care and daily practice, because FGR fetuses may suffer increased risk of perinatal morbidity and mortality. Renal volume (RV) might be one of the important parameters of fetal growth. Yet, no prenatal assessment of fetal RV in FGR fetuses by 3-D ultrasound (US) has been reported. We undertook a prospective and cross-sectional study using quantitative 3-D US to assess the efficacy of fetal RV in predicting FGR. All fetuses were singletons and were followed-up to delivery to determine whether they had FGR complications. In total, 221 fetuses without FGR and 28 fetuses with FGR were included. Our results showed fetal RV assessed by 3-D US can differentiate fetuses with FGR from fetuses without FGR. The best predicting threshold for FGR is at the tenth percentile of fetal RV. Using the tenth percentile as the cutoff, the efficacy of fetal RV in predicting FGR was sensitivity 96.4%, specificity 95.9%, positive predictive value 75.0%, negative predictive value 99.5% and accuracy 96.0%, respectively. Fetal RV assessed by 3-D US can be applied to detect FGR prenatally. We believe fetal RV assessment using 3-D US is a useful test in detecting fetuses with FGR.

Human antibody and antigen response to IncA antibody of Chlamydia trachomatis

The high prevalence of C. trachomatis worldwide has underscored the importance of identifying specific immunogenic antigens in facilitating diagnosis as well as vaccine development. The aim of this study is to evaluate IncA antibody and antigen production in natural human infections. Our temporal expression study showed that IncA transcription and protein expression could be detected as early as 4 hours after the start of infection. Antibody responses could be detected in urine and genital swab samples from C. trachomatis-positive patients. It is especially interesting to note that the IncA antigen could be detected in urine. In conclusion, we have identified IncA as an important antigen in human. The potential applicability of the IncA antibody or antigen in the diagnosis as well as to vaccine development for C. trachomatis is also discussed.

Electromyographic evaluation in children with spina bifida

BACKGROUND

It is controversial to predict ambulation potential using neurological level or specific pattern of muscle strength in patients with spina bifida. We attempted to analyze the relationship between the mobility outcome and its influencing factors utilizing electromyography to study motor unit activity in lower limbs. A subsidiary aim was to evaluate the external anal sphincter with electromyography and to determine the relevant factors of bowel and bladder functions.

METHODS

Among 156 patients with spina bifida who had received electromyographic examination and were followed at the out-patient clinic between 1998 and 2000, functional assessment with Pediatric Evaluation of Disability Inventory (PEDI) was applied in 47 randomly selected patients. Other assessments included clinical neurological examination, bowel and bladder function survey, and ambulation evaluation. We correlated the parameters of electromyography with the ambulatory ability and PEDI scores. The innervation of external sphincter was compared between groups with or without neurogenic bowel or bladder dysfunction.

RESULTS

The innervations of hip adductor and quadriceps were found to correlate with walking ability (p < 0.01); above muscles as well as anterior tibialis, and gastrocnemius were related to PEDI scores (p < 0.01). The neurological level still manifested correlation with walking ability (p < 0.05) and PEDI scores (p < 0.01). Both denervation potentials and recruitment pattern were important parameters for ambulation and mobility prediction. Significant difference was obtained in denervation patentials of sphincter within bowel groups (p = 0.036) and bladder groups (p = 0.016).

CONCLUSIONS

Both traditional neurological level and specific muscle innervation exert crucial influence on walking and mobility functions. Electromyographic assessment demonstrates its contribution in prediction of functional outcome in spina bifida.

Penetration of evaporative emissions into a home from an M85-fueled vehicle parked in an attached garage

The use of both oxygenated fuels in carbon monoxide (CO) nonattainment areas and reformulated gasoline in ozone nonattainment areas has been mandated by the 1990 Clean Air Act Amendments. Methanol has been proposed as an alternative fuel for CO nonattainment areas. Its use will potentially increase indoor methanol inhalation exposure resulting from the evaporation of methanol vapor from methanol-fueled vehicles parked in residential garages. Indoor air concentrations of methanol, benzene, and toluene were measured in a residential home with an attached garage. The effects of vehicle emission control devices (charcoal canister hose connection); home heating, ventilation, and air conditioning (HVAC) fans; ambient air, garage, and fuel tank temperatures; and wind speed were examined. The disconnection of the charcoal canister hose, which simulates a spent evaporative emission control device, resulted in elevated benzene, toluene, and methanol concentrations in the garage and attached home. Higher fuel tank temperatures resulted in higher benzene and toluene concentrations in the garage, but not methanol. The concentrations for all compounds in the garage and concentrations of benzene and toluene in the adjacent room were lower when the HVAC fan was on than when it was off, while the concentrations of all three compounds in the rest of the house were higher, although these differences were not statistically significant. Thus, the portion of the population that parks cars in garages attached to homes will experience increased methanol exposures if methanol is used as an automotive fuel.

Stimulating effect of hydrocortisone on the catabolism of endogenous fatty acyl groups by fatty acid-supplemented mouse L fibroblasts

Hydrocortisone stimulated the catabolism of prelabeled fatty acyls in mouse L fibroblasts supplemented with exogenous fatty acid. Both oxidation to 14CO2 and release as free fatty acid from prelabeled lipids increased up to 20-fold under the described experimental conditions. The stimulating effect of hydrocortisone was observed even at concentrations as low as 1 microgram/ml. Neither the hormone nor exogenous fatty acid alone had a significant effect on endogenous fatty acyl catabolism. The activity of a cellular pH 6.5 lipase was unaffected by exogenous fatty acid, slightly increased by hydrocortisone, but increased 2-fold when both supplements were present. It is suggested that since exogenous fatty acids shunt phospholipid acyls to triglycerides, the latter induce the formation of more pH 6.5 lipase. Hydrocortisone is either needed for this induction to occur, or activates the newly formed enzyme. The lipase acts on the triglycerides to liberate free fatty acids that are then oxidized to 14CO2 or lost into the medium.

Effect of exogenous fatty acids on the retention of phospholipid acyl groups by mouse L fibroblasts

Exogenous oleic or linoleic acid, given at a high but nontoxic level (1 mg fatty acid/day for 20 . 10(6) cells in 50 ml medium), caused substantial redistribution of the otherwise permanently retained phospholipid acyls in mouse L fibroblasts. 18--40% of the preformed phospholipid acyls were shifted to triglycerides but most returned to phospholipids when the supply of exogenous fatty acid was removed. The phospholipid acyls could be reshuttled back to triglycerides again whenever an adequate amount of exogenous fatty acid was provided. Daily changes of medium containing oleic acid bound to bovine serum albumin caused a still greater total loss of phospholipid acyls into the medium. The removal of the prelabeled phospholipid acyls also occurred with phospholipid acyls which had been synthesized from [1-(14C)]acetate 3 days earlier. The results demonstrate the fact that the apparent permanently retained phospholipid acyl groups found in L-cells could in fact be displaced through experimental manipulations.

Fatty acid synthesis and metabolism of phospholipid acyl groups in strain L mouse fibroblasts

Strain L mouse fibroblasts grown in medium supplemented with 2.5% delipidized horse serum were found capable of desaturating oleic and linoleic acid to dienoic and trienoic acid(s), respectively. Although 40-60% of de novo fatty acid synthesis from [2-3H]acetate was inhibited by the administration of exogenous oleic or linoleic acid, sterole synthesis was only slightly affected. Within 24-48 h after incorporation, phospholipid fatty acyl groups could undergo active exchange between phospholipids. After this dynamic transition period was over, not only were the phospholipid acyls retained but some vicinal fatty acyl pairs of phospholipid also appeared to be stable and remained together throughout the depletion period. At any time in the experiment, however, introduction of exogenous fatty acid perturbed this phospholipid acyl retention, delayed the time at which the phospholipid acyl groups no longer moved between phospholipids and also decreased the ultimate number of phospholipid acyl groups retained by strain L mouse fibroblasts.