Huntington's disease: prediction and prevention

The identification of a DNA restriction fragment length polymorphism closely linked to Huntington's disease on the short arm of chromosome 4 has for the first time allowed presymptomatic prediction to be undertaken in first-degree relatives at risk. The late and variable onset of this dominantly inherited disorder makes such prediction a powerful and potentially valuable aid in genetic counselling, but in the absence of effective therapy there are serious ethical reservations concerning such a predictive test. The new developments have stimulated an active and informative debate among professionals and family members on whether and how predictive tests should be used. Guidelines have emerged which should be useful not only for Huntington's disease, but for other serious late-onset neurogenetic disorders. Meanwhile, studies in Wales and elsewhere have not only confirmed the original linkage but have excluded multi-locus heterogeneity as a significant problem. Genetic prediction for the individual at risk remains critically dependent on a suitable family structure, present in only a minority of families in Wales. A more feasible alternative for most families is prenatal exclusion, which can allow risk prediction for a pregnancy without altering the situation for the person at risk. This approach has already been applied in Wales; the experience gained will be useful in full prediction, which is currently being introduced.     

The effect of human sperm chromatin maturity on ICSI outcomes

Because sperm chromatin may play a key role in reproductive success, we verify the associations between sperm chromatin abnormalities, embryo development and the ability to achieve pregnancy. The evaluation of sperm chromatin maturity using aniline blue (AB), chromomycin A3 (CMA3) and toluidine blue (TB) staining were carried out in group of males from infertile couples that underwent ICSI. Low levels of sperm chromatin abnormalities (< 16%) were found in most subjects (> 50%). A higher percentage of TB-positive sperm cells were discovered in the men from couples who achieved ≤ 50% fertilized oocytes compared to men who achieved > 50%. No significant differences were discovered by the applied tests between the men from couples who achieved ≤ 50% and those who achieved > 50% high-quality embryos on the 3rd or 5th day after fertilization, nor between the men from couples who achieved pregnancy and those who failed. The sperm chromatin maturity did not correlate with the ICSI results. However, the ROC analysis revealed a significant predictive value of TB-positive spermatozoa only for fertilization. Therefore, the TB assay can be considered as a useful test for the prediction of fertilization. Our findings suggest that the level of sperm chromatin abnormalities of the examined men was not clinically significant. No found associations between sperm chromatin maturity and embryo development and the ability to achieve pregnancy. We could not exclude the effects of the repairing processes in the fertilized oocyte. The use of complementary tests that verify the status of the sperm chromatin seems justified.     

Thrombosis during pregnancy: Risks,prevention, and treatment for mother and fetus—harvesting the power of omic technology,biomarkers and in vitro or in vivo models to facilitate the treatment of thrombosis

Maternal thromboembolism and a spectrum of placenta‐mediated complications including the pre‐eclampsia syndromes, fetal growth restriction, fetal loss, and abruption manifest a shared etiopathogenesis and predisposing risk factors. Furthermore, these maternal and fetal complications are often linked to subsequent maternal health consequences that comprise the metabolic syndrome, namely, thromboembolism, chronic hypertension, and type II diabetes. Traditionally, several lines of evidence have linked vasoconstriction, excessive thrombosis and inflammation, and impaired trophoblast invasion at the uteroplacental interface as hallmark features of the placental complications. “Omic” technologies and biomarker development have been largely based upon advances in vascular biology, improved understanding of the molecular basis and biochemical pathways responsible for the clinically relevant diseases, and increasingly robust large cohort and/or registry based studies. Advances in understanding of innate and adaptive immunity appear to play an important role in several pregnancy complications. Strategies aimed at improving prediction of these pregnancy complications are often incorporating hemodynamic blood flow data using non‐invasive imaging technologies of the utero‐placental and maternal circulations early in pregnancy. Some evidence suggests that a multiple marker approach will yield the best performing prediction tools, which may then in turn offer the possibility of early intervention to prevent or ameliorate these pregnancy complications. Prediction of maternal cardiovascular and non‐cardiovascular consequences following pregnancy represents an important area of future research, which may have significant public health consequences not only for cardiovascular disease, but also for a variety of other disorders, such as autoimmune and neurodegenerative diseases. Birth Defects Research (Part C) 105:209–225, 2015. © 2015 Wiley Periodicals, Inc.     

Establishment of predictive model for analyzing clinical pregnancy outcome based on IVF-ET and ICSI assisted reproductive technology

ObjectiveIn order to explore the predictive model for analyzing clinical pregnancy outcomes based on IVF-ET (in vitro fertilization and embryo transfer) and ICSI (Intracytoplasmic sperm injection) assisted reproductive technology (ART). Methods: this study selected the embryo transfer (fresh) patients who received IVF-ET or ICSI treatment in the First Affiliated Hospital of Guangxi Medical University as the subjects. Moreover, the controlled ovarian stimulation (COS) and follow-up were conducted to collect relevant data for analysis, and finally a prediction model was established. Results: The results showed that the patients were divided into different ovarian response groups at first. The age, bFSH and bFSH/bLH were the highest in the poor ovarian response group (POR), followed by the normal ovarian response group (NOR) and the lowest in the high ovarian response group (HOR). The area under the ROC curve was 0.669 according to the predictive model of pregnancy-related factors. The confidence interval of 94% was 0.629–0.697, with statistical significance (P = 0.000, P < 0.01). Conclusion: it can be concluded that in clinical pregnancy, for many related factors, regression equation can be used to establish a prediction model to diagnose the success rate of pregnancy. In conclusion, a prediction model can be built based on the relevant experimental results, to provide experimental reference ideas for increasing the success rate of ART in late clinical pregnancy, which is of great research significance.     

Medical Presentations of Choriocarcinoma

Choriocarcinoma commonly presents with symptoms resulting from metastases in the lungs, central nervous system, or alimentary tract. This tumour may occur without any gynaecological symptoms and when pelvic examination and uterine curettage show no abnormality. Several years may elapse between the antecedent pregnancy and presentation with metastatic disease. The ability to eradicate these tumours with present chemotherapeutic methods depends on detecting their presence as soon as possible after the antecedent pregnancy.Wider recognition of the varied manifestations of metastatic choriocarcinoma and greater use of tests for chorionic gonadotrophin should result in earlier diagnosis and an improved prognosis in these patients. In particular, such tests should be made in patients with unexplained intracranial haemorrhage, progressive dyspnoea, and gastrointestinal haemorrhage.     

Early pregnancy diagnosis in sheep by progesterone and pregnancy-associated glycoprotein tests

The aim of this study was to compare the accuracy of the progesterone (P4) and pregnancy associated glycoprotein (PAG) tests for determination of early pregnancy in sheep. Estrus was synchronized in 182 Awassi x Merino ewes and blood samples were collected at Days 0 (day of the insemination), 18, 22, 29, 36, and 50 after artificial insemination (AI). Plasma P4 concentrations at Days 0 and 18 were determined by double antibody radioimmunoassay, while PAG concentrations at Days 22, 29, 36 and 50 were determined by a heterologous, double-antibody radioimmunoassay (RIA) using the bovine PAG 67 kDa subunit as tracer and standard and rabbit antiserum raised against a mixture of caprine 55 and 59 kDa PAG subunits as the first antibody. The discriminatory value for diagnosis of pregnancy by the P4 and the PAG-RIA tests was > or = 1 ng/ml. Based on lambing data, the accuracy for diagnosing pregnant (sensitivity) and non-pregnant ewes (specificity) and predictivity of both tests were calculated. The sensitivity, specificity, positive and negative predictive values for P4 and PAG tests were 100, 95.4, 81.6, and 100% at Day 18 (P4) and 93.5, 100, 100 and 98.7% at Day 22 (PAG), respectively. For diagnosis of non-pregnant ewes the PAG test had significantly higher specificity than the P4 test (P < 0.05). It is concluded that ovine pregnancy can be reliably diagnosed at Day 22 after AI by using a heterologous radioimmunoassay of PAG.     

Place des tests d’interaction sperme-mucus dans le bilan masculin de l’infécondité

In infertile couples, it may be necessary to finely analyze the fertilization ability of spermatozoa. The postcoital test (PCT) has long been the only sperm functional assay. It tests the sperm penetration and survival ability in the cervical mucus. These are the first steps of a long cascade of events that spermatozoa have to undergo during their ascension in the female genital tract, on their way to the site of fertilization. However, the PCT may evoke emotional stress and should be done in a simple way to avoid sexual inhibitions. In optimal conditions, the number of motile spermatozoa seen in the upper cervical mucus correlates well with semen analysis and the odds of subsequent pregnancies. Antisperm antibodies may impair the PCT and only few, if at all, or many immobile or shaking spermatozoa, may be seen in cervical mucus, in contrast to the sperm quality in the ejaculate. In vitro Sperm-Mucus tests may be done using Kurzrok or Kremer technique with human or bovine mucus as well as with synthetic media. These in vitro tests do allow a good evaluation of sperm quality but only partially correlate with natural PCT. In an IVF group the PCT correlates with IVF fertilization and pregnancy outcome. It helps detecting the high risk group in which additional tests, antisperm antibody detection, acrosome reaction test, hamster test (SPA), hemizona assay (HZA), are recommended. These tests may sort those couples requiring sperm egg micro-injection. However, the PCT has been criticized for its poor methodology and mainly for its weak validity. In this IVF group, we performed a validity analysis of PCT and all sperm tests against fertilization and pregnancy rate. It confirms the weak validity indices of PCT and of all sperm tests as well. Nevertheless, in the stepwise regression analysis of all these tests against IVF fertilization and pregnancy, F-test value of PCT was almost similar to SPA/HZA and higher than sperm morphology. Thus, PCT is important and the weak validity indices of all sperm tests are probably due to the multifactorial nature of sperm quality. So, no single test may reliably check sperm fertilization potential. Male work-up does require a cascade of examinations including PCT to allow reliable evaluation and rational therapeutic act.     

Report of the Canadian Hypertension Society Consensus Conference: 1. Definitions,evaluation and classification of hypertensive disorders in pregnancy

OBJECTIVES: To provide Canadian physicians with a standard definition of hypertension in pregnancy, recommendations for laboratory investigations and tests for the assessment and management of hypertensive disorders in pregnancy, and a classification of such disorders. OPTIONS: To improve or not improve Canadian uniformity and standardization in the investigation and classification of hypertensive disorders in pregnancy. OUTCOMES: 1) Accuracy, reliability and practicality of diagnostic clinical criteria for hypertensive disorders in pregnancy. 2) Laboratory tests useful to determine severity and prognosis of disorders as measured by maternal and neonatal adverse outcomes. 3) A classification of disorders for use by Canadian physicians to facilitate uniformity and diffusion of research through a common language. EVIDENCE: Articles on hypertensive disorders in pregnancy published from 1966 to 1996, retrieved through MEDLINE search, related to definitions, tests, diagnostic criteria and classification, as well as documents on diagnosis and classification from authorities in the United States, Europe and Australia and from special interest groups. VALUES: High priority was given to the principle of preventing adverse maternal and neonatal outcomes through the provision of diagnostic criteria for severity and prognosis and through dissemination of reliable and pertinent information and research results using a common language. BENEFITS, HARMS AND COST: Higher degree of vigilance in diagnosing hypertensive disorders in pregnancy, allowing for earlier assessment and intervention, and more efficient dissemination of comparative information through common language. No harm or added cost is perceived at this time. RECOMMENDATIONS: (1) A diastolic blood pressure of 90 mm Hg or more should be the criterion for a diagnosis of hypertension in pregnancy and should trigger investigation and management. Except for very high diastolic readings (110 mm Hg or more), all diastolic readings of 90 mm Hg or more should be confirmed after 4 hours. (2) A regularly calibrated mercury sphygmomanometer, with an appropriate-sized cuff, is the instrument of choice. A rest period of 10 minutes should be allowed before taking the blood pressure. The woman should be sitting upright and the cuff positioned at the level of the heart. (3) Both Korotkoff phase IV and V sounds should be recorded, but the phase IV sound should be used for initiating clinical investigation and management. (4) A urine protein level of more than 0.3 g/d should be the criterion for a diagnosis of proteinuria; 24-hour urine collection should be the standard method for determining proteinuria. (5) Edema and weight gain should not be used as diagnostic criteria. (6) Hypertensive disorders diagnosed during pregnancy should be classified as pre-existing hypertension; gestational hypertension with or without proteinuria; pre-existing hypertension with superimposed gestational hypertension with proteinuria; and unclassifiable antenatally but final classification 42 days after delivery. VALIDATION: Except for expert opinions and reviews solicited for this project, these recommendations need to be field tested and validated in Canada. Guidelines endorsed by the Canadian Hypertension Society and the Society of Obstetricians and Gynaecologists of Canada.     

Evolution of testing strategies for genetic toxicity

Shortly following the inception of genetic toxicology as a distinct discipline within toxicology, questions arose regarding the type and number of tests needed to classify a chemical as a mutagenic hazard or as a potential carcinogen. To some degree the discipline separated into two sub-specialties, (1) genetic risk assessment and (2) cancer prediction since data from experimental oncology also supports the existence of a genotoxic step in tumor initiation. The issue of which and how many tests continued to be debated, but is now focused more tightly around two independent phenomena. Tier or sequential testing was initially proposed as a logical and cost-effective method, but was discarded on the basis that the lower tier tests appeared to have too many false responses to force or exclude further testing of the test agent. Matrix (battery) testing was proposed for screening on the hypothesis that combinations of endpoints and multiple phylogenetic target organisms were needed to achieve satisfactory predictability. As the results from short-term test 'validation' studies for carcinogen prediction and evaluations of EPA's Gene-Tox data accumulated, it became obvious that qualitative differences remained between predictive and definitive tests and by assembling different combinations of short-term assays investigators did not appear to resolve the lack of concordance. Recent trends in genetic toxicology testing have focused on mathematical models for test selection, and standardized systems for multi-test data assessment.     

Immunological Pregnancy Diagnosis in the Mare

An immunological gel-diffusion test for the diagnosis of pregnancy in the mare is described. 56 blood samples from 50 different mares were tested. Control tests were made both by the Ashheim-Zondek method and by clinical examination. The accuracy of the immunological method was 96.4 %. No false positive reactions were observed. It is recommended to draw the blood sample at approximately 45 days or more after the last service. The immunological method is simple, cheap and accurate and is recommended as a routine test for the diagnosis of pregnancy in mares.     

Limitations of the nonhuman pregnancy kit for pregnancy diagnosis in baboons

The Nonhuman Primate Pregnancy Test (NHPPT) kit was evaluated for diagnosis of pregnancy in baboons. Unreadable controls rendered 33% of all tests inconclusive. Refrigeration and dilution did little to improve the number of inconclusive tests. Positive-and false-negative results from readable tests on days 20 to 27 of confirmed pregnancy were 75% and 25%, respectively. The NHPPT did not always provide an accurate diagnosis of pregnancy and often proved unreadable.     

Pregnancy diagnosis based on the fecal progesterone concentration in beef and dairy heifers and beef cows

The present study was undertaken to examine whether pregnancy diagnosis was possible by measuring fecal progesterone concentrations in beef and dairy heifers and beef cows. Rectal fecal samples collected on days 18–24 after insemination or days 11–17 after embryo transfer were mixed with methanol and shaken for preparation of a fecal solution. After centrifugation, the supernatant was extracted with petroleum ether followed by an enzyme immunoassay for progesterone. All pregnant animals showed fecal progesterone concentrations greater than 50 ng/g of fecal material on days 18–24 after AI or estrus. In non-pregnant animals, however, the fecal progesterone concentrations ranged widely from 5 to 180 ng/g of fecal material. In non-pregnant cattle, the percentage of cattle with <50 ng progesterone/g of fecal material compared with the total number was 37–60% on days 18–20, whereas the percentages increased more than 70% to a maximum of 78.1% on day 23. When 50 ng/g was considered as the cut-off value, the sensitivity and specificity of positive pregnancy tests were less than 70% on days 21–24, and 100% for negative pregnancy tests on days 18–24. There were significant differences in the mean fecal progesterone concentrations between pregnant and non-pregnant cattle on days 19–24. These results suggest that feces can be utilized to substitute for plasma and milk to measure progesterone for the purpose of pregnancy diagnosis in heifers and cows.     

Proteome analysis of maternal serum samples for trisomy 21 pregnancies using ProteinChip arrays and bioinformatics.

A surface-enhanced laser desorption/ionization time of flight (SELDI-TOF)-based ProteinChip System was used as a tool for rapid discovery and identification of protein patterns in serum that discriminate between trisomy 21 and unaffected pregnancies. We analyzed 24 serum samples from women carrying a trisomy 21 pregnancy and 32 with an unaffected pregnancy, ranging from 10.0 to 14.0 weeks of gestation. The resulting protein profiles were submitted to a clustering algorithm, a rule extraction, a rating, and a rule base construction step. For the generated combined rule base, the specificity and sensitivity for the prediction of a trisomy 21 pregnancy reach 97% and 91%, respectively.     

Pregnancy diagnosis in swine by palpation and by amplitude-depth ultrasound scanning

The relative accuracy of two pregnancy testing methods for swine were compared in a field study. The procedures used were manual palpation and amplitude-depth ultrasonic scanning. A total of 369 sows were examined by both methods. Seven additional gilts were examined by ultrasound only and 46 sows by palpation per rectum only. The number of correct positive and negative diagnoses made by both methods were calculated, and determination of accuracy as well as comparison between the tests were made on this basis. The relative accuracy was 97.6% for the manual method and 96.8% for the ultrasound method. Both tests had a high sensitivity, 99.2 and 98.9%, respectively. The ability of the tests to detect the non-pregnant animals was not as high, which is reflected by a lower specificity. No significant differences were noted between the two methods. A lower specificity and a lower negative predictive value were provided by ultrasound scanning as compared with those acquired by manual palpation. Both procedures were considered to be quick and convenient to perform. It was concluded that in spite of the new pregnancy testing methods introduced in the swine industry, manual palpation remains the most practical in terms of its accuracy, ease, and the minimal requirement for equipment. In gilts, palpation is unsuitable and ultrasonography currently remains the best choice for the diagnosis of pregnancy.     

Preparation and analysis of the common urinary forms of human chorionic gonadotropin

Human chorionic gonadotropin (hCG) is the hormone of pregnancy and forms the basis of all pregnancy tests as well as diagnostic assays for a variety of pathological states including certain types of cancers and some diseases of pregnancy and genetic abnormalities. In recent years, the discovery of the diagnostic utility of measurement of the free subunits and fragments of the hormone, especially in urine, has proven of special use for diagnosis of very early pregnancy loss, an important phenomenon related to infertility, as well as part of screening programs for Down Syndrome and gynecological cancers. This article summarizes existing and new methods for the preparation of hCG, its subunits, and the beta core fragment from urinary sources. The methods for proper analyses of these materials are also described to enable investigators to prepare and analyze these materials in various quantities in their own laboratories.     

Point-of-care salivary microbial tests for detection of cariogenic species — Clinical relevance thereof — <Emphasis Type="Italic">review</Emphasis>

Dental caries is a highly prevalent multifactorial disease that can result in serious health impairment. It was shown that oral bacteria play a significant role in caries development. Point-of-care (POC) salivary microbial tests for detection of cariogenic species have been investigated as a potential tool for caries risk assessment. This review aims to evaluate clinical relevance of these tests in the light of recent scientific evidence. Methodology involved PubMed search using key words salivary microbial tests, cariogenic bacteria and caries risk prediction. Articles obtained by the search were cross-referenced to obtain further sources. Specificity and negative-predictive value of these tests are higher than their sensitivity and positive value. Predictive power of the POC salivary microbial tests as a single predictor is generally weak, although it increases when included in multifactorial models for caries prediction. Literature findings support the use of these tests for screening of at-risk individuals in a population of young preschool children without visible caries and for motivation of subjects on individual level. POC salivary microbial tests are simple and inexpensive and, therefore, may be advantageous from public health perspective.     

A Scoring Tool to Identify East African HIV-1 Serodiscordant Partnerships with a High Likelihood of Pregnancy

Introduction

HIV-1 prevention programs targeting HIV-1 serodiscordant couples need to identify couples that are likely to become pregnant to facilitate discussions about methods to minimize HIV-1 risk during pregnancy attempts (i.e. safer conception) or effective contraception when pregnancy is unintended. A clinical prediction tool could be used to identify HIV-1 serodiscordant couples with a high likelihood of pregnancy within one year.

Methods

Using standardized clinical prediction methods, we developed and validated a tool to identify heterosexual East African HIV-1 serodiscordant couples with an increased likelihood of becoming pregnant in the next year. Datasets were from three prospectively followed cohorts, including nearly 7,000 couples from Kenya and Uganda participating in HIV-1 prevention trials and delivery projects.

Results

The final score encompassed the age of the woman, woman’s number of children living, partnership duration, having had condomless sex in the past month, and non-use of an effective contraceptive. The area under the curve (AUC) for the probability of the score to correctly predict pregnancy was 0.74 (95% CI 0.72–0.76). Scores ≥7 predicted a pregnancy incidence of >17% per year and captured 78% of the pregnancies. Internal and external validation confirmed the predictive ability of the score.

Discussion

A pregnancy likelihood score encompassing basic demographic, clinical and behavioral factors defined African HIV-1 serodiscordant couples with high one-year pregnancy incidence rates. This tool could be used to engage African HIV-1 serodiscordant couples in counseling discussions about fertility intentions in order to offer services for safer conception or contraception that align with their reproductive goals.