Reduced folate carrier gene is a risk factor for neural tube defects in a Chinese population

BACKGROUND: There is a considerable body of data demonstrating that periconceptional supplementation of folic acid can prevent a significant proportion of neural tube defects (NTDs). At present, the mechanism by which folic acid exerts its beneficial effect remains unknown. Folate transporter genes, including the reduced folate carrier gene (RFC1), have been proposed as NTD risk factors. METHODS: The study population included 104 nuclear families with NTDs and 100 nonmalformed control families. We investigated the possible association between a common RFC1 polymorphism (A80G) and NTD risk among offspring, as well as potential gene-environment interactions between the infant RFC1 genotype and maternal periconceptional use of folic acid through a population-based case-control study. RESULTS: We observed that the infants of the GG genotype were associated with a 2.56-fold increased risk of NTDs when compared to the AA genotype (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.04-6.36) in our study population. Among mothers who did not utilize folic acid supplements, the risk for having a child with an NTD was 3.30 (95% CI, 1.15-9.65) for offspring with the GG genotype, compared to the reference (AA) genotype. Children who had the GG genotype and whose mothers did not take folic acid had an elevated risk for NTDs (OR, 8.80; 95% CI, 2.83-28.69), compared to offspring with the AA and GA genotypes whose mothers utilized folic acid supplements. CONCLUSIONS: Our findings suggest that the RFC1 G allele is likely to be an important genetic factor in determining folate transport and subsequently may be a risk factor for NTDs in this Chinese population.     

A case report of lead dysfunction presenting as high ventricular premature complex burden

Pacemaker-troubleshooting is an important step in the evaluation of a patient with syncope post-pacemaker-implantation. The basic functions of sensing, pacing and impedance may remain spuriously normal in the case of lead-microfracture or insulation break. We report a case in which the lead dysfunction was diagnosed based on multiple episodes of premature ventricular beats.     

Differential effects of stretch and compression on membrane currents and [Na]c in ventricular myocytes

Mechano-electrical feedback was studied in the single ventricular myocytes. A small fraction (approximately 10%) of the cell surface could be stretched or compressed by a glass stylus. Stretch depolarised, shortened the action potential and induced extra systoles. Stretch activated non-selective cation currents (I_ns) showed a linear voltage dependence, a reversal potential of 0 mV, a pure cation selectivity, and were blocked by 8 μM Gd³⁺ or 30 μM streptomycin. Stretch reduced Ca²⁺ and K⁺ (I_K) currents. Local compression of broadwise attached cells activated I_K but not I_ns. Cytochalasin D or colchicin, thought to disrupt the cytoskeleton, suppressed the mechanosensitivity of I_ns and I_K. During stretch, the cytosolic sodium concentration increased with spatial heterogeneities, local hotspots with [Na⁺]_c>24 mM appeared close to surface membrane and t-tubules (pseudoratiometric imaging using Sodium Green fluorescence). Electronprobe microanalysis confirmed this result and indicated that stretch increased total sodium [Na] in cell compartments such as mitochondria, nuclear envelope and nucleus. Our results obtained by local stretch differ from those obtained by end-to-end stretch (literature). We speculate that channels may be activated not only by axial but also by shear stress, and, that stretch can activate channels outside the deformed sarcomeres via second messenger.     

白细胞介素-2对心肌负性肌力作用机制的探讨

为研究白细胞介素-2（IL-2）对心肌的负性肌力作用的可能机制,本采用酶解分离成年大鼠心室肌细胞,用细胞内双波长荧光系统和膜片钳全细胞记录检测细胞膜钙离子通道和细胞内酸碱度（pHi）及钙水平的变化,分别以fura-2/AM和BCECF/AM作为细胞内钙离子和氢离子荧光指示剂。结果：（1）IL-2(2.5-200U/ml）浓度依赖性地降低单个心室肌细胞电刺激诱导的钙瞬变幅度,使舒张末钙水平升高,选择性κ-阿片受体阻断剂nor-BNI(10nmol/L）可阻断IL-2对心肌细胞内钙的作用;（2）用200U/ml的IL-2灌流10min后,与对照组相比膜片钳全细胞记录的L-型钙电流无明显改变;（3）用200U/ml的IL-2灌流后,与对照组相比Mn^2 对fura-2/AM的淬灭率无明显改变。（4）IL-2(200U/ml）使大鼠心室肌细胞pHi降低,其作用可被选择性κ-阿片受体阻断剂nor-BNI(10nmol/L）所减弱。结论：IL-2引起的心室肌细胞pHi降低可能是其负性肌力作用机制之一,细胞膜上L-型钙离子通道可能不参与IL-2降低心肌收缩力的作用;细胞膜上的阿片受体可能介导IL-2对心肌的负性肌力作用。     

Similar rhythms of seasonal conceptions in neural tube defects and schizophrenia: a hypothesis of oxidant stress and the photoperiod

BACKGROUND: Numerous studies have found that people with schizophrenia tend to be born most often in late winter and least often in late summer. The same rhythm appears in the birth of children with neural tube defects (NTDs). In the northern hemisphere, both disorders thus show a conception peak in May-June and a trough around November-December. The senior author found the same May-June conception peak among left-handed American baseball players and the opposite effect (a November-December peak) among extreme right-handed players. A similar rhythm appeared with respect to characteristics related to artistic as opposed to scientific modes of thought. DISCUSSION: Schizophrenia has been proposed to involve a deficit in the establishment of lateral asymmetry, as does left-handedness. The artist-scientist dichotomy is also believed to involve cerebral dominance. Thus, the similarity of seasonal variation in month of conception between NTDs, schizophrenia, left-handedness, and artistic intuition suggests that these four conditions may share some factor affecting the cellular processes involved in both neural tube closure and asymmetry development during the early-fourth week, neural-fold stages of embryogenesis. We propose that maternal oxidant stress, which can rise with exposure to intense solar radiation, may interfere with both neural tube closure and asymmetry development. The June and December extremes of sunlight would thus explain the peak times of the seasonal fluctuations. Moreover, regardless of mechanisms, the parallel between the two conception rhythms suggests that the same periconceptional folate regimens found effective in preventing NTDs may also lower the risk of schizophrenia. This paper reviews some of the clinical and experimental evidence supporting this hypothesis.     

Gene-environment interactions in rare diseases that include common birth defects

Rare syndromes often feature specific types of birth defects that frequently are major diagnostic clues to the presence of a given disorder. Despite this specificity, not everyone with the same syndrome is equally or comparably affected, and not everyone with a specific birth defect manifests the same syndrome or is affected with all the features of a particular syndrome. A symposium sponsored by the National Institutes of Health Office of Rare Diseases, and the National Toxicology Program Center for the Evaluation of Risks to Human Reproduction attempted to explore how much of this variability is due to genetic factors and how much is due to environmental factors. The specific types of birth defects examined included cardiovascular defects, holoprosencephaly, clefts of the lip and/or palate, neural tube defects, and diaphragmatic hernias.     

Can folic acid protect against congenital heart defects in down syndrome?

BACKGROUND: Several studies have suggested a protective effect of folic acid (FA) on congenital heart anomalies. Down syndrome (DS) infants are known to have a high frequency of heart anomalies. Not all children with DS suffer from heart anomalies, which raises the question whether maternal factors might affect the risk of these anomalies. Our objectives were to investigate whether first-trimester FA use protects against heart anomalies among DS children. METHODS: Women with liveborn DS children participating in the Slone Epidemiology Center Birth Defects Study between 1976 and 1997 were included. We performed case-control analyses using DS, with heart anomalies as cases and DS, without heart anomalies as controls. Subanalyses were performed for defects that have been associated with FA in non-DS populations (conotruncal, ventricular septal [VSD]) and for those that are associated with DS (ostium secundum type atrial septal defects [ASD] and endocardial cushion defects [ECD]). Exposure was defined as the use of any FA-containing product for an average of at least 4 days per week during the first 12 weeks of pregnancy, whereas no exposure was defined as no use of FA in these 12 weeks. RESULTS: Of the 223 cases, 110 (49%) were exposed versus 84 (46%) of the 184 controls. After adjustment for possible confounders, no protective effect of FA was found on heart anomalies overall (OR 0.95, 95% CI: 0.61-1.47) nor separately for conotruncal defects, VSDs, ASDs, or ECDs. CONCLUSIONS: Our study does not show a protective effect of FA on heart anomalies among infants with DS.     

Maternal birthplace and major congenital malformations among New York Hispanics

BACKGROUND: Little is known about the association between maternal nativity and congenital malformations among Hispanics living in the United States. METHODS: We conducted a cross-sectional study to investigate the association between maternal nativity and various congenital malformations among singleton live-births born to Hispanic women in New York from 1993 to 2001. Birth certificates, used to identify maternal birthplace, were linked with congenital malformation registry files to obtain birth defects outcome. We examined how the risk of birth defects varied by maternal birthplace by estimating the adjusted odds ratios (aORs) using logistic regression. RESULTS: A foreign maternal birth showed statistically negative associations with overall congenital malformations (aOR, 0.70; 95% CI, 0.68-0.73), cardiovascular defects (aOR, 0.85; 95% CI, 0.77-0.93), central nervous system defects (aOR, 0.76; 95% CI, 0.63-0.91), and multiple defects (aOR, 0.80; 95% CI, 0.74-0.86). Specifically, foreign-born Hispanic women were statistically at reduced risk to deliver live babies with cleft palate (aOR, 0.56; 95% CI, 0.40-0.80), atresia and stenosis of rectum or anus (aOR, 0.58; 95% CI, 0.35-0.97), and craniosynostosis (aOR, 0.71; 95% CI, 0.51-0.99). Hispanic mothers born in Puerto Rico had a similar risk of delivering children with birth defects compared to U.S.-born Hispanic mothers. In contrast, Hispanic mothers born in Mexico, or Cuba and Central and South America were at reduced risk of delivering infants with overall congenital malformations (aOR, 0.64; 95% CI, 0.60-0.67) and (aOR, 0.65; 95% CI, 0.63-0.68), respectively. CONCLUSIONS: Foreign-born Hispanic mothers had a slightly lower risk to deliver live-born singleton infants with major congenital malformations than did U.S. born Hispanic mothers.