Ethical guidance on human embryonic and fetal tissue transplantation: A European overview

This article presents an overview ofregulations, guidelines and societal debates ineight member states of the EC about a)embryonic and fetal tissue transplantation(EFTT), and b) the use of human embryonic stemcells (hES cells) for research into celltherapy, including `therapeutic' cloning. Thereappears to be a broad acceptance of EFTT inthese countries. In most countries guidance hasbeen developed. There is a `strong' consensusabout some of the central conditions for `goodclinical practice' regarding EFTT.International differences concern, amongstothers, some of the informed consent issuesinvolved, and the questions whether anintermediary organisation is necessary, whetherthe methods of abortion may be influenced bythe possible use of EFT, and whether EFTTshould only be used for the experimentaltreatment of rare disorders. The potential useof hES cells for research into cell therapy hasgiven a new impetus to the debate about (human)embryo research. The therapeutic prospects withregard to the retrieval and research use of hEScells appear to function as a catalyst for theintroduction of less restrictive regulationsconcerning research with spare embryos, atleast in some European countries. It remains tobe seen whether the prospect of treatingpatients suffering from serious disorders withtransplants produced by therapeutic cloningwill decrease the societal and moral resistanceto allowing the generation of embryos for`instrumental' use.     

Adjustment for misclassification in studies of familial aggregation of disease using routine register data

This paper discusses the misclassification that occurs when relying solely on routine register data in family studies of disease clustering. A register study of familial aggregation of schizophrenia is used as an example. The familial aggregation is studied using a regression model for the disease in the child including the disease status of the parents as a risk factor. If all the information is found in the routine registers then the disease status of the parents is only known from the time when the register started and if this information is used unquestioningly the parents who have had the disease before this time are misclassified as disease-free. Two methods are presented to adjust for this misclassification: regression calibration and an EM-type algorithm. These methods are used in the schizophrenia example where the large effect of having a schizophrenic mother hardly shows any signs of bias due to misclassification. The methods are also studied in simulations showing that the misclassification problem increases with the disease frequency.     

Neonatal diagnosis of familial type II hyperlipoproteinemia.

Cord serum prebeta-beta-lipoprotein concentration was measured in a radial immunodiffusion assay in 303 randomly selected, full-term infants whose parental phenotypes were unknown. Six infants had elevated concentrations, that is above a cut-off limit of 197 mg/100 ml (97.5th percentile). Three of these infants suffered from classic type II hyperlipoproteinemia, and this diagnosis was confirmed by family studies at follow-up. The three other infants and their parents were shown to be normolipemic at follow-up. The elevated cord serum prebeta-beta-lipoprotein in these three infants could be explained by highly elevated cord serum triglyceride and/or cholesterol. The 297 infants with normal cord serum prebeta-beta-lipoprotein and their parents were all shown to be normalipemic at follow-up. It is concluded that the measurement of prebeta-beta-lipoportein in cord serum allows the identification of children with familial type II hyperlipoproteinemia, if infants with transient neonatal hypertriglyceridemia and hypercholesterolemia are excluded.     

Screening for hyperlipoproteinemia in 10,000 Danish newborns. Follow-up studies in 522 children with elevated cord serum VLDL-LDL-cholesterol.

Among 10 440 newborns, 522 with upper 5 percentile values for very low-low density lipoprotein cholesterol in cord serum were selected for follow-up studies. Follow-up was possible in 446 of these 522 families (85%) and familial hypercholesterolemia (FH) was diagnosed in 11. In 273 of the 522 children, serum lipids were determined between the ages of 1 and 2 years and were now found to be normal, except in the 11 children with FH. Furthermore the serum lipids were compared in subgroups of these 273 children divided according to obstetric complications (i.e. low birth-weight, perinatal asphyxia and antepartum betamethasone treatment), which may cause a rise in serum lipids at birth. No differences were found between these subgroups at the age of 1--2 years.     

Familial hypobetalipoproteinaemia in 9 children diagnosed as the result of cord blood screening for hypolipoproteinaemia in 10 000 Danish newborns.

Out of 10 440 children, 266 with low (less than 2.5 centile) values for very low-low density lipoproteins in cord serum were chosen to be followed up to find out how many came from families with familial hypobetalipoproteinaemia (FHBL). In 176 families (66% of 266 families), FHBL was diagnosed in 9 children and their families.     

Dietary habits and serum lipids during first 4 years of life. A study of 95 Danish children.

Early infant feeding habits, current dietary intake and serum lipids were investigated in 31 infants, age 6--10 months and 64 children, age 3--4 years. In the infants there was a correlation between serum lipid levels and the amount of saturated fat and the P/S ratio of the diet. No such correlation was found in the 3--4 year old children. Neither was there any correlation between the type and duration of early infant feeding and subsequent serum lipid levels. In both the infants and the 3--4 year old children serum cholesterol concentration correlated with the serum cholesterol concentration in each of the parents.     

In vitro agreement between magnetic resonance imaging and intraluminal Doppler ultrasound for high flow velocity measurements

OBJECTIVE: Differences of opinion in the literature about the agreement between magnetic resonance imaging (MRI) and ultrasound Doppler (USD) for high blood velocity measurement were the basis for this investigation. It compares in vitro velocity measurements by MRI with intraluminal USD, using a specially designed flow phantom. DESIGN: The flow phantom consisted of a pulsatile pump, tubing, a prosthetic heart valve, measurement sections and a reservoir. Peak systolic velocities (0.7-5.0 m/s, n = 10) were measured with standard MRI phase shift velocity mapping using different regions of interest (ROIs). Intravascular USD velocity measurements were carried out using a thin cannula measuring peak systolic local maximum and local mean velocity within the small sample volume. RESULTS: Using maximum velocity USD recordings, comparison with MRI velocities was poor when the ROI covered the complete vessel lumen giving offset -22.3% and limits of agreement (LOA) 57.5 and 105.1%. When the ROI was small the velocities were closer with offset -11.8% and LOA 75.3-103.3%. When the spatial resolution was comparable and the spatial mean was read from the USD recordings, the velocities showed good agreement with an offset close to zero (0.45%). CONCLUSION: This study shows the importance of selecting small ROIs when using MRI for evaluating valve stenosis. Only when using spatially mean velocities over comparable regions the two methods showed good agreement.     

The combination of pregnancy and acute salpingitis in a case of uterus didelphys

A pregnant woman, with a uterus didelphys, developed abdominal pain. Laparotomy disclosed a severe infection of the tube of the non-pregnant horn. The diagnosis of acute salpingitis should be considered when a patient with a uterus didelphys develops unilateral abdominal pain. The present case seems to prove the blocking effect of an intrauterine pregnancy on an ascending infection.