Genetic amniocentesis: a twelve years' experience

The first 2,013 fetuses in 2,000 patients undergoing genetic amniocentesis at our institution were analyzed for the incidence of abnormal findings and for the safety and accuracy of the procedure. One percent of the patients were found to have aneuploid fetuses and another 1% were found to have elevated amniotic fluid concentrations of alpha-fetoprotein. Advanced maternal age was the indication for amniocentesis in 84% of the women with aneuploid fetuses. Thirty-two (1.6%) of the pregnancies ended in spontaneous abortion and 35 (1.7%) were terminated because of abnormal results of the prenatal diagnostic procedure. Our error rate was 0.15%, and tissue culture was successful in 97.7% of the procedures. During the latter part of our experience concurrent ultrasonography was utilized with the amniocentesis, resulting in a reduction in blood-tinged specimens from 15.0% to 5.2%. In experienced hands, midtrimester amniocentesis for the purpose of prenatal diagnosis of genetically determined defects is a safe, accurate, and valuable procedure for the identification of fetal abnormalities.     

Association of C-reactive protein with coronary heart disease risk factors in patients with type 2 diabetes mellitus

The assessment of markers of systemic inflammation, such as C-reactive protein (CRP) and interleukin 6 (IL6), could be used to identify persons at high risk of coronary heart disease (CHD). This study evaluates the relationship of CRP and IL6 with CHD risk factors in patients with type 2 diabetes mellitus (DM) with CHD and age and sex matched type 2 DM controls without CHD. CRP, IL-6, total plasma homocysteine (tHcy), lipoprotein (a) [Lp(a)] and sialic acid (SA) were determined in 55 type 2 diabetic patients with CHD and 51 age- and sex-matched type 2 diabetic controls without CHD. Multivariate and logistic regression analyses were used to relate these markers with CHD risk factors. CRP (P=0.02) and tHcy (P=0.03) were significantly higher in patients with CHD compared with the control group even after correction for age and sex. IL6, Lp(a), SA and lipid parameters were not significantly different between the two groups of patients. After adjustment for potential confounders, the odds ratio (OR) for elevated CRP was 2.00 (95% confidence interval [CI], 1.12-3.58) (P=0.02) but the OR for IL6 was 3.41 95% CI, 0.70-17.17 (P=0.14). Partial correlation analyses of CRP and IL6 with other variables showed significant correlation of CRP with tHcy, and SA in patients with CHD only. Our results support the inclusion of CRP (high-sensitivity assay), in the risk assessment of diabetic subjects.     

Insulin binding substances,autoimmunity and type i diabetes in kuwaiti patients and their kindred

Summary Insulin autoantibodies (IAAs) are associated with type I diabetes mellitus (DM) and have been suggested as predictive markers of the disease. Using an ELISA assay, we have studied the prevalence of binding to human insulin in sera from an Arab type I DM population and compared it with the prevalence in the family members (FMs) of the probands, in type II DM patients from the same population, and in Arab control subjects. Significant levels of binding occurred in 11/16 (69%) of type I DM patients and in 21/34 (62%) of their FMs, but in only 5/31 (16%) of type II DM patients and in 1/25 (4%) of control subjects. Within families, there was homogeneity with regard to the level of insulin binding and the mean family levels correlated with those of the proband (r=0.68, df=7, p=0.05). HLA-DR3 or -DR4 antigens occurred in 55/63 (87%) of type I DM patients and in 95/118 (81%) of their FMs. This was significantly higher (p<0.001) than in either type II DM patients (39/75, 52%) or in control subjects (34/93, 37%). ICAs were present in significantly more (25/43, 58%) of type I DM patients than their FMs (3/82, 3%) (p<0.001). They did not occur in either type II DM patients or in the control group. In conclusion, insulin binding occurred in sera from both type I diabetic patients and their kindred, and hence did not appear to be specifically associated with the development of clinical diabetes.     

Study the Electrical Properties of Surface Mount Device Integrated Silver Coated Vectran Yarn

Smart textiles have attracted huge attention due to their potential applications for ease of life. Recently, smart textiles have been produced by means of incorporation of electronic components onto/into conductive metallic yarns. The development, characterizations, and electro-mechanical testing of surface mounted electronic device (SMD) integrated E-yarns is still limited. There is a vulnerability to short circuits as non-filament conductive yarns have protruding fibers. It is important to determine the best construction method and study the factors that influence the textile properties of the base yarn. This paper investigated the effects of different external factors, namely, strain, solder pad size, temperature, abrasion, and washing on the electrical resistance of SMD integrated silver-coated Vectran (SCV) yarn. For this, a Vectran E-yarn was fabricated by integrating the SMD resistor into a SCV yarn by applying a vapor phase reflow soldering method. The results showed that the conductive gauge length, strain, overlap solder pad size, temperature, abrasion, and washing had a significant effect on the electrical resistance property of the SCV E-yarn. In addition, based on the experiment, the E-yarn made from SCV conductive thread and 68 Ω SMD resistor had the maximum electrical resistance and power of 72.16 Ω and 0.29 W per 0.31 m length. Therefore, the structure of this E-yarn is also expected to bring great benefits to manufacturing wearable conductive tracks and sensors.     

Beneficial changes in serum apo A-1 and its ratio to apo B and HDL in stable hyperlipidaemic subjects after Ramadan fasting in Kuwait

BACKGROUND: In patients with metabolic and nutritional disorders such as diabetes and hyperlipidaemia, where strict compliance to advice on timing and composition of food intake is important, the prolonged daylight fasting during the month of Ramadan could produce undesirable biochemical consequences. AIM: The study aimed to compare pre- and post-Ramadan lipid and lipoprotein profiles in stable Kuwaiti hyperlipidaemic subjects attending a Lipid Clinic. SUBJECTS AND METHODS: The study population comprised 64 adult Kuwaitis (33 M, 31 F) who had been attending a Lipid Clinic for at least 12 months and were considered stable, without any acute systemic illness. At each clinic visit, the following parameters were measured: weight, total cholesterol (TC), triglycerides (TG), HDL, LDL, apo A-1, apo B, glucose and uric acid. These biochemical parameters were measured by routine automated analyzer techniques. The pre-Ramadan values comprised the means of two measurements taken at about 3 month and 1 month before commencement of Ramadan. Post-Ramadan values were obtained within 1 month of the end of the Ramadan fast. The parameters so obtained were compared in the whole group, and then according to gender, glycaemic status and modality of treatment (diet alone or with a fibrate or statin). RESULTS AND DISCUSSION: In the nondiabetic subjects, apo A-1 and apo A-1/apo B and apo A-1/HDL ratios were increased post-Ramadan (P<0.001). Weight did not change and the other lipid parameters-TC, TG, LDL, apo B-did not worsen. These observations, more consistent in the men than in the women, and in subjects treated with a fibrate or a statin rather than on diet alone, indicate a favorable coronary heart disease (CHD) risk profile. In the diabetic patients, these changes in the apo A-1 level and its ratio to HDL and apo B were also present, but TC and apo B levels increased, the latter significantly (P<0.05). These divergent effects in diabetic patients could variably influence CHD risk liability. Serum uric acid levels were also simultaneously reduced post-Ramadan in the non-diabetic subjects and those on statin treatment. CONCLUSION: When pre- and post-Ramadan lipid and lipoprotein profiles were compared in stable hyperlipidaemic subjects attending a Lipid Clinic in Kuwait, the most consistent changes post-Ramadan were increased levels of apo A-1 and apo A-1/apo B and apo A-1/HDL ratios and reduced uric acid levels. Body weight remained essentially unchanged and the other lipoprotein and lipid parameters were not worsened. These results suggest that Ramadan fasting in hyperlipidaemic subjects might favorably influence CHD risk.     

Peripheral and central nervous system alterations in hypothyroidism: electrophysiological findings

The purpose of this study is to evaluate objectively the functional changes in the nervous system in hypothyroidism by different electrophysiological parameters and to determine the frequencies of these changes in patients with hypothyroidism. We enrolled 23 patients (17-64 years old, mean 38.2) with biochemical evidence of hypothyroidism, with thyroxine less than 4 microg/dl and thyrotropin above 4.5 mU/ml, and 200 age- and sex-matched normal subjects. Detailed clinical examination and electrophysiological measurements included electromyography, motor conduction velocity, visual-evoked potentials (VEPs), brainstem auditory-evoked potentials (BAEPs) and event-related potentials. Determinations of P300, Wechsler Adult Intelligence Scale (IQ) and electroencephalography (EEG) were performed. Of the hypothyroid patients 52% had peripheral nervous system (PNS) involvement. Entrapment neuropathy was the commonest (35%). Axonal neuropathy was recorded in 9% and myopathy was recorded in another 9%. The central nervous system (CNS) was affected in 78% of the cases. Significant prolongations of P100 latency of VEP, latency and interpeak latency of BAEPs of different waves of hypothyroid patients were compared to the control group. 52% had abnormal VEPs and BAEPs above the mean +/- 2 SD of the normal control group. Six patients (26%) had prolonged P300 latency while 16 patients had an IQ below 90. Eight patients (35%) had EEG changes. Diffuse slowing of background activity was the commonest. No significant correlation was observed between hormonal levels and the different electrophysiological parameters. Thus, the CNS is more vulnerable to the effect of hypothyroidism than the PNS. Therefore, we suggest performing electrophysiological studies in hypothyroid patients, even in the asymptomatic ones, early in the course of disease in order to detect the nervous system involvement.     

Role of partial splenic arterial embolization for hypersplenism in patients with liver cirrhosis and thrombocytopenia

Background  

Hypersplenism is traditionally treated by surgical splenectomy. Transcatheter ablation of splenic parenchyma is an alternative treatment modality.     

Compartment- and context-specific changes in tissue-type plasminogen activator (tPA) activity following brain injury and pharmacological stimulation

Tissue-type plasminogen activator (tPA) is a major protease of the central nervous system. Most studies to date have used in situ- or gel-based zymographic assays to monitor in vivo changes in neural tPA activity. In this study, we demonstrate that the amidolytic assay can be adapted to accurately detect changes in net tPA activity in mouse brain tissues. Using the amidolytic assay, we examined differences in net tPA activity in the cerebral cortex, sub-cortical structures and cerebellum in wildtype (WT) and tPA(-/-) mice, and in transgenic mice selectively overexpressing tPA in neurons. In addition, we assessed changes in endogenous net tPA activity in WT mice following morphine administration, epileptic seizures, traumatic brain injury and ischaemic stroke-neurological settings in which tPA has a known functional role. Under these conditions, acute and compartment-specific regulation of tPA activity was observed. tPA also participates in various forms of chronic neurodegeneration. Accordingly, we assessed tPA activity levels in mouse models of Alzheimer's disease (AD) and spinocerebellar ataxia type-1 (SCA1). Decreased tPA activity was detected in the cortex and subcortex of AD mice, whereas increased tPA activity was found in the cerebellum of SCA1 mice. These findings extend the existing hypotheses that low tPA activity promotes AD, whereas increased tPA activity contributes to cerebellar degeneration. Collectively, our results exemplify the utility of the amidolytic assay and emphasise tPA as a complex mediator of brain function and dysfunction. On the basis of this evidence, we propose that alterations in tPA activity levels could be used as a biomarker for perturbations in brain homeostasis.     

Plasma concentrations of C-reactive protein and total homocysteine in relation to the severity and risk factors for cerebrovascular disease

Higher C-reactive protein (CRP) and plasma homocysteine (tHcy) concentrations have been shown to indicate increased risk of coronary heart disease and cerebrovascular disease (CVD), but the mechanisms by which they increase the risk of atherothrombotic disease are under investigation. This study evaluates the associations of high-sensitivity C-reactive protein (hs-CRP) and tHcy with the risk factors, severity, and outcome on discharge in patients with CVD. hs-CRP, fasting tHcy, and lipid profile were determined in 50 patients with CVD and 20 healthy control subjects. Clinical data, National Institutes of Health stroke scale (NIHSS) on admission and disability Rankin scale on discharge, were recorded. Based on epidemiologic studies, cutoff points of 1.5 mg/L (hs-CRP) and 15mumol/L (tHcy) were used to indicate increased risk. Univariate and multivariate logistic regression analyses were used to relate tHcy with other CVD risk factors, NIHSS on admission and the disability Rankin scale on discharge. Overall, 38% of patients had increased hs-CRP and 26% had elevated tHcy. hs-CRP (P = 0.005) and tHcy (P < 0.0001) concentrations were significantly higher in patients compared with controls, and these differences remained significant after correction for age and sex. tHcy showed significant correlations with hs-CRP (rs = 0.35; P = 0.003) and low-density lipoprotein-cholesterol (LDL-C; rs = 0.49; P = 0.005). Logistic regression analysis with CVD as the dependent variable showed significant association with hs-CRP (P = 0.01) and tHcy (P < 0.0001) after adjustment for potential confounders. hs-CRP showed increased trend with disease severity and significant association with the disability Rankin scale (P = 0.033). These data support 4 main conclusions: (1) Elevation of hs-CRP and tHcy are common in CVD; (2) the significant relationship between tHcy and hs-CRP suggests that the association of tHcy with CVD risk may be dependent on inflammation-related mechanisms; (3) increased hs-CRP and tHcy show that patients with CVD may be at greater risk of subsequent coronary heart disease; and (4) admission hs-CRP could be used as an indicator of prognosis.     

Investigation of spatial resolution improvement by use of a mouth-insert detector in the helmet PET scanner

The dominant factor limiting the intrinsic spatial resolution of a positron emission tomography (PET) system is the size of the crystal elements in the detector. To increase sensitivity and achieve high spatial resolution, it is essential to use advanced depth-of-interaction (DOI) detectors and arrange them close to the subject. The DOI detectors help maintain high spatial resolution by mitigating the parallax error caused by the thickness of the scintillator near the peripheral regions of the field-of-view. As an optimal geometry for a brain PET scanner, with high sensitivity and spatial resolution, we proposed and developed the helmet–chin PET scanner using 54 four-layered DOI detectors consisting of a 16 × 16 × 4 array of GSOZ scintillator crystals with dimensions of 2.8 × 2.8 × 7.5 mm³. All the detectors used in the helmet–chin PET scanner had the same spatial resolution. In this study, we conducted a feasibility study of a new add-on detector arrangement for the helmet PET scanner by replacing the chin detector with a segmented crystal cube, having high spatial resolution in all directions, which can be placed inside the mouth. The crystal cube (which we have named the mouth-insert detector) has an array of 20 × 20 × 20 LYSO crystal segments with dimensions of 1 × 1 × 1 mm³. Thus, the scanner is formed by the combination of the helmet and mouth-insert detectors, and is referred to as the helmet–mouth-insert PET scanner. The results show that the helmet–mouth-insert PET scanner has comparable sensitivity and improved spatial resolution near the center of the hemisphere, compared to the helmet–chin PET scanner.