Randomized clinical trial of transabdominal versus transcervical chorionic villus sampling methods

The relative advantages and disadvantages of transabdominal (TA) and transcervical (TC) chorionic villus sampling (CVS) in terms of fetal risks and efficacy were evaluated in a clinical trial conducted on 1194 women randomized at 7–12 weeks' gestation. The results of the study indicate that, if any, the relative risk of fetal loss following either procedure is less than double that of the alternative technique when performed by a skilled operator. Overall, the fetal loss rate (spontaneous abortions following randomization, terminations of pregnancy, and perinatal deaths) is 16.5 and 15.5 per cent, respectively, among women allocated to TA- and TC-CVS. The two procedures are equally effective, although TA-CVS is associated with a significantly lower rate of repeat device insertions; on the other hand, a higher weight of chorionic tissue is obtained, on average, with TC-CVS. Bleeding is more common following TC-CVS, while peritoneal reaction developed only after TA-CVS. No diagnostic problems specifically related to one sampling technique were identified.     

浙江墩头盆地横山组孢粉化石的发现及其地层意义

浙江墩头盆地红色岩层中上部首获丰富的以Cassopllis为主(58.39—62.54％)伴有Exesipollenites(15.21—15.84％),Hsuisporites(0.56—0.62％),Cicatricosisporites(0—0.31％)等孢粉化石。该孢粉组合特征既与国内外晚侏罗世孢粉组合面貌差别较大,又与早白垩世中晚期孢粉组合面貌存在明显差异,显示了早白垩世早期孢粉组合的色彩。笔者认为这套红色岩层应归早白垩世早期横山组为宜。     

First-trimester diagnosis of menkes disease: Intermediate copper values in chorionic villi from three affected male fetuses

Chorionic villus samples with copper contents of 1·91, 4·2, 5·6, and 6·3 ng/mg were observed in four cases with male karyotypes. These values were outside the range for unaffected males (0·30–0·85 ng/mg), and three of them were outside the control range (0·20–2·39 ng/mg). But these three values were below the values previously observed for affected Menkes fetuses (12·0–24·8 ng/mg). Follow-up by ⁶⁴Cu uptake studies on the amniotic fluid cells was performed in three of these cases. A combination of ⁶⁴Cu uptake and chase experiments on the amniotic fluid cells showed more convincingly than ⁶⁴Cu uptake per se the direct copper values of 4·2 and 5·6 ng/mg to correspond to affected fetuses. Amniotic fluid cells from the male fetus with the CV copper value of 1·9 ng/mg showed normal results. The CV copper value of 6·3 ng/mg was considered pathognomonic for Menkes disease. The pregnancy was terminated, and the diagnosis was confirmed on fetal fibroblasts. Maternal deciduum prepared from the placentae showed in one of the cases with an affected fetus copper values ranging from 1·5 to 5·7 ng/mg. In six additional diagnostic cases, the copper content was determined in both CV samples and maternal deciduum. In three of these cases with normal CV sample copper, maternal decidua values of 4·85–7·8 ng/mg copper were observed. These results show that maternal deciduum contamination of a CV sample could cause a false-positive diagnosis.     

First trimester chorionic villus sampling versus mid-trimester genetic amniocentesis-preliminary results of a controlled prospective trial

This controlled prospective study assesses the relative risks of first trimester chorionic villus sampling (CVS) versus mid-trimester gentic amniocentesis (GA). CVS subjects and amnio-centesis controls were comparable with regard to several confounding variables which might influence the risk of pregnancy loss including maternal age, smoking, alcohol consumption, gestational age at study entry, and history of vaginal bleeding or poor prior reproductive outcome. The most common indication for prenatal diagnosis was advanced maternal age (n = 511). In this subgroup, spontaneous abortion (<24 weeks) occurred in 2·9 per cent of CVS subjects versus 4−3 per cent of amniocentesis controls. The sum of spontaneous and therapeutic abortions (<24 weeks) was identical (5·3 per cent) in both groups. Therefore, intervention in the CVS group (i.e., therapeutic abortion for cytogenetic abnormalities) did not influence the observed risk of pregnancy loss. Overall perinatal mortality rates were also similar in both groups. No significant differences were identified for a number of pregnancy outcome parameters including 5 min Apgar score, birth weight, body length, head circumference, gestational age at delivery, preterm delivery, fetal growth retardation, congenital malformations, and neonatal complications. Preliminary results of this controlled prospective study suggest that chorionic villus sampling carries a low and acceptable risk.     

First trimester prenatal diagnosis of haemophilia A: Two years' experience

We evaluated the feasibility, reliability, and acceptability of prenatal diagnosis of haemophilia A by DNA analysis of chorionic villi. Twenty-two women at risk to transmit the abnormal gene were referred for prenatal diagnosis, two of them twice. Two of the 22 women appeared to be non-carriers by DNA analysis. In one of these women, the results were known only after chorionic villus sampling had been carried out. Thirteen of the twenty carriers were heterozygous for an intragenic (Bell or Xbal) marker; six women were only heterozygous for the extragenic DXS52 (Stl4) locus. One of the women was homozygous for all the presently known DNA markers within or closely linked with the factor VIII locus. Twelve of the 22 fetuses at risk were male, ten were female. Seven of the 12 male fetuses were shown to be affected and were subsequently aborted. Four male fetuses appeared to be not affected. In one case, the diagnosis was made by use of an extragenic marker. The woman rejected fetal blood sampling to confirm the diagnosis. After birth, a normal factor VIII level was found in three of the four cases. The fourth pregnancy is still continuing. In one of the 12 male fetuses, no diagnosis at the gene level was possible. DNA analysis is expected to provide maximum certainty as to the phenotype of the fetus for approximately 60 per cent of the women; for another 37 per cent a rate of misdiagnosis of 4–5 per cent applies. In only 3 per cent of the cases will no diagnosis at the gene level be possible as yet. The new possibility of a prenatal diagnosis in the first trimester of pregnancy enabled some of these women to have a family of their own and was appreciated in particular by the women who underwent fetoscopy in an earlier pregnancy.     

Early prenatal diagnosis of congenital hypophosphatasia: Case report

Congenital hypophosphatasia is an autosomal recessive disorder, which usually has a fatal outcome during the neonatal period. This report presents the prenatal diagnosis of hypophosphatasia at 16 weeks of gestation. The characteristic ultrasonic findings in this abnormality demonstrate the superiority of ultrasound as compared with radiography.     

幼儿环境教育实施策略的探讨

开展幼儿环境教育实践的目的是让幼儿成为环境的主人,引导他们自主地欣赏,观察日常生活中具体的环境要素和环境问题,使他们懂得我们周围的环境与人类的一切活动息息相关,并使幼儿逐步养成与环境友善的行为习惯。     

井架背车液压系统故障诊断与处理

介绍了井架背车液压系统常见故障现场快速诊断方法,列举了常见故障处理实例及故障诊断效果。     

IWRM视角下污水治理体系问题系统诊断与对策研究——以浙江省为例

基于集成水资源管理理念框架,较系统地构建了污水治理体系问题诊断指标体系并明确了诊断标准.实证研究表明,浙江省污水治理体系仍存在政策不协调,投资结构不合理,体制横向不协调、纵向不到位、职责分散,民主参与决策与监督机制不健全,排污行为监测监管不到位,经济激励不够、行业自律不足等问题.建议浙江省应进一步协调区域发展政策,优化污水治理城乡投融资结构,完善机构设置,优化部门协调,加强政府监测监管等,以提高污水治理绩效.     

Storm impacts along European coastlines. Part 2: lessons learned from the MICORE project

This paper describes the MICORE approach to quantify for nine field sites the crucial storm related physical hazards (hydrodynamic as well as morphodynamic) in support of early warning efforts and emergency response.As a first step historical storms that had a significant morphological impact on a representative number of sensitive European coastal stretches were reviewed and analysed in order to understand storm related morphological changes and how often they occur around Europe. Next, an on-line storm prediction system was set up to enable prediction of storm related hydro- and morphodynamic impacts. The system makes use of existing off-the-shelf models as well as a new open-source morphological model. To validate the models at least one year of fieldwork was done at nine pilot sites. The data was safeguarded and stored for future use in an open database that conforms to the OpenEarth protocols.To translate quantitative model results to useful information for Civil Protection agencies the Frame of Reference approach ( [Van Koningsveld et al., 2005] and [Van Koningsveld et al., 2007] ) was used to derive Storm Impact Indicators (SIIs) for relevant decision makers. The acquired knowledge is expected to be directly transferred to the civil society trough partnerships with end-users at the end of the MICORE project.