Altered expressions of glutamate transporter subtypes in rat model of neonatal cerebral hypoxia-ischemia.

Glutamate transporters are essential for maintaining the extracellular levels of glutamate at synaptic clefts and are regulated developmentally in a subtype-specific manner. We investigated chronological changes of immunoreactivities for glial glutamate transporters GLAST and GLT-1 and a neuronal glutamate transporter, EAAC1, in postnatal 7-day-old rat neocortices and hippocampi at 12, 24, 48 and 72 h after hypoxia-ischemia. Glutamate transporter subtypes are differentially expressed in the ischemic core and the boundary area of the neonatal rat brain with hypoxia-ischemia. Expressions of these glutamate transporters decreased in the ischemic core at 12 h, then immunoreactivities for GLAST and GLT-1 were recovered at the hippocampus. This was accompanied by a GFAP-positive gliosis at 72 h, whereas these immunoreactivities were reduced at the neocortex in the ischemic core. Glial glutamate transporters, especially GLAST, were noted in some astrocytes appearing as apoptosis as well as shrunken pyramidal neurons mainly in the boundary area of the neocortex. Increased perikaryal expression of EAAC1 was associated with that of MAP2 at the border of the boundary area. These temporal and regional expressions of glutamate transporters may contribute towards understanding the excitotoxic cell death mechanism in hypoxic-ischemic encephalopathy during the perinatal period.

Rapid detection of chromosome aneuploidies by prenatal interphase FISH (fluorescence in situ hybridization) and its clinical utility in Japan.

OBJECTIVE: The purpose of this study was to assess the accuracy, informative rate, detection rate, and clinical utility of prenatal interphase fluorescence in situ hybridization (FISH) analysis of amniotic fluid samples from Japanese women. METHODS: Amniotic fluid specimens from 2,639 Japanese women were received for prenatal interphase FISH and chromosome analysis. A questionnaire was designed to evaluate FISH clinical utility by collaboration sites. RESULTS: Based on 2,319 tested samples, the accuracy (100%), informative (94%), and detection (87.6%) rates were all high. The accuracy (100%), informative (90.2%), and detection (90.0%) rates were also remarkable in third-trimester pregnancies. We perceive significant advantages from this test regarding medical management and patient satisfaction. CONCLUSIONS: This novel report shows that in Japan prenatal interphase FISH testing is highly informative and accurate, not only in second-trimester pregnancies but also in third-trimester pregnancies. This test provides advantages to both physicians and patients, provided that its capabilities and limitations are understood.

Triple marker screening for trisomy 21, trisomy 18 and open neural tube defects in singleton pregnancies of native Japanese pregnant women.

OBJECTIVE: To report the results of prenatal triple marker screening on a population of Japanese pregnant women. METHODS: From April 1994 through March 1999, a total of 32,925 native Japanese women with singleton pregnancies requested a triple marker-screening test. Multiples of the median values for 3 markers and individual risks for each patient were calculated following adjustment for the Japanese weight correction factor. The risk cut-off values used for Down syndrome (T21), open spina bifida (OSB) and trisomy 18 (T18) were 1: 295, 1: 290, and 1: 100, respectively. Follow-up information was collected postpartum and statistically analyzed. RESULTS: Detection rates (DR) of T21 for women less than 35 years, over 35 years and overall were 58, 94, and 83%, respectively. DR of T18 for women less than 35 years, over 35 years and overall were 75, 79, and 79%, respectively. DR of open neural tube defects (ONTD) was 100%. CONCLUSIONS: The first cumulative data of an intervention program and prospective follow-up studies in Japan have proven to be similar to other published reports. Individual risk values were calculated for each pregnancy for T21, T18 and ONTD. This screening program is more effective than age-dependent screening for detecting T21, T18 and ONTD pregnancies.

A case of large placental chorioangioma with non-immunological hydrops fetalis.

A 34-year-old Japanese woman (gravida 2, para 2) with polyhydramnios and non-immunological hydrops fetalis was referred to our department at 32 weeks of gestation. On admission, the blood pressure was 120/60 mmHg and there was no pitting edema of the lower extremities. An ultrasound examination disclosed a large placental tumor 5.8 cm x 4.4 cm x 4.8 cm. Fetal lung compression was suspected because the lung-thorax transverse area ratio was 0.13. The preload index of the inferior vena cava was 0.74, suggesting fetal cardiac failure. After fetal pleural effusion was aspirated, lung compression developed. Cordocentesis was performed at 33 weeks of gestation, and the fetal karyotype was confirmed to be 46, XY from an umbilical blood cultivation. The patient underwent a cesarean section at 33 weeks of gestation due to severe uterine contraction after preterm PROM. The baby was a 3,840 g male with a distended abdomen. Apgar score at 1 minute was 1. A chest X-ray demonstrated respiratory distress syndrome. The baby was discharged on the 69th day after birth and he is now 2 years and 9 months old and healthy.

Prenatal diagnosis of congenital lipoid adrenal hyperplasia.

BACKGROUND: There are no published reports of prenatal diagnosis of congenital lipoid adrenal hyperplasia, which is the rarest form of congenital adrenal hyperplasia. CASE: Congenital lipoid adrenal hyperplasia was diagnosed prenatally based on the existence of one affected sibling in the family, the presence of an amniotic fluid cell karyotype of 46,XY, the appearance of normal female genitalia on ultrasonography, relatively low amniotic fluid concentration of 17 alpha-hydroxyprogesterone, low maternal plasma and urinary concentrations of estriol, and a positive response to the dehydroepiandrosterone sulfate loading test. CONCLUSION: Congenital lipoid adrenal hyperplasia can be diagnosed prenatally. Treatment in early infancy can lead to normal mental and physical development.

[Continuous fetal biochemical monitoring and cardiotocography].

Changes in fetal scalp transcutaneous PO2 (tcPO2) were compared with those of the fetal heart rate (FHR) in 31 high-risk pregnancies. Fetal tcPO2 at 10 minutes prior to the delivery was quite similar to umbilical arterial PO2. The abnormal FHR pattern evaluated by the FHR score was well correlated with the fetal tcPO2, umbilical arterial PO2, umbilical arterial pH and Apgar score. When there were signs of fetal distress in the FHR pattern, such as late deceleration, severe variable deceleration, or prolonged fetal bradycardia, the tcPO2 was lower than 15mmHg, and there occurred a temporary fall in tcPO2 of more than 5mmHg. It was concluded that proficiency in evaluating FHR tracings might eliminate the necessity of fetal biochemical monitoring, including fetal blood sampling, and also decrease the frequency of cesarean sections for fetal distress.

Respiratory and metabolic responses of fetal and neonatal perfused livers to catecholamines and anoxia.

The effects of catecholamine and anoxia on the respiratory and metabolic function of developing livers were studied. The characteristic feature of the fetal liver was catecholamine induced glycolysis, although that of the neonatal liver was gluconeogenesis. Infusion of lactate and pyruvate caused a reduction in NAD in the fetus and adult, and NAD oxidation in the newborn. The fetal liver demonstrated marked tolerance of anoxic load, but the tolerance was rapidly lost after birth. The metabolic response to catecholamine may be mediated by the alpha-adrenergic receptor rather than the beta-receptor.

[Fundamental studies on transcutaneous bilirubinometry in newborn infants using an organ scanning spectrophotometer].

In vivo reflectance spectra in the visible region were recorded on the blanched skin on the foreheads, chests, arms and legs of 140 newborn infants using an organ scanning spectrophotometer, and corresponding total serum bilirubin levels were determined. An elevation in the absolute spectra was observed in the 460 nm region for the higher bilirubin level, and the isosbestic point was located in the 510 nm region. A linear relationship was observed between the reflectance spectra difference and the serum bilirubin level. Although the best analysis results were obtained from the measurements of the reflectance spectra difference between 460 nm and 510 nm on the chests (r = 0.954, Y = 40.62X + 1.36), or on sums of 4 measuring sites (r = 0.973, Y = 46.59X + 0.61), there was no statistical difference from the values obtained between 460 nm and 550 nm on the foreheads (r = 0.913, Y = 33.55X + 5.30). The slopes and the Y-intercepts of the linear regressions differed considerably at various measuring sites. Marked decreases in the reflectance spectra differences were observed during the phototherapies and prominent rebounds followed for 24 hours after the cessation of phototherapies. The noninvasive and simple reflectance method was sensitive to the bilirubin level in the tissue and might be a better indicator of neonatal risk of kernicterus. However, the optical method has a certain limitations in representing the bilirubin concentration in the blood stream, especially during, and for 24 hours, after phototherapies.

[Prenatal diagnosis and treatment of intrauterine growth retardation].

A diagnosis of intrauterine growth retardation (IUGR) was made in 150 pregnancies on the basis that the estimated fetal body weight was less than -1.5 SD of the intrauterine growth curve for the Japanese population in two consecutive measurements. The estimation of fetal body weight was made from the biparietal diameter and abdominal circumference using the formula of Shepard et al. Maternal plasma estriol, urinary estriol and plasma hPL were determined, and routine instructions to take daytime bedrest and a high protein diet were made. 75 optionally selected cases were given oral allylestrenol 30 mg/day until the time of delivery (the medicated group), and the other 75 cases (control group) were given no medication. Ultrasonic and biochemical measurements were repeated every two weeks thereafter. The estimated fetal weight calculated from Shepard's formula was of sufficient accuracy to make it possible to predict the fetal weight before delivery. In the control group, the estimated fetal weight averaged 1,281 grams at the initial measurements at an average of 32.7 weeks' gestation when the diagnosis of IUGR was made, and 2,498 grams at the final measurements at an average of 38.7 weeks gestation immediately before delivery. In the medicated group, the estimated fetal weight averaged 1,242 grams at the initial measurements at 32.8 weeks' gestation, and 2,826 grams at the final measurements at 39.0 weeks' gestation. Statistically significant increases in the fetal body weight were noted in the medicated group. Maternal plasma estriol, urinary estriol and plasma hPL concentrations rose significantly in the medicated group when compared with the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Albumin therapy and intrauterine growth retardation in gestosis.

Intravenous administrations of albumin, 8-16 g for 5-46 days, to the total doses of 56-736 g (averaged 198 g) were given for 10 patients suffered from both EPH gestosis and hypoalbuminemia averaged 2.4 g/dl. Plasma albumin level, total proteins and A/G ratio were elevated from 2.4 to 3.3 g/dl, from 4.9 to 5.8 g/dl, and from 0.97 to 1.28, respectively in average, following the albumin therapies. Slight decreases in hematocrit, urinary protein, SGOT and SGPT were observed, while BUN increased slightly. Pregnancies were maintained until 36.7 weeks in average. Fourteen newborn infants were delivered in good conditions, mean birth weight being 2,475 g. Four infants (28.6%) were SFDs, while ten (71.4%) were AFDs. Intravenous albumin therapies appear to be safe and effective for those who have both EPH gestosis and hypoalbuminemia.

Prenatal diagnosis and treatment of intrauterine growth retardation.

Prenatal treatment consisting of daytime bedrest, high protein diet and oral administration of allylestrenol was assessed in a prospective study of 30 patients with IUGR infants whose ultrasonically estimated body weight was less than the 10th percentile. In these pregnancies, the gestational age was confirmed in the first trimester, and the fetal weight was estimated from the BPD and AC measurements in the third trimester (Fig. 1). Following treatment, ultrasonic and biochemical determinations were performed. As results: The estimated fetal weight of 1,362 g at 32.9 g gestational weeks increased to 2,678 g at 39.2 weeks on average. The average weekly weight gain was significantly higher than the standard, and 16 cases (53.3%) were more than 10th percentile at birth (Tab. I, Fig. 2). A significant correlation (r = 0.94) between the estimated fetal weight and the birth weight was found. Following prenatal treatments, maternal plasma and urinary estriol, plasma HPL and progesterone increased significantly (Tab. II).

[Prenatal diagnosis and treatments of intrauterine growth retardation (author's transl)].

Prenatal management consisting of bed rest, high protein diet and oral administration of allylestrenol was assessed in prospective studies of 22 IUGR pregnancies, in which ultrasonographically determined fetal body weight was less than 10th percentile of Japanese population. In these cases, the gestational age was ascertained and corrected in the first trimester of pregnancy by the routine sonar measurements of CRL and BPD. Early in the third trimester, the fetal body weight was estimated by BPD and AC using the method of Warsof et al. Following the prenatal treatment, sonar measurements and biochemical determinations of maternal plasma and urinary E3, plasma HPL and progesterone, and serum HSAP and LAP were made biweekly. As results: (1) The fetal estimated body weight, averaging initially 1431 +/- 284 g at 33.8 +/- 2.1 weeks of gestation, increased finally up to 2612 +/- 451 g at 39.5 +/- 1.8 weeks. (2) Average delta/week weight gain, being 212 +/- 67 g in these cases, exceeded significantly that, being 162 +/- 43 g, of normal 50th percentile level. (3) Fifty percent of the newborn was larger than 10th percentile of normal population, at the delivery. (4) Neonatal birth weight correlated significantly with finally estimated fetal body weight (r = 0.82, Y = 1.01 X + 17.5). (5) Maternal plasma E3, which was initially low in 20 out of 22 cases (91%), being 2.1 +/- 1.5 ng/ml, elevated to 4.1 +/- 3.6 ng/ml following 2 weeks treatment. Urinary E3 increased significantly from 14.0 +/- 6.9 mg/day to 23.7 +/- 11.2 mg/day. Plasma progesterone raised significantly from 110 +/- 14 ng/ml to 133 +/- 31 ng/ml. Those results suggested that maternal increases in steroid levels were at least partly due to a stimulation of placental function by allylestrenol.

[Ultrasonic and biochemical detection and prenatal treatments of intra-uterine fetal growth retardation (author's transl)].

Efficacy of three ultrasonographic and six biochemical methods for the detection of intrauterine growth retardation were assessed in prospective studies of 40 cases associated with short uterine fundal height less than -1.5 SD and/or small ultrasonographically determined total intrauterine volume (TIUV) less than -1 SD of normal populations. Prenatal treatments, consisting of bed rest, high protein diet, intravenous drip infusion of 10% maltose, 500 ml per day, for more than 12 days, etc., were administered on them. Fifteen cases (37.5%) delivered small-for-date infants, 9 of which complicated by toxemia of pregnancy. At the final determinations, small TIUV were found in all small-for-date cases (100%), short biparietal diameter 80.0%, and short longitudinal intracavital uterine length 53.3% of 15 small-for-date cases. In biochemical parameters, low maternal plasma estriol levels were found in 73.3%, low plasma human placental lactogen levels 66.7%, low urinary estriol excretion 53.3%, abnormal plasma alpha-fetoprotein levels 33.3%, and low plasma progesterone levels 20.0% of 15 small-for-date cases. Nineteen cases (47.5%) demonstrated remarkable increases in TIUV following prenatal treatments, and delivered appropriate-for-date infants. Despite of marked growth in biophysical parameters, abnormal biochemical values were mostly not improved by these treatments.