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peer-reviewed Objective Increased fetal size is associated with shoulder dystocia during labor and subsequent need for assisted delivery. We sought to investigate if increased fetal adiposity diagnosed sonographically in late pregnancy is associated with increased risk of operative delivery. Methods This secondary analysis of the Genesis Study recruited 2392 nulliparous women with singleton pregnancy in cephalic presentation, in a prospective, multicenter study, to examine prenatal and intrapartum predictors of Cesarean delivery. Participants underwent ultrasound and clinical evaluation between 39 + 0 and 40 + 6 weeks' gestation. Data on fetal biometry were not revealed to patients or to their managing clinicians. A fetal adiposity composite of fetal thigh adiposity and fetal abdominal wall thickness was compiled for each infant in order to determine whether fetal adiposity > 90th centile was associated with an increased risk of Cesarean or operative vaginal delivery. Results After exclusions, data were available for 2330 patients. Patients with a fetal adiposity composite > 90th centile had a higher maternal body mass index (BMI) (25 ± 5 kg/m2 vs 24 ± 4 kg/m2; P = 0.005), birth weight (3872 ± 417 g vs 3585 ± 401 g; P 90th centile were more likely to require Cesarean delivery than were those with adiposity composite ≤ 90th centile (P 90th centile remained a risk factor for Cesarean delivery (P 90th centile was more predictive of the need for unplanned Cesarean delivery than was an estimated fetal weight > 90th centile (odds ratio, 2.20 (95% CI, 1.65–2.94; P 90th centile was not associated with an increased likelihood of operative vaginal delivery when compared with having an adiposity composite ≤ 90th centile (P = 0.37). Conclusions Fetuses with increased adipose deposition are more likely to require Cesarean delivery than are those without increased adiposity. Consideration should, therefore, be given to adding fetal thigh adiposity and abdominal wall thickness to fetal sonographic assessment in late pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. ACCEPTED peer-reviewed

The objective of this study was to evaluate the efficacy of three off-loading techniques to heal diabetic foot wounds: total contact casts (TCCs), healing sandals (HSs) and a removable boot with a shear-reducing foot bed (SRB). This was a 12-week, single-blinded randomised clinical trial with three parallel treatment groups of adults with diabetes and a foot ulcer (n = 73). Ulcer healing was defined as full reepithelialisation with no drainage. Diabetic patients with grade UT1A or UT2A forefoot ulcers on the sole of the foot were enrolled. Patients with malignancy, immune-compromising diseases, severe peripheral vascular disease (ankle-brachial index < 0·60 or transcutaneous oxygen < 25 mm/Hg), alcohol or substance abuse within 6 months, untreated osteomyelitis or Charcot arthropathy with residual deformity that would not fit the HS or boot were excluded. In the intent-to-treat analysis, significantly higher proportion of patients were healed in the TCC group (69·6%) compared to those treated with the SRB (22·2%, P < 0·05). There was no difference in the rate of healed ulcers in the HS (44·5%) and TCC groups. Ulcers in the TCC group healed faster than those in the HS group (5·4 ± 2·9 versus 8·9 ± 3·5 weeks, P < 0·02). However, there was no difference in the time to healing in the TCC and SRB groups (6·7 ± 4·3 weeks, P = 0·28). Patients who used HS were significantly more active (4022 ± 4652 steps per day, P < 0·05) than those treated with TCCs (1447 ± 1310) or SRB (1404 ± 1234). It is concluded that patients treated with TCCs had the highest proportion of healed wounds and fastest healing time. The novel shear-reducing walker had the lowest healing and highest rate of attrition during the study.

Microbial fuel cell research is a relatively new and fast growing field of interdisciplinary effort that has drawn scientists from several disparate disciplines. Consequently, establishing a “common language” regarding the “means and ways” of experimental preparation, data collection and characterization to obtain accurate and comparable figures of merit (describing microbial fuel cell performance) has proven difficult. We present a methodology for comprehensive engineering analysis from inoculation through batch, fed-batch and finally continuous flow operation, and detail how a modified stack cell design complements this. More, our cell is able to operate near the thermodynamic maximum potential for oxidation of lactate.

Objective Early elective termination of pregnancy is the most common outcome of a diagnosis of anencephaly in developed countries. Experience and expertise with management of ongoing pregnancies is limited. We aimed to investigate the natural history of these pregnancies from diagnosis to delivery and to determine timing of death. Method A retrospective review of cases of anencephaly diagnosed between 2003 and 2009 in tertiary-referral university teaching hospitals in Cork. Results The majority of cases (25/26; 96%) were diagnosed prenatally at a median gestation of 21+2 weeks (range 13+4–32+4). The median maternal age was 30 years (range 17–41) and 50% were primigravidae. Seven pregnancies were complicated by polyhydramnios and four deliveries were complicated by shoulder dystocia. The median gestation at delivery was 35 weeks (range 22+5–42+6); 69% of labours were induced at a median gestation of 34 weeks. Six women (6/26; 23%) had a pre-labour intrauterine fetal death and nine women (9/26; 35%) had an intrapartum fetal death. Median neonatal survival time was 55 min (range 10 min to 8 days). Six parents donated neonatal organs for transplantation. Conclusion This study provides useful information for health professionals caring for patients with a diagnosis of anencephaly. The majority of these infants die prior to delivery but short-term survival is possible. Copyright © 2010 John Wiley & Sons, Ltd.

Aim: Inherited thrombophilic polymorphisms have been linked to pregnancy-related thromboembolism and other adverse pregnancy outcomes. As there are limited data on the prevalence of these polymorphisms in Australian populations, we aimed to assess this in an antenatal population. Methods: Healthy nulliparous women (n = 2031) were recruited to this study. The women had no past or family history of venous thromboembolism. Women were excluded if they or a family member was known to be a carrier of any thrombophilic marker. Genotyping from venous blood for the factor V Leiden, prothrombin 20210A, MTHFR 677 and 1298 and thrombomodulin C1418T polymorphisms was undertaken. Results: Key findings were that 107 of 2019 (5.30, 95% confidence interval 4.36–6.37%) women tested were heterozygous carriers of factor V Leiden and one was homozygous (0.05, 0–0.27%); 2.43% of women were heterozygous carriers of the prothrombin gene mutation (1.80–3.20%) while no women were homozygous for this mutation; 11.62% (10.22–13.02%) and 9.98% (8.67–11.29%) were homozygous for the MTHFR 677 and 1298 polymorphisms, respectively, and 3.43% (2.63–4.22%) of women were homozygous for the thrombomodulin polymorphism. Conclusions: The prevalence of these polymorphisms is consistent with previously published data in Caucasian populations. These data will provide the basis for further assessment of the relationship between poor pregnancy outcome and these inherited thrombophilic polymorphisms in an asymptomatic antenatal population.

Methods Twenty-four-hour ambulatory blood pressure monitoring was performed on 40 women (20 hypertensive, 20 normotensive) on a hospitalised and nonhospitalised day. Mean blood pressure differences were calculated for the awake, sleeping and 24-hour periods on both days. Results Mean heart rate was higher at home (1.79, p = 0.04) than in hospital, but there were no significant differences in mean systolic (1.30 mmHg, p = 0.06), diastolic (0.78 mmHg, p = 0.21) or mean arterial blood pressure (0.81 mmHg, p = 0.19) between the hospitalised and non hospitalised day for the group overall. Nevertheless, the range of individual responses was wide (-8.5 mmHg to 15.4 mmHg mean arterial blood pressure). Hypertensive women receiving antihypertensive therapy had significantly greater differences in mean arterial blood pressure between the hospital and non-hospital day when compared to the rest of the group (5.8 mmHg, compared to 3.3 mm Hg, p = 0.02). Conclusions Although hospitalisation does not significantly lower blood pressure in pregnant women as a group, women receiving antihypertensive therapy demonstrate significant differences in blood pressure between hospital and home. Based on conventional blood pressure measurements alone, these women may be at risk of either under treatment, or over treatment, of blood pressure.

Low doses of fenvalerate, a widely used type-II pyrethroid insecticide, have been shown previously to produce abnormal olfactory centers in the brain and abnormal olfactory-mediated behavior in beetles (Wegerhoff et al. [1998] Neuroreport 9:3241-3245). Here, we use the experimental advantages of the moth Manduca sexta to explore the cellular changes that lead to these abnormalities. Our results indicate that treatment with fenvalerate may affect multiple aspects of the development of the primary olfactory centers, the antennal lobes, in Manduca, including ingrowth of olfactory receptor axons, axon fasciculation, and targeting within the antennal lobe, and intercellular signaling between the receptor axons and the glial cells that ordinarily surround and stabilize the developing olfactory glomeruli.

Objectives To estimate the rate of folate catabolism in pregnant and nonpregnant women and to derive the recommended dietary allowance for folate. Design Prospective, observational study. Setting Rotunda Hospital, Dublin. Women Twenty-four healthy gravid women were studied once during each trimester and postpartum. Twenty-five nonpregnant controls were assessed before and after folic acid supplementation. Interventions Women provided 24-hour urine collections while adhering to a strict dietary regimen containing no exogenous folate catabolites. Main outcome measures Urinary levels of p-acetamidobenzoylglutamate and p-aminobenzoylglutamate were measured by high pressure liquid chromatography. Results The 24-hour excretion of folate catabolites, expressed as mean [95% CI] folate equivalents in μg) progressively increased during pregnancy. A peak was reached in the third trimester (349.1 μg [308.1 to 390.1]) where the rate was more than twice the rate in the nonpregnant control group (136.4 μg [112.4 to 160.4]) (P < 0.001). Based on our results the recommended dietary allowance for folate in nonpregnant women should be 250 μg and this should rise during pregnancy to 430 μg in the second trimester and 540 μg in the third trimester. Conclusions The rate of folate catabolism progressively increases during pregnancy reaching a peak in the third trimester at the time of maximal fetal growth. The increased demand for folate during pregnancy appears to be due to the accelerated breakdown of the vitamin because of its participation in cellular biosynthesis. These results provide a quantitative basis for the current debate on the appropriate recommended dietary allowance for folate in both pregnant and nonpregnant women.

Karyotype–phenotype correlations of common trisomy mosaicism prenatally diagnosed via amniocentesis was reviewed in 305 new cases from a collaboration of North American cytogenetic laboratories. Abnormal outcome was noted in 10/25 (40%) cases of 47,+13/46, 17/31 (54%) cases of 47,+18/46, 10/152 (6.5%) cases of 47,+20/46, and in 49/97 (50%) cases of 47,+21/46 mosaicism. Risk of abnormal outcome in pregnancies with less than 50% trisomic cells and greater than 50% trisomic cells were: 26% (4/15) versus 60% (6/10) for 47,+13/46, 52% (11/21) versus 75% (6/8) for 47,+18/46, 4.5% (6/132) versus 20% (4/20) 47,+20/46, and 45% (27/60) versus 59% (22/37) for 47,+21/46. Phenotypically normal liveborns were observed with mean trisomic cell lines of 9.3% for 47,+13/46, 8.6% for 47,+18/46, 27% for 47,+20/46, and 17% for 47,+21/46. Cytogenetic confirmation rates were 46% (6/13 cases) for 47,+13/46 mosaicism, 66% (8/12 cases) for 47,+18/46, 10% (10/97 cases) for 47,+20/46, and 44% (24/54 cases) for 47,+21/46. There were higher confirmation rates in pregnancies with abnormal versus normal outcome: 50% versus 44% for 47,+13/46 mosaicism, 100% versus 33% for 47,+18/46, 66% versus 7% for 47,+20/46, and 55% versus 40% for 47,+21/46. Repeat amniocentesis is not helpful in predicting clinical outcome. It may be considered when there is insufficient number of cells or cultures to establish a diagnosis. Fetal blood sampling may have a role in mosaic trisomy 13, 18, and 21 as the risk for abnormal outcome increases with positive confirmation: 1/5 (20%) normal cases versus 5/8 (62%) abnormal cases. High resolution ultrasound examination(s) is recommended for clinical correlation and to facilitate genetic counselling. Copyright © 2000 John Wiley & Sons, Ltd.

Fli-2 is a common site of proviral integration in multistage erythroleukemia cells induced by Friend murine leukemia virus (F-MuLV) or the polycythemia strain of Friend leukemia virus (FV-P). Previously, we reported that integration of Friend virus into the Fli-2 locus in CB3, an erythroleukemia cell line that harbors a homozygous inactivation of the Fli-2 locus, results in the loss of expression of two genes encoding the 45-kDa subunit of the erythroid-specific nuclear factor p45 NFE2 and the splicing factor HnRNP A1. Here, we report the identification of a third gene, Heterochromatin protein 1 (HP1alpha, also known as CBX5), which is located downstream of HnRNP A1, and p45 NFE2. Northern blot analysis revealed that the expression of HP1alpha, along with p45 NFE2 and HnRNP A1, is either undetectable or substantially reduced in CB3 cells, suggesting that HP1alpha expression is also regulated by proviral insertion within the Fli-2 locus in CB3 cells. Because p45 NFE2 was previously mapped to mouse chromosome 15, our results demonstrate that HP1alpha and HnRNP A1 are also located on mouse chromosome 15 and that the p45 NFE2, HnRNP A1, and HP1alpha genes are arranged contiguously. Contiguous arrangement of these three genes was also detected in man; this consequently localizes HP1alpha to human chromosome band 12q13.

This study describes the macromixing within a hydro-dynamic vortex separator and considers its potential as a disinfectant contact tank. It is typically used in the sedimentation process during the treatment of sewage. The macromixing was investigated by conducting tracer experiments from which the retention time distribution was obtained and interpreted to characterize the mixing. The separator was operated in a continuous mode with no baseflow, and the retention-time distribution was obtained using a pulse input for a range of flow-rates. The method of moments was used to obtain various functions and axial dispersion and tanks-in-series model parameters.

Olfactory receptor axons in many species terminate centrally in an array of distinct glomeruli that are thought to encode the molecular features of odors. Particular molecular attributes are detected by receptor neurons widely distributed over the sensory epithelium, but these neurons then project to a small number of glomeruli in the olfactory bulb. This raises perplexing questions about olfactory axon guidance, especially how axons sort by odor specificity and how they find their appropriate targets in the brain. Taking advantage of the relative cellular simplicity of the moth antennal system, we have examined receptor axons in normally developing animals and also in preparations in which the nerve was experimentally misrouted. Just before they enter the antennal lobe, receptor axons undergo a dramatic reorganization in a discrete zone filled with glial cells. Here they shed neighbor relationships and become associated with axons that have common targets and presumably share common odor specificities. Electron microscopy revealed that the growth cones of early arriving axons travel preferentially next to glial processes. The growth cones of receptor axons were relatively simple except as they entered newly forming glomeruli. Misrouted nerves turned and ran along the surface of the brain until they reached the region of the antennal lobe. In only 6% of cases did misrouted axons enter the brain ectopically, never forming glomeruli. Our results suggest that olfactory receptor axons are attracted to the antennal lobe by soluble or surface-bound cues and sort by odor specificity by using a mechanism that may involve glial cells.

We report on a girl with duplication of 6q22.32 → qter and microcephaly, frontal bossing, facial anomalies, and webbed neck. She has congenital heart disease, renal hypoplasia, and hearing loss along with severe developmental delay. Published reports of seven other patients are reviewed and compared. The most frequent anomalies include microcephaly, abnormal face, webbed neck, congenital heart disease, limb contractures, and developmental delay. Am. J. Med. Genet. 78:123–126, 1998. © 1998 Wiley-Liss, Inc.

Twenty-six laboratories used X and Y chromosome probes and the same procedures to process and examine 15,600 metaphases and 49,400 interphases from Phaseolus vulgaris-leucoagglutinin (PHA)-stimulated lymphocytes. In Part I, each laboratory scored 50 metaphases and 200 interphases from a normal male and a normal female from its own practice. In Part II, each laboratory scored 50 metaphases and 200 interphases on slides prepared by a central laboratory from a normal male and a normal female and three mixtures of cells from the male and female. In Part III, each laboratory scored 50 metaphases (in samples of 5, 10, 15, and 20) and 100 interphases (in samples of 5, 10, 15, 20, and 50) on new, coded slides of the same specimens used in Part II. Metaphases from male specimens were scored as 98-99% XY with no XX cells, and 97-98% of interphases were scored as XY with 0.04% XX cells. Metaphases from female specimens were scored as 96-97% XX with 0.03% XY cells, and 94-96% of interphases were scored as XX with 0.05% XY cells. Considering the data as a model for any probe used with fluorescence in situ hybridization (FISH), a statistical approach assessing the impact of analytical sensitivity on the numbers of observations required to assay for potential mosaicisms and chimerisms is discussed. The workload associated with processing slides and scoring 50 metaphases and 200 interphases using FISH averaged 27.1 and 28.6 minutes, respectively. This study indicates that multiple laboratories can test/develop guidelines for the rapid, efficacious, and cost-effective integration of FISH into clinical service.

Objective To assess the role of 24-hour ambulatory blood pressure measurement in the mid-second trimester as a predictive test for the development of hypertension in pregnancy. Design Prospective intervention. Setting The Rotunda Hospital, Dublin. Participants One thousand one hundred and two healthy primigravid women. Intervention 24-hour ambulatory blood pressure measurement at 18 to 24 weeks of gestation. Main outcome measures The development of pre-eclampsia or gestational hypertension. Results A total of 1048 women had sufficient readings to be included in the final analysis. Of these, 23 (2.2%) developed pre-eclampsia, 64 (6.1%) developed gestational hypertension and 961 (91.7%) remained normotensive. Significantly higher ambulatory blood pressures were recorded in both the pre-eclamptic and gestational hypertensive group compared with the normotensive group. In addition, the gestational hypertensive group had significantly higher clinically measured blood pressure compared with the normotensive group. There were no differences between the pre-eclamptic and the gestational hypertensive group for any of the blood pressure parameters analysed. The best overall predictor for pre-eclampsia was 24-hour mean diastolic pressure which using a cutoff level of 71 mmHg gave a test with a sensitivity of only 22% and a positive predictive value of 15%. Conclusion Because the absolute differences are small and the overlap between the hypertensive and normotensive groups large, ambulatory blood pressure measurement, in a healthy primigravid population, between 18 and 24 weeks of gestation is not a useful predictor of hypertension.

Although fluorescent in situ hybridization (FISH) is rapidly becoming a part of clinical cytogenetics, no organization sponsors multi-center determinations of the efficacy of probes. We report on 23 laboratories that volunteered to provide slides and to use a probe for SNRPN and a control locus. Experiences with FISH for these laboratories during 1994 ranged from 0 to 645 utilizations (median = 84) involving blood, amniotic fluid and bone marrow. In an initial study of hybridization efficiency, the median percentage of metaphases from normal individuals showing two SNRPN and 2 control signals for slides prepared at each site was 97.0 (range = 74-100); for slides prepared by a central laboratory, it was 97.8 (range = 81.6-100). In a subsequent blind study, each laboratory attempted to score 5 metaphases from each of 23 specimens [8 with del(15) (q11.2--q12) and 15 with normal 15 chromosomes]. Of 529 challenges, the correct SNRPN pattern was found in 5 of 5 metaphases in 457 (86%) and in 4 of 5 in 33 (6%). Ambiguous, incomplete or no results were reported for 32 (6%) challenges. Seven (1%) diagnostic errors were made including 6 false positives and 1 false negative: 1 laboratory made 3 errors, 1 made 2, and 2 made 1 each. Most errors and inconsistencies seemed due to inexperience with FISH. The working time to process and analyze slides singly averaged 49.5 minutes; slides processed in batches of 4 and analyzed singly required 36.9 minutes. We conclude that proficiency testing for FISH using an extensive array of challenges is possible and that multiple centers can collaborate to test probes and to evaluate costs.

Objective To assess the measurement of inactive urinary kallikrein (IUK) to creatinine (Cr) ratio (IUK:Cr) on an untimed urine sample, collected between 16 and 20 weeks of pregnancy, as a predictive test for the development of both proteinuric and nonproteinuric pre-eclampsia. Design A prospective longitudinal study. Setting A clinic for antenatal care and a university research department. Participants Three hundred and seven normotensive women randomly selected (124 nulliparous and 183 parous) attending the antenatal clinic for their booking visit. Main outcome measures 1. Nonproteinuric pre-eclampsia: a rise in diastolic blood pressure of 25 mmHg or more and a crossing of the threshold of 90 mmHg; 2. Proteinuric pre-eclampsia: same as 1. plus the development of significant proteinuria (> 1+ on urine dipstick). Results Thirty-seven women developed pre-eclampsia, 12 of whom had proteinuria. Median 1UK:Cr ratio in this group was 78.27, compared with 358.19 in the remainder. Analysis of receiver-operator characteristics gave an area under the curve of 0803. An IUK:Cr ratio of 170 or less in this study predicted nonproteinuric or proteinuric pre-eclampsia with a sensitivity of 70% and a specificity of 86%. Ten of the twelve women who had proteinuria had an 1UK:Cr below 170. Median 1UK:Cr for those with proteinuric pre-eclampsia was 72.91. Conclusions Measurement of 1 UK: Cr on a urine sample, collected between 16 and 20 weeks of gestation, represents a simple and practical test for the risk of subsequent pre-eclampsia, with a sensitivity and specificity comparable to those reported by other investigators using the widely recognised, but less practical, angiotensin I1 sensitivity test.

We present a large review of 446 cases of paracentric inversions (PAI), including 120 new cases, to assess their incidence, distribution, inheritance, modes of ascertainment, interchromosomal effects, viable recombinant offspring, and clinical relevance. All 23 autosomes and sex chromosomes had inversions. However, none were identified in chromosome arms 18p, 19q, 20q, and Yp. PAI were most commonly reported in chromosomes 1, 3, 5, 6, 7, 11, and 14 and less frequently in chromosomes 4, 16, 17, 18, 19, 20, 21, 22, and Y. Inversions were most common in chromosome arms 6p, 7q, 11q, and 14q and observed least in chromosome arms 2p, 2q, 3q, 4q, and 6q. Frequently encountered breakpoints included 3(p13p25), 6(p12p23), 6(p12p25), 7(q11q22), and 11(q21q23). Ascertainment was primarily incidental (54.5%), mental retardation and/or congenital anomalies (22.2%), spontaneous abortions (11.4%), associations with syndromes (3.0%), and infertility (2.0%) accounted for the remainder. Ascertainment was neither related to the length of the inverted segment nor to specific inversions except for PAI of Xq which often presented with manifestations of Ullrich-Turner syndrome. Sixty-six percent of PAI were inherited while 8.5% were de novo. Recombination was observed in 17 cases, 15 of which resulted in a monocentric chromosomal deletion or duplication. No common factors were identified that suggested a tendency towards recombination. The incidence of viable recombinants was estimated to be 3.8%. This review documents that PAI are perhaps more commonly identified than suggested in previous reviews. Despite the possible bias of ascertainment in some cases, there may be associated risks with PAI that require further examination. Our data suggest that PAI carriers do not appear to be free of risks of abnormalities or abnormal progeny and caution is recommended when counseling.

Infection with herpes simplex virus (HSV) is a common worldwide problem. Primary infection with HSV-1 rarely causes significant problems although widespread involvement in atopic eczema can be life-threatening as may associated encephalitis. Keratoconjunctivitis, pharyngitis and hepatitis can also complicate primary infection. Twenty to 40% of the population at some stage have recurrent orolabial infections with HSV although in only 1% of these cases is this recurrence severe. Recurrent erythema multiforme appears to be associated with HSV-65% of patients are thought to have preceding herpes labialis. Many primary and recurrent infections with HSV-1 require little more than topical antiseptic therapy to control secondary infection. Systemic acyclovir, however, is indicated in various situations including complicated primary infection, infection in neonates, eczema herpeticum, HSV infections in the immunocompromised, and recurrent erythema multiforme. In the latter, prophylactic treatment with 6 months acyclovir appears to be effective.

A case of congenital acute lymphoblastic leukemia (ALL) displayed an X;6 translocation. This is the third reported case of ALL with an X;6 translocation. In addition, two of the three ALL cases occurred during infancy, at ages 2 months and newborn, and both translocations involved the band q15-16 region of chromosome 6. Anomalies of the long arm of chromosome 6, mainly interstitial and terminal deletions, have been reported as a recurrent karyotypic event in a significant number of ALL cases. The molecular basis and propensity of an X;6 rearrangement in this case of congenital ALL is unclear and merits further investigation. The similarities in this case and the other infant ALL case cited suggest that an X;6 rearrangement with a breakpoint in bands q15-16 of chromosome 6 is characteristic of a form of congenital ALL.

Saccharomyces cerevisiae cells treated by high voltage and made transformation-competent (electroporation) are also made hyper-recombinational as determined by an assay that measures interchromosomal mitotic recombination between chromosome III homologs, each containing mutant heteroallelic copies of the trp1 and his3 genes. There is a 10-fold stimulation of Trp+ and 21-fold stimulation of His+ prototrophs. Although this stimulation coincides with conditions for maximal transformation competence it is independent of the presence of transforming plasmid DNA. Electroporation does not increase the reversion frequency of these mutations, nor is there a stimulation in Ty transposition. Among the electroporation-stimulated Trp+ and His+ recombinants there is no dramatic difference in the pattern of events: that is to say that, while there is an increase in the number of recombinants, the distribution of gene conversion and cross-over events among the stimulated recombinants is not significantly altered compared to spontaneously arising Trp+ and His+ recombinants. This electroporation-stimulated recombination is abolished in an isogenic rad52 mutant strain consistent with the increase in Trp+ and His+ prototrophs being the result of a stimulation of a RAD52-dependent recombination pathway.

We describe a premature male infant with an interstitial deletion of 7q [46,XY,del(7) (pter----q21.3::q31.3----qter]. Manifestations include absence of lower limbs, unilateral ectrodactyly, facial anomalies, gingival hyperplasia, feeding problems, and atrial septal defect. Chromosome 7 deletions of the q21.3----q31.3 region are reviewed with emphasis on limb anomalies.

Methods: Patients with singleton pregnancies at term in the second stage of labor underwent serial sonographic examination. Obstetric management was decided on the basis of the clinical examinations. Results: Seventy-six patients (59 para 0) were enrolled. Of those that were delivered vaginally, 14 had a posterior occiput and were excluded from the analysis. In the remaining cases, serial examination revealed the passage of the fetal occiput below the symphysis in 36/44. In the infrapubic scan this resulted in a typical image (Figure 1). Vaginal examination performed at the time of this observation demonstrated in all these cases a station >+3 cms and a rotation

F. Manning1,3, M. Geary2, F. McAuliffe6,11, J. Higgins9,12, J. Morrison8,13, S. Daly5, J. Doran7,14, G. Burke10, S. Higgins4, F. Malone3,2 1Perinatal Ireland, Dublin, Ireland; 2Fetal Assessment, Rotunda Hospital, Dublin, Ireland; 3Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland; 4Fetal Assessment, Our Lady of Lourdes Hospital, Drogheda, Ireland; 5Fetal Assessment, Coombe Womens & Infants University Hospital, Dublin, Ireland; 6Fetal Assessment, National Maternity Hospital, Dublin, Ireland; 7Fetal Assessment, Royal Jubilee Maternity Hospital, Belfast, United Kingdom; 8Fetal Assessment, University College Hospital, Galway, Ireland; 9Fetal Assessment, Cork University Maternity Hospital, Cork, Ireland; 10Fetal Assessment, Mid Western Regional Maternity Hospital, Limerick, Ireland; 11Obstetrics & Gynaecology, University College Dublin, Dublin, Ireland; 12Obstetrics & Gynaecology, University College Cork, Cork, Ireland; 13Obstetrics & Gynaecology, University College Galway, Galway, Ireland; 14Obstetrics & Gynaecology, Queens University, Belfast, United Kingdom

Pichia pastoris is a methylotrophic yeast and can be used as a heterologous expression system. This microorganism is as easy to manipulate as Escherichia coli, but has many of the advantages of eukaryotic expression (e.g., protein processing, folding, and post-translational modifications), and it is faster, easier, and cheaper to use than other eukaryotic expression systems, such as baculovirus or mammalian tissue culture. It also generally yields higher expression levels. This overview discusses important considerations for the use of Pichia pastoris, including strains for expression, expression plasmids, transformation by integration, and post-translational modifications. Examples of expression are given and finally, legal issues regarding patent rights for heterologous protein expression in Pichia pastoris are described.

Cystic hygromas are considered a form of vascular malformations of the lymphatic system, with an estimated incidence of 1 in 12,000 births (Fonkalsrud). They are fluid-filled sacs consisting of single or multiple cysts, that result from a blockage in the lymphatic system, mostly at the neck. They occur in approximately 1% of fetuses and have a high mortality rate when diagnosed prior to 30 weeks, because they can progress to hydrops and fetal death, or evolve to webbed neck, edema and lymphangioma. They may be an isolated finding or part of a syndrome such as Turner, Noonan and some trissomies. The success of the pregnancy depends on several factors, and the birth is a critical moment for the life of the patient. Primigesta, young Eastern European women, where a left cystic cervical hygroma was detected at 27 weeks of gestation in routine ultrasound. A medical interruption of pregnancy was proposed but refused and the pregnancy was carried out until full term. A thorough study was performed, with ultrasound scans and MRI, and no other congenital anomalies detected. Delivery was by a planned cesarean at full term, with Apgar scores 9 and 10 at first and five minutes, respectively, and the weight, height and head circumference were appropriate for gestational age. As shown by previous imaging studies, there was a clear airway and neither respiratory distress nor trouble feeding was observed. The karyotype was 46, XY and on day 16, he had surgical removal of the hygroma, which occurred without incidents. This case exemplifies the difficulty of pre-natal diagnosis and advising parents of a potential deadly condition. Even though this case was a surgical success, pre-natal findings of cystic hygroma are generally associated with a poor prognosis, especially when diagnosed prior to 30 weeks. The MRI assisted us in the decision taking process by reassuring a non-obstructed airway and normal fetal anatomy.

Objectives: The aim of this study was to obtain left ejection fraction (LEF) from fetal heart using four-dimensional ultrasound (4DUS) and spatio-temporal image correlation (STIC) in late middle pregnancy. Methods: 4D volumes of the fetal heart were acquired by sonography using a convex transabdominal transducer (RAB 4–8-MHz probe, Voluson 730 Expert, GE Medical Systems, Milwaukee, WI, USA) and the offline analysis was performed using 4DView software. Ventricular volumes were measured using STIC in 265 normal singleton pregnancies at 20 to 34+6 weeks’ gestation. By Virtual Organ Computer-aided AnaLysis (VOCAL) technique, left ventricular volume were obtained after a 30 degrees rotation around a fixed axis extending from the apex of the heart to the point that divides symmetrically mitral valve. The inner contour of left ventricle was drawn manually and the 4D volumes in end systole (ESV) and end diastole (EDV) were estimated. Stroke volume (SV) is calculated by formula SV = EDV−ESV and finally EF is obtain by the ratio between SV and EDV, by formula: EF = SV/EDV. Results: Based on frequency distribution of LEF according to gestational age, we built nomograms for 5, 10, 50, 90 and 95 centiles (Table 1). Linear regression equation provided the best fit for EF (Figure 2); LEF = 0.904 − 0.007. GA (r = 0.075, P < 0.001). Conclusions: Despite advancing gestational age, LEF remained stared stable.

An acute abdomen is a common diagnostic problem for physicians. A case is presented in which a Filshie clip had undergone torsion resulting in the presentation of an acute abdomen. This unusual complication should be considered in patients who present with abdominal pain following laparoscopic sterilization using Filshie clips.

Sir, read with interest the paper by Girling et al. (Vol 104, February 1997)’. We wish to provide some extra data and comment on the results for gamma glutamyl transferase (GGT). Previous work has suggested that GGT activity levels are increased in pre-eclampsia and that this increase is independent of other biochemical markers of hapatic damage2. To assess whether GGT could be an early preclinical marker of pre-eclampsia we measured serum levels of GGT in 985 healthy primigravidae between 18 and 24 weeks of gestation (these women had all been recruited for a study on the predictive value of 24-hour ambulatory blood pressure m~nitoring)~. Women were classified according to their subsequent pregnancy outcome into three groups; normotensive, pre-eclamptic or gestational hypertensive. After logarithmic transformation the data for GGT was normally distributed. ANOVA analysis showed no significant effect due to outcome on GGT levels (P = 0.20) (Table 1). GGT levels appear not to be an early preclinical marker of subsequent hypertension in pregnancy. It is noteworthy that our normal pregnancy range (3-24) is not nearly as wide as the range reported by Girling et al. (543). We wonder whether this difference reflects the size of our study in that it is less likely to be effected by a small number of high outliers or an ethnic difference. (all our women were Caucasian). Alcohol consumption is another possible confounder of these results. In our study 336 women (34%) admitted to consuming alcohol during pregnancy. Among these women there was a statistically significant positive correlation between their GGT levels and the number of units of alcohol consumed per week (P < 0.001). However the R2 value was only 4.9% suggesting that alcohol consumption contributes to only a very small proportion of the variability of GGT levels. In conclusion, we strongly endorse the view of Girling ef al. that pregnancy specific reference ranges should be available for all liver hction tests. As our results illustrate, these should be based on large longitudinal studies performed separately for each hospital laboratory. In the interim, we hope the data we have presented will be useful to others.

Malignant cells from 49 children with lymphoid neoplasms other than Hodgkin disease were evaluated by surface marker and morphologic studies. We classified the patients into three groups: 36 patients (74%) with acute lymphocytic leukemia; 7 (14%) classified as convoluted lymphocytic lymphoma/leukemia; and 6 (12%) with small noncleaved follicular center cell lymphoma/leukemia. Diffuse marrow involvement was present at diagnosis in some patients in the latter two groups, but their clinical course was not characteristic of the patients with acute lymphocytic leukemia. Male predominance, poor prognosis, and high incidence of central nervous system disease characterized patients in the convoluted lymphocytic and follicular center cell lymphoma/leukemia groups. Clinical presentation in these two groups differed. Proliferations of convoluted lymphocytes were associated with mediastinal masses and proliferations of follicular center cells with intraabdominal tumors. The high incidence of CNS disease in children with neoplasms of convoluted lymphocytes and follicular center cells suggests that these processes have a predilection for the CNS and that patients with them may benefit from CNS prophylaxis.