Chromosomal microarray analysis versus noninvasive prenatal testing in fetuses with increased nuchal translucency.

OBJECTIVE: To evaluate if the NT value of 2.5 mm ≤ NT < 3.0 mm is an appropriate indication for CMA tests among fetuses with isolated increased NT and NIPT is more suitable instead. METHODS: A total of 442 fetuses with NT ≥ 2.5 mm were included, in which 241 fetuses underwent karyotype. CMA tests were then carried out when cytogenic analysis showed normal chromosomes and CNV status was compared between 2.5 mm ≤ NT < 3.0 mm and ≥3.0 mm subgroups. For the NIPT evaluation, 201 of 442 fetuses with smaller increased NT (2.5 mm ≤ NT < 3.0 mm) was examined by either NIPT or karyotype. RESULTS: Of the 241 fetuses with NT ≥ 2.5 mm, 47(19.50%) were identified by karyotype with chromosomal abnormalities. Among 194 cases with normal karyotype, CMA unraveled additional CNVs in 16(8.25%) cases, including 3(1.55%) pathogenic CNVs, 2(1.03%) likely pathogenic CNVs and 11(5.67%) VOUS. After the subgroup analysis, however, only one case (1.16%) of likely pathogenic was identified by CMA among 86 fetuses with NT between 2.5 mm and 3.0 mm, whereas the rest of 15 CNV cases were all presented in fetuses with NT ≥ 3.0 mm. For the NIPT evaluation, the detection rate of 201 fetuses with isolated increased NT between 2.5 and 3.0 mm was 3.98%, which was indifferent to karyotype with the rate of 5%. In comparison with fetuses with 2.5-3.0 mm combined with other risks, the detection rate of karyotype was 26.92%. CONCLUSION: While no pathogenic CNVs were detected in fetuses, chromosomal aneuploidies and genomic imbalance were found to be the major type of abnormalities when NT was 2.5-3.0 mm. Therefore, our data suggested that CMA should not be recommended when fetuses with an NT value less than 3.0 mm. Instead, NIPT with similar rate of detection as karyotype was recommended for fetuses with isolated increased NT between 2.5 and 3.0 mm.

Identification of minor chromosomal defects causing abnormal foetus and spontaneous abortions.

BACKGROUND: Chromosomal abnormalities are the most common cause of recurrent abortions and miscarriages (RAM), but micro-variations on chromosomes causing RAM have never been previously studied. Single nucleotide polymorphisms (SNPs) are the single nucleotide variations frequently present at genome with the density of at least one common (>20% allele frequency) SNP per kilobase pair. It has already been reported that SNP array examination for chromosomal abnormalities has better performance than the conventional cytogenetic karyotyping. METHODS: We applied SNP array to detect the chromosomal defects in 80 placental villi and foetal tissues of abnormal foetus and spontaneous abortions. RESULTS: The analyses of data revealed that total 52.5% (42/80) cases were found to have chromosomal abnormalities. The trisomies were most commonly found 26/42 (61.9%) in current samples. Total 8/42 (19.1%) cases were found to have other structural aberrations including translocations in 2/8 (25%), duplications and deletions in 3/8 (37.5%) cases, respectively. SNP analysis also successfully detected triploidy 69,XXX and tetraploidy 92,XXXY. Total 12/80 cases were performed by cytogenetic karyotyping and results were compared with SNP data. Total 5/12 (41.7%) cases were found to have same findings with SNP data while results of 2/12 (16.7%) cases had partial similarity between both techniques. Four cases were declared as karyotypically normal (46,XY or 46,XX) by cytogenetic examination, but later on these four cases were found to have small chromosomal variation which could be the cause of RAM in women. CONCLUSION: Therefore, we conclude that use of a high-density SNP platform in diagnosis can give better understanding of molecular causes of pregnancy loss and foetal abnormalities.

Value of noninvasive prenatal testing in the detection of rare fetal autosomal abnormalities.

OBJECTIVES: To evaluate the value of noninvasive prenatal testing (NIPT) in the screening of rare autosomal abnormalities and provide further support for the clinical application of NIPT. STUDY DESIGN: A total of 81,518 pregnant women who underwent NIPT at the Anhui Maternal and Child Health Hospital between May 2018 and March 2022 were selected. The high-risk samples were analyzed using amniotic fluid karyotype and chromosome microarray analysis (CMA), and the pregnancy outcomes were followed up. RESULTS: NIPT detected 292 cases (0.36%) with rare autosomal abnormalities among the 81,518 cases sampled. Of these, 140 (0.17%) showed rare autosomal trisomies (RATs), and 102 of these patients agreed to undergo invasive testing. Five cases were true positives, with a positive predictive value (PPV) of 4.90%. Copy number variants (CNV) were detected in 152 samples of the total cases (0.19%), and 95 of the patients involved agreed to the use of CMA. Twenty-nine of these cases were confirmed to be true positive, with a PPV of 30.53%. Detailed follow-up information was obtained in 81 cases from 97 patients with false-positive results for RATs. Thirty-seven of these cases (45.68%) had adverse perinatal outcomes, with a higher incidence of small for gestational age (SGA), intrauterine growth retardation (IUGR), and preterm birth (PTB). CONCLUSIONS: NIPT is not recommended for screening for RATs. However, considering that positive results are associated with an increased risk of IUGR and PTB, additional fetal ultrasound examination should be performed to monitor fetal growth. In addition, NIPT has a reference value in screening for CNVs, especially pathogenic CNVs, but a comprehensive analysis of prenatal diagnosis combined with ultrasound and family history is still needed.

Iron phosphonate for highly efficient capture of U(VI) from acidic solution.

In this study, a novel, high surface area iron phosphonate (IP) for highly efficient adsorption of uranyl ion in acidic medium was described. The as-prepared IP was amorphous with its specific surface area and total pore volume as high as 268 m2/g and 1.04 cm3/g, respectively. Particularly, the as-prepared IP with ferrous ions and oxygen, nitrogen-bearing functional groups prove excellent U(VI) adsorption capacity (154.6 mg/g) as compared to that of amorphous FePO4 (67.3 mg/g) and Fe3(PO4)2(H2O)8 (33.8 mg/g). Surprising, the saturation adsorption capacity could achieve up to 353.9 mg/g. Besides, the IP also had a fast adsorption rate for attaining adsorption equilibrium within 20 min, and followed pseudo-second-order kinetic and Freundlich models. Moreover, both the Dubinin-Radushkevich isotherm adsorption model and the value of enthalpy indicated a chemisorption process. Otherwise, the Na+-independent U(VI) adsorption on IP and the adsorption-desorption isotherm studies revealed that inner-layer surface complexation is the control step for U(VI) adsorption process, and the adsorbent featured an irreversible adsorption process. The structure and functional groups of the adsorbent remained unchanged after capture of U(VI). Further, X-ray photoelectron spectra (XPS) analysis demonstrated that the capture mechanism of U(VI) on IP from acidic aqueous solution was due to not only redox reaction, but also ascribed to the coordinated chemical adsorption.

Clinical application of noninvasive prenatal testing in the detection of fetal chromosomal diseases.

OBJECTIVE: To assess the detection efficiency of noninvasive prenatal testing (NIPT) for fetal autosomal aneuploidy, sex chromosome aneuploidy (SCA), other chromosome aneuploidy, copy number variation (CNV), and to provide further data for clinical application of NIPT. MATERIALS AND METHODS: 25,517 pregnant women who underwent NIPT testing in Anhui Province Maternity and Child Health Hospital from September 2019 to September 2020 were selected, and samples with high-risk test results were subjected to karyotype analysis for comparison by using amniotic fluid, with some samples subjected to further validation by chromosomal microarray analysis, and followed up for pregnancy outcome. RESULTS: A total of 25,517 pregnant women who received NIPT, 25,502 cases were tested successfully, and 294 high-risk samples (1.15%) were detected, there were 96 true positive samples, 117 false positive samples and 81 cases were refused further diagnosis. Samples with high risk of autosomal aneuploidy were detected in 71 cases (0.28%), and 51 cases were confirmed, including: trisomy 21 (T21) in 44 cases, trisomy 18 (T18) in 5 cases, and trisomy 13 (T13) in 2 cases; the positive predictive value (PPV) was 91.67%, 45.45%, and 33.33%, respectively, and the negative predictive value was 100%, the false positive rate (FPR) was 0.02%, 0.02%, and 0.02%, respectively.13 samples with high risk of mosaic trisomies 21, 18, and 13 were detected, and 1 case of T21mos was confirmed with a PPV of 8.33%. Samples with high risk of SCA were detected in 72 cases (0.28%), and the diagnosis was confirmed in 23 cases, with a PPV of 41.07% and a FPR of 0.13%. These included 3 cases of 45,X, 6 cases of 47,XXY, 8 cases of 47,XXX and 6 cases of 47,XYY, with PPVs of 12.00%, 50.00%, 72.73%, and 75.00%, respectively, and false-positive rates of 0.09%, 0.02%, 0.01% and 0.01% respectively. Samples with high risk of CNV were detected in 104 cases (0.41%) and confirmed in 18 cases, with a PPV of 32.14% and a FPR of 0.15%. Samples with high risk of other chromosomal aneuploidy were detected in 34 cases (0.13%), and the diagnosis was confirmed in 3 cases, which were T2, T9, and T16 respectively. The overall PPV for other chromosome aneuploidy was 12.50%, with a FPR of 0.08%. CONCLUSION: NIPT is indicated for trisomies 21, 18 and 13 screening, especially for T21. It also has some certain reference value for SCA and CNV, but is not recommended for screening of other chromosomal aneuploidy.

Noninvasive prenatal testing for assessing foetal sex chromosome aneuploidy: a retrospective study of 45,773 cases.

OBJECTIVE: To assess the positive predictive value (PPV) of noninvasive prenatal testing (NIPT) as a screening test for sex chromosome aneuploidy (SCA) with different maternal characteristics and prenatal decisions in positive cases. MATERIALS AND METHODS: We retrospectively analysed 45,773 singleton pregnancies with different characteristics that were subjected to NIPT in the Maternity and Child Health Hospital of Anhui Province. The results were validated by karyotyping. Clinical data, diagnostic results, and data on pregnancy outcomes were collected. RESULTS: In total, 314 cases were SCA positive by NIPT; among those, 143 underwent invasive prenatal diagnostic testing, and 58 were true-positive. Overall, the PPVs for 45,X, 47,XXX, 47,XXY and 47,XYY were 12.5%, 51.72%, 66.67% and 83.33%, respectively. Interestingly, when only pregnant women of advanced maternal age (AMA) were screened, the PPVs for 45,X, 47,XXX, 47,XXY and 47,XYY were 23.81%, 53.33%, 78.95%, and 66.67%, respectively. The frequency of SCA was significantly higher in the AMA group than in the non-AMA group. The frequencies of 47,XXX and 47,XXY were significantly correlated with maternal age. CONCLUSION: NIPT performed better in predicting sex chromosome trisomies than monosomy X, and patients with 45,X positive foetuses were more eager to terminate pregnancy than those with 47,XXX and 47,XYY. AMA may be a risk factor of having a foetus with SCA. Our findings may assist in genetic counselling of AMA pregnant women. Our pre- and posttest counselling are essential for familiarizing pregnant women with the benefits and limitations of NIPT, which may ease their anxiety and enable them to make informed choices for further diagnosis and pregnancy decisions.

Expanding the application of non-invasive prenatal testing in the detection of foetal chromosomal copy number variations.

PURPOSE: The aim of this study was to assess the detection efficiency and clinical application value of non-invasive prenatal testing (NIPT) for foetal copy number variants (CNVs) in clinical samples from 39,002 prospective cases. METHODS: A total of 39,002 pregnant women who received NIPT by next-generation sequencing (NGS) with a sequencing depth of 6 M reads in our centre from January 2018 to April 2020 were enrolled. Chromosomal microarray analysis (CMA) was further used to diagnose suspected chromosomal aneuploidies and chromosomal microdeletion/microduplication for consistency assessment. RESULTS: A total of 473 pregnancies (1.213%) were positive for clinically significant foetal chromosome abnormalities by NIPT. This group comprised 99 trisomy 21 (T21, 0.254%), 30 trisomy 18 (T18, 0.077%), 25 trisomy 13 (T13, 0.064%), 155 sex chromosome aneuploidy (SCA, 0.398%), 69 rare trisomy (0.177%), and 95 microdeletion/microduplication syndrome (MMS, 0.244%) cases. Based on follow-up tests, the positive predictive values (PPVs) for the T21, T18, T13, SCA, rare trisomy, and MMS cases were calculated to be 88.89%, 53.33%, 20.00%, 40.22%, 4.88%, and 49.02%, respectively. In addition, the PPVs of CNVs of < 5 Mb, 5-10 Mb, and > 10 Mb were 54.55%, 38.46%, and 40.00%, respectively. Among the 95 cases with suspected CNVs, 25 were diagnosed as true positive and 26 cases as false positive; follow-up prenatal diagnosis by CMA was not performed for 44 cases. Moreover, among the 25 true positive cases, 10 were pathogenic, 3 were likely pathogenic, and 12 were of uncertain significance. CONCLUSION: NIPT is not only suitable for screening T21, T18, T13, and SCA but also has potential significance for CNV detection. As combined with ultrasound, extended NIPT is effective for screening MMS. However, NIPT should not be recommended for whole-chromosome aneuploidy screening.

Performance of non-invasive prenatal testing for foetal chromosomal abnormalities in 1048 twin pregnancies.

OBJECTIVE: To investigate the clinical value of non-invasive prenatal testing (NIPT) to screen for chromosomal abnormalities in twin pregnancies and to provide further data on NIPT manifestations in twin pregnancies. MATERIALS AND METHODS: In a 4-year period, 1048 women with twin pregnancies were voluntarily prospectively tested by NIPT to screen for chromosomal abnormalities by sequencing cell-free foetal DNA (cffDNA) in maternal plasma. Positive NIPT results were confirmed by karyotyping, while negative results were followed up 42 days after delivery. RESULTS: Thirteen women had positive NIPT results as follows: 2 cases of trisomy 21 (T21), 1 of trisomy 18 (T18), 7 of sex chromosome aneuploidy (SCA), 1 of microdeletion, and 2 of microduplication. Of these 13 cases, 2 were true-positive cases confirmed by foetal karyotype analysis, namely, 1 case of T21 and 1 of microdeletion. Furthermore, the remaining 11 high-risk pregnant women were confirmed as false positive by foetal karyotyping. Thus, the combined positive predictive value (PPV) of NIPT screening for chromosomal abnormalities in twin pregnancies was 15.4% (2/13). There were no false-negative case via our follow-up results. CONCLUSION: Safe and rapid NIPT has a certain clinical application value; however, the PPV is limited, and the screening efficiency is not stable. Careful use should be made in the screening of chromosomal abnormalities in twin pregnancies.

Quantitative Study on Solubility Parameters and Related Thermodynamic Parameters of PVA with Different Alcoholysis Degrees.

In recent years, inverse gas chromatography (IGC) and molecular dynamics simulation methods have been used to characterize the solubility parameters and surface parameters of polymers, which can provide quantitative reference for the further study of the surface and interface compatibility of polymer components in the future. In this paper, the solubility parameters and surface parameters of two kinds of common alcoholysis, PVA88 and PVA99, are studied by using the IGC method. The accuracy of the solubility parameters obtained by the IGC experiment is verified by molecular dynamics simulation. On the basis of this, the influence of repeated units of polyvinyl alcohol (PVA) on solubility parameters is studied, so as to determine the appropriate chain length of the PVA for simulation verification calculation. The results show that the solubility parameters are not much different when the PVA chain length is 30 and above; the numerical trends of the solubility parameters of PVA88 and PVA99 at room temperature are the same as the results of molecular dynamics simulation; the dispersive surface energy γsd and the specific surface energy γssp are scattered with the temperature distribution and have a small dependence on temperature. On the whole, the surface energy of PVA99 with a higher alcoholysis degree is higher than that of PVA88 with a lower alcoholysis degree. The surface specific adsorption free energy (ΔGsp) indicates that both PVA88 and PVA99 are amphoteric meta-acid materials, and the acidity of PVA99 is stronger.

Whole Exome Sequencing Identifies a Novel Mutation in the PITX3 Gene, Causing Autosomal Dominant Congenital Cataracts in a Chinese Family.

BACKGROUND: Congenital cataract is the cloudiness of the eye's natural lens and is a primary cause of congenital vision loss. It accounts for almost 10% of childhood vision loss worldwide. METHODS: A four generation Chinese family having seven affected individuals was recruited for the current study. Exome sequencing was performed to identify the genetic cause of congenital cataract. RESULTS: Analysis of data identified a novel frameshift mutation, c.608delC (p.A203fs), in the PITX3 gene. This mutation was only observed in the affected individuals while the unaffected members of the family as well as 100 ethnically matched normal controls did not contain this deletion. CONCLUSION: These findings suggest that p.A203fs is the cause of cataracts in the recruited family. This information would be further helpful in the genetic diagnosis of cataract and in the genetic counseling of similar patients.

Pharyngeal wall floppiness: a novel technique to detect upper airway collapsibility in patients with OSAS.

OBJECTIVE: To measure pharyngeal wall floppiness (PWF) under different pressures, a novel method and technique were introduced in the present study. STUDY DESIGN: A prospective clinical study. SUBJECTS AND METHODS: Forty-seven healthy subjects (32 male; mean age, 37.9 years) and 49 patients with obstructive sleep apnea syndrome (OSAS) (46 male; mean age, 41.45 years) were recruited. The pharyngeal cavity volume was measured by acoustic reflection under positive (10 cm H2O) and negative (-10 cm H2O) pressures. The pharyngeal cavity volume was detected from the segment of 10 to 20 cm from the incisor. Moreover, PWF was calculated from the difference of pharyngeal cavity volumes under positive and negative pressures divided by the sum of the volumes under positive and negative pressures. The measurements were conducted on a group of 7 subjects weekly over 3 consecutive weeks to evaluate test-retest variability. RESULTS: The mean PWF was 0.19 ± 0.11 in healthy subjects and 0.24 ± 0.07 in the OSAS group, with a significant difference (P < .01). There was moderate positive correlation between PWF and age or body mass index in healthy subjects. In the 7 subjects, the mean measured interclass correlation coefficient was 0.9 (P < .05) in 3 consecutive weekly measurements. CONCLUSION: The OSAS population had greater PWF compared to healthy subjects. The age dependency of PWF in healthy subjects implied which might play important roles in the development of OSAS. This noninvasive and reproducible technique might be a useful tool in OSAS clinical applications.

[Analyses of clinical features and efficacy of sudden deafness with vertigo and dizziness].

OBJECTIVE: To investigate the clinical characteristics and the effect of drug treatment for sudden hearing loss with vertigo or dizziness. METHODS: In a prospective, randomized, single blinded randomized multicenter clinical study, patients with sudden deafness, ranging in age from 18 to 65 years old, with a duration less than 2 weeks, and with no any medical treatments were collected. In accordance with the hearing curve, those patients were divided into four types, i.e., low and intermediate frequency descent type; high frequency descent type; fall flat type; and total deafness type. Each type was treated by four different treatment options, according to the unified design of the random table, and randomly selected one of the options for treatment. The efficacy of the patients with sudden deafness with vertigo and dizziness was analyzed statistically after the follow-up for 4 weeks. SPSS 13.0 software was used to analyze the data. RESULTS: In August 2007 to October 2011, 33 hospitals in the country included 1 024 patients with sudden deafness in line with the inclusion criteria, of whom 296 (28.91%) were accompanied by vertigo/dizziness symptoms, 126 were males and 170 were females, with an average age of (41.2 ± 13.5) years old. types of the different audiometric curves of sudden deafness, the occurrence of complete deafness with vertigo/dizziness was the highest (44.93%), followed by flat down type (25.87%), high frequency descent type (21.28%) and low intermediate frequency descent type (18.54%). After the standard treatment, the vertigo and dizziness symptoms of the sudden deafness patients could disappear, and the hearing in each group was obviously improved. The hearing curative effect on patients accompanied by vertigo/dizziness of low frequency and intermediate frequency descent type was the best, and the total efficiency can reach up to 94.74%, with the cure rate of 68.42%; followed by flat type, in which the total effective rate was 80.76%, with the recovery rate of 22.12%; and the effects on patients in high frequency descent type and total deafness type effect were relatively poor, in which the total effective rates were 70.00% (recovery rate of 10.00%) and 65.32% (recovery rate of 5.65%), respectively. The total effective rate of patients with sudden deafness associated with halo had no statistical significance (P > 0.05), in comparison to that of patients without halo; but, the cure rate of patients with no vertigo/dizziness of total deafness and the high frequency decreased patients with sudden deafness was significantly higher than that of vertigo/dizziness patients, with a statistical difference (P < 0.05). CONCLUSIONS: The patients with sudden deafness in each type have a certain proportion of vertigo/dizziness, especially the deaf type. The possibility of hearing complete recovery in patients with vertigo/dizziness was significantly lower than that without vertigo/dizziness.