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Second-trimester screening for fetal abnormalities
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Jolene C. Muscat, Anthony M. Vintzileos
Alpha-fetoprotein (AFP) is a normal fetal protein found in high concentrations in the fetal serum. It is present in amniotic fluid in normal pregnancies, presumably reaching the fluid through excretion in the fetal urine. From the amniotic fluid, AFP diffuses across the fetal membranes and can be detected in the maternal serum beginning at approximately 12 weeks of gestation (2). In cases of fetal anencephaly or open spina bifida, increased levels of AFP reach the amniotic fluid secondary to the concentration gradient from fetal serum to amniotic fluid. This increased AFP concentration can then be detected in the maternal serum. Ventral wall defects (i.e., omphalocele or gastroschisis) can also result in similar elevations in MSAFP through this same mechanism. Other causes of elevated MSAFP are listed in Table 1.
Valproate
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
J. Christine Dean, J. Kiffin Penry
The most convincing studies documenting VPA as a teratogen are those of Elizabeth Robert (92) linking the occurrence of spina bifida with the use of VPA. Other congenital abnormalities such as cleft palate, renal agenesis, and facial dysmorphism have been linked with VPA used in combination with other AEDs. While there are no controlled studies documenting the absolute association of neural tube defects and spina bifida with VPA administration, published reports indicate that the association is higher for VPA than for the other AEDs. Neural tube defects have been observed when VPA was administered during the first trimester of pregnancy. The absolute risk of various neural tube defects is about 1 to 2% of all pregnant women on VPA (93). If a woman becomes pregnant while taking VPA, amniocentesis, alpha-fetal protein determination, and ultrasonography before the twentieth week of gestation to screen for the presence of a neural tube defect is indicated.
The Extracellular Matrix as a Substrate for Stem Cell Growth and Development and Tissue Repair
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Stephen F. Badylak, Mervin C. Yoder
Similarly, gene expression of alpha fetal protein (AFP) and apolipoprotein A-II are increased during differentiation of the endodermal cell lineage. ESC can be stimulated to form embryoid bodies with cells of all three germ cell layers by exposure to selected ECM factors and conditioned media. Stated differently, the ECM can be used as an indicator of progenitor cell differentiation events.
Percutaneous ablation of the tumor feeding artery for hypervascular hepatocellular carcinoma before tumor ablation
Published in International Journal of Hyperthermia, 2018
Zhong-yi Zhang, Jung-chieh Lee, Wei Yang, Kun Yan, Wei Wu, Yan-jie Wang, Min-hua Chen
The treatment response was evaluated using contrast-enhanced computed tomography (CECT) or magnetic resonance imaging (MRI) 1 month after the RFA procedure. CECT using the triple-phase technique includes arterial, portal and delay phases. The MRI protocol included at least T1-weighted imaging, T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced T1-weighted imaging. Then, the serum alpha-fetal protein (AFP) test, an abdominal ultrasound and a CECT or MRI were performed every 3 months for 2 years and every 6 months thereafter. Technique success was defined as no abnormal enhancement or washout within or around the ablation zone one month after the RFA. The ablation was considered a technique failure if abnormal enhancement was observed within or around the ablation zone one month after the RFA. A case with no abnormal enhancement found one month after the RFA but the development of abnormal enhancement washout around the ablation zone at follow-up was defined as local tumor progression. Identification of a new tumor in another region of the liver was defined as intrahepatic distant recurrence.
Steroid hormones and pregnancy
Published in Gynecological Endocrinology, 2019
Nancy Noyola-Martínez, Ali Halhali, David Barrera
On the other hand, T inhibits and stimulates significantly gene expression of the others cytochromes such as enzymes involved in the synthesis and degradation of calcitriol; CYP27B1 and CYP24A1, respectively, which results in decreased bioavailability of this important secosteroid during pregnancy [76], like seen in PE [77]. Furthermore, it has been suggested that exacerbated production of maternal androgens downregulates placental amino acid transporters expression which could be related with decreased fetal protein synthesis [78]. In addition to T, others factors (environment factors and endocrine or immunologic disruptors, Table 1) could potentially affect placental steroidogenesis and function in each one of these pregnancy complications, which deserves more investigation.
Cerebral hemorrhage as the initial manifestation in patients with systemic cancer
Published in International Journal of Neuroscience, 2018
Gelun Huang, Li Chen, Chao Qin, Daobin Cheng, Qiuhong Lu, Lixia Yu, Zhijian Liang
A total of 8,326 patients with cerebral hemorrhage were admitted to the stroke unit from January 2010 to December 2015. Only a group of 17 (0.02%) patients met the present study criteria (i.e. discovery of cancer and diagnosis followed after cerebral hemorrhage), including 11 men and 6 women. The mean age of the 17 patients was 53.65 ± 12.42 years (range: 36–76 years), with a median age of 55 years. Of the 17 patients, 14 patients did not have vascular risk factors, but the other 3 patients were found with conventional vascular risk factors (Table 1). All patients experienced a sudden onset of symptoms due to increased intracranial pressure, including some degree of headache and vomiting, as well as presentations of a focal neurological deficiency, such as body paralysis, numbness and slurred speech. The mean NIHSS score was 12.41 ± 7.25 (range: 3–22) on the day of hemorrhage, and all patients received a head CT scan shortly after the onset of symptoms in clinic or emergency, then underwent brain MRI scans including plain scan, enhancement scan, diffusion weighted and susceptibility weighted imaging to exclude brain primary/metastatic tumor, infection, amyloid angiopathy, cerebral infarction, intracranial venous sinus thrombosis, hemorrhagic conversion of cerebral infarction or intracranial venous sinus thrombosis and other complications of the central nervous system during hospitalization. From the susceptibility weighted imaging, signals indicating microbleeds were not found in all 17 patients. Hemorrhages were located in the lobes in five patients (29.4%) (Figure 1), the basal ganglia in six patients (35.3%), the thalamus in two patients (11.8%), the brainstem in three patients (17.6%) (Figure 2) and the cerebellum in one patient (5.9%) (Table 2). The CT and MRI reexamination confirmed cerebral hemorrhage by examining changes of the brain lesions and the signals matched hemorrhagic lesions over time without evidence of primary cancer or intracranial metastasis. After cerebral hemorrhage, cancer was diagnosed within seven days for eight patients and within two weeks for the other nine patients. At the time cancer was determined, metastasis was observed in 11 cancer patients (64.7%). The cancer subtypes included lung cancer (6/17, 35.3%), liver cancer (5/17, 29.4%), gastric carcinoma (5/17, 29.4%), rectal cancer (3/17, 17.6%) and melanoma (1/17, 5.9%) (Table 3). Based on the laboratory tests, most patients (11/17, 64.7%) displayed elevations in the plasma levels of one or more cancer biochemical markers (including cancer antigen (CA)125, CA153 and CA199, carcino-embryonic antigen, and alpha fetal protein). Fifteen patients (15/17, 88.23%) exhibited coagulopathy. Eight patients (47.1%) received cancer therapies, and the other nine patients (52.9%) rejected therapy. On the 30th day after cerebral hemorrhage, three patients (17.6%) were completely independent, with an mRS score of 0–1; three patients (17.6%) were partially independent, with an mRS score of 2–3; four patients (23.5%) were completely dependent, with an mRS score of 4–5; seven patients (41.1%) died, with an mRS score of 6.