Introdução: As trissomias 18 (T18) e Trissomia 13 (T13) são respectivamente a segunda e terceira causa mais comum de aneuploidias, com um aumento no diagnóstico dado o desenvolvimento de métodos e protocolos que incluem rastreio ecográfico e bioquímico, com a possibilidade de realizar um diagnóstico pré-natal a partir da realização de cariótipo fetal. São síndromes polimalformativas graves, potencialmente letais, associadas a uma alta taxa de aborto espontâneo, morte intrauterina e uma vida pós-natal curta, com morte neonatal precoce. O presente estudo visa descrever e analisar a história natural destas trissomias em um país onde não há previsão legal para interrupção terapêutica para estes casos. Objetivos Analisar e descrever a história natural das gestações com diagnóstico pré-natal de trissomia 13 e trissomia 18, identificadas através da realização de amniocentese para obtenção de cariótipo, que foram realizadas entre outubro de 1994 até outubro de 2017 no Serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre e acompanhadas pelo grupo de Medicina Fetal, e assim comparar os dados encontrados nesta casuística local com a literatura atual a respeito do tema. Métodos: Realizado análise dos prontuários das pacientes que realizaram cariótipo fetal através de amniocentese, e fizeram diagnóstico pré-natal de trissomia 13 ou trissomia 18.Quando incompletos, foram realizadas ligações telefônicas para completá-los. A partir dos dados coletados (demográficos, ecográficos, curso da gestação) foram avaliados os possíveis desfechos fetais (abortamento espontâneo, óbito fetal e nascido vivo), descrevendo a sua história natural, e considerando principalmente a sobrevida dos nativivos. Análise estatística usando SPSS versão 18.0. Resultados: Quarenta e duas pacientes foram incluídas, sendo 13 (31%) T13 e 29 (69%) T18. Todos os casos fizeram cariótipo para diagnóstico pré-natal através de amniocentese. 92,9% das pacientes foram encaminhadas devido a malformações detectadas em ecografia. Na avaliação das malformações, encontrou-se que a identificação de fenda labial e/ou palatina (p 0,008), dilatação pielocalicial (p 0,037) e holoprosencefalia (p <0,0001) foram achados ecográficos com significância estatística freqüentes em T13. A taxa de abortamento foi de 9% para T18, enquanto não houve casos em T13. Óbito fetal aconteceu em 46% e 52% dos casos para T13 e T18 respectivamente. A taxa de nascidos vivos foi de 54% para T13, sendo que a mediana de sobrevida foi de um dia (IC95% -33,55-90,40). 71% dos casos morreram nas primeiras 24 horas e dois casos que ultrapassaram a primeira semana de vida: com 14 dias e 180 dias respectivamente. Para T18 a mediana de sobrevida foi de dois dias [IC95% -1,89-13,17]. Cinco casos (45%) faleceram dentro das primeiras 24 horas. Outros 45% morreram na primeira semana de vida. Um caso (10%) ultrapassou o primeiro mês de vida, com sobrevida de 39 dias. Nenhum caso em ambas as trissomias ultrapassou o primeiro ano de vida. Conclusões: Os resultados deste estudo são consistentes com os referenciados na literatura acerca do diagnóstico de T13 e T18, quando realizado no pré-natal. A presença de malformações em ecografia foi o que mais motivou o encaminhamento para o atendimento especializado e realização de procedimentos diagnósticos, sendo identificados alguns achados característicos que podem aumentar a suspeita diagnóstica, quando detectados no exame ultrassonográfico, principalmente para trissomia 13, como são a defeitos de línea media e dilatação pielocalicial. Além disso, foi possível confirmar as características de síndrome polimalformativa potencialmente letal, destas trissomias quando avaliada a história natural, caracterizando-se por uma taxa alta de morte fetal intra-uterina e com uma sobrevida global curta ao nascimento. Este estudo também proporcionará informações importantes para definir condutas e protocolos de manejo e acompanhamento a serem executadas por equipes multidisciplinares treinadas, que permitam adequados processos de aconselhamento pré-concepcional e genético, e assim facilitar a tomada de decisões pela paciente gestante, seu parceiro e a família. Além disso, proporcionará informações que permitam reavaliar as políticas em saúde coletiva, abrindo a discussão sobre se deve também ser considerada a interrupção terapêutica da gestação em casos de trissomia 13 e trissomia 18 a partir do desejo dos pais e da autorização judicial. / Introduction: Trisomy 18 (T18) and Trisomy 13 (T13) are respectively the second and third most common cause of aneuploidies, with an increase in diagnosis given the development of methods and protocols that include ultrasound and biochemical screening, with the possibility of performing a prenatal diagnosis from the fetal karyotype. These are a serious, potentially lethal polymalformative syndromes associated with a high rate of spontaneous abortion, intrauterine death and short postnatal life with early neonatal death. The present study aims to describe and analyze the natural history of these trisomies in a country where there is no consider a legal provision for therapeutic interruption in these cases. Objectives To analyze and describe the natural history of pregnancies with prenatal diagnosis of trisomy 13 and trisomy 18, identified through amniocentesis to obtain a fetal karyotype, which were performed between October 1994 and October 2017 at the Gynecology and Obstetrics Service of Hospital de Clínicas de Porto Alegre and accompanied by the Fetal Medicine Group, and thus compare the data found in this local casuistry with the current literature on the subject. Methods: Analyzed the medical records of patients who performed a fetal karyotype, through amniocentesis, for prenatal diagnosis of trisomy 13 or trisomy 18. When incomplete, telephone calls were made to complete them. The possible fetal outcomes (spontaneous abortion, fetal death and live birth), describing their natural history, and considering mainly the survival of the 16 children were born alive. Data about each patient was collected and organized (demographic, ultrasound, gestation course) in order to do a secondary analysis. Statistical analysis using SPSS version 18.0. Results: Forty-two patients were included, being 13 (31%) T13 and 29 (69%) T18. All cases had a fetal karyotype for prenatal diagnosis through amniocentesis. 92.9% of the patients were referred due to malformations detected on ultrasound. In the malformations assessment, it was found that the identification of cleft lip and / or palate (p 0.008), pyelocalycial dilatation (p 0.037) and holoprosencephaly (p <0.0001) were frequent echographic findings in T13. The abortion rate was 9% for T18, while there were no cases in T13. Fetal death occurred in 46% and 52% of cases for T13 and T18 respectively. The rate of live births was 54% for T13, and the median survival was one day [95% CI - 33.55-90.40]. 71% of the cases died in the first 24 hours and two cases that exceeded the first week of life: 14 days and 180 days respectively. For T18 the median survival was 2 days [95% CI -1.89-13.17]. Five cases (45%) died within the first 24 hours. Another 45% died in the first week. One case (10%) exceeded the month of life, with a survival of 39 days. No case in both trisomies has exceeded the year of life. Conclusions The results of this study are consistent with those referenced in the literature on the diagnosis of T13 and T18, when performed in the prenatal period. The presence of malformations in ultrasound was the most motivated the referral to specialized care and diagnostic procedures, being identified some characteristic findings that can increase the diagnostic suspicion, when detected in the ultrasound examination, mainly for trisomy 13, as they are defects of midline and pyelocalycial dilatation. In addition, it was possible to confirm the characteristics of a potentially lethal polymalformative syndrome of these trisomies when evaluated its natural history, characterized by a high rate of intrauterine fetal death and short overall survival at birth. This study will also provide important information to define management and follow-up procedures and protocols to be carried out by trained multidisciplinary teams that allow adequate preconceptional and genetic counseling processes, and thus facilitate decision making by the pregnant patient, her partner and the family. In addition, it will provide information to reassess collective health policies, opening the discussion on whether to also consider the therapeutic interruption of gestation in cases of trisomy 13 and trisomy 18, based on parental desire and judicial authorization.

Introdução: As trissomias 18 (T18) e Trissomia 13 (T13) são respectivamente a segunda e terceira causa mais comum de aneuploidias, com um aumento no diagnóstico dado o desenvolvimento de métodos e protocolos que incluem rastreio ecográfico e bioquímico, com a possibilidade de realizar um diagnóstico pré-natal a partir da realização de cariótipo fetal. São síndromes polimalformativas graves, potencialmente letais, associadas a uma alta taxa de aborto espontâneo, morte intrauterina e uma vida pós-natal curta, com morte neonatal precoce. O presente estudo visa descrever e analisar a história natural destas trissomias em um país onde não há previsão legal para interrupção terapêutica para estes casos. Objetivos Analisar e descrever a história natural das gestações com diagnóstico pré-natal de trissomia 13 e trissomia 18, identificadas através da realização de amniocentese para obtenção de cariótipo, que foram realizadas entre outubro de 1994 até outubro de 2017 no Serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre e acompanhadas pelo grupo de Medicina Fetal, e assim comparar os dados encontrados nesta casuística local com a literatura atual a respeito do tema. Métodos: Realizado análise dos prontuários das pacientes que realizaram cariótipo fetal através de amniocentese, e fizeram diagnóstico pré-natal de trissomia 13 ou trissomia 18.Quando incompletos, foram realizadas ligações telefônicas para completá-los. A partir dos dados coletados (demográficos, ecográficos, curso da gestação) foram avaliados os possíveis desfechos fetais (abortamento espontâneo, óbito fetal e nascido vivo), descrevendo a sua história natural, e considerando principalmente a sobrevida dos nativivos. Análise estatística usando SPSS versão 18.0. Resultados: Quarenta e duas pacientes foram incluídas, sendo 13 (31%) T13 e 29 (69%) T18. Todos os casos fizeram cariótipo para diagnóstico pré-natal através de amniocentese. 92,9% das pacientes foram encaminhadas devido a malformações detectadas em ecografia. Na avaliação das malformações, encontrou-se que a identificação de fenda labial e/ou palatina (p 0,008), dilatação pielocalicial (p 0,037) e holoprosencefalia (p <0,0001) foram achados ecográficos com significância estatística freqüentes em T13. A taxa de abortamento foi de 9% para T18, enquanto não houve casos em T13. Óbito fetal aconteceu em 46% e 52% dos casos para T13 e T18 respectivamente. A taxa de nascidos vivos foi de 54% para T13, sendo que a mediana de sobrevida foi de um dia (IC95% -33,55-90,40). 71% dos casos morreram nas primeiras 24 horas e dois casos que ultrapassaram a primeira semana de vida: com 14 dias e 180 dias respectivamente. Para T18 a mediana de sobrevida foi de dois dias [IC95% -1,89-13,17]. Cinco casos (45%) faleceram dentro das primeiras 24 horas. Outros 45% morreram na primeira semana de vida. Um caso (10%) ultrapassou o primeiro mês de vida, com sobrevida de 39 dias. Nenhum caso em ambas as trissomias ultrapassou o primeiro ano de vida. Conclusões: Os resultados deste estudo são consistentes com os referenciados na literatura acerca do diagnóstico de T13 e T18, quando realizado no pré-natal. A presença de malformações em ecografia foi o que mais motivou o encaminhamento para o atendimento especializado e realização de procedimentos diagnósticos, sendo identificados alguns achados característicos que podem aumentar a suspeita diagnóstica, quando detectados no exame ultrassonográfico, principalmente para trissomia 13, como são a defeitos de línea media e dilatação pielocalicial. Além disso, foi possível confirmar as características de síndrome polimalformativa potencialmente letal, destas trissomias quando avaliada a história natural, caracterizando-se por uma taxa alta de morte fetal intra-uterina e com uma sobrevida global curta ao nascimento. Este estudo também proporcionará informações importantes para definir condutas e protocolos de manejo e acompanhamento a serem executadas por equipes multidisciplinares treinadas, que permitam adequados processos de aconselhamento pré-concepcional e genético, e assim facilitar a tomada de decisões pela paciente gestante, seu parceiro e a família. Além disso, proporcionará informações que permitam reavaliar as políticas em saúde coletiva, abrindo a discussão sobre se deve também ser considerada a interrupção terapêutica da gestação em casos de trissomia 13 e trissomia 18 a partir do desejo dos pais e da autorização judicial. / Introduction: Trisomy 18 (T18) and Trisomy 13 (T13) are respectively the second and third most common cause of aneuploidies, with an increase in diagnosis given the development of methods and protocols that include ultrasound and biochemical screening, with the possibility of performing a prenatal diagnosis from the fetal karyotype. These are a serious, potentially lethal polymalformative syndromes associated with a high rate of spontaneous abortion, intrauterine death and short postnatal life with early neonatal death. The present study aims to describe and analyze the natural history of these trisomies in a country where there is no consider a legal provision for therapeutic interruption in these cases. Objectives To analyze and describe the natural history of pregnancies with prenatal diagnosis of trisomy 13 and trisomy 18, identified through amniocentesis to obtain a fetal karyotype, which were performed between October 1994 and October 2017 at the Gynecology and Obstetrics Service of Hospital de Clínicas de Porto Alegre and accompanied by the Fetal Medicine Group, and thus compare the data found in this local casuistry with the current literature on the subject. Methods: Analyzed the medical records of patients who performed a fetal karyotype, through amniocentesis, for prenatal diagnosis of trisomy 13 or trisomy 18. When incomplete, telephone calls were made to complete them. The possible fetal outcomes (spontaneous abortion, fetal death and live birth), describing their natural history, and considering mainly the survival of the 16 children were born alive. Data about each patient was collected and organized (demographic, ultrasound, gestation course) in order to do a secondary analysis. Statistical analysis using SPSS version 18.0. Results: Forty-two patients were included, being 13 (31%) T13 and 29 (69%) T18. All cases had a fetal karyotype for prenatal diagnosis through amniocentesis. 92.9% of the patients were referred due to malformations detected on ultrasound. In the malformations assessment, it was found that the identification of cleft lip and / or palate (p 0.008), pyelocalycial dilatation (p 0.037) and holoprosencephaly (p <0.0001) were frequent echographic findings in T13. The abortion rate was 9% for T18, while there were no cases in T13. Fetal death occurred in 46% and 52% of cases for T13 and T18 respectively. The rate of live births was 54% for T13, and the median survival was one day [95% CI - 33.55-90.40]. 71% of the cases died in the first 24 hours and two cases that exceeded the first week of life: 14 days and 180 days respectively. For T18 the median survival was 2 days [95% CI -1.89-13.17]. Five cases (45%) died within the first 24 hours. Another 45% died in the first week. One case (10%) exceeded the month of life, with a survival of 39 days. No case in both trisomies has exceeded the year of life. Conclusions The results of this study are consistent with those referenced in the literature on the diagnosis of T13 and T18, when performed in the prenatal period. The presence of malformations in ultrasound was the most motivated the referral to specialized care and diagnostic procedures, being identified some characteristic findings that can increase the diagnostic suspicion, when detected in the ultrasound examination, mainly for trisomy 13, as they are defects of midline and pyelocalycial dilatation. In addition, it was possible to confirm the characteristics of a potentially lethal polymalformative syndrome of these trisomies when evaluated its natural history, characterized by a high rate of intrauterine fetal death and short overall survival at birth. This study will also provide important information to define management and follow-up procedures and protocols to be carried out by trained multidisciplinary teams that allow adequate preconceptional and genetic counseling processes, and thus facilitate decision making by the pregnant patient, her partner and the family. In addition, it will provide information to reassess collective health policies, opening the discussion on whether to also consider the therapeutic interruption of gestation in cases of trisomy 13 and trisomy 18, based on parental desire and judicial authorization.

Background: Talipes equinovarus, also termed club foot, is a congenital deformity of the ankle joint. Despite its prevalence of approximately 1 per 1000 live births, fetal talipes is relatively poorly studied since the introduction of percutaneous tendo Achilles tenotomies. Objectives: To document the associations, outcomes and prognosis of patients with antenatally diagnosed fetal talipes. The study aims to examine the association between, and prevalence of, fetal talipes and other abnormalities, structural and chromosomal, as well as the outcome in relation to postnatal surgery. The accuracy of prenatal ultrasound in diagnosing fetal talipes is also examined. Methods: A retrospective observational study was made of all cases presenting to the Fetal Medicine Unit between 1 January 2009 and 31 December 2014. All the identified cases were analysed to identify isolated talipes, associated abnormalities, and chromosomal abnormalities. The pregnancy outcomes were determined using the Astraia database as well as maternity records. When the outcome resulted in a live infant, these infants were followed up using the files at the referral hospital to determine the treatment method used and the number requiring surgery. Results: There were 155 cases, all referred to the Fetal Medicine Unit. Antenatal data included 75 who had other structural abnormalities and 75 who had isolated talipes. In five of the cases were no sufficient data could be found. Twenty-five cases were lost to follow-up, and 12 cases had no clubfoot at birth. Only one was labelled as having positional clubfoot. There were 91 live births. Of the cases of talipes with associated abnormalities, 21.19% were live births (excluding ENND). All terminations of pregnancy as well as 90.9% of intrauterine fetal deaths were complex talipes, and 94.52% of the cases of isolated talipes were live births. The most common associated abnormalities were of the central nervous system. Seventeen of the live births were lost to follow-up. Of the cases of isolated talipes, 53.19% had tenotomies and Ponseti treatment. The false positive rate of detecting fetal talipes on ultrasound was 7.74%. Conclusion: The study made it evident that complex talipes is associated with a poor pregnancy outcome defined as pregnancy loss, where isolated talipes is usually associated with a good pregnancy outcome. Ultrasound is a good diagnostic tool when diagnosing talipes antenatally but cannot diagnose the severity of the clubfoot. False negatives were not studied. The introduction of tenotomy can make a difference in the outcome of clubfoot in comparison with previous studies where tenotomies were not performed. Medical professionals need to address the importance of counselling, and a multidisciplinary team should be involved in cases involving prenatal counselling.

Phenotypic effects and transmission rates of the extra chromosome in interspecific trisomics of Cucurbita moschata cv. Butternut (2n C. moschata + 1 C. palmata chromosome) were compared with those of a primary trisomic of C. moschata. Based on gross morphological similarities, 17 interspecific trisomic lines were placed in six phenotypic groups, suggesting that six different C. palmata chromosomes were recovered. Fruit from one of the interspecific trisomics exhibited the hard rind of C. palmata, indicating that this is a dominant trait carried on one chromosome. Some phenotypic effects of the extra chromosome were similar in both the interspecific and primary trisomics, showing a chromosomal effect due to genic imbalance. Transmission of the extra chromosome through the female ranged from 15% to 32% for the C. palmata chromosomes, and was 44% in the primary trisomic. None of the extra chromosomes were transmitted through the male parent.

Submitted by (ana.araujo@ufrpe.br) on 2017-02-22T14:59:44Z No. of bitstreams: 1 Winston Jose Pessoa Felix.pdf: 3066003 bytes, checksum: e332581b7efc29ec2ebf2e0c4af9c437 (MD5) / Made available in DSpace on 2017-02-22T14:59:44Z (GMT). No. of bitstreams: 1 Winston Jose Pessoa Felix.pdf: 3066003 bytes, checksum: e332581b7efc29ec2ebf2e0c4af9c437 (MD5) Previous issue date: 2009-06-29 / The cytogenetic characteristics and CMA / DAPI band patterns in seven species of Zephyranthes and a Habranthus were studied in this paper to evaluate the karyotypic differences between these species. All individuals presented reticulated or semi-reticulated interphased nuclei and karyotype formed by a set of metacentric chromosomes, in addition to submetacentric and acrocentric chromosomes. Zephyranthes robusta, with 2n = 12 and karyotypic formula 4M +2 SM presented more symmetrical karyotype. Z. sylvatica showed chromosome complement composed of 2n = 12 being 1M+5SM, 2n = 13 being 1M+5SM + (B) SM and 2n = 18 formed by cracks, one with metacentric and five with only submetacentric (1M+5SM). For the cultivated species Zephyranthes rosea Lindl. presented karyotype with 2n = 24 and karyotypic formula 4M+7SM +1A. Zephyranthes grandiflora Lindl. presented the same chromosome count of the previous species, being observed 2M +5 SM +5 A. Zephyranthes aff. rosea Lindl. presented 2n = 25, being 3M + (1M "crack") +7 SM +1 A. Furthermore, it was observed the presence of trisomy in fourth metacentric pair. Zephyranthes brachyandra Herb. presented karyotype with 2n = 24 +1 B and formula 4M +3 SM +5 A +1 B. In Zephyranthes candida Herb. 2n = 38 was observed with 9M +5 SM +5 A. For H. itaobinus Ravenna, a numeric variation in the counts was observed, where in most populations the additional chromosomes were formed by 2n = 45 or 5M +12 SM +5 A + (B) M and in a single population the species showed presented karyotype with 2n = 44, 6M +12 SM +5 A +3 (B)M. Interstitial and subterminal DAPI bands were observed only in Z. robusta and Z. brachyandra. The remaining species showed no AT-rich heterochromatin. In species with 2n = 12 was found a CMA+ block in a chromosome pair of Z. robust and Zephyranthes sp., while in Z. sylvatica was observed a small additional terminal block. Z. rosea and Z. grandiflora had four CMA+ bands, while there were eight interstitial pinpoint bands, apart from the heterochromatic RON and a bigger block in the terminal of the short arm of B chromosome in Z. brachyandra. In Z. candida, there were 14 subterminal CMA bands and in H. itaobinus, seven bands with strong differentiated amplification in the heterochromatic RON. Taxonomic implications and the karyotypic evolution are discussed for the species studied. / No presente trabalho foram estudados a caracterização citogenética e os padrões de banda CMA/DAPI em sete espécies de Zephyranthes e uma de Habranthus com o objetivo de avaliar as diferenças cariotípicas entre essas espécies. Todos os indivíduos apresentaram núcleo interfásico reticulado ou semi-reticulado e cariótipo formado por um conjunto de cromossomos metacêntricos, além de cromossomos submetacêntricos e acrocêntricos. Zephyranthes robusta, com 2n=12 e fórmula cariotípica 4M+2SM, apresentou cariótipo mais simétrico. Z. sylvatica apresentou complemento cromossômico formado por 2n=12 sendo 1M+5SM, 2n=13 sendo 1M+5SM+(B)SM e 2n=18 formadas por trincas, uma com metacêntricos e cinco apenas com submetacêntricos (1M+5SM). Para as espécies cultivadas, Zephyranthes rosea Lindl. Apresentou cariótipo com 2n=24 e fórmula cariotípica 4M+7SM+1A. Zephyranthes grandiflora Lindl. apresentou a mesma contagem cromossômica da espécie anterior, sendo que foram observados 2M+5SM+5A. Zephyranthes aff. rosea Lindl., apresentou 2n=25, sendo 3M+(1M“trinca”) +7SM+1A. Além disso, pôde-se observar a presença de trissomia no par quatro metacêntrico. Zephyranthes brachyandra Herb. apresentou cariótipo com 2n=24+1B e fórmula 4M+3SM+5A+1B. Para Zephyranthes candida Herb. observou-se 2n=38, sendo 9M+5SM+5A. Em H. itaobinus Ravena observou-se variação numérica nas contagens onde na maioria das populações os complementos cromossômicos foram formados por 2n=45 ou 5M+12SM+5A+(B)M e em uma única população a espécie apresentou cariótipo com 2n=44, 6M+12SM+5A+3(B)M. Foram observadas bandas DAPI subterminais e intersticiais apenas em Z. robusta e em Z. brachyandra. As demais espécies não apresentaram heterocromatina rica em AT. Nas espécies com 2n=12 foi observado um bloco CMA+ em um par cromossômico de Z. robusta e Zephyranthes sp., enquanto em Z. sylvatica foi observado um pequeno bloco terminal adicional. Z. rosea e Z. grandiflora, tiveram quatro bandas CMA+, enquanto em Z. brachyandra, ocorreram oito bandas intersticiais puntiformes, além da RON heterocromática e de um bloco maior no terminal do braço curto do cromossomo B. Em Z. candida, observouse 14 bandas CMA subterminais e em H. itaobinus, sete bandas, com forte amplificação diferenciada na RON heterocromática. São discutidas as implicações taxonômicas e a evolução cariotípica para as espécies estudadas.

Bakgrund: Efterfrågan på tidig fosterdiagnostik har ökat bland blivande föräldrar. KUB är den vanligast förekommande fosterdiagnostiska metoden men är inte diagnostiserande utan kalkylerar en sannolikhet för huruvida trisomi 13, 18 eller 21 föreligger. Detta är kvinnorna inte alltid medvetna om, varför förberedelse och noggrann information är viktigt. Denna studie utfördes därmed för att belysa kvinnors upplevelser relaterat till genomfört KUB. Syfte: Att beskriva kvinnors upplevelser relaterat till genomfört KUB. Metod: Kvalitativ innehållsanalys med induktiv ansats användes. 10 trådar från Internetforumet Familjeliv.se och 12 bloggar hittades under datainsamlingen och låg till grund för dataanalys. Resultat: Analysen mynnade ut ett sammanfattande tema: KUB ses som en möjlighet att bekräfta graviditeten men leder till varierande känslor som barnmorskor måste stödja på ett förtroendefullt sätt. De mest framträdande känslorna som beskrevs relaterat till KUB var oro och rädsla. Barnmorskor upplevdes inte ge det stöd som behövdes. Konklusion: KUB ses som ett sätt att bekräfta graviditeten. För att minska oron behöver barnmorskor ge individanpassad information till kvinnorna. Kvinnors oro relaterat till KUB tenderar att grumla graviditeten och kvarstå lång tid framöver. / Background: The demand on prenatal diagnosis increases among expecting parents. CUB is the most common method for the matter but doesn’t provide any diagnosis. CUB only calculates the probability of a fetus with trisomy 13, 18 or 21. Women aren’t always aware of this. Hence, careful preparations and information are necessary. This study was performed to enhance knowledge in women’s experiences in relation to have undergone CUB. Aim: To describe women’s experiences related to having undergone CUB. Method: A qualitative content analysis with an inductive approach was used. Internet was used for data collection. This collection resulted in 10 threads from bulletin board Familjeliv.se and 12 blogs which became the base for data analysis. Result: The analysis resulted in one theme: CUB is seen as an opportunity to confirm the pregnancy but leads to mixed feelings which the midwives need to support in a trustful way. Anxiety and fear are the most common emotions mentioned among women who have undergone CUB. Women felt that midwives didn’t always provide enough information or the requested information. The encounters with midwives during CUB were described as stressful and even unpleasant. Conclusion: CUB is seen as an early way to confirm the pregnancy. To reduce the anxiety, midwives need to give individualised information. Anxiety tends to obscure the pregnancy and remain a long time.

Childhood acute leukemias are genetically complex disorders, with recurrent or random aberrations found in most patients. Their proper functional characterization is crucial for understanding the role they play in the process of leukemogenesis. We aimed to identify and characterize the genetic background of two leukemic entities. The transient myeloproliferative disorder (TMD) is a preleukemic condition that occurs in 10% of newborns with Down syndrome. Trisomy 21 together with in-utero gained mutations in the GATA1 gene are essential in TMD and represent an ideal "multi-hit" model to study leukemogenesis. We investigated an alternative pathogenic mechanism enabling TMD development in a confirmed absence of trisomy 21. Novel deletions in the GATA1 and JAK1 genes were described as potential drivers of this TMD. The deletion D65_C228 in GATA1 results in the expression of an aberrant isoform, which is predicted to lose transactivation potential and, more importantly, to partially lose the ability of recognizing physiological DNA binding sites, possibly triggering TMD alone. Our thorough characterization of JAK1 F636del questions its role in TMD development. Analysis of JAK/STAT signaling suggested decrease of kinase activity upon F636 loss. Cells harboring the aberrant JAK1 did not obtain cytokine-...

Maintenance of gene dosage is important for proper cellular function and development, as evidenced by the natural silencing of one X-chromosome in mammalian females, and by the embryonic lethality of most autosomal aneuploidy. A notable exception is Down syndrome (DS), which occurs in 1/700 newborns. It has been known for 50+ years that DS is caused by trisomy for chromosome 21 (chr21), yet biological understanding remains wanting; even what cell types and pathways are impacted by chr21 dosage has remained unclear. Given the complexity of DS, better experimental approaches have been needed. This thesis advances understanding of DS pathobiology using an innovative approach that translates the X-inactivation mechanism via the XIST gene, to an inducible system to “silence trisomy” in DS patient-derived iPSCs and their differentiated derivatives. I investigated the most immediate and direct effects of silencing trisomy on mRNAs genome-wide. Initial studies revealed trisomy 21 (T21) impairs early developmental pathways for two major cell type processes: neurogenesis and, surprisingly, angiogenesis. Further analysis of endothelial cells showed chr21 overexpression reduces pathways relating to cell migration, projection, and signaling, and functional assays showed delayed response to angiogenic cues causing a deficit in microvessel formation. The previously unknown cell-autonomous effect of T21 on angiogenesis has broad significance for systems impacted, including brain and heart development, and comorbidities throughout life such as early-onset Alzheimer’s disease. This work also has implications for understanding of dosage sensitivity and genome balance, a fundamental but poorly understood aspect of genome biology.

Bakgrund: Down Syndrom (DS) är den kromosomavvikelsen som är vanligast i Sverige. Kännetecken ses vid födseln. Barn med DS löper stor risk att få somatiska problem. Screening används för att undersöka kromosomavvikelser hos fostret och kan skapa etiska dilemman mellan vårdpersonal och föräldrar. Sjuksköterskan arbetssätt var holistiskt, det hjälper föräldrarna att få en fungerande framtid.  Syfte: Syftet med denna studie var att beskriva föräldrars erfarenheter av att leva med barn som har Down Syndrom. Metod: En beskrivande litteraturstudie, där de bibliografiska databaserna PubMed och Cinahl användes för att hitta artiklar. 11 artiklar inkluderades i litteraturstudien. Fem teman identifierades: (1) Ändrade livssituationer utifrån barnens specifika omsorgsbehov, (2) Föräldrars utveckling och påverkan, (3) Känslor gällande barnets framtid, (4) Social acceptans, (5) Kontakt med hälso- och sjukvården. Huvudresultat: Resultatet påvisade föräldrarnas ändrade livssituationer utifrån barnet med DS omsorgsbehov. Utmaningarna föräldrar ställdes inför visade en personlig utveckling och påverkan på livssituationen. Resultatet visade en oro inför barnets framtid och vuxenliv. Föräldrarnas erfarenheter av social acceptans gentemot barn med DS var varierande likväl erfarenheterna av kontakten med hälso-och sjukvården utifrån barnets diagnos. Slutsats: Liknande oroskänslor kring framtiden för barnen med DS är genomgående i studierna. Problemet är bristen på kunskap och forskning i sjukvården gällande diagnosen DS och påverkan på familjen. Bristfällig information och stöd ökade föräldrarnas stress. Det krävs fortsatt forskning kring ämnet DS och hur en sjuksköterska ska bemöta föräldrar vid olika möten. Genom god kunskap inom ämnet kan en sjuksköterska hjälpa familjer att leva sitt liv så normalt som möjligt / Background: Down syndrome (DS) is the most common chromosome disorder in Sweden. Characteristics is seen at birth. Children with DS have increased risk to develop somatic problems. Screening is used to examine chromosomal abnormalities in the fetus and this can cause ethical dilemmas between healthcare personnel and parents. Nurses work with a holistically approach, it helps parents to have a functional future. Purpose:  The purpose of this study was to describe parents' lived experience of living with a child that has the diagnosis Down syndrome. Method: A descriptive literature review with a thematic design. The bibliographic databases PubMed and Cinahl were used to find articles. 11 articles were included in the study. Five themes were identified: (1) Changed life situations on the child's specific need of care, (2) Parents’ growth and impact, (3) Emotions regarding the child's future, (4) Social acceptance, (5) Contact with healthcare services. Main result: The studies show that parents have had to change their life situations due to the child's caring need. The challenges that parents are faced with showed a personal growth and affected them on a personal level. The result showed a concern for the children's future and adulthood. Parents experiences regarding social acceptance and the contact with healthcare against children with DS was varied. Conclusion: Similar concerns regarding the future for the children with DS is consistently seen all through the studies. The problem is the lack of knowledge and research within the healthcare system regarding DS and the effects it has on the family. Lackluster information and support. Inadequate information and support increased the parents stress levels. Further research regarding DS and how the nurse should treat parents in encounters with them is important. A nurse can through good knowledge help families live their lives as normal as possible.

Indiana University-Purdue University Indianapolis (IUPUI) / Down syndrome (DS) is a genetic disorder that results from triplication of human chromosome 21 (Hsa21) and occurs in around 1 in 1000 live births. All individuals with DS present with skeletal abnormalities typified by craniofacial features, short stature and low bone mineral density (BMD). Differences between males and females with DS suggest a sexual dimorphism in how trisomy affects skeletal deficits associated with trisomy 21 (Ts21). Previous investigations of skeletal abnormalities in DS have varied methodology, sample sizes and ages making the underlying causes of deficits uncertain. Mouse models of DS were used to characterize skeletal abnormalities, but the genetic and developmental origin remain unidentified. Over-expression Dyrk1a, found on Hsa21 and mouse chromosome 16 (Mmu16) has been linked to cognitive deficits and skeletal deficiencies. Dp1Tyb mice contain three copies of all of the genes on Mmu16 that are homologous to Hsa21, males and females are fertile, and therefore are an excellent model to test the hypothesis that gene dosage influences the sexual dimorphism of bone abnormalities in DS. Dp1Tyb at 6 weeks 16 weeks showed distinctive abnormalities in BMD, trabecular architecture, and reduced bone strength over time that occur generally through an interaction between sex and genotype. Increased gene dosage and sexual dimorphism in Dp1Tyb mice revealed distinct phenotypes in bone formation and resorption. To assess how Dyrk1a influences the activity and function of osteoblasts Ts65Dn female trisomic mice, female mice with a floxed Dyrk1a gene (Ts65Dn, Dyrk1afl/+) were be bred to Osx1-GFP::Cre+ mice to generate Ts65Dn animals with a reduced copy of Dyrk1a in mature osteoblast cells. Female Ts65Dn,Dyrk1a+/+/+ and Ts65Dn,Dyrk1a+/+/-displayed significant defects in both trabecular architecture and cortical geometry. Ultimate force was reduced in trisomic animals, suggesting whole bone and tissue level properties are not adversely affected by trisomy. Reduction of Dyrk1a functional copy number in female mice did not improve skeletal deficits in an otherwise trisomic animal. Dyrk1a may not alter osteoblast cellular activity in an autonomous manner in trisomic female mice. These data establish sex, gene dosage, skeletal site and age as important factors in skeletal development of the skeleton in DS mice, potentially paving the way for identification of the causal dosage-sensitive genes in both male and female animals.