Background: This study assesses the effects of the \'Radiant\' image enhancement technique on fetal nuchal translucency (NT) measurements during first-trimester sonographic exams. Methods: A retrospective analysis of 263 ultrasound images of first-trimester midsagittal sections was conducted. NT measurements were obtained using a semi-automatic tool. Statistical methods were applied to compare NT measurements with and without \'Radiant\' enhancement. An in vitro setup with predefined line distances provided additional data. Results: Incremental increases in NT measurements were observed with varying levels of \'Radiant\' application: an average increase of 0.19 mm with \'Radiant min\', 0.24 mm with \'Radiant mid\', and 0.30 mm with \'Radiant max.\' The in vitro results supported these findings, showing consistent effects on line thickness and measurement accuracy, with the smallest mean deviation occurring at the \'Radiant mid\' setting. Conclusions: \'Radiant\' image enhancement leads to significant increases in NT measurements. To avoid systematic biases in clinical assessments, it is advisable to disable \'Radiant\' during NT measurement procedures. Further studies are necessary to corroborate these findings and to consider updates to the NT reference tables based on this technology.

Goal: FetSAM represents a cutting-edge deep learning model aimed at revolutionizing fetal head ultrasound segmentation, thereby elevating prenatal diagnostic precision. Methods: Utilizing a comprehensive dataset-the largest to date for fetal head metrics-FetSAM incorporates prompt-based learning. It distinguishes itself with a dual loss mechanism, combining Weighted DiceLoss and Weighted Lovasz Loss, optimized through AdamW and underscored by class weight adjustments for better segmentation balance. Performance benchmarks against prominent models such as U-Net, DeepLabV3, and Segformer highlight its efficacy. Results: FetSAM delivers unparalleled segmentation accuracy, demonstrated by a DSC of 0.90117, HD of 1.86484, and ASD of 0.46645. Conclusion: FetSAM sets a new benchmark in AI-enhanced prenatal ultrasound analysis, providing a robust, precise tool for clinical applications and pushing the envelope of prenatal care with its groundbreaking dataset and segmentation capabilities.

This study represents our second investigation into NIPT, involving a more extensive patient cohort with a specific emphasis on the high-risk group. The high-risk group was subsequently divided into two further groups to compare confirmed cases versus unconfirmed via direct methods. The methodology encompassed the analysis of 1400 consecutive cases from a single genetic center in western Romania, where NIPT was used to assess the risk of specific fetal chromosomal abnormalities. All high-risk cases underwent validation through direct analysis of fetal cells obtained via invasive methods, including chorionic villus sampling and amniocentesis. The confirmation process utilized QF-PCR, karyotyping, and SNP-Array methods customized to each case. Results: A high risk of aneuploidy at NIPT was identified in 36 out of 1400 (2.57%) cases and confirmed in 28 cases. The study also detected an increased risk for copy number variations (CNVs) in 1% of cases, confirmed in two instances involving one large microdeletion and one large microduplication. Trisomy 21 was the exclusive anomaly where NIPT confirmed all cases with identified risk. High-risk NIPT results which were not validated by invasive methods, were classified as false positives; parents in these cases determined to continue the pregnancy. In conclusion, NIPT can serve as a screening method for all pregnancies; however, in high-risk cases, an invasive confirmation test is strongly recommended.

Bevezetés: Az elmúlt évtized egyik jelentős technológiai újdonsága az ún. ’high-throughput’ molekuláris genetikai vizsgálati módszerek – mint a kromoszomális microarray-analízis (chromosomal microarray analysis, CMA) és a teljesexom-szekvenálás (whole-exome sequencing, WES) – elterjedése a praenatalis diagnosztikában. Célkitűzés: Az elmúlt 5 évben munkacsoportunk több mint 252 praenatalis vizsgálatot végzett hazai laboratóriumi háttérrel, amelyek indikációját különböző súlyosságú strukturális magzati ultrahangeltérések képezték. A klasszikus citogenetikai vizsgálatok eredményétől függően végeztük el a nagy felbontású CMA- és WES-analíziseket a praenatalis diagnosztika érdekében. Módszer: A CMA-vizsgálatokat a „GeneChip System 3000 Instrument” platformmal végeztük az SNP-alapú komparatív hibridizálás módszerével. Az általunk elvégzett újgenerációs szekvenálás során a teljes humán exom szekvenciájának meghatározása IonTorrent és Illumina platformokkal történt. Eredmények: Összesen 252 magzati CMA-vizsgálatot végeztünk, és 42%-ban mutattunk ki valamilyen hiányt vagy többletet, ebből 22%-ban igazoltunk kóros eltérést. 42 esetben végeztünk WES-t, amelyből 9 esetben (21,4%) azonosítottunk kóros eltérést az öröklésmenetet támogató, a magzati fenotípussal feltételezhetően összefüggésben lévő, a ClinVar adatbázis vagy az ACMG-klasszifikáció alapján. Megbeszélés: Tekintettel arra, hogy a magzati fenotípus értékelése közvetett, a praenatalis CMA- és WES-elemzésnek elsősorban a magzati ultrahangvizsgálat során azonosítható strukturális anomáliákkal összefüggő génekre, kromoszomális régiókra kell korlátozódnia. A szülők vizsgálata mind a CMA-, mind a WES-analízisek során kiemelt jelentőséggel bír, főleg azokban az esetekben, amelyeknél a kapott eltérés nem hozható egyértelmű összefüggésbe az ultrahangeltérésekkel. Következtetés: Fontos meghatározni azokat a paramétereket, amelyek alapján a magzati mintában talált kópiaszám-eltéréseket és WES-vizsgálattal igazolt variánsokat a leletben közöljük (figyelembe véve a nemzetközi ajánlásokat). Ezek alapján a praenatalis klinikai genetikai tanácsadáskor sokkal használhatóbb információk adhatók. Orv Hetil. 2024; 165(14): 523–530.

Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is an uncommon genetic disorder inherited in an autosomal recessive pattern that affects the muscles that line the bladder and intestines. The most common genes associated with MMIHS mutations are ACTG2, LMOD1, MYH11, MYL9, MYLK, and PDCL3. However, the complete genetic landscape of MMIHS still needs to be fully understood. The diagnosis of MMIHS can be challenging. However, advances in prenatal and diagnostic techniques, such as ultrasound and fetal urine analysis, have improved the ability to detect the syndrome early. Targeted next-generation sequencing (NGS) and other diagnostic tests can also diagnose MMIHS. The management of MMIHS involves addressing severe intestinal dysmotility, which often necessitates total parenteral nutrition (TPN), which can lead to complications such as hepatotoxicity and nutritional deficiencies. Multivisceral and intestinal transplantation has emerged as therapeutic options, offering the potential for improved outcomes and enteral autonomy. Understanding the genetic underpinnings of MMIHS is crucial for personalized care. While the prognosis varies, timely interventions and careful monitoring enhance patient outcomes. Genetic studies have given us valuable insights into the molecular mechanisms of MMIHS. These studies have identified mutations in genes involved in the development and function of smooth muscle cells. They have also shown that MMIHS is associated with defects in the signaling pathways that control muscle contraction. Continued research in the genetics of MMIHS holds promise for unraveling the complexities of MMIHS and improving the lives of affected individuals.

Miscarriages affect 50-70% of all conceptions and 15-20% of clinically recognized pregnancies. Recurrent pregnancy loss (RPL, ≥2 miscarriages) affects 1-5% of recognized pregnancies. Nevertheless, our knowledge about the etiologies and pathophysiology of RPL is incomplete, and thus, reliable diagnostic/preventive tools are not yet available. Here, we aimed to define the diagnostic value of three placental proteins for RPL: human chorionic gonadotropin free beta-subunit (free-β-hCG), pregnancy-associated plasma protein-A (PAPP-A), and placental growth factor (PlGF). Blood samples were collected from women with RPL (n = 14) and controls undergoing elective termination of pregnancy (n = 30) at the time of surgery. Maternal serum protein concentrations were measured by BRAHMS KRYPTOR Analyzer. Daily multiple of median (dMoM) values were calculated for gestational age-specific normalization. To obtain classifiers, logistic regression analysis was performed, and ROC curves were calculated. There were differences in changes of maternal serum protein concentrations with advancing healthy gestation. Between 6 and 13 weeks, women with RPL had lower concentrations and dMoMs of free β-hCG, PAPP-A, and PlGF than controls. PAPP-A dMoM had the best discriminative properties (AUC = 0.880). Between 9 and 13 weeks, discriminative properties of all protein dMoMs were excellent (free β-hCG: AUC = 0.975; PAPP-A: AUC = 0.998; PlGF: AUC = 0.924). In conclusion, free-β-hCG and PAPP-A are valuable biomarkers for RPL, especially between 9 and 13 weeks. Their decreased concentrations indicate the deterioration of placental functions, while lower PlGF levels indicate problems with placental angiogenesis after 9 weeks.

Introduction: Small supernumerary marker chromosomes (sSMCs) are infrequent findings in prenatal diagnostics, however they pose a great challenge for prenatal genetic counseling. Methods: We report prenatal 12 sSMC cases detected in a single center during 10 years period, their molecular characterization by fluorescence in situ hybridization (FISH) or chromosomal microarray (CMA). Those cases were found among 9620 prenatal diagnostic analyzes by GTG-banding technique. In selected cases, additional UPD testing was also done. Results: Incidence of sSMCs in our study was 0.12%. sSMC characterization was done by FISH in 9 cases, in the remainder of three CMA was employed. The most common sSMC shape was centric minute, followed by inverted duplication and one case with ring conformation. sSMCs originating from acrocentric chromosomes (chromosomes 14, 21 and 22), sex chromosomes (X, Y) and non-acrocentric autosomal chromosomes (chromosome 4 and 18) were confirmed in 3 cases each; no result could be obtained in 3 further cases. Discussion: No anomalies were detected by prenatal ultrasound in any of the cases. In 58% of the cases, outcome was reported as normal at birth, while anomalies at birth were described in one case. Only two patients opted for pregnancy termination. Preterm labor occurred in case of twin pregnancy resulting in stillbirth and early neonatal death of twins. Overall, our study highlights the importance of a sSMC characterization by molecular cytogenomic methods in order to make appropriate genotype-phenotype correlations and ensure adequate genetic counseling.

QF-PCR is a widely used molecular biology method. To name just a few of its uses, it is considered to be useful in paternity tests, identification tests or prenatal diagnostics. Therefore, there is a good chance that medical faculty students would come into contact with this technology - directly or indirectly - during their professional work. The following article proposes a teaching classes scenario conducted in the problem-based learning manner, which aims to familiarize students with the QF-PCR technique. In addition, other modern methods of molecular genetics are among topics that students can learn during the problem-based learning modules. The classes are divided into three parts. In the first part, students learn about the possible usage of QF-PCR in paternity tests. The second part focuses on learning about the advantages and limitations of QF-PCR in prenatal diagnosis. Learning activities in the last part are designed to show the limitations of the diagnostic properties of the method - students analyze the case study, in which QF-PCR must be replaced by other modern methods of molecular genetics. By analyzing three independent stories, students learn about usage, advantages and limitations of QF-PCR, and additionally gain knowledge in basic, pre-clinical and clinical sciences. This course is designated as an elective course for final year medical students who have completed either: a basic genetics course, a molecular genetics course, a biochemistry course or a molecular biology course. The focus of the classes is to draw students\' attention to the possible application and rapid development of molecular biology techniques, which is the base for modern therapeutic and diagnostic strategies.

Variants in TTN are associated with a broad range of clinical phenotypes, from dominant adult-onset dilated cardiomyopathy to recessive infantile-onset myopathy. However, few foetal cases have been reported for multiple reasons. Next-generation sequencing has facilitated the prenatal identification of a growing number of suspected titinopathy variants. We investigated six affected foetuses from three families, completed the intrauterine course of the serial phenotypic spectrum of TTN, and discussed the genotype-phenotype correlations from a broader perspective. The recognizable prenatal feature onset at the second trimester was started with reduced movement, then contracture 3-6 weeks later, followed with/without hydrops, finally at late pregnancy was accompanied with polyhydramnio (major) or oligohydramnios. Two cases with typical arthrogryposis-hydrops sequences identified a meta-only transcript variant c.36203-1G>T. Deleterious transcriptional consequences of the substitution were verified by minigene splicing analysis. Case 3 identified a homozygous splicing variant in the constitutively expressed Z-disc. It presented a milder phenotype than expected, which was presumably saved by the isoform of corons. A summary of the foetal-onset titinopathy cases implied that variants in TTN present with a series of signs and a spectrum of clinical severity, which followed the dosage/positional effect; the meta-only transcript allele involvement may be a prerequisite for the development of fatal hydrops.

This is an editorial focusing on the clinical perspective of a long-read sequencing method in the prenatal diagnosis of alpha- and beta-thalassemia, including a comparison between this method and standard PCR-based methods. Though incremental, the increased sensitivity and specificity using long-read sequencing is an important advantage of this methodology in the prenatal diagnostic arena due to false positive or false negative results having greater consequence when a family is making decisions about their pregnancy.