Association between maternal oxygenation and brain growth in fetuses with left-sided cardiac obstructive lesions

OBJECTIVE

Impaired brain growth has been observed in fetuses with left-sided obstructive lesions (LSOL). Maternal oxygenation (MO) can alter fetal cerebral oxygenation and vascular reactivity. Our aim was to observe whether brain growth improves during MO in fetuses with LSOL.

METHODS

Forty-six fetuses with LSOL and 23 control fetuses were enrolled in this prospective longitudinal study. Fetuses with LSOL were subgrouped into those with MO (LSOL-MO, n = 23) and those without MO (LSOL-nMO, n = 23). Fetal head circumference (HC) and total intracranial volume (TIV) were evaluated serially at 4-week intervals. Brain biometry and growth were analyzed using linear mixed models adjusted for gestational age and sex. Spearman's correlation coefficients were calculated to identify baseline characteristics predictive of brain growth in the LSOL-MO group.

RESULTS

Duration of MO therapy had significant interaction effects on cerebral biometry in fetuses with LSOL. TIV increased more rapidly after 8 weeks of oxygen exposure and HC was larger after 16 weeks of oxygen exposure in the LSOL-MO group compared with the LSOL-nMO group (P < 0.001). The change in TIV at the final time- point relative to the initial timepoint in the LSOL-MO group correlated negatively with the baseline pulsatility index of the middle cerebral artery (r = -0.58, P = 0.003) and baseline myocardial performance index of the left ventricle (r = -0.68, P < 0.001).

CONCLUSIONS

TIV and HC increased faster in fetuses with LSOL which had MO compared with those that did not. Lower cerebral vascular resistance and preserved left heart function at baseline may predict greater cerebral biometric growth during MO. Additional research, including larger serial studies, is needed to confirm these preliminary findings and evaluate the clinical application of MO in this population. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Oncogene DEK is highly expressed in lung cancerous tissues and positively regulates cell proliferation as well as invasion

DEK is a protein ubiquitously expressed in multicellular organisms as well as certain unicellular organisms. It is associated with the regulation of cell proliferation, differentiation, migration, apoptosis, senescence, self-renewal and DNA repairing. In tumor cells it is associated with the carcinogenesis process, however there have been few previous studies into the expression of DEK in lung cancer. In the present study the expression level of DEK mRNA and protein was detected in lung cancer tissues and non-cancerous counterparts by performing reverse transcription-quantitative polymerase chain reaction and immunohistochemical staining. It was revealed that the expression of DEK was increased in lung cancer tissues compared with normal tissue. Knock-down and over-expression of DEK in A549 cells were performed to determine the role of DEK in tumor formation. An MTT assay, colony formation assay and Matrigel invasion assay demonstrated that DEK positively regulated cell proliferation and invasion. These results suggest that DEK is highly expressed in lung cancer tissues and positively regulates cell proliferation and invasion.

Expression of plzfa in embryo and adult of medaka Oryzias latipes

In this study, a homologous gene named plzfa was identified and characterized in medaka Oryzias latipes. Oryzias latipes plzfa was detected in all the tissues including brain, gill, muscle, liver, intestine, kidney, spleen, testis and ovary using reverse transcriptase (RT)-PCR. plzfa was detected in the oocytes of the ovary and in the spermatogonia and somitic cells of the testis by in situ hybridization. plzfa had a maternal origin with continuous and dynamic expression during embryonic development. plzfa was observed in the brain, neural rod and sensor organs including the eyes, ears and nose during embryogenesis. plzfa was also detected in the neural crest, somite, pectoral fin, intestine and skin. These results indicate that plzfa is a pleiotropic gene that may play major roles in various tissues.

Volume of intracranial structures on three-dimensional ultrasound in fetuses with congenital heart disease

OBJECTIVE

To investigate the volume of intracranial structures in fetuses with congenital heart disease (CHD).

METHODS

Total intracranial volume, frontal lobes volume, thalamus volume and cerebellar volume were prospectively evaluated and compared in 73 fetuses with CHD and 168 normal fetuses using three-dimensional ultrasound combined with post-processing software at 20 + 0 to 36 + 6 weeks of gestation. Multiple regression analyses were performed to identify risk factors for reduced volume of intracranial structures.

RESULTS

From the 28th week of gestation onwards, total brain volumes and those of specific structures became progressively smaller in fetuses with CHD relative to those in controls (P < 0.05). The decrease was largest in frontal lobes volume, followed by total intracranial volume and cerebellar volume, and the smallest decrease was in thalamus volume (P < 0.05). Multivariable analysis showed that the diagnostic category (P < 0.001) was independently associated with smaller brain volumes in fetuses with CHD. The largest differences from controls occurred in hypoplastic left heart syndrome (HLHS), followed by aortic hypoplasia, transposition of the great arteries (TGA) and tetralogy of Fallot (TOF).

CONCLUSIONS

The volume of intracranial structures is smaller in fetuses with CHD, particularly in those with HLHS, aortic hypoplasia or TGA. This study highlights the need for routine brain screening and early intervention to improve neurodevelopmental outcomes in fetuses with CHD.

Prenatal echocardiographic differential diagnosis of fetal cardiac tumors

OBJECTIVES

To present data on echocardiographic findings of fetal cardiac tumors and discuss their differential diagnoses.

METHODS

We retrospectively reviewed 14 cases of fetal echogenic cardiac mass diagnosed between 1990 and 2003; 12 were confirmed to be cardiac tumors and two were false-positive diagnoses. The echocardiographic characteristics examined included number, size, location and associated complications.

RESULTS

Eight fetuses had a single tumor and four fetuses had multiple tumors. The left ventricle was most often affected. Parents of eight fetuses opted for termination of pregnancy, one fetus died in utero and three affected fetuses survived. Histopathological examination revealed cardiac rhabdomyoma in six fetuses, fibroma in two, teratoma in two, lipoma in one and hemangioma in one. The pitfalls associated with prenatal echocardiographic diagnosis of cardiac tumors include: they may be too small to be visualized, intracardiac echogenic foci may mimic tumors, and echogenicity resulting from extracardiac structures or neoplasms near the heart may falsely appear as tumors.

CONCLUSION

Fetal cardiac tumors can be detected by echocardiography. However, differential diagnosis is important as this will affect prognosis and subsequent management.

[Location of the pre-excitation part in Wolff-Parkinson-White syndrome by Doppler tissue imaging]

OBJECTIVE

To evaluate the feasibility of newly developed Doppler tissue imaging (DTI) for locating the early contraction sites in Wolff-Parkinson-White (WPW) syndrome.

METHODS

The time-sequential changes in ventricular wall motion of thirty-three patients suffering from WPW syndrome were examined by DTI. The pre-excitation site was represented as a red region appearing on the myocardium right after the delta wave of the electrocardiogram and confirmed by electrophysiology.

RESULT

Of 21 patients with left-sided accessory pathways, the early contractive sites were correctly identified by DTI in 18 patients, while the sites were determined by DTI in 8 of 12 patients with right-sided accessory pathways. There was no significant difference between the two groups (P > 0.05).

CONCLUSION

The DTI system is helpful to localize the accessory pathways and evaluate the results after radiofrequency ablation.

Impairment of endothelial function after a high-fat meal in patients with coronary artery disease

OBJECTIVE

To determine the effect of postprandial lipid changes on endothelial function in patients with coronary artery disease (CAD) after a high-fat meal.

METHODS

We studied 50 CAD patients and 25 control participants, who were all normocholesterolemic. Flow-mediated vasodilatation of the brachial artery was evaluated by the high-resolution ultrasound technique before and after a single high-fat meal (800 calories; 50 g fat).

RESULTS

Postprandial serum triglyceride level increased significantly at 2-7 h and mean flow-mediated vasodilatation was impaired significantly (from 4.22 +/- 0.44 to 2.75 +/- 0.33%, P < 0.01) for 75 subjects. The increment in 2 h serum triglyceride level correlated positively with the decrement in postprandial flow-mediated vasodilatation (r = 0.459, P < 0.01). Postprandial triglyceride level was significantly higher in CAD patients than in control participants. Flow-mediated vasodilatation was significantly impaired in CAD patients (from 3.04 +/- 0.39 to 1.69 +/- 0.23%, P < 0.01) and control participants (from 6.58 +/- 0.52 to 4.87 +/- 0.19%, P < 0.05) after a high-fat meal. The impairment of flow-mediated dilatation was more severe in CAD patients (44.41%) than in control participants (25.99%, P < 0.01).

CONCLUSION

Postprandial endothelium-dependent vasodilatation after a single high-fat meal was severely impaired in normocholesterolemic CAD patients and control participants. The disordered postprandial metabolism of triglyceride-rich lipoproteins may play an atherogenic role by inducing endothelial dysfunction.

[Value of transvaginal sonography in diagnosis of placenta previa]

OBJECTIVE

To investigate the value of transvaginal sonography (TVS) in diagnosis of placenta previa.

METHODS

Transabdominal sonography(TAS) and TVS localization of the placenta were performed in 78 pregnant women after 35 week's gestation. It was suspected of having placenta previa when the placental edge appeared to be over or within 2 cm in diameter of the internal cervical os demonstrated by TAS or TVS. Final diagnosis depended on diagnosis at delivery. The diagnostic sensitivity, specificity, false-positive rate and coincidence rate were made in comparison between TVS and TAS.

RESULTS

The sensitivity, specificity, false-positive rate and coincidence rate of TVS were 100%, 90%, 10% and 93.6%, while that of TAS were 71.4%, 60%, 40% and 64.1%, respectively. The coincidence rate of TVS was better than TAS (p < 0.01).

CONCLUSION

TVS is superior to TAS in diagnosis of placenta previa.

Protective effect of high density lipoprotein on endothelium-dependent vasodilatation

Low concentrations of high-density lipoprotein cholesterol (HDL-C) have been associated with increased risk of coronary heart disease (CHD) even when the total cholesterol (TC) and triglyceride (TG) levels are not elevated. The mechanism by which HDL confers protection against atherosclerosis remains speculative. Using high-resolution ultrasound, we measured the dilatation changes of brachial arteries during reactive hyperemia and after sublingual glyceryl trinitrate (GTN) in 63 patients with established (CHD) and 45 controls, in which the serum TC level was normal. The results showed that both flow-mediated dilatation (FMD) and GTN-induced dilatation of brachial arteries in patients with CHD were much reduced compared with control group (2.31+/-2.46% vs. 7.43+/-4.10% and 16.41+/-6.15% vs. 22.44+/-8.63%, respectively, P<0.001 for all). Univariate analysis indicated that FMD of brachial arteries was inversely related to age (r=-0.226, P<0.05), hypertension (r=-0.229, P<0.05), baseline diameter (r=-0.299, P<0.01) and LDL-C (r=-0.237, P<0.05) and positively related to HDL-C (r=0.491, P<0.01). GTN induced vasodilatation was inversely related to age (r=-0.216, P<0. 05) and baseline diameter (-0.476, P<0.01). Multiple stepwise regression analyses in two groups taken together showed that HDL-C and age were the independent predictors of the FMD of brachial arteries (beta=0.466, P=0.000 and beta=-0.184, P=0.020, respectively). Baseline diameter was significant predictor of GTN-induced vasodilatation (beta=-0.390, P=0.000). The analysis in the group of CHD patients showed that only HDL-C was significantly relate to the FMD of brachial arteries (beta=0.295, P=0.018 ) and in controls that hypertension and HDL-C were significantly relate to the FMD of brachial arteries (beta=-0.395, P=0.004 and beta=0.344, P=0.011, respectively). These finding suggest that endothelium-dependent and endothelium-independent vasodilatation are impaired in the patients with CHD. HDL exerts a protective effect on endothelium-dependent vasodilatation in TC being relatively normal population.

Endothelium-dependent and -independent functions are impaired in patients with coronary heart disease

Endothelium plays a pivotal role in the development of atherosclerosis. Endothelial dysfunction participates in the course of acute coronary event. Using high-resolution ultrasound technique, endothelial dysfunction has been demonstrated in patients with atherosclerosis and risk factors for coronary disease, such as hypertension, diabetes mellitus, hypercholesterolemia and being smokers. In the present study, using this non-invasive method, the endothelial function of the brachial artery of patients with coronary heart disease (CHD) (n = 71) and control subjects (n = 34) was investigated. The results showed that endothelium-dependent and -independent vasodilatation were impaired in patients with CHD (2.61+/-2.91 vs. 8.10+/-7.81%, 17.20+/-7.93 vs. 23.19+/-8.89%, respectively) (P<0.001). Flow-mediated dilation (FMD) was significantly positively correlated with nitroglycerine-induced dilation (P<0.001). On univariate and multivariate analysis, the extent of FMD was significantly correlated with serum HDL-C levels (P<0.01). In conclusion, our study indicates both endothelial and underlying smooth muscle functions were impaired in patients with CHD. Decreased HDL-C levels may impair endothelial function.

Endothelial dysfunction associated with left ventricular diastolic dysfunction in patients with coronary heart disease

OBJECTIVE

We sought to assess the correlation between endothelial vasodilation and left ventricular diastolic function.

BACKGROUND

Previous studies have demonstrated that similar neurohumoral factors are involved in myocardial and vascular endothelial impairment. The degree of endothelial dysfunction is related to the clinical severity of the heart failure. However, it is not clear whether endothelial dysfunction develops with the progression of left ventricular diastolic dysfunction. We hypothesize that the endothelial dysfunction is associated with left ventricular diastolic dysfunction.

METHODS

Using high-resolution ultrasound, we measured the dilator response of the brachial artery to hyperemia (endothelium-dependent vasodilation) and to 0.5 mg nitroglycerin (endothelium-independent vasodilation), and measured peak velocities of the early wave (Evmax) and the atrial wave (Avmax) in 40 coronary heart disease (CHD) patients and 20 normal subjects. We analyzed the relationship between the Evmax/Avmax ratio and endothelium-dependent vasodilation.

RESULTS

The results showed that endothelium-dependent and endothelium-independent vasodilation as well as the Evmax/Avmax ratio were lower in the CHD group than those in the control group (4.29%+/-1.42%, 17.58%+/-2.99%, 0.81+/-0.24 vs. 9.62%+/-2.34%, 24.18%+/-3.15%, 1.07+/-0.29, respectively, P<0.01). The Evmax/Avmax ratio was related to endothelium-dependent vasodilation (r=0.45, P<0.01).

CONCLUSIONS

Our results showed that the development of endothelial dysfunction was associated with the progression of myocardial diastolic dysfunction, which suggests that the same mechanisms may be involved in the impairment of endothelium and myocardium.

[The spectral characters of pulsed Doppler in fetal arrhythmia]

Blood flow spectra of left ventricular inflow and outflow of the fetus were measured by pulsed Doppler echocardiography in 82 cases who were diagnosed as fetal arrhythmia clinically. By analysing the order of atrio- ventricular excitation, the spectral characters and the relationship of time- phase, the classification of fetal arrhythmia was confirmed. Among the 82 cases, there were 17 cases of sinus bradycardia, 16 cases of sinus tachycardia, 28 cases of atrial premature beats, 16 cases of ventricular premature beats, 3 cases of II degrees atrioventricular conduction block, 2 cases of atrial fibrillation. These common spectral characters of fetal arrhythmia were confirmed by the examination of neonatal Doppler echocardiography and ECG. This study indicated that this method could be used as one of the diagnostic methods for fetal arrhythmia.