The fetal circulation

Accumulating data on the human fetal circulation shows the similarity to the experimental animal physiology, but with important differences. The human fetus seems to circulate less blood through the placenta, shunt less through the ductus venosus and foramen ovale, but direct more blood through the lungs than the fetal sheep. However, there are substantial individual variations and the pattern changes with gestational age. The normalised umbilical blood flow decreases with gestational age, and, at 28 to 32 weeks, a new level of development seems to be reached. At this stage, the shunting through the ductus venosus and the foramen ovale reaches a minimum, and the flow through the lungs a maximum. The ductus venosus and foramen ovale are functionally closely related and represent an important distributional unit for the venous return. The left portal branch represents a venous watershed, and, similarly, the isthmus aorta an arterial watershed. Thus, the fetal central circulation is a very flexible and adaptive circulatory system. The responses to increased afterload, hypoxaemia and acidaemia in the human fetus are equivalent to those found in animal studies: increased ductus venosus and foramen ovale shunting, increased impedance in the lungs, reduced impedance in the brain, increasingly reversed flow in the aortic isthmus and a more prominent coronary blood flow. Copyright © 2004 John Wiley & Sons, Ltd.     

The concurrence of fetal supraventricular tachycardia and obstruction of the foramen ovale

Fetal supraventricular tachycardia (FSVT) is a cardiac arrhythmia that bears a high mortality rate. In the majority of cases no morphological anomalies are found and death is caused by congestive heart failure. This report presents two cases of FSVT in which cross sectional echocardiography revealed obstruction of the foramen ovale with dilatation of the right heart without structural cardiac anomalies. After birth sinus rhythm re-established under digitalis medication in both cases. The association between premature obstruction of the foramen ovale and unexplained intrauterine death in the third trimester of gestation is suggested.     

Doppler echocardiographic diagnosis of intrauterine closure of the ductus arteriosus

A case of in utero closure of the ductus arteriosus was detected by Doppler echocardio-graphy at 31 weeks of gestation. It presented as a non-hydropic distressed fetus with ultrasound detection of tricuspid regurgitation. Pulsed Doppler ultrasound showed markedly decreased blood flow through the tricuspid and pulmonary valves and absent blood flow at the ductus arteriosus. These, as well as the resultant increased right-to-left shunting across the foramen ovale, were reaffirmed by colour flow mapping.     

Fetal marfan syndrome: Prenatal ultrasound diagnosis with pathological confirmation of skeletal and aortic lesions

Sonography was performed during the second trimester in two pregnancies at risk for the Marfan syndrome. In one, the limbs were significantly longer than expected (p < 0·0025) and a diagnosis of the Marfan syndrome was established. Pathological examination of the fetus after pregnancy interruption showed typical foci of cystic medial necrosis in the ascending aorta.     

Prenatal and presymptomatic diagnosis of the marfan syndrome using fluorescence pcr and an automated sequencer

The Marfan syndrome (MFS) is a heritable connective tissue disorder characterized by skeletal, ocular, and cardiovascular abnormalities. Defects in fibrillin, an elastin-associated microfibrillar protein, are now known to cause MFS. Since the discovery of fibrillin as the gene responsible for MFS, requests for prenatal and presymptomatic diagnosis have become common-place. Here we report the use of the polymerase chain reaction (PCR), using fluorescence labelled primers and an automated sequencer, to establish linkage data for “molecular diagnosis”. The mistaken clinical diagnosis of MFS based on the appearance of a common cardiovascular manifestation, mitral valve prolapse, and a positive family history is also discussed.     

Prenatal ultrasound diagnosis of congenital heart disease associated with intrauterine growth retardation. A report of 2 cases

Two fetuses with extreme growth retardation (IUGR) of 31 and 34 weeks gestation were studied using a combination of two dimensional echocardiography (2DE), pulse wave Doppler (PWD) and differential measurement of the instantaneous vessel diameter techniques. The first fetus was diagnosed as having univentricular heart or possible double outlet right ventricle (DORV). Descending aorta blood flow was reduced as was indexing for weight. The second fetus was diagnosed as having univentricular heart with periodic bigeminal and trigeminal rhythm. Descending aorta blood flow was measured on two occasions and was reduced both times. Indexing for weight was within normal limits the first time and showed gross reduction on the second occasion prior to fetal demise. Fetal death occurred in both cases at 34 weeks gestation. Cardiovascular evaluation in fetuses with IUGR is useful as the detection of severe congenital cardiac abnormalities may substantially alter the management of these pregnancies, in particular caesarean section may be avoided when the prognosis for the fetus is considered hopeless.     

小孔板对阀门噪声的控制作用及对阀门流量控制的影响

本实验采用在阀门下游安装小孔板的方法可完全防止阀门噪声向下游传播,使下游噪声仅为小孔板小孔喷注的噪声,比阀门噪声低很多,但小孔板将影响阀门的流量控制作用,本文从理论上提出计算阀门及阀门下游加上孔板后两种情况阀门的开度与流量及驻点压降的关系的方法,特例的数值计算的结果与实验测量符合良好,该法可以可靠地用于工程设计。     

半干法烟气脱硫系统中喷水调节阀的控制及选型

喷水流量的控制对半干法脱硫效率至关重要,通过分析喷水调节阀的控制对吸收塔温度的影响,表明该阀流量特性选择的重要性,并提出喷水调节阀的选型及计算方法。     

Prenatal diagnosis of Apert syndrome: report of two cases

Two de novo cases with Apert Syndrome detected prenatally are presented herein. In the first, fetal ultrasound findings of syndactyly of the hands, craniosynostosis and proptosis resulted in a prenatal diagnosis in the nineteenth week of gestation. This is the earliest prenatal diagnosis of this syndrome in a not-at-risk case. Following counseling, this pregnancy was terminated and subsequent pathological examination and DNA analysis confirmed the diagnosis of Apert Syndrome and coarctation of the aorta. In the second case, fetal ultrasound at 21 weeks' gestation revealed a hypoplastic left heart and clover-leaf skull. Following counseling, this pregnancy was also terminated. Further examination of the fetus and DNA analysis led to a diagnosis of Apert Syndrome. These cases emphasize the need to complete a thorough fetal ultrasound in cases with potentially lethal cardiac abnormality and the importance of incorporating a fetal pathologist, as well as a medical geneticist, in the investigations performed after delivery or pregnancy termination when a fetal abnormality is detected on ultrasound. Copyright © 2003 John Wiley & Sons, Ltd.     

Cardiac flow after fetal blood sampling in normally grown and growth-retarded fetuses

The objective of this study was to evaluate the effect of fetal blood sampling on cardiac flow velocity waveforms. Flow velocity waveforms were measured from the ascending aorta and pulmonary artery immediately before and after fetal blood sampling in 29 normally grown and 12 growth-retarded fetuses. The latter group was characterized by abnormal Doppler indices in the umbilical artery and middle cerebral artery suggestive of uteroplacental insufficiency as the causative factor of the impaired growth. The flow velocity parameters studied were the peak velocity, the time to peak velocity, and the left and right cardiac output and their ratio. In normally grown fetuses, the peak velocity and right and left cardiac output values increased significantly after fetal blood sampling, while no significant changes were observed in the other indices considered. The gestational age at the time of the procedure was positively related to the amplitude of these changes. In growth-retarded fetuses, fetal blood sampling did not induce any significant increase in cardiac output or peak velocities, while in more than 50 per cent of the fetuses these Doppler indices decreased. The amplitude of the decrease was significantly related to the severity of acidosis in the umbilical vein. In conclusion, the cardiac haemodynamic response to fetal blood sampling differs between normally grown and growth-retarded fetuses. This difference may explain the higher rate of complications occurring in the latter group of fetuses after blood sampling.     

Fetal behaviour in growth retardation: Its relationship to fetal blood flow

The fetal behaviour of asymmetrical growth retarded fetuses was compared with that of a control group of healthy fetuses. Fetuses underwent simultaneous cardiotocographic and echographic examinations for two consecutive hours at 36–38 weeks of gestation. The distribution of gross fetal body movements, fetal breathing movements and fetal eye movements was analysed during the different fetal heart rate patterns. Furthermore, the incidence and organization of fetal behavioural states was investigated. The degree of vascular peripheral resistance was also evaluated by means of pulsed doppler ultrasonic equipmznt. Growth retarded fetuses were divided into two groups on the basis of the presence or absence of end diastolic flow in the fetal thoracic descending aorta. Growth retarded fetuses showed a delay in the integration of behavioural patterns and a lower coincidence of behavioural states. These findings are particularly evident in the fetuses with a severe increase of peripheral vascular resistance (absence of end diastolic flow in descending aorta). Thus, we suggest that a delay in central nervous system development is present in asymmetrical growth retarded fetuses and that there is a possible relationship of this delay to the degree of peripheral vascular resistance.     

液压振动台时域建模与仿真

基于Matlab/Simulink建立了液压振动台系统时域仿真模型,模型包括信号给定、油泵、溢流阀、蓄能器、伺服阀、控制器、液压缸、位移测量等模块。针对大流量动圈伺服阀,按物理规律和常见因素建模,特别考虑了瞬间油液回流情况。仿真算例结果表明,仿真获得的振动位移、速度、加速度响应波形及其他相关波形与实际振动台波形有良好的相似性。建模时考虑了尽可能多的因素,仿真获得了真实的波形特征,可为振动台系统设计提供较好参考。     

亚热带典型小流域总氮最大日负荷(TMDL)及影响因子研究——以金井河流域为例

本研究以亚热带红壤丘陵区为研究区域,选取10个典型小流域,根据土地利用和畜禽养殖密度分为4种类型(森林、森林-种植、养殖和种植-养殖小流域),并基于近3年小流域把口站的原位观测数据,采用负荷历时曲线模型(LDC)计算了不同类型小流域水体总氮(TN)的最大日负荷(TMDL),运用灰度分析法定量研究了不同流量阶段小流域主要因子对TN负荷消减率的影响.结果表明,小流域TN负荷特征与流域类型密切相关,10个小流域TN年均负荷为739.0~2798.4 kg·km-2·a-1,由小到大依次为森林、森林-种植、养殖、种植-养殖小流域,其中,养殖、种植-养殖小流域水质整体超标严重,且应针对中、低流量条件下(秋、冬季节)负荷进行消减,而森林-种植小流域TN负荷超标情况略好,但高流量阶段(春、夏)超标率过高.灰度分析结果表明,TN负荷消减率在高、中流量阶段下主要受农田面积比例影响,而低流量阶段受畜禽密度影响.农田面积比例对高、中流量段TN消减率影响显著,而畜禽养殖密度在低流量段具有更大影响,小流域景观越破碎、类型越丰富、斑块分布越零散、形状越复杂,TN负荷通量则越大.     

加氢原料缓冲罐串压事故动态模拟研究

通过工艺流程动态模拟,研究某渣油加氢装置在反应进料泵事故紧急停车后,不同工艺设计方案组合条件下,引发高压气体反串到低压原料缓冲罐的事故影响。研究结果表明:泵出口双单向阀和紧急切断阀的设计对降低超压事故的发生有很好的保护作用;切断阀关闭时间越短对原料缓冲罐超压保护越有利;安全阀和缓冲罐的设计条件须与切断阀关闭时间和单向阀数量等设计条件综合考虑。通过动态模拟方法研究工艺操作异常工况,对优化工艺设计,提高本质安全设计有参考价值。     

Fetal arrhythmias: the Saint-Justine hospital experience

We intend to review our experience with the investigation and management of foetal arrhythmia on the basis of superior vena cava/ascending aorta (SVC/AA) Doppler flow velocity recordings. Irregular rhythms n = 307. Premature atrial and ventricular contractions were easily identified and generally self-limited in time. Sustained bradycardia n = 19. Four had sinus bradycardia, six presented with blocked atrial bigeminism, three showed 2:1, and five had a complete atrio-ventricular (AV) block. Another foetus that presented with first-degree AV block developed a Luciani–Wenckebach phenomenon 1 week later. These different types of bradycardia were all identified on SVC/AA Doppler recordings. Tachyarrhythmia n = 30. Five types of tachyarrhythmia were observed: Type I: Short ventriculo-atrial (VA) tachycardia (VA < AV) , n = 11. Ten foetuses of this group presented a distinctive Doppler flow velocity pattern characterised by 1:1 AV conduction and a tall atrial wave (‘a’ wave) superimposed on the aortic ejection wave. They were considered to have re-entrant tachycardia through a fast-conducting AV accessory pathway; all 10 responded to digoxin therapy. The eleventh foetus with short VA tachycardia had atrial ectopic tachycardia with AV node dysfunction; he was treated successfully with sotalol. Type II: Long VA tachycardia (VA > AV): n = 8. In seven cases, an ‘a’ wave of normal amplitude with normal AV time interval could be clearly identified in front of the aortic ejection wave: one foetus in this group was considered to be in sinus tachycardia based on the variability of its heart rate; in another, sudden onset of tachycardia triggered by extrasystoles led to the possibility of permanent junctional reciprocating tachycardia (PJRT). The five other foetuses had atrial ectopic tachycardia. The last foetus presented with AV and VA intervals of the same duration and a heart rate of 210 beats/min; he did not respond either to digoxin or to sotalol, and was found after birth to have PJRT. The drug of first choice in this group was sotalol. Type III: Simultaneous onset of atrial and ventricular contractions : n = 3. These foetuses were classified as junctional ectopic tachycardia. Two responded to amiodarone. The other foetus converted spontaneously to sinus rhythm. Type IV: Flutter : n = 7. All presented with 2:1 AV relationship except one who had a variable block. Digoxin was prescribed as a first choice associated with sotalol in three cases. Conversion to sinus rhythm was documented in all; however, one hydropic foetus with advanced cardiomyopathy died one day after birth. Type V: Ventricular tachycardia : n = 1. This 30-week foetus presented alternance of AV dissociation (atrial rate: 130, ventricular rate: 170 beats/min) and atrial capture (ventricular rate of 138 beats/min). The arrhythmia responded well to propanol, and no recurrence was recorded after birth. Precise prenatal identification of arrhythmia type can be achieved with the SVC/AA Doppler approach. Such information allows for a better management and a rational choice of appropriate anti-arrhythmic drug. Copyright © 2004 John Wiley & Sons, Ltd.     

Prenatal diagnosis of Fanconi anemia (Group C) subsequent to abnormal sonographic findings

Manifestations of Fanconi Anemia Complementation Group C (FA-C) include multiple major congenital malformations, hypoplastic radius, absent thumb, growth retardation, elfin-like facial features, microphthalmia, microcephaly, café-au-lait spots, early onset of hematologic disease and poor survival (Auerbach, 1997). We describe two cases in which second-trimester sonographic findings led to parental carrier testing for FA-C and subsequent prenatal diagnosis of affected fetuses. Copyright © 2005 John Wiley & Sons, Ltd.     

Complex cardiac defect with hypoplastic right ventricle in a fetus with valproate exposure

We describe a fetus with a hypoplastic right ventricle detected by prenatal ultrasound examination. A possible causal relationship with prenatal valproate exposure is discussed. Copyright © 2005 John Wiley & Sons, Ltd.     

Longitudinal assessment of blood flow velocity waveforms in the healthy human fetus

A longitudinal study was carried out on 30 healthy fetuses in order to assess the modifications of fetal blood flow throughout pregnancy. The pulsatility index was evaluated at two-week intervals by means of pulsed Doppler equipment. In the umbilical artery measurements were performed from 20 weeks onwards, whereas in the descending aorta and internal carotid artery analysis started from 26 weeks onwards. A decrease of the pulsatility index in umbilical artery and in the ratio between the pulsatility indexes in umbilical artery and internal carotid artery was found over the second half of pregnancy.     

On the parental origin of the X's in a prenatally diagnosed 49,XXXXX syndrome

A 49,XXXXX fetus was detected in amniotic fluid cell cultures from a 39-year-old mother. On ultrasonography, growth retardation and bilateral radioulnar synostosis were found. Additional clinical manifestations were mild facial anomalies and hypoplastic ovaries depleted of oocytes. Molecular analysis showed that this aneuploidy arose by successive maternal non-disjunction.     

基于遗传算法的综合热能管理系统代偿优化

在SIMULINK平台下搭建了飞机综合热能管理系统仿真模型,并利用遗传算法对其可控参数如发动机引气的阀门开度、冲压空气进口面积和液体环路的流量等进行在不同飞行状态下的寻优,使得飞机在满足温度等要求的情况下起飞总重的代偿较小。结果表明,利用智能算法可以实现这种复杂系统的参数优化,从而提高飞机燃油经济性。