The making of fetal surgery

Fetal diagnosis prompts the question for fetal therapy in highly selected cases. Some conditions are suitable for in utero surgical intervention. This paper reviews historically important steps in the development of fetal surgery. The first invasive fetal intervention in 1963 was an intra-uterine blood transfusion. It took another 20 years to understand the pathophysiology of other candidate fetal conditions and to develop safe anaesthetic and surgical techniques before the team at the University of California at San Francisco performed its first urinary diversion through hysterotomy. This procedure would be abandoned as renal and pulmonary function could be just as effectively salvaged by ultrasound-guided insertion of a bladder shunt. Fetoscopy is another method for direct access to the feto-placental unit. It was historically used for fetal visualisation to guide biopsies or for vascular access but was also abandoned following the introduction of high-resolution ultrasound. Miniaturisation revived fetoscopy in the 1990s, since when it has been successfully used to operate on the placenta and umbilical cord. Today, it is also used in fetuses with congenital diaphragmatic hernia (CDH), in whom lung growth is triggered by percutaneous tracheal occlusion. It can also be used to diagnose and treat urinary obstruction. Many fetal interventions remain investigational but for a number of conditions randomised trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programmes. The safety of fetal surgery is such that even non-lethal conditions, such as myelomeningocoele repair, are at this moment considered a potential indication. This, as well as fetal intervention for CDH, is currently being investigated in randomised trials. Copyright © 2010 John Wiley & Sons, Ltd.     

The amniotic fluid as a source of mesenchymal stem cells with lung-specific characteristics

The amniotic fluid is a clinically accessible source of mesenchymal stem cells (AF-MSC) during gestation, which enables autologous cellular therapy for perinatal disorders. The origin of AF-MSC remains elusive: renal and neuronal progenitors have been isolated from the AF-MSC pool, yet no cells with pulmonary characteristics. We analyzed gene expression of pulmonary and renal markers of 212 clonal lines of AF-MSC isolated from amniocentesis samples. AF-MSC were cultured on dishes coated with extracellular matrix (ECM) proteins from decellularized fetal rabbit lungs. In vivo differentiation potential of AF-MSC that expressed markers suggestive of lung fate was tested by renal subcapsular injections in immunodeficient mice. Of all the isolated AF-MSC lines, 26% were positive for lung endodermal markers FOXA2 and NKX2.1 and lacked expression of renal markers (KSP). This AF-MSC subpopulation expressed other lung-specific factors, including IRX1, P63, FOXP2, LGR6, SFTC, and PDPN. Pulmonary marker expression decreased over passages when AF-MSC were cultured under conventional conditions, yet remained more stable when culturing the cells on lung ECM-coated dishes. Renal subcapsular injection of AF-MSC expressing lung-specific markers resulted in engrafted cells that were SPTB positive. These data suggest that FOXA2+/NKX2.1+/KSP- AF-MSC lines have lung characteristics which are supported by culture on lung ECM-coated dishes.     

Spatial distribution and internal metal concentrations of terrestrial arthropods in a moderately contaminated lowland floodplain along the Rhine River

Soil metal concentrations, inundation characteristics and abundances of 14 arthropod taxa were investigated in a moderately contaminated lowland floodplain along the Rhine River and compared to the hinterland. Internal metal concentrations were determined for the orders of Coleoptera (beetles) and Araneida (spiders) and were related to soil concentrations. The floodplain was characterized by larger arthropod abundance than the hinterland, in spite of recurrent inundations and higher soil metal concentrations. Most arthropod taxa showed increasing abundance with decreasing distance to the river channel and increasing average inundation duration. For Cd, Cu, Pb and Zn, significant relations were found between arthropod concentrations and concentrations in soil. Significant relations were few but positive, indicating that increasing soil concentrations result in increasing body burdens in arthropods. For arthropod-eating vertebrates, these results might imply that larger prey availability in the floodplain coincides with higher metal concentrations in prey, possibly leading to increased exposure to metal contamination.     

Symmetry is in the eye of the ‘beeholder’: innate preference for bilateral symmetry in flower-naïve bumblebees

Bilateral symmetry has been considered as an indicator of phenotypic and genotypic quality supporting innate preferences for highly symmetric partners. Insect pollinators preferentially visit flowers of a particular symmetry type, thus leading to the suggestion that they have innate preferences for symmetrical flowers or flower models. Here we show that flower-naïve bumblebees (Bombus terrestris), with no experience of symmetric or asymmetric patterns and whose visual experience was accurately controlled, have innate preferences for bilateral symmetry. The presence of color cues did not influence the bees original preference. Our results thus show that bilateral symmetry is innately preferred in the context of food search, a fact that supports the selection of symmetry in flower displays. Furthermore, such innate preferences indicate that the nervous system of naïve animals may be primed to respond to relevant sensory cues in the environment.     

CO2 emissions from Polish cement industry

The cement industry is one of the most significant sources of anthropogenic emissions of CO₂. It is connected with the specific character of the production processes, during which great quantities of CO₂ are produced. Basic actions to reduce CO₂ emissions recommended by the European Union's, Reference Document on Best Available Techniques in the Cement and Lime Manufacturing Industries, include: reduction of fuel consumption, selection of raw materials with low content of organic compounds and fuels with low coal contribution to heating value. All actions connected with the improvement of energy conversion efficiency of the cement production process cause CO₂ emissions reduction. The use of at most acceptable by the valid standards amounts of waste as raw materials and additives for cement production, also brings about the reduction of significant part of CO₂ emissions. These measures have been and continue to be pursued by the cement factories in Poland. This article describes the evolution of the cement industry in Poland over the period 1998–2008 and the resulting changes in CO₂ emissions and explores the drivers for these changes. The sources of CO₂ emissions in cement industry have been presented in this article as well as a discussion of potential ways to reduce Polish cement industry emissions even further.     

Gender impact on first trimester markers in Down syndrome screening

The influence of fetal gender on the level in the first trimester of the serological markers alpha-fetoprotein (AFP), pregnancy-associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (βhCG) and on nuchal translucency is described for 2637 singleton pregnancies with normal outcome. Mean log MoM values for pregnancies with female and male fetuses were calculated using regression of log marker values on gestational age expressed as crown rump length and on maternal weight. A pronounced gender impact was found for free βhCG, being 16% higher for female than for male fetuses. Copyright © 2002 John Wiley & Sons, Ltd.     

Experts under the microscope: the Wivenhoe Dam case

Prosecution of experts in the wake of disasters has emerged as common in the context of increasing social intolerance of risk. This paper examines expert blame using as a case study the decisions of engineers who operated Wivenhoe Dam during the Queensland floods in January 2011 and the criticisms of those decisions by the subsequent Commission of Inquiry. Our analysis draws on the literature on organisational safety, organisational learning and expertise to examine the relevance of the criteria against which the engineers were judged, the relevant competence of those who made this assessment and the broader implications of such exercises. Our analysis shows that lay judgements of expert practice can be misleading, as evidenced by the Commission of Inquiry’s misguided focus on procedural adherence. We argue that such inquiries—where the focus is on assigning blame—detract from opportunities to learn from incidents and can negatively impact on professional practices. If the aim is to make future disasters less likely, then inquiries that take this approach may be failing in this endeavour, or at least not maximising their contribution.