The legal frameworks that govern fetal surgery in the United Kingdom,European Union,and the United States

The specialty of fetal surgery or fetal intervention is one of the most exciting emerging fields of modern medicine. It is made possible by decades of major developments in antenatal imaging, obstetric anaesthesia, fetal medicine, paediatric surgery, and of course by the bold and novel practitioners willing to take new steps to advance the field. Beginning in the 1970s, it has now reached a stage of maturity where there are several established in utero procedures and countless clinical trials and studies to develop more. But what is the legal situation that fetal surgeons find themselves in? What are the rights and legal protections for the fetus and the mother, both of which are arguably the patient? This article will address this question, discussing and summarising the current legal frameworks governing fetal surgery in the jurisdictions of the United Kingdom, European Court of Human Rights, and the United States of America as well as discuss what the future may hold and how researchers and physicians in the specialty can best navigate the legal environment.     

Women's opinions on the offer and use of maternal serum screening

We studied the opinions and experiences concerning maternal serum screening of two groups of women: (A) women who were not eligible for prenatal diagnosis; and (B) women for whom prenatal diagnosis was available because of advanced maternal age, and who either underwent chorionic villus sampling or amniocentesis. Many of the women were in favour of the availability of serum screening and would apply for this test in a future pregnancy. This applied also to many respondents who had previously undergone prenatal diagnosis. Most of these women, however, did not intend to decline diagnostic amniocentesis if the screening results did not indicate an increased risk. The majority of the group of respondents of 36 years and over did not consider it acceptable if age indication was dropped altogether. A system based on serum screening will have other implications than a policy based on age indication, since specific individual risk assessment is perceived as being of more significance than a risk statistically derived from age alone. Serum screening is often seen as a means of reassurance and many women are not aware of the possible drawbacks. As technology becomes increasingly complicated, counselling has to be adjusted correspondingly. Further research is needed to establish whether and how distress can be minimized and well-considered individual choice can be achieved.     

Expanding multiple marker screening for Down's syndrome to include Edward'S syndrome

Information on maternal age and maternal serum alpha-fetoprotein, unconjugated oestriol (uE₃), and human chorionic gonadotrophin (hCG) levels was used to investigate retrospectively the effect of estimating Edward's syndrome risk in women having multi-marker screening for Down's syndrome. The screened population comprised 15 pregnancies affected by Edward's syndrome, 15 with Down's syndrome and 5472 unaffected pregnancies. The use of all three markers to estimate Edward's syndrome risk would have led to the detection of 10–12 (67–80 per cent) cases with a false-positive rate of 0.3–0.6 per cent depending on the risk cut-off. A further case would have been detected as a result of screening for Down's syndrome alone. Similar results were obtained when the Edward's syndrome risk was based on uE₃ and hCG only. These data suggest that extending Down's syndrome screening to include Edward's syndrome risk will yield a high detection rate with only a small increase in the false-positive rate.     

环渤海芦苇湿地磷的吸附容量及释放风险评估

滨海湿地地处陆海交汇的关键带,是磷的"汇"、"源"和"转化器",在全球磷循环过程中扮演着十分重要的角色,其对水体磷素的截留能力日益受到关注.本文以环渤海地区芦苇湿地沉积物为研究对象,利用批处理实验研究了湿地磷的吸附容量和释放风险.结果表明,湿地沉积物磷的最大吸附容量(Q_max)为693. 7～2 117. 2 mg·kg^-1,平均值为1 468. 6 mg·kg^-1,Q_max的大小顺序为七里海湿地>北大港湿地>南大港湿地>辽河三角洲湿地>寿光滨海湿地>黄河三角洲湿地.环渤海湿地沉积物磷吸附主要受Ca、Mg和TOC含量的影响.环渤海湿地磷吸附饱和度(DPS)和释放风险指数(ERI)分别为0. 28%～4. 50%和0. 53%～10. 10%,结果表明除寿光滨海湿地磷释放风险为中度风险外,其它湿地磷释放风险较低.总之,环渤海地区芦苇湿地沉积物具有较强磷吸附能力,沉积物为水体磷的"汇",沉积物释磷风险较低.建议在环渤海污染治理过程中充分发挥滨海湿地对磷的净化拦截作用,以降低...     

Cx43 regulates mechanotransduction mechanisms in human preterm amniotic membrane defects

Objective

The effects of mechanical stimulation in preterm amniotic membrane (AM) defects were explored.

Methods

Preterm AM was collected from women undergoing planned preterm caesarean section (CS) due to fetal growth restriction or emergency CS after spontaneous preterm prelabour rupture of the membranes (sPPROM). AM explants near the cervix or placenta were subjected to trauma and/or mechanical stimulation with the Cx43 antisense. Markers for nuclear morphology (DAPI), myofibroblasts (αSMA), migration (Cx43), inflammation (PGE₂) and repair (collagen, elastin and transforming growth factor β [TGFβ₁]) were examined by confocal microscopy, second harmonic generation, qPCR and biochemical assays.

Results

In preterm AM defects, myofibroblast nuclei were highly deformed and contractile and expressed αSMA and Cx43. Mechanical stimulation increased collagen fibre polarisation and the effects on matrix markers were dependent on tissue region, disease state, gestational age and the number of fetuses. PGE₂ levels were broadly similar but reduced after co-treatment with Cx43 antisense in late sPPROM AM defects. TGFβ₁ and Cx43 gene expression were significantly increased after trauma and mechanical stimulation but this response dependent on gestational age.

Conclusion

Mechanical stimulation affects Cx43 signalling and cell/collagen mechanics in preterm AM defects. Establishing how Cx43 regulates mechanosignalling could be an approach to repair tissue integrity after trauma.