Methods for prenatal assessment of fetal cardiac function

Fetal cardiac function is increasingly recognized as a marker of disease severity and prognosis in selected fetal conditions. Magnetic resonance imaging (MRI) has been used in experimental (animal) fetal cardiology but the lack of a noninvasive fetal electrocardiogram (ECG) to trigger image acquisition remains a major limiting factor precluding its application in humans. Fetal medicine specialists are therefore limited to ultrasound to evaluate human fetal cardiac function. In this review, we aim to provide a complete overview of the different ultrasound techniques that can be used for fetal cardiac function assessment and we discuss their (theoretical) strengths and shortcomings. Conventional methods include M-mode assessment of ventricular contractility and Doppler assessment of the precordial veins and cardiac output (CO). More recent techniques such as the measurement of the myocardial performance index (MPI), myocardial motion analysis with tissue Doppler, speckle tracking and three-dimensional (3D) ultrasound techniques are also discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Fetal therapy: practical ethical considerations

Progress in prenatal diagnosis can lead to the diagnosis of severe fetal abnormalities for which natural history anticipates a fatal outcome or the development of severe disability despite optimal postnatal care. Intrauterine therapy can be offered in these selected cases. Prenatal diagnosis is the only field of medicine in which termination is an option in the management of severe diseases. Fetal therapy has therefore developed as an alternative to fatalist expectant prenatal management as well as to termination of pregnancy (TOP). There are few standards of fetal care that have gone beyond the stage of equipoise and even fewer have been established based on appropriate studies comparing pre- and postnatal care. Several ethical questions are being raised as fetal surgery develops, including basic Hippocratic principles of patients' autonomy and doctors' duty of competence moving the boundaries between experimental surgery, therapeutic innovation and standard care. In addition, the technical success of a fetal intervention can only rarely fully predict the postnatal outcome. Managing uncertainty regarding long-term morbidity and the possibility for fetal therapy to change the risk of perinatal death into that of severe handicap remains a critical factor affecting women's choice for TOP as an alternative to fetal therapy. Copyright © 2011 John Wiley & Sons, Ltd.     

The nuchal translucency and the fetal heart: a literature review

In this overview the current knowledge of the relationship between an increased nuchal translucency (NT) measurement and fetal heart structure and function in chromosomally normal fetuses is reviewed. Relevant pathophysiological theories behind the increased NT are discussed. Fetuses with an increased NT have an increased risk for congenital heart disease (CHD) with no particular bias for one form of CHD over another. This risk increases with increasing NT measurement. Although the NT measurement is only a modestly effective screening tool for all CHD when used alone, it may indeed be effective in identifying specific CHD “likely to benefit” from prenatal diagnosis. The combination of an increased NT, tricuspid regurgitation and an abnormal ductus venosus (DV) Doppler flow profile, is a strong marker for CHD. A fetal echocardiogram should be performed at 20 weeks' gestation in fetuses with an NT ≥ 95th percentile but < 99th percentile. When the NT measurement is ≥ 99th percentile, or when tricuspid regurgitation and/or an abnormal DV flow pattern is found along with the increased NT, an earlier echocardiogram is indicated, followed by a repeat scan at around 20 weeks' gestation. The resultant increased demand for early fetal echocardiography and sonographers with this special expertise needs to be planned and provided for. Copyright © 2009 John Wiley & Sons, Ltd.     

Oxidative stress-mediated cardiac mast cell degranulation

Pulmonary mast cell degranulation is a well-characterized response to diesel exhaust exposure. A primary constituent of fossil fuel combustion is sulfur dioxide (SO₂). SO₂ was shown to induce mast cell degranulation in an immortalized cell line secondary to induction of intracellular oxidative stress; however, it is not known whether SO₂-induced oxidative stress directly triggers the activation of cardiac mast cells. Accordingly, this study sought to determine whether Na₂SO₃ induces degranulation of cardiac mast cells, and furthermore whether cardiac mast cell activation may be prevented by inhibition of oxidative stress. To this end, cardiac mast cells were isolated from epicardial surface of the heart and incubated with increasing concentrations of Na₂SO₃ (0, 0.5, or 5 mM). Antioxidant compounds targeting different mechanisms of free radical generation, including ebselen, diphenyleneiodonium (DPI), or α-tocopherol, were incubated with 5 mM of Na₂SO₃ in order to determine their efficacy in preventing mast cell degranulation. Na₂SO₃ induced a significant concentration-dependent histamine release from cardiac mast cells ranging from 8.87% to 18.86%, which was prevented by ebselen. No effect was observed with DPI and α-tocopherol under these conditions. In conclusion, these findings indicate that SO₂ is capable of producing cardiac mast cell degranulation in vitro; however, the variable effectiveness of the three antioxidants evaluated is indicative of a multifactorial mechanism mediating SO₂-induced cardiac mast cell degranulation. The particular effectiveness of ebselen in preventing mast cell degranulation may be related to its multiple mechanisms of preventing oxidative stress.     

PM2.5对小鼠和H9C2细胞心肌肥大相关因子mRNA表达的影响

用采自太原市4个不同季节的细颗粒物(PM_(2.5))对小鼠心肌细胞H9C2进行染毒后,采用荧光定量PCR技术检测心肌肥大相关因子ANP和TGF-β的mRNA水平.采用浓度分别为0、1、3、10μg·mL~(-1)的冬季PM_(2.5)处理H9C2细胞后,检测心肌肥大相关因子ANP、β-MHC、MMP2和MMP9的mRNA水平.之后分别选取4周龄、4月龄、10月龄C57BL/6雌性小鼠作为实验模型,采用咽后壁滴注的方法用3 mg·kg~(-1) PM_(2.5)暴露4周.采用苏木素-伊红染色(HE)对小鼠心脏组织病理切片进行观察,并检测ANP和β-MHC的mRNA水平.结果发现,与对照组相比,冬季PM_(2.5)诱导H9C2细胞中ANP和TGF-β的mRNA水平升高最为显著;其中,当冬季PM_(2.5)染毒浓度较高时可诱导ANP、β-MHC、MMP2和MMP9的mRNA水平均显著升高.经PM_(2.5)暴露4周后,幼年和老年小鼠心肌细胞核质比显著降低.老年小鼠心脏组织中ANP和β-MHC的mRNA表达水平显著上升.实验表明,冬季PM_(2.5)诱导心肌肥大标志物表达改变的效应要强于其他季节,且有一定的剂量效应关系,而老年小鼠对PM_(2.5)诱导的心肌肥大效应最为敏感.     

铜及其与四环素的联合暴露对斑马鱼胚胎的毒性效应

近年来工业和养殖业中铜和四环素的滥用,导致了一定的水环境污染问题。为探究铜与四环素对水生生物的毒害作用,选择斑马鱼作为受试生物,研究了铜及其与四环素的联合暴露对斑马鱼胚胎的毒性效应,并进一步探索了其可能的致毒机制。结果表明：铜在低浓度下（10%致死浓度LC10=2.5 μg?L-1,10%效应浓度EC10=0.1 μg?L-1）明显延迟了斑马鱼胚胎的孵化、卵黄囊吸收、头部、鱼鳔和体长等生长指标的发育,同时在心脏区域引起明显细胞凋亡效应。幼鱼体内总铜含量检测结果显示低浓度下铜的生物利用度相对更高。基因表达结果显示环境浓度的铜可能通过影响神经和心脏相关基因的表达引起斑马鱼胚胎的神经发育和心脏发育异常。铜和四环素的联合暴露实验结果表明二者的复合污染类型为拮抗作用,且两者相互作用可以形成络合物。综合以上结论,说明环境浓度的铜可能通过细胞凋亡、分子水平的变化等方式对水生生物的早期生长发育产生危害,如延迟生长发育、神经及心脏发育异常,另外铜可通过和四环素等环境中其他污染物的结合改变铜的生物有效性和毒性。     

SO2污染激活AT1R改变运动大鼠心肌胶原纤维形态学并导致心功能降低

为了观察SO₂污染环境下运动对大鼠心功能的影响,从心脏局部肾素-血管紧张素系统（renin-angiotensin system,RAS）核心成员——血管紧张素Ⅱ（angiotensin Ⅱ,AngⅡ）Ⅰ型受体（AT₁R）介导的心肌胶原纤维形态结构重塑的角度出发,应用心脏插管技术观察大鼠的心脏功能;采用放射免疫技术（ELISA）、免疫组织化学和胃酶酸解法等方法对心肌局部ρ（AngⅡ）、AT₁R蛋白表达水平、w（HYP）（HYP为羟脯氨酸）及胶原容积分数进行检测.结果表明:①单纯运动组（EG）大鼠主动脉收缩压、左室内压峰值、±dp/dt_max（左室内压最大上升速率/下降速率）显著升高（P < 0.01）,舒张压、AT₁R蛋白表达显著降低（P < 0.01）,w（HYP）、w（CC）（心肌胶原浓度）、PVCA（血管周围胶原面积）、CVF（心肌胶原容积分数）及ρ（AngⅡ）有升高趋势（P>0.01）;②单纯SO₂污染组（SRG）大鼠左室末期舒张压显著升高（P < 0.01）,左室内压±dp/dt_max显著降低（P < 0.01）;w（HYP）、w（CC）、PVCA、CVF、ρ（AngⅡ）及AT₁R蛋白表达水平均显著升高（P < 0.01）;③SO₂污染+运动组（SEG）大鼠左室末期舒张压显著升高（P < 0.01）,主动脉收缩压、左室内压峰值、左室内压±dp/dt_max显著降低（P < 0.01）,w（HYP）、w（CC）、PVCA、CVF、ρ（AngⅡ）及AT₁R蛋白表达水平均显著升高（P < 0.01）,并且较SRG大鼠升高更显著（P < 0.01）.研究显示,SO₂污染导致运动大鼠心肌胶原纤维形态结构发生异常重塑,最终使大鼠的心功能产生显著的负性变力性效应,其机制可能与心脏局部RAS系统的激活有关.