Cerebroplacental hemodynamics in fetuses with transposition of the great arteries and usefulness in predicting neonatal condition.

OBJECTIVES: Literature on cerebroplacental hemodynamics in fetuses with transposition of the great arteries (TGA) is scarce and provides conflicting results regarding the presence of a brain-sparing effect. The aims of this study were to examine Doppler parameters in the middle cerebral artery (MCA) and umbilical artery (UA) in a large cohort of fetuses with TGA, and to assess their possible utility in predicting the need for urgent balloon atrial septostomy (BAS) in the neonate. METHODS: This was a retrospective observational study of fetuses diagnosed with TGA between 2008 and 2022 and an age-matched cohort of normal fetuses, conducted in a single tertiary fetal cardiology center. Medical records and echocardiographic examinations were reviewed to collect demographic, sonographic and follow-up data. Selected Doppler parameters were compared between fetuses with TGA and normal fetuses, as well as between TGA fetuses with and those without an associated ventricular septal defect (VSD), to assess the impact of this congenital heart defect on cerebroplacental circulation. Additionally, Doppler indices in patients with a restrictive foramen ovale (FO) were analyzed to identify potential predictors of the need for urgent BAS. RESULTS: A total of 541 examinations of 159 fetuses with TGA performed between 19 and 40 weeks' gestation and 1300 examinations of 1215 age-matched normal fetuses were included in the study. MCA pulsatility index (PI) and UA-PI followed expected trends throughout pregnancy, with slightly higher values observed in TGA fetuses, albeit within the limits for the normal population. Cerebroplacental ratio (CPR) values were similar in normal and TGA fetuses. The presence of a small VSD did not have a clinically significant impact on Doppler parameters. Peak systolic velocity (PSV) in the MCA increased gradually after 35 weeks' gestation, especially in fetuses that did not develop restriction of the FO after birth. MCA-PSV values below 1.16 multiples of the median measured at 38 weeks or later predicted the need for urgent BAS with 81.4% sensitivity and 52.4% specificity. CONCLUSIONS: MCA-PI, UA-PI and CPR values in fetuses with TGA usually fall within normal limits throughout pregnancy. The presence of a small VSD does not affect the Doppler parameters significantly. MCA-PSV increases in TGA fetuses after 35 weeks, and its value measured at the last prenatal examination (ideally after 37 weeks) may serve as an additional predictive factor for the need for urgent BAS. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

4D imaging of fetal right ventricle-feasibility study and a review of the literature.

Functional analysis of the fetal cardiovascular system is crucial for the assessment of fetal condition. Evaluation of the right ventricle with standard 2D echocardiography is challenging due to its complex geometry and irregular muscle fibers arrangement. Software package TOMTEC 4D RV-Function is an analysis tool which allows assessment of right ventricular function based on volumetric measurements and myocardial deformation. The aim of this study was to determine the feasibility of this method in fetal echocardiography. The retrospective study was conducted in the high-flow Referral Center for Fetal Cardiology. We recorded 4D echocardiographic sequences of 46 fetuses with normal hearts. Following parameters were calculated: end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF), right ventricle longitudinal free-wall (RVLS free-wall) and septal strain (RVLS septum). Tei index was calculated as a standard measure or RV function for comparison. 4D assessment was feasible in 38 out of 46 fetuses (83%). RV volumetric parameters-EDV, ESV and SV-increased exponentially with gestational age. Functional parameters-RV Tei index, EF and strains-were independent of gestational age. Mean EF was 45.2% (± 6%), RV free-wall strain was - 21.2% and RV septal strain was - 21.5%. There was a statistically significant correlation between septal and free-wall strains (r = 0.51, p = 0.001) as well as between EF and RV free-wall strain (r = - 0.41, p = 0.011). 4D RV assessment is feasible in most fetuses. Its clinical application should be further investigated in larger prospective studies.

Functional up-converting SrTiO3:Er(3+)/Yb(3+) nanoparticles: structural features, particle size, colour tuning and in vitro RBC cytotoxicity.

SrTiO3 nanoparticles co-doped with a broad concentration range of Er(3+) and Yb(3+) ions were fabricated using the citric route as a function of annealing temperatures of 500-1000 °C. The effect of a broad co-dopant concentration range and sintering temperature on structural and up-conversion properties was investigated in detail by X-ray diffraction techniques and optical spectroscopy. The TEM technique was used to estimate the mean particle size, which was around 30 nm for the inorganic product annealed at 600 °C. Up-conversion emission color tuning was achieved by particle size control. Power dependence of the green and red emissions was found to be a result of temperature determination in the operating range of SrTiO3 nanoparticles and a candidate for the fast and local microscopic heating and heat release induced by IR irradiation. The color changed from white-red-yellow-green upon an increase of sintering temperature, inducing changes in the surface-to-volume ratio and the number of optically active ions in particle surface regions. The cytotoxic activity of nanoparticles on human red blood cells was investigated, showing no harmful effects up to a particle concentration of 0.1 mg ml(-1). The cytotoxic response of a colloidal suspension of nanoparticles to RBC cells was connected with the strong affinity of SrTiO3 particles to the cell membranes, blocking the transport of important biological solutes.

Possible usefulness of echocardiographic Z-scores in autopsy routine of the foetal great vessels.

BACKGROUND: Abnormal diameters of foetal vessels are common findings in congenital heart defects. However, it is difficult for pathologist to assess whether the diameters of the vessels are normal or not and to compare with echocardiographic data. The Z-score is a dimensionless quantity representing the distance between the raw score and population mean in standard deviation units. Using Z-score, we can compare single cases to average standards in the population. AIM: To compare diameters of great arteries measured in specimens fixed in 10% formalin solution to normal values obtained on echocardiography using Z-scores. MATERIAL AND METHODS: The study was performed on 43 formalin-fixed normal foetal hearts aged from 19 to 40 weeks of gestation. Each specimen was dissected and the following diameters were measured: aortic valve (AoV), ascending aorta (AAo), descending aorta (DAo), aortic isthmus (AoI), ductus arteriosus (DA), pulmonary trunk valve (PV), and pulmonary arteries (RPA and LPA). Z-score parameters were calculated for all structures using the Foetal Echo Z-score Calculator. RESULTS: Z-score values of all measured foetuses were mostly found to fit within the echocardiographic norms, although the most reliable results were obtained for foetuses aged 23 weeks. This group was represented by the highest number of specimens. The minimal and maximal Z-score values were, respectively: AoV -3.45, 1.4; AAo -4.24, -0.11; DAo -2.12, 1.29; PV -3.21, 0.69; RPA -3.4, 0.84; LPA -2.25, 0.31; AoI -1.97, 0.96; DA -3.56, -1.52. CONCLUSIONS: The diameters of great arteries measured on autopsy are comparable to the results obtained from echocardiographic measurement. Z-score values for foetal echocardiography can be applied to post-mortem examination.

Pregnancy in a woman after eight reconstructive urological operations due to bladder extrophy: case report.

The progress of reconstructive surgical treatment of congenital malformations is associated with an increasing number of patients requiring special care in pregnancy. Although there have been some communications concerning the management of pregnancy after one or two reconstructions of bladder extrophy, a case with a successful course of pregnancy after eight urological operations of this disorder is presented.

Transient dystonias in three patients treated with tiagabine.

PURPOSE: Tiagabine (TGB) is a new antiepileptic drug (AED) with gamma-aminobutyric acid (GABA)ergic mechanism of action. GABAergic compounds may influence the extrapyramidal system, probably via modulation of dopaminergic nigrostriatal neurons. A well-known side effect of TGB is probably dose-related extrapyramidal tremor. To our knowledge, acute dystonias associated with TGB treatment have yet to be described. METHODS: Three patients with transient acute dystonic reactions while taking TGB as add-on therapy with carbamazepine (CBZ) are presented. The focal limb dystonia in one case, an oromandibular dystonia in second, and writer's cramp in third one were observed. RESULTS: In all cases dystonic movements resolved spontaneously without discontinuation of TGB therapy and without any concomitant treatment. CONCLUSIONS: Tiagabine may cause various mild extrapyramidal side effects. All three cases reported were diagnosed with transient possibly drug-related dystonia after increase in TGB dose. It remain unclear whether dystonic movements are specific for patients treated with TGB/CBZ bitherapy.

[Formaldehyde emissions from wooden products and office furniture]. / Emisja formaldehydu z meblarskich tworzyw drzewnych i z mebli biurowych.

The formaldehyde emission from wood-products (particleboards, particleboards veneered with artificial veneer, laminated particleboard, hard fibreboards, plywood) and office furniture was measured with the use of environmental chamber (0.2 m3, 0.6 m3, 1.0 m3 capacity) in the following conditions: temperature 23 degrees C, relative humidity 45%, 1 air exchange/hour and factor loading 1 m2/m3. Formaldehyde was determined by using colorimetric methods. Among the tested products, hard fibreboards, plywood and almost all of the enriched particleboards should not contaminate indoor air with formaldehyde over its threshold limit values. The tested office furniture fulfill of the hygienic requirements.

Yeast protein phosphatase active with acidic ribosomal proteins.

A protein phosphatase dephosphorylating acidic ribosomal proteins was purified from Saccharomyces cerevisiae ribosome-free extract. It was shown that phosphoproteins from both P1 and P2 subfamilies as well as 60S "core" P0 protein were substrates for the enzyme. The phosphatase can dephosphorylate ribosomes as well as histones and casein but the two last substrates with significantly lower efficiency. It was found that the enzyme activity is Mn(2+)-dependent and inhibited by okadaic acid, tautomycin, cantharidin and nodularin at concentrations typical for protein phosphatase type 2A. The possible implications of those findings in the control of ribosome phosphorylation and therefore in the control of translation is discussed.