Spatial ecology of the Giant Sea Bass, Stereolepis gigas, in a southern California kelp forest as determined by acoustic telemetry.

The fisheries history of the Giant Sea Bass, Stereolepis gigas (Telostei: Polyprionidae), is closely linked to its spatial ecology. Its overharvest is directly associated with formation of spatially distinct spawning aggregations during summer, while its subsequent recovery is hypothesized to be the result of spatially explicit gear restrictions. Understanding the spatial ecology of Giant Sea Bass is a key part of efforts to assess contemporary threats such as commercial harvest and incidental catch by recreational fisheries. In this study, we used acoustic telemetry to characterize Giant Sea Bass space use in the La Jolla kelp forest using an acoustic array that encompasses two marine protected areas (MPAs) and heavily trafficked recreational fishing grounds. Five of the seven fish we tagged remained in the La Jolla array for at least 6 months. Two fish were resident across multiple years, with one fish consistently detected for 4 years. Only one fish was detected in the broader network of regional acoustic receivers, moving north approximately 8 km to Del Mar. Most tagged fish had home ranges and core use areas indicating they spend considerable time outside MPAs, particularly in areas with high recreational fishing activity. During spawning season we detected fish less frequently in the La Jolla array and recorded higher movement rates. While the current MPA network in La Jolla by no means offers complete protection to this fish, it does appear to support long-term persistence of some individuals in a region of exceptionally high recreational fishing pressure.

Learning from mistakes when reporting urgent and emergency vascular studies.

The majority of out-of-hours cases relate to neurological, chest, and gastrointestinal pathologies with acute vascular cases being encountered less commonly. Trainees and exposure of non-vascular/interventional radiology (IR) consultants to angiographic imaging is often limited in working hours and this may lead to reporting on-call cases outside of normal daytime practice. In a recent local review, a number on-call vascular studies were found to contain a number of vascular-related discrepancies. Vascular reporting is a complex subspecialty, which comprises many clear diagnoses (large vessel occlusions, large vessel aneurysms, or dissections); however, also several subtle and complex abnormalities. These more subtle abnormalities, at times, require dedicated vascular specialist review to ensure subtle findings are communicated appropriately to the clinical team. The recent increased complexity of endovascular treatments and their complications has also provided further challenge for the non-specialist reporter. Similarly, improved imaging techniques have allowed for non-obvious but significant findings that may require urgent management, such as small aneurysms and dissection flaps. We will review a range of key vascular findings that demonstrate learning opportunities, particularly within the acute and on-call settings. These will include gastrointestinal haemorrhage, subtle aortic pathologies, head and neck vascular emergencies, small to mid-sized vessel injuries and imaging of post-procedural complications. Educational hints and tips will be provided to enable learning from mistakes encountered by trainees and non-vascular specialist radiologists in the on-call or urgent reporting settings, and these will be reviewed with reference to the literature.

Smartphone speech-to-text applications for communication with profoundly deaf patients.

OBJECTIVE: Visual communication aids, such as handwriting or typing, are often used to communicate with deaf patients in the clinic. This study aimed to establish the feasibility of communicating through smartphone speech recognition software compared with writing or typing. METHOD: Thirty doctors and medical students were timed writing, typing and dictating a standard set of six sentences appropriate for a post-operative consultation, and the results were assessed for accuracy and legibility. RESULTS: The mean time for smartphone dictation (17.8 seconds, 95 per cent confidence interval = 17.0-18.7) was significantly faster than writing (59.2 seconds, 95 per cent confidence interval = 56.6-61.7) or typing (44 seconds, 95 per cent confidence interval = 41.0-47.1) (p < 0.001). Speech recognition was slightly less accurate, but accuracy increased with time spent dictating. CONCLUSION: Smartphone dictation is a feasible alternative to typing and handwriting. Slow speech may improve accuracy. Early clinical experience has been promising.

Pre-operative sildenafil and pulmonary endothelial-related complications following cardiopulmonary bypass: a randomised trial in children undergoing cardiac surgery.

In a randomised trial, we compared the effects of oral sildenafil (0.5 mg.kg(-1) ) and placebo, administered the day before cardiac surgery, in 24 children. In sildenafil vs placebo patients, pre-cardiopulmonary bypass median (IQR [range]) cyclic-guanosine-monophosphate was not significantly different (29.9 (2.1-208.1 [0.5-391.5]) vs 5.2 (0.3-54.6 [0-628.9]) pmol.ml(-1) , respectively). Post-cardiopulmonary bypass, nitrate/nitrite levels were also not significantly different (0.7 (0-8.0 [0-142.8]) vs 0 (0-2.7 [0-52.7]) µM, respectively). Postoperatively, mean (SD) pulmonary vascular resistance (2.64 (2.28) vs 1.90 (1.12) WU.m(-2) , respectively and oxygenation index (5.29 (4.60) vs 3.38 (2.54), respectively) remained unchanged, whilst oxygen delivery (57.18 (21.24) vs 74.13 (35.46) ml.min(-1) .m(-2) , respectively) and bi-ventricular systolic function (left ventricle 3.78 (0.94) vs 4.55 (1.08) cm.s(-1) , respectively; p=0.002; right ventricle 6.93 (1.47) vs 8.09 (2.25) cm.s(-1) , respectively; p<0.001) were significantly reduced in the sildenafil group. In this trial, pre-operative sildenafil did not affect postoperative pulmonary vascular resistance. There was, however, a negative impact on ventricular function and oxygenation.

Inhibitors of heme oxygenase reduce invasion of human primary cytotrophoblast cells in vitro.

Having previously demonstrated that heme oxygenase (HO) is expressed on invasive trophoblast within the human placental bed, we have now further hypothesised that HO may play a role in trophoblast invasion. To begin to test this hypothesis we have used a well characterised in vitro model of trophoblast invasion to determine whether antibodies raised against HO-1 and HO-2, or selective inhibition of HO with the HO inhibitor zinc protoporhyrin-9 (Zn PP-9), would affect the invasive ability of trophoblast cells. Cytotrophoblast cells were purified from term human placenta then cultured on Matrigel-coated chambers in the presence or absence of HO antibodies or Zn PP-9. The HO-1 antibody had no effect on invasion whereas the presence of the HO-2 antibody significantly inhibition invasion (p<0.05). The presence of Zn PP-9 resulted in a significant reduction in invasion (p<0.05) whereas the vehicle alone had no effect. Taken together these results suggest, that at least in vitro, HO-2 may be important in controlling trophoblast invasion.

Heme oxygenase expression in human placental villous tissue in response to exposure to in vitro ischemia-reperfusion injury.

Heme oxygenases (HO-1 and HO-2) are responsible for the production of carbon monoxide, a vasodilator. The products of heme oxygenase are also anti-oxidants. HO is expressed within the placenta and is important in controlling placental blood flow. HO can be sensitive to oxygen, with responses differing depending on the cell type. Recent studies have suggested that in preeclampsia, the placenta would be subjected to fluctuations in oxygen tension analogous to an ischemia-reperfusion injury. Thus the present study tested the hypothesis that HO-1 and or HO-2 expression in placental villous explants would be altered by an ischemic-reperfusion insult. Human term placental explants were exposed to hypoxia then re-oxygenation in 5% or 20% O(2) or repeated cycles of hypoxia-re-oxygenation. HO protein concentrations were assessed by Western blotting. No changes in HO-1 or HO-2 were found with any treatment protocol. Chemical induction of HO-1 was possible in explants showing that HO-1 induction in explants is possible. The results suggest that cells in term placental villous tissue do not respond to hypoxia-re-oxygenation by altering the amount of HO-1 or HO-2 protein.

Expression of TGF beta in the placental bed is not altered in sporadic miscarriage.

Extravillous trophoblast invasion of uterine stroma and spiral arteries (SA) is essential for normal pregnancy and is reduced in preeclampsia and late miscarriage. The control mechanisms are not understood, but transforming growth factor-beta (TGF-beta) may be a candidate. Placental and placental bed biopsies were obtained from early (8(+0)-12(+6) weeks) euploid miscarriages (n = 10), early aneuploid miscarriages (n = 10), late (13(+0)-19(+6) weeks) euploid miscarriages (n = 10) and controls of the same gestation (n = 20). Frozen sections were immunostained for TGF-beta1, 2 and 3. Immunoreactivity of trophoblast and uterine cell populations was assessed semi-quantitatively. TGF-beta1 immunolocalization was limited to extracellular matrix in cytotrophoblast islands and cytotrophoblast shell, perivascular fibrinoid and interstitial trophoblast and did not differ in miscarriage compared with controls. TGF-beta2 was expressed additionally in endovascular trophoblast and multinucleate trophoblast giant cells. There was no aberrant TGF-beta2 immunolocalization in late miscarriage, but TGF-beta2 immunoreactivity was increased in extracellular matrix in cytotrophoblast islands in early miscarriage. TGF-beta3 was absent from all cell populations. Stromal and extravillous trophoblast TGF-beta2 immunolocalization suggests a more important role in trophoblast invasion than TGF-beta1, but neither isoform was altered in miscarriage. Altered TGF-beta localization is therefore unlikely to play a role in abnormal trophoblast invasion and SA transformation in miscarriage.

Effect of cryopreservation on human cytotrophoblast cells in culture: hCG and PALP production.

Term villous cytotrophoblasts differentiate into syncytiotrophoblast during culture exhibiting characteristic changes in cellular morphology and protein expression profiles. Measurement of human chorionic gonadotropin (hCG) and placental alkaline phospatase (PALP) is often used to assess viability and syncytialisation of cultured cells. The objective of this study was to assess the effect of cryopreservation of isolated cytotrophoblasts on the expression hCG and PALP by cells during subsequent culture. Villous cytotrophoblasts isolated from term placentae from uncomplicated pregnancies were either cultured immediately after isolation or were cryopreserved (liquid nitrogen) prior to culture. Cells were cultured in identical conditions (5% CO(2) in air) for 96 h. Protein and DNA content of cells and HCG and PALP levels in culture medium were measured at 24 h intervals. Cryopreservation had no significant effect on the protein or DNA content of cultured cells but hCG levels in culture medium were significantly reduced after 72 h (P=0.025) compared to cultures of fresh cells. PALP levels were unchanged. Cryopreservation of cytotrophoblast cells prior to culture resulted in a decrease in basal secretion of hCG possibly caused by a failure or delay in the morphological and functional differentiation of cells.

Late sporadic miscarriage is associated with abnormalities in spiral artery transformation and trophoblast invasion.

Trophoblast invasion of uterine decidua and myometrium, and spiral artery transformation, are essential for the development of normal pregnancy; this process is impaired in pre-eclampsia, fetal growth restriction, and pre-term labour. The hypothesis that late miscarriage is associated with reduced trophoblast invasion and spiral artery transformation was tested in a large series of placental bed biopsies containing decidua and myometrium from late, karyotyped, embryonic miscarriage (>or=13 weeks' gestation; n = 26; n = 96 spiral arteries) and gestationally matched ultrasound-dated normal pregnancies (n = 74; n = 236 spiral arteries). Cryostat sections were immunostained using an avidin-biotin peroxidase technique for cytokeratin, desmin, and von Willebrand factor to detect trophoblast, myometrium, and vascular smooth muscle and endothelium, respectively. Trophoblast invasion and individual features of spiral artery transformation were assessed and analysed using a logistic regression model. Compared with normal pregnancy, myometrial spiral arteries in late miscarriage showed reduced endovascular (4% vs. 31%, p = 0.001) and intramural trophoblast (76% vs. 88%, p = 0.05), and less extensive fibrinoid change (4% vs. 18%, p = 0.01). In contrast, endovascular trophoblast in decidual spiral arteries was increased (40% vs. 66%, p = 0.04). These findings suggest that, in common with pre-eclampsia, late sporadic miscarriage may be associated with reduced trophoblast invasion and inadequate transformation of myometrial spiral arteries.

Early embryonic demise: no evidence of abnormal spiral artery transformation or trophoblast invasion.

Invasion by extravillous trophoblast of uterine decidua and myometrium and the associated spiral artery 'transformation' are essential for the development of normal pregnancy. Small pilot studies of placental bed and basal plate tissues from miscarriages have suggested that impaired interstitial and endovascular trophoblast invasion may play a role in the pathogenesis of miscarriage. The hypothesis that early miscarriage is associated with reduced extravillous trophoblast invasion and spiral artery transformation was tested in a large series of placental bed biopsies containing decidua and myometrium and at least one spiral artery from early, karyotyped embryonic miscarriages (

Dissolved oxygen concentration in culture medium: assumptions and pitfalls.

Oxygen is a key factor in the regulation of cytotrophoblast differentiation, proliferation and invasion in early pregnancy. Abnormalities in oxygen concentration have also been linked to a number of pregnancy disorders. Cell culture models have been used to study the effect of oxygen on cytotrophoblast behaviour in vitro, however, there is often little or no validation of oxygen levels in these cell culture systems. In this study, dissolved oxygen levels in culture medium maintained in standard culture conditions (18% O(2)) measured 18%. On transfer to a low oxygen environment (2% O(2)), oxygen levels decreased to 6-8% after 4h and reached 2% only after 24h in culture. Culture medium pre-gassed with nitrogen to remove dissolved oxygen quickly absorbed oxygen when exposed to ambient air during dispensing and required further incubation in a 2% oxygen environment before dissolved oxygen levels equilibrated to 2%. Thus, cultured cells placed in a low oxygen environment would be exposed to varying levels of oxygen before the desired level of oxygen exposure is reached. This study highlights the importance of validation of oxygen levels and potential problems associated with in vitro studies on the regulatory effects of oxygen.

Priming and remodelling of human placental bed spiral arteries during pregnancy--a review.

It is now well known that in order to establish human hemochorial placentation and to provide a progressive increase in blood supply to the growing fetus, the uterine spiral arteries must undergo considerable alterations. This physiological modification is thought to be brought about by the interaction of invasive cytotrophoblast with the spiral artery vessel wall. Despite intensive research our understanding of the mechanisms that control human trophoblast invasion in normal, let alone abnormal pregnancy, are still poorly understood. This is partly due to difficulties in obtaining "true" placental bed biopsies and most investigators have relied on in vitro models of trophoblast invasion. Clearly interpretation of such studies must be tempered with a degree of caution. This review outlines why the placental bed is important, how we can sample and study it, what morphology actually occurs in the placental bed spiral arteries during pregnancy and then briefly summarise the findings on the placental bed in pre-eclampsia.

Alphafetoprotein and alphafetoprotein receptor expression in the normal human placenta at term.

Alphafetoprotein (AFP) is detectable in maternal serum from around six weeks of gestation and is synthesised by the yolk sac and the fetal liver. The role of the placenta in the transport and possible synthesis of AFP is uncertain. The aim of this study was to investigate placental expression of AFP and the AFP receptor in uncomplicated pregnancies at term. Immunohistochemistry and Western blotting clearly demonstrated the presence of AFP in villous tissue at term. However, evidence of AFP mRNA expression or synthesis of AFP was not found following reverse transcription polymerase chain reaction of total RNA isolated from villous tissue and trophoblast cell cultures. The presence of a cell surface receptor for AFP in placental villous tissue, identified by immunohistochemistry and Western blotting, suggests a possible receptor-mediated mechanism for placental transport of AFP while the patterns of expression of AFP and its receptor may indicate a possible route by which AFP is transported across the placenta between the fetal and maternal circulations. These findings demonstrate that the placenta does not synthesise AFP at term and that the presence of AFP in the placenta is a reflection of transplacental transport of AFP possibly via a receptor-mediated mechanism.

Heme oxygenase expression in cultured human trophoblast cells during in vitro differentiation: effects of hypoxia.

Heme oxygenases (HO-1 and HO-2) are responsible for the production of carbon monoxide, a vasodilator. HO is important in controlling placental blood flow and expression can be sensitive to oxygen. We previously reported a reduction in HO-2 expression in placentae obtained from patients with pre-eclampsia or living at high altitude, both associated with placental hypoxia. Thus we hypothesized that HO expression in cultured trophoblasts would be altered by exposure to hypoxia. HO-1 and HO-2 expression was assessed in trophoblast cell cultures following exposure to different oxygen environments. Western blot analyses showed that HO-1 expression in syncytiotrophoblast was significantly lower than in cytotrophoblasts in standard conditions (p < 0.05). There was no difference in HO-1 expression in cytotrophoblasts transferred to 2% O2 for various times. However, exposure of syncytiotrophoblast cultures to hypoxia for 12 h resulted in a significant reduction in HO-1 expression (p < 0.05). HO-2 expression was not affected by exposure to hypoxia in either cytotrophoblast or syncytiotrophoblast cultures. Possible interpretations of these findings are that chronic hypoxia alone is not responsible for reduced HO-2 expression or a much longer exposure to chronic hypoxia (perhaps months) is required. This study also reinforces the complexities of HO regulation by oxygen.

The human placental bed revisited.

Pre-eclampsia, fetal growth restriction and spontaneous miscarriage have all been linked to abnormalities in trophoblast invasion into the placental bed. Despite intensive research our understanding of the mechanisms that control human trophoblast invasion in normal, let alone abnormal pregnancy, are still poorly understood. This is partly due to difficulties in obtaining "true" placental bed biopsies and most investigators have relied on in vitro models to try and understand the processes which control trophoblast invasion. The purpose of this article is to review the various studies which have attempted to sample the placental bed along with their success rate in doing so and secondly to review our current understanding of the morphological changes which occur in the placental bed in normal pregnancy, pre-eclampsia and spontaneous miscarriage.

Transforming growth factor beta expression in human placenta and placental bed during early pregnancy.

Normal human pregnancy depends on physiological transformation of spiral arteries. Pre-eclampsia and fetal growth restriction are associated with impaired trophoblast invasion and spiral artery transformation. Recent data obtained from studies on placenta suggest that temporal changes in expression of TGF-beta3 play a key role in trophoblast invasion and that over-expression of TGF-beta3 in pre-eclampsia is responsible for inadequate trophoblast invasion. There are, however, no studies of specific TGF-betas in the placental bed throughout pregnancy although this is where the invasive trophoblast and spiral arteries are located. In this study we have used immunohistochemistry, Western blot analysis, ELISA and RT-PCR to examine the expression of TGF-beta1, TGF-beta2 and TGF-beta3 in placental bed biopsies and placentas from 7--19 weeks' gestation. The results show that TGF-beta1, 2 and 3 are expressed in the placenta throughout this time but the striking temporal changes in TGF-beta3 expression previously reported were not observed. Extravillous trophoblast within the placental bed expressed TGF-beta2 but not TGF-beta1 or TGF-beta3 while extracellular TGF-beta1 and cytoplasmic TGF-beta2 were detected in decidua. These data suggest that TGF-beta1 and TGF-beta2 but not TGF-beta3 may play a role in trophoblast invasion.

Transforming growth factor-beta expression in human placenta and placental bed in third trimester normal pregnancy, preeclampsia, and fetal growth restriction.

Normal human pregnancy depends on physiological transformation of spiral arteries by invasive trophoblasts. Preeclampsia (PE) and fetal growth restriction (FGR) are associated with impaired trophoblast invasion and spiral artery transformation. Recent studies have suggested that transforming growth factor (TGF)-beta3 is overexpressed in the placenta of PE patients and that this may be responsible for failed trophoblast invasion. There are, however, no studies on TGF-betas in the placenta in FGR or in the placental bed in PE or FGR. In this study we have used immunohistochemistry, Western blot analysis, and enzyme-linked immunosorbent assay to examine the expression of TGF-beta1, TGF-beta2, and TGF-beta3 in placenta and placental bed of pregnancies complicated by PE and FGR and matched control pregnancies. The results show that TGF-beta1, -beta2, and -beta3 are not expressed in villous trophoblasts but are present within the placenta. TGF-beta1, -beta2, and, to a much lesser extent, TGF-beta3 were present within the placental bed but only TGF-beta2 was present in extravillous trophoblast. No changes in expression of either isoform were found in placenta or placental bed in PE or FGR compared with normal pregnancy. These data are not consistent with overexpression of TGF-beta3 being responsible for failed trophoblast invasion in PE. Our findings suggest that the TGF-betas do not have a pathophysiological role in either PE or FGR.

Human trophoblast invasion and spiral artery transformation: the role of PECAM-1 in normal pregnancy, preeclampsia, and fetal growth restriction.

During early human pregnancy extravillous cytotrophoblasts invade the uterus and spiral arteries transforming them into large vessels of low resistance. Failure of trophoblast invasion and spiral artery transformation occurs in preeclampsia and fetal growth restriction (FGR); these processes are not well understood. Recent studies have suggested that cytotrophoblasts that invade spiral arteries mimic the endothelial cells they replace and express PECAM-1. It was also reported that in preeclampsia, cytotrophoblasts fail to express PECAM-1 and that failure to express endothelial cell adhesion molecules may account for failed trophoblast invasion. Despite the possible importance of adhesion molecules in trophoblast invasion, no study has systematically investigated the expression of PECAM-1 in the placental bed throughout the period of invasion, particularly in the myometrial segments where the key failure occurs. There are no studies on PECAM-1 expression in the placental bed in FGR. We have examined the expression of PECAM-1 in placental bed biopsies and placentas from 8 to 19 weeks of gestation and in the placenta and placental bed in the third trimester in cases of preeclampsia, FGR, and control pregnancies. PECAM-1 was expressed on endothelium of vessels in the placenta and placental bed but not by villous or extravillous trophoblasts in normal or pathological samples. These findings do not support a role for PECAM-1 in normal invasion or in the pathophysiology of preeclampsia or FGR.

Heme oxygenase expression in human placenta and placental bed: reduced expression of placenta endothelial HO-2 in preeclampsia and fetal growth restriction.

In this study we tested the hypothesis that expression of heme oxygenases HO-1 and HO-2, which are responsible for the production of carbon monoxide, are reduced in the placenta and placental bed of pregnancies complicated by preeclampsia (PE) and fetal growth restriction (FGR) compared with control third-trimester pregnancies. Placental protein expression was determined by Western blotting (n=10 in each group) and immunohistochemistry (controls n=18, PE n=19, FGR n=10). Extravillous trophoblast expression was determined by immunohistochemistry of placental bed biopsy samples (controls n=17, PE n=19, FGR n=10). Western blot analysis of placental homogenates showed no overall differences in HO-2 among groups. However, immunohistochemical analysis showed a reduction in HO-2 expression in endothelial cells in both abnormal groups (PE P<0.01; FGR P<0.0005 vs. control group) but no differences in villous trophoblast staining. HO-1 was undetectable by Western blotting in control and abnormal pregnancies and immunoreactivity was very low, suggesting that there is little HO-1 in the placenta. Within the placental bed, HO-2 but not HO-1 was detected on all populations of extravillous trophoblast, but expression of HO-2 or HO-1 did not change in PE or FGR. The reduced expression of HO-2 on endothelial cells in PE and FGR may be responsible for reduced placental blood flow in these conditions. The data do not show changes in HO in the placental bed in PE or FGR.