Spiral (uteroplacental) arteries of the human placental bed show the presence of amniotic basement membrane antigens

The spiral arteries of the placental bed lose clearly recognizable arterial features early in pregnancy because of their invasion by extravillous trophoblast. Extensive structural alterations take place in the walls of invaded arteries, their walls containing an amorphous acidophilic "fibrinoid" matrix in which endovascular trophoblast is embedded. Such spiral arteries examined by immunofluorescence techniques in placental bed biopsy specimens obtained at cesarean section show a characteristic pattern of reaction with antisera to epithelial basement membrane amniotic antigens. These antisera have been previously demonstrated to react with the basement membrane of human amnion and of ectodermally derived epithelium such as breast ducts and skin. Interstitial trophoblast usually does not contain these antigens, and it is postulated that, following vascular invasion, endovascular trophoblast produces amniotic antigens to establish its presence. This may be of importance in maintaining the structural integrity of spiral arteries and thereby adequate maternal blood flow to the fetal-placental unit.     

Increasing Intake of an Unfamiliar Vegetable in Preschool Children Through Learning Using Storybooks and Sensory Play: A Cluster Randomized Trial

BackgroundMost children eat fewer vegetables than recommended. Storybooks and sensory play may increase vegetable intake.ObjectiveThis study tested the effects on intake of learning about an unfamiliar vegetable (celeriac) through storybooks and sensory play. It was predicted that an illustrated, congruent storybook would increase intake of celeriac compared to an incongruent storybook (carrot); and that adding congruent sensory play with celeriac to the storybook would produce a synergistic effect on intake of celeriac.DesignChildren from 12 UK preschools were randomly assigned by clusters to four intervention conditions using a 2×2 factorial design. The factors were vegetable congruency (sensory play and/or storybook were congruent, or incongruent [carrot] with celeriac) and intervention type (storybook only or storybook combined with sensory play).Participants/settingThree hundred and thirty-seven children aged 2 to 5 years were recruited to take part in November 2017.InterventionOver a 2-week period, children in all four conditions were read a vegetable storybook featuring celeriac or carrot. In addition, two conditions received sensory play with either carrot or celeriac added to the storybook method.Main outcome measuresIntake of the unfamiliar vegetable (celeriac) was measured at baseline and after the 2-week intervention.Statistical analysis performedComplex samples logistic regression and general linear modeling were performed to examine group differences at post-intervention.ResultsChildren receiving the congruent (celeriac) storybook had higher odds of eating celeriac compared to children who received the incongruent (carrot) storybook. Receiving congruent sensory play increased the odds of eating celeriac, whereas receiving incongruent sensory play did not. From the 267 children who completed both baseline and post-intervention assessments, 85 ate no celeriac at baseline and were classed as non-eaters. Sensory play (congruent or incongruent) increased the odds of eating some celeriac in non-eaters compared to storybook only conditions.ConclusionsCongruency between storybook and vegetable increased intake; sensory play with celeriac increased the likelihood of eating celeriac. Storybooks and sensory play are simple interventions to increase willingness to try an unfamiliar vegetable.     

The JT Interval as a Depolarization Independent Measurement of Repolarization: Lessons from Catheter Ablation of the Wolff-Parkinson-White Syndrome

In patients with Wolff-Parkinson-White syndrome (WPW), preexcitation precludes accurate assessment of the ventricular repolarization by the QT_C. In patients with long QT syndrome, it has been demonstrated that the JT_C does not change when depolarization abnormalities develop. We hypothesized that this phenomenon should also be applicable to WPW patients. To test this, we assessed the surface ECG of 29 patients (16 males, 13 females) with WPW pre- and postablation. The QRS, QT, and JT intervals were measured pre- and postablation at 50 mm/s paper speed in leads II and V₂. QT_C and JT_C were calculated according to Bazett's formula. The average age was 12.8 ± 4.9 years (range 1.5–21). All patients had no residual preexcitation on postablation ECG. Early and late follow-up ECGs were obtained at 32 ± 34 days and 388 ± 197 days postablation, respectively. Both the QRS and the QT_C intervals shortened significantly on the postablation versus preablation ECGs (QRS: 115 ± 23 ms vs 89 ± 15 ms, respectively; P < 0.0001), (QT_C: 454 ± 26 vs 423 ± 23, respectively; P < 0.0001). The preablation JT_C interval did not change, postablation (319 ± 21 vs 323 ± 23, respectively; P > 0.2). Also, the JT_C interval did not change between early and late follow- up, postablation. JT_C: is an independent measure of repolarization, not related to depolarization. JT_C may be a useful tool in assessing repolarization in patients with WPW and other depolarization abnormalities.     

JT Dispersion in Wolff-Parkinson-White Syndrome: Effect of Eccentric Ventricular Depolarization on the Dispersion of Repolarization

There is much interest in QT dispersion for noninvasive risk stratification of patients at risk of arrhythmias. However, little is known about the genesis of abnormal QT dispersion. In particular, whether eccentric ventricular depolarization, as seen in preexcitation, can lead to abnormal dispersion of repolarization is unknown. We studied 24 children aged 1–19 years (mean ± SD, 11 ± 5 years) with manifest preexcitation due to Wolff-Parkinson-White syndrome who had successful catheter ablation. Standard ECGs done preablation, early postablation (< 1 week), mid postablation (> 1 week, < 2 months), and late postablation (> 2 months) were reviewed. The QRS duration prior to ablation ranged from 90–160 ms (mean ± SD, 123 ±21 ms). On the preablation ECG, the JT and JTc dispersions showed no relationship to the QRS duration (r = 0.04 and 0.07, respectively). There was no change in JT dispersion when the preablation (42 ±15 ms) ECG was compared to early (43 ±15 ms), mid (44 ±13 ms), and late postablation (48 ± 19 ms) ECGs. There was no significant change in JTc dispersion as well. Thus, JT dispersion is unrelated to QRS duration and unaffected by catheter ablation in patients with Wolff-Parkinson-White syndrome. Eccentric ventricular depolarization does not lead to abnormal dispersion of repolarization.     

Dispersion of repolarization and beta-thalassemia major: the prognostic role of QT and JT dispersion for identifying the high-risk patients for sudden death

Background: Patients with beta‐thalassemia major (β‐TM) are at increased risk for sudden cardiac death (SCD). Heterogeneity of ventricular repolarization is considered to provide an electrophysiological substrate for malignant arrhythmias. QT dispersion (QTc‐D) and JT dispersion (JTc‐D) are electrocardiographic parameters indicative of heterogeneity of ventricular repolarization. The aim of our study was to evaluate the heterogeneity of ventricular repolarization in patients with beta‐thalassemia and to test the hypothesis that an abnormal QTc and JTc dispersion may predict SCD in this population. Materials and Methods: The study involved 51 patients with β‐TM (age 33.9 ± 8.4; 33 M) and 51 healthy subjects used as controls, matched for age, gender, and body mass index (BMI). Among the β‐TM group, 14 patients with β‐TM (age 27 ± 6.64; 11 M) died from SCD during follow‐up. For each patient, QTD and JTD intervals were calculated. Results: Compared to the healthy control group, β‐TM group presented increased values of the QTc‐D (65.36 ± 33.95 vs. 37, 62 ± 17.65; P < 0.003) and JTc‐D (74.64 ± 33.27 vs. 40.32 ± 12.45; P < 0.001). In the β‐TM sudden death group, QTc‐D and JTc‐D were significantly greater than in survived β‐TM group (92.70 ± 44.24 vs. 56.14 ± 23.80, P = 0.0001; 101.54 ± 47.93 vs. 64.47 ± 17.90, P = 0.0001). A cutoff value of 70 ms for QTc‐D had a sensitivity and specificity of 77% in identifying patients at risk for SCD. A cutoff value of 100 ms for JTc‐D had a sensitivity of 65% and a specificity of 94% in identifying this category of patients. Conclusion: β‐TM is associated with significant changes in heterogeneity of ventricular repolarization. QTc and JTc dispersion are useful markers of risk of SCD in patients with β‐TM.     

Acute psychological stress and the propensity to ventricular arrhythmias; evidence for a linking mechanism.

AIMS: This study was designed to test the hypothesis that acute psychological stress is capable of inducing an increase in the dispersion of repolarization in patients with underlying coronary artery disease. METHODS AND RESULTS: Twenty four patients undergoing elective coronary angiography were studied, 17 with significant coronary artery disease and seven with normal coronary arteries. Following coronary angiography they were subjected to a series of timed cognitive tests, well known to induce acute psychological stress. An individual's perception of stress was assessed by visual analogue scales. Serial ECGs were recorded during the cognitive tests and QT, QRS and JT intervals measured from which QT, QRS and JT dispersion were calculated. Psychological stress was reported by the seven patients with normal coronaries and 14 of the 17 with coronary artery disease. In patients who experienced stress a marked increase in QT dispersion, reflecting JT dispersion, was observed in those with coronary artery disease (F=22.4, P=0.0001) but not in those without. At baseline there was no difference in QT dispersion between those with and without coronary artery disease (27-57 ms, 17-53 ms, P > or = 0.5). CONCLUSION: Acute psychological stress induces an increase in QT dispersion in patients with underlying coronary artery disease due to changes in JT dispersion (rather than QRS dispersion). This suggests that psychological stress modifies the dispersion of repolarization through ischaemia related changes in action potential duration.     

急性颅脑损伤病人心电图QT离散度的临床意义

将１１２例急性颅脑损伤病人分为轻型、中型、重型及死亡４组。测量其心电图的ＱＴ间期、ＪＴ间期，计算ＱＴ离散度（ＱＴｄ）、校正的ＱＴ离散度（ＱＴｃｄ）、ＪＴ离散度（ＪＴｄ）。结果：轻、中、重型及死亡组随着损伤程度加重，ＱＴｄ、ＱＴｃｄ及ＪＴｄ逐渐增大。中、重型及死亡组与轻型组比较有显著性差异（Ｐ＜０．０５～０．００１）。