Music Modulates Autonomic Nervous System Activity in Human Fetuses.

Context: Fetal Autonomic Nervous sysTem Evaluation (FANTE) is a non-invasive tool that evaluates the autonomic nervous system activity in a fetus. Autonomic nervous system maturation and development during prenatal life are pivotal for the survival and neuropsychiatric development of the baby. Objective: Aim of the study is to evaluate the effect of music stimulation on fetal heart rate and specific parameters linked to ANS activity, in particular fetal heart rate variability. Methods: Thirty-two women between the 32nd and 38th week with a singleton uncomplicated pregnancy were recruited. All FANTE data collections were acquired using a 10-derivation electrocardiograph placed on the maternal abdomen. In each session (5 min basal, 10 min with music stimulus, and 5 min post-stimulus), FANTE was registered. The music stimulus was "Clair de lune" Debussy, played through headphones on the mother's abdomen (CTR: 31927). Results: Music does not change the mean value of fetal heart rate. However, indices of total fetal heart rate variability statistically increase (RRsd p = 0.037, ANNsd p = 0.039, SD2 p = 0.019) during music stimulation in comparison to the basal phase. Heart rate variability increase depends mainly on the activation of parasympathetic branches (CVI p = 0.013), meanwhile, no significant changes from basal to stimulation phase were observed for indices of sympathetic activity. All the parameters of heart rate variability and parasympathetic activity remained activated in the post-stimulus phase compared to the stimulus phase. In the post-stimulus phase, sympathetic activity resulted in a significant reduction (LFn p = 0.037). Conclusion: Music can influence the basal activity of the fetal autonomic nervous system, enhancing heart rate variability, without changing fetal heart rate mean value. Music is enabled to induce a relaxation state in a near-to-term fetus, mediated by parasympathetic activation and by a parallel sympathetic inhibition.

Clinical Use of Indocyanine Green in Bowel Endometriosis Surgery.

STUDY OBJECTIVE: To show feasibility of using indocyanine green (ICG) in endometriosis surgery, especially bowel endometriosis shaving, and to discuss its potential benefits. DESIGN: Stepwise demonstration of this technique with narrated video footage. SETTING: Endometriosis is a common benign chronic disorder, characterized by the presence of endometrial tissue outside the uterus. Deep infiltrating endometriosis (DIE) represents the most aggressive presentation. Robot-assisted laparoscopy represents an important innovation and has opened new perspectives for the treatment of endometriosis, offering numerous advantages especially in the most complex procedures, particularly when extragenital endometriosis diffusely involves pelvic structures including the bowel and the urinary tract [1]. Endometriosis affects the bowel in 30% of DIE cases, and it is usually associated with ovarian and ureteral involvement; therefore, a multidisciplinary team with both general and gynecologic surgeons is required. The goal of endometriosis surgery in these cases is to obtain long-term outcomes without compromising intestinal function. One possible treatment is laparoscopic shave excision, which consists of dissection, keeping it as superficial as possible to avoid compromising bowel integrity [2]. Recent studies have shown that ICG can be useful to evaluate the size and depth of penetration of lesions during endometriosis surgery to understand shaving excision and to prevent a major iatrogenic intestinal complication [3-7]. INTERVENTIONS: Total robot-assisted laparoscopic approach to a DIE case with adnexal, uterine, and intestinal endometriosis, with the presence of a nodular rectal lesion. The excision consisted of several key strategies to minimize iatrogenic rectal injury: CONCLUSION: The approach to DIE, particularly rectal endometriotic lesions, could be more accurate with ICG evaluation of vascular pertinence, in attempt to evaluate shaving feasibility of lesions in endometriosis laparoscopic robotic surgery.

A feasibility study on non-invasive fetal ECG to evaluate prenatal autonomic nervous system activity.

BACKGROUND: Maturity of the autonomic nervous system (ANS) is of paramount importance for fetal adaptation to extrauterine life and for early neurological development. Markers of ANS maturity, such as electrophysiological heart rate parameters, are of interest as tools to determine prenatal fetal maturity. The available technology, fetal magnetocardiography is expensive and not suitable for clinical use. Detection of fetal electrocardiographic signals using traditional ECG leads on the maternal abdomen may be brought to the bedside, but is technically challenging. Our group has recently developed an innovative system consisting of a standard ECG with external leads applied on the maternal abdomen coupled with a software that extracts the fetal heart signal from the maternal noise. OBJECTIVE: To validate the use of this innovative non-invasive system to detect fetal ECG (fECG) and its ability to detect changes in electrophysiological fetal cardiac parameters associated with ANS maturation. STUDY DESIGN: we recruited 50 pregnant women between 24 and 41 weeks and they received non-invasive recording of fECG. RESULTS: fECG was measurable at all gestational ages. Fetal heart rate variability (RR interval) and other associated parameters, such as low and high frequency increased with gestational age, particularly up to the 31st week. CONCLUSIONS: This study shows that non-invasive fECG is feasible throughout a broad range of gestational ages and allows detecting electrophysiological parameters of the fetal heart that may be used a surrogate of ANS maturity. Technological implementation of this system and its further exploitation may generate new tool to estimate fetal maturity.

Regulatory effects of estetrol on the endothelial plasminogen pathway and endothelial cell migration.

BACKGROUND: Estetrol (E4) is a natural estrogen produced solely during human pregnancy. E4 is suitable for clinical use since it acts as a selective estrogen receptor modulator. In clinical trials E4 has been seen to have little or no effect on coagulation. Hence, it is interesting to investigate whether E4 alters endothelial-dependent fibrinolysis. OBJECTIVES: We studied the effects of E4 on the fibrinolytic system and whether this could influence the ability of endothelial cells to migrate. In addition, we compared the effects of E4 with those of 17ß-estradiol (E2). STUDY DESIGN: Human umbilical vein endothelial cells (HUVEC) were obtained from healthy women. Expression of plasminogen-activator inhibitor-1 (PAI-1), urokinase-type plasminogen activator (u-PA) and tissue plasminogen activator (t-PA) proteins was evaluated by Western blot analysis. Endothelial cell migration was studied by razor-scrape horizontal and multiwell insert systems assays. RESULTS: E4 increased the expression of t-PA, u-PA and PAI-1 in HUVEC, but less so than did equimolar amounts of E2. The effects of E4 on t-PA, u-PA and PAI-1 were mediated by the induction of the early-immediate genes c-Jun and c-Fos. E4 in combination with E2 antagonized the effects induced by pregnancy-like E2 concentrations but did not impair the effects of postmenopausal-like E2 levels. We also found that the increased synthesis of PAI-1, u-PA and t-PA induced by E2 and E4 is important for horizontal and three-dimensional migration of HUVEC. CONCLUSIONS: These results support the hypothesis that E4 acts as an endogenous selective estrogen receptor modulator (SERM), controlling the fibrinolytic system and endothelial cell migration.