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Objective:To explore the application advantages of hospital-community linkage network blood glucose management model for elderly type 2 diabetes patients in community in order to supply reference for improve patients′ qualitye of life.Methods:This study was a randomized controlled study. A total of 84 elderly patients in Huangpu Community Hospital of Guangzhou from February to September 2022 were selected and divided into control group and intervention group by a table of random numbers. The control group adopted the hospital community linkage management model, and the intervention group followed the network management mode on the basis of the routine management. After 6 months of intervention, we compared the level of fasting blood glucose, blood glucose two hours after meal and glycosylated hemoglobin, and the scores of the Summary of Diabetes Self-Care Activities (SDSCA), Diabetes Specificity Quality of Life Scale(DSQL) between the two groups to illustrate the application advantages.Results:There were no significant differences in blood glucose two hours after meal, fasting blood glucose and glycosylated hemoglobin between the intervention and control groups (all P>0.05). After 6 months of intervention, the blood glucose two hours after meal, fasting blood glucose and glycosylated hemoglobin of the intervention group were (9.25 ± 2.87) mmol/L, (6.07 ± 0.69) mmol/L and (7.04 ± 1.59) %, respectively, which were lower than those of the control group (11.04 ± 3.75) mmol/L, (6.57 ± 0.95) mmol/L and (8.02 ± 2.25)%. The differences were statistically significant ( t = 2.45, 2.76, 2.30, all P<0.05). After 6 months of intervention, the scores of SDSCA scale and DSQL scale were (34.21 ± 10.43) and (135.64 ± 10.71) points, which were higher than (29.12 ± 7.36) and (145.85 ± 10.33) points in the control group, and the differences were statistically significant ( t = 2.58, 4.44, both P<0.05). Conclusions:The hospital-community linkage network management model can improve the blood glucose level of elderly patients with type 2 diabetes mellitus in the community and has a positive effect on improving self-management behavior ability and improving quality of life.
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Objective:To investigate the genetic etiology of fetal conotruncal heart defects (CTDs) and to evaluate the performance of copy number variation sequencing (CNV-seq) and whole exome sequencing (WES) in identifying the genetic etiology.Methods:This retrospective study involved 196 fetuses diagnosed with CTDs by fetal echocardiography in Beijing Anzhen Hospital, Capital Medical University from June 2017 to December 2021. CNV-seq was performed to screen for chromosomal abnormalities [aneuploidy and copy number variations (CNVs)] in the fetuses and their parents, and then WES was performed if CNV-seq was negative. The diagnostic yields of genetic abnormalities [aneuploidy+CNVs+single nucleotide variations (SNVs)] for different types of CTDs were compared using Chi-square test. Results:CNV-seq revealed 54 cases (27.6%, 54/196) with chromosomal abnormalities, including 14 (7.1%, 14/196) aneuploidies, 39 (19.9%, 39/196) CNVs and one aneuploidy complicated by CNVs. Together with another 13 fetuses with pathogenic or likely pathogenic SNVs detected by WES among the rest 142 cases whose CNV-seq results were negative, the total detection rate of genetic abnormalities was 34.2% (67/196). WES increased the diagnostic yield for CTDs by 9.2% (13/142). There was significant difference in the diagnostic yields for different types of CTDs ( χ2=20.31, P=0.002). The diagnostic yield was relatively high for interrupted aortic arch of type B, absent of the pulmonary valve -type of tetralogy of Fallot (9/10 and 8/12), but low for transposition of the great arteries (12.5%, 5/40). Conclusions:CNVs are the common genetic abnormalities in fetal CTDs, and SNVs are also detected in some cases. It is recommended that all fetuses with CTDs should undergo genetic testing. CNV-seq should be used in combination with WES if possible to improve the identification of genetic etiology and provide reference for genetic counseling.
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Objective:To investigate the differences of umbilical vein diameter(D), time average peak velocity(TAmax) and blood flow between congenital heart disease and normal fetus.Methods:The umbilical vein diameter and time average peak velocity of 69 fetuses with congenital heart disease (disease group) from 22 to 27 weeks were prospectively studied in Maternal-Fetal Medical Center in Fetal Heart Disease of Beijing Anzhen Hospital from May 2021 to September 2021. Q 1 (umbilical venous blood flow) was calculated according to the formular [Q=0.5TAmax·π·(D/2) 2)], and Q 2 (Q 2=Q 1/weight) was calculated according to the fetal weight. At the same time, 111 normal fetuses with matched gestational age were selected as control group. The differences of fetal umbilical vein D, TAmax, Q 1 and Q 2 between the two groups were analyzed. Results:The inner diameter of umbilical vein D, TAmax, Q 1 and Q 2 in the congenital heart disease group were lower than those in the control group(all P<0.05). In the control group, the inner diameter of umbilical vein D, TAmax and Q 1 increased with the increase of gestational age and showed a positive linear correlation( r=0.608, 0.320, 0.626; all P≤0.001), while there was no obvious linear correlation between Q 2 and gestational age( r=0.189, P=0.047). Conclusions:The decrease of umbilical vein D, TAmax, Q 1 and Q 2 in the fetus with congenital heart disease indicates the decrease of effective blood flow in placenta-fetus circulation, which indirectly reflects the decrease of placental function in the fetus with congenital heart disease.
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Objective:To summarize the etiological mechanism, echocardiographic and clinical features of fetal cardiomyopathies (FCMs).Methods:According to the data of echocardiography in Maternal-Fetal Medicine Center in Fetal Heart Disease of Beijing Anzhen Hospital during 2015 January to 2020 December, 70 cases with FCMs were retrospectively reviewed, and the clinical, ultrasonic, pathological and clinical outcome data were collected. Whole exome sequencing and whole genome sequencing were used to identify the genetic changes.Results:Primary FCMs were diagnosed in 55 cases (78.6%, 55/70), including 39 fetuses with non-compaction of the ventricular myocardium (NVM), 10 with dilated cardiomyopathy (DCM), 5 with hypertrophic cardiomyopathy (HCM), and 1 with restricted cardiomyopathy (RCM). Secondary FCMs were diagnosed in 15 cases (21.4%, 15/70), including 7 fetuses with maternal anti-Ro/La antibodies (presenting with DCM), 4 with twin-twin transfusion syndrome (2 with DCM and 2 with HCM), 2 with fetal anemia (presenting with DCM), 1 with maternal diabetes (presenting with HCM) and 1 with chorioangioma of the placenta (presenting with DCM). In all cases, 9 cases were born, 3 cases died in perinatal period, and 58 pregnancies were terminated due to ineffective treatment or the decisions of pregnant women. Thirty cases with primary FCMs were performed with genetic tests, and 13 of them were identified with positive genetic changes related to FCMs, including 12 cases with NVM and 1 with HCM.Conclusions:Primary FCMs are more common than secondary FCMs in fetal period. The genetic disorders have a high proportion in fetal NVM. Fetal DCM and HCM have a large spectrum of intrinsic and extrinsic causes.
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【Objective】 To investigate the effect of AIDET communication mode in informing blood donors of reactive viral markers results. 【Methods】 Blood donors who came FOR COUNSELLING AFTER NOTIFICATION OF THEIR REACTIVE SCREENING TEST RESULTS from Jan 2018 to Sep 2021 were selected as the subjects. They were divided into two groups according to the blood donation time and notification mode: control group who were notified by a conventional mode(n=128), from Jan 2018 to Dec 2019, and the experimental group(n=92) who were notified by AIDET mode, from Jan 2020 to Sep 2021. The anxiety state and degree of satisfaction to the notification were compared between the two groups. 【Results】 After attending COUNSELLING, the anxiety level of the experimental group was significantly lower, while the degree of satisfaction to the notification was significantly higher than that of the control group (P<0.05). 【Conclusion】 AIDET communication mode established a standardized and effective communication channel and reduced the anxiety of blood donors WHEN NOTIFYING THE REACTIVE SCREENING TEST RESULTS. Moreover, it can enhance the trust and satisfaction between donors and medical staff as well as the quality of notification, which is of great significance to promote the healthy and continuous development of voluntary blood donation.
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Early and prompt comprehensive prevention and treatment of fetal congenital heart disease (CHD) has become an international consensus and trend, with the aim of improving its prenatal detection rate, diagnostic accuracy, and the overall pregnancy outcome. Prenatal and postnatal integrated management of fetal CHD has been shown to be clinically effective in the prevention and treatment of CHD, which consists of early and accurate diagnosis, identification of structure-related multi-dimensional etiology, standardized consultation, primary prevention for the next fetus, and postnatal management. This review summarizes the current status, challenge, and future trend of implementing prenatal and postnatal integrated management of fetal CHD in China.
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Objective:To explore the changes of biparietal diameter, head circumference and cerebrovascular hemodynamics in fetuses with hypoplastic left heart syndrome (HLHS) during middle pregnancy.Methods:The biparietal diameter, head circumference, middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI) and MCA-PI/UA-PI (CPR) of 41 fetuses with HLHS(HLHS group) were retrospectively analyzed from January 2015 to December 2019 in Beijing Anzhen Hospital, and were compared with those of 82 normal fetuses matched for gestational age at the same period (control group).Results:The Z-scores of head circumference, MCA-PI and CPR in with HLHS group were lower than in control group(all P<0.05); Head circumference in HLHS group were weakly and positively correlated with the MCA-PI and CPR ( r=0.385, 0.416; all P<0.05). Conclusions:There are some changes in the head circumference and cerebral hemodynamics in fetuses with HLHS during mid-gestational age, and the head circumference is weakly and positively correlated with MCA-PI and CPR, which has clinical significance.
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Objective:To evaluate the heart hemodynamics in fetuses with premature ductus arteriosus constriction or closure using fetal heart quantification (FHQ).Methods:The clinical data of 50 singleton fetuses with ductus arteriosus constriction ( n=35) or ductus arteriosus closure ( n=15) who underwent echocardiography in Department of Ultrasound, Beijing Anzhen Hospital were retrospectively analyzed, from May 2013 to January 2020. Fifty healthy singleton fetuses were randomly selected as the control group. The ductus arteriosus diameter (DA), pulsatility index (PI), diameter of the left atrium(LA) and right atrium(RA), diameter of the left ventricle (LV) and right ventricle (RV), tricuspid regurgitation/right atrium area ratio (TR/RA Ratio), pressure gradient of tricuspid regurgitation (PG of TR), and heart/chest ratio were measured using conventional fetal echocardiography; the correlations among the parameters were analyzed. Speckle-tracking analysis was used to analysis and compute the LV and RV global spherical index (GSI), fractional area change (FAC) and global strain (GS), the LV ejection fraction(EF) and stroke volume (SV). These variables and their correlations were compared and analyzed. Results:Compared with the control group, the GS and FAC of the LV and RV in the ductus arteriosus constriction or closure groups were lower ( P<0.05) while the LV-SV was higher ( P<0.05). The FAC, GS, and EF values of the LV were higher in the premature ductus arteriosus closure group than in the ductus arteriosus constriction group ( P<0.05), while the RV-FAC was lower ( P<0.05), the RV-GS and LV-SV showed no significant changes ( P>0.05). Correlation analyse showed that the PI was positively correlated with DA( r=0.364, P<0.05); the PG of TR was negatively correlated with DA( r=-0.414, P<0.05); the TR/RA Ratio was negatively linearly correlated with PI( r=-0.388, P<0.05), and positively correlated with RV/LV Ratio ( r=0.369, P<0.05); the other parameters were not significantly correlated with the DA or PI ( P>0.05). Conclusions:Fetal heart hemodynamics in the premature ductus arteriosus constriction or closure groups change significantly, FHQ can provide valuable information for the evaluation of the fetal heart with ductus arteriosus constriction or closure.
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【Objective】 To investigate the role of thromboelastography (TEG) in the diagnosis and treatment of PICC related venous thrombosis in tumor patients, and provide basis for predicting PIC related venous thrombosis. 【Methods】 148 tumor patients who underwent PICC catheterization in our hospital from January to July 2019 were enrolled. The patients were subjected to TEG examination and ultrasound examination of limb blood vessels on catheterization side regularly one day before catheterization and 4 successive weeks after catheterization(once a week), respectively. The patients with venous thrombosis were subjected to TEG examination and vascular ultrasound regularly for 3 successive weeks(once a week) after anticoagulant therapy. The relationship between the occurrence and time of venous thrombosis and the changes of TEG parameters was analyzed. 【Results】 The pre-/post-catheterization TEG parameter of 81 patients without venous thrombosis indicated that coagulation state was normal (R value F=0.198, K value F=0.047, α value F=0.442, MAvalue F=0.079, CIvalue F=0.026, P>0.05). The TEG parameter of 67 patients, who developed asymptomatic venous thrombosis 1 to 3 weeks after catheterization(38 cases in 1 week, 16 in 2 weeks and 13 in 3 weeks), indicated the blood was hypercoagulable and the TEG parameter was statistically different from the pre-catheterization value(P0.05). 【Conclusion】 TEG can reflect the status of PICC related venous thrombosis in tumor patients.Strengthening TEG monitor in tumor patients 1 to 3 weeks after PICC catheterization is conducive to early detection, diagnosis and treatment for PICCrelated thrombosis, thus reducing the harm of venous thrombosis to patients.
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Objective:To investigate the value of post left atrium space index (PLASI) in the diagnosis of fetal isolated total anomalous pulmonary venous connection (TAPVC).Methods:Twenty-six cases of fetal isolated TAPVC were retrospectively analyzed as the TAPVC group and 243 normal fetuses were selected as the control group from October 2012 to April 2019 in the Consultation Center of Maternal-Fetus Medicine in Fetal Heart Disease in Beijing An Zhen Hospital. The width of the PLAS and the diameter of the descending aorta were measured in the four chamber view, and then the PLAS index (PLASI) (the width of the PLAS/the diameter of the descending aorta) was calculated. The relationships between the width of PLAS, the diameter of descending aorta and the PLASI and gestational age were analyzed. The difference of the PLASI between isolated TAPVC group and control group was analyzed, and ROC curve was used to analyze the sensitivity and specificity in identifying the isolated TAPVC fetuses and normal fetuses.Results:In the 243 normal fetuses in control group, both the width of the PLAS and the diameter of the descending aorta increased with gestational age ( r s=0.362, 0.648, P<0.05). There was no statistically significant correlation between the PLASI and gestational age ( r s=-0.065, P>0.05). The PLAS and the PLASI in isolated TAPVC group were all significantly higher than those in control group ( t=26.31, 34.90, P<0.01). Based on the ROC curve analysis, when the cutoff value was set to 3.6 mm, the sensitivity and specificity of PLAS in identifying isolated TAPVC and normal fetuses were 97.5% and 100%, respectively. When the cutoff value was set to 1.1, the sensitivity and specificity of PLASI in identifying isolated TAPVC and normal fetuses were 100% and 100%, respectively. Conclusions:The PLASI is a sensitive parameter in identifying the isolated TAPVC, which is helpful for the rapid screening of the isolated TAPVC.
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Objective:To investigate the value of artificial intelligence in screening normal or abnormal four-chamber view of the fetal heart.Methods:Selecting 3 996 pictures of normal and abnormal end systolic four chamber views and 450 video clips from the database of Beijing Key Laboratory of Fetal Heart Disease Maternal and Fetal Medicine Research in Beijing Anzhen Hospital as training set, test set and verification set to train, test and verify DGACNN model. ①Comparing DGACNN, DGACNN-ALOCC and other classification models(Densenet, Resnet50, InceptionV3, InceptionResnetV2) to detect the model with the most advanced level by recognizing 200 normal pictures and 200 abnormal pictures. ②Fetal echocardiographers were divided into three groups according to their experiences: primary, intermediate and advanced, 3 doctors in each group, and comparing the average score between each group or three groups and DGACNN by recognizing 100 normal pictures and 100 abnormal pictures.Results:①When the the false positive rate(FPR) was in the range of 20%, the recognition accuracy of DGACNN was the highest with 0.850, the recognition accuracy of other models were DGACNN-ALOCC 0.835, Densenet 0.780, Resnet50 0.700, InceptionV3 0.670, InceptionResnetV2 0.650, respectively. ②When FPR was in the range of 20%, the area under ROC curve of DGACNN was the largest with 0.881, the area under ROC curve of other models were DGACNN-ALOCC 0.864, Densenet 0.850, Resnet50 0.822, Inceptionv3 0.779, InceptionResnetV2 0.703, respectively. ③When the FPR was in the range of 20%, the average recognition accuracy of the senior fetal echocardiographer group was the highest with 0.863, followed by DGACNN 0.840, which was higher than the average recognition accuracy of the primary and intermediate groups with 0.760, 0.807; the average recognition accuracy of DGACNN was higher than the total average recognition accuracy of the primary, intermediate and advanced groups with 0.810.Conclusions:Artificial intelligence is accessible in screening four chamber view of fetal echocardiography, with high recognition accuracy.
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Objective:Based on the methodology of network pharmacology, this study preliminarily predicted the major targets and pathways of Andrographis herba in the treatment of breast cancer. Methods:The active components of Andrographis herba were screened by Traditional Chinese Medicine Systems Pharmacology Database (TCMSP); breast cancer targets were predicted and screened by Genecard database platform and OMIM database platform; active ingredient-targets networks were built by Cytoscape (3.7.2) software, and protein interaction networks were built by String database platform. Finally, Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were performed by using Bioconductor platform and R language. Results:A total of 24 active ingredients of Andrographis herba and 13 234 targets for breast cancer were obtained, involving 71 targets related to Andrographis herba. There were 51 common targets for Andrographis herba-breast cancer. The top five targets are TP53, IL6, JUN, CCND1, and ERS1. Andrographis herba-breast cancer KEGG-enriched pathways are estrogen signaling pathway, P53 signaling pathway, Notch signaling pathway, and Wnt signaling pathway. Conclusions:The TP53, ERS1, and CCND1 and other targets may be the key targets for Andrographis herba paniculata to treat breast cancer. It plays an anti-breast cancer effect by regulating the signal pathways such as the estrogen receptor pathway and the P53 signaling pathway. This paper provides a theoretical basis for further exploration of the mechanism research of Andrographis herba in the treatment of breast cancer.
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Objective:By taking network pharmacology approach to search for active components and the rapeutic targets of Huanglian-Ejiao Decoction. Methods:According to the pharmacokinetic parameters, this research screened components of this decoction, and diged the drugs and disease targets with network pharmacology and constructed the drug-target-pathway network by Cytoscape system to investigate the mechanism of Huanglian-Ejiao Decoction. Results:It was found that 19 components such as hydroberberine, β-sitosterol, curcumin, kaempferol, berberine and Ramie flavonoids in Huanglian-Ejiao Decoction could take effecton insomnia by regulating 25 targets such as 5-hydroxytryptamine, dopamine, gamma aminobutyric acid, opioid receptor and acetylcholine. Conclusion:Huanglian-Ejiao Decoction may play an important role in treating insomnia by regulating multiple-targets.
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Objective: To observe the types and accompanied malformations of fetal atrioventricular septal defect (AVSD), and to analyze the characteristics of AVSD gene with second-generation sequencing. Methods: Data of 150 AVSD fetuses diagnosed with ultrasound were reviewed, including 47 fetuses underwent genetic testing. Echocardiographic images were analyzed, and the types and accompanied intracardiac and extracardiac malformations were evaluated. Then the whole genome and whole exon sequencing were performed together with peripheral blood of the parents and umbilical cord tissue from 47 samples. Results: There were 7 (7/47, 14.89%) partial type, 2 (2/47, 4.26%) transitional type and 38 (38/47, 80.85%) complete type AVSD, Among 47 fetuses, including 27 (27/47, 57.45%) associated intracardiac malformation, 19 (19/47, 40.43%) with associated extracardiac malformation and 14 (14/47, 29.79%) with both intracardiac and extracardiac malformation. Tissue degradation was found in 4 samples during genetic testing, while results were obtained in 43 samples including 22 (22/43, 51.16%) positive ones. The positive rate of genomic studies in AVSD fetuses with accompanied intracardiac malformation was 40.74% 11 (11/27), in AVSD with accompanied extracardiac malformation was 73.68% (14/19), while in AVSD with both intracardiac and extracardiac malformation was 78.57%(11/14). Conclusion: Fetal AVSD, especially complete type AVSD has obvious association with extracardiac and intracardiac malformations. Genomic abnormalities are common in AVSD, chromosomal abnormalities are more likely to occur when AVSD combined with extracardial malformations. Genetic testing is necessary when AVSD is diagnosed with prenatal ultrasound. Second-generation sequencing technology is conducive for detection of different levels of genetic abnormalities.
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Objective To identify the chemical constituents of Xiakucao Xiaoliu mixture by high performance liquid chromatography-high resolution time-of-flight mass spectrometry (HPLC-TOF/MS). Methods The chromatographic separation ACE (3.0mm×150 mm) column was used. The mobile phase was methanol (A) and 0.1% formic acid (B). The gradient elution was: 0-5 min, 5% A; 5-10 min, 5%-15% A; 10-30 min, 15%-45%A; 30-40 min, 45%-70%B; 40-50 min, 70%-90%B. The injection volume was 2 μl. The flow rate was 0.4 ml/min. The column temperature was 25°C. The mass spectrometry was characterized by time-of-flight mass spectrometry, using ESI ion source. The common monitoring was in positive and negative ion mode. The reference ion was m/z 121.9856, 1033.9881. The scanning range was m/z 100-1200. Results A total of 37 chemical constituents were identified in the Xiakucao Xiaoliu mixture, 8 in the positive ion mode fragment voltage of 160 V, 28 in the negative ion mode fragment voltage of 160 V, and 19 in the fragment voltage of 260 V. Both positive and negative ions had 4 responses. The negative ion mode has 16 responses under both fragment voltages. And the ingredients were medicinal. Conclusion An effective method for the identification of the chemical constituents of Prunella vulgaris L. by HPLC-TOF/MS was established, which laid a foundation for its quality control and in-depth study in vivo.
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Objective To investigate the therapeutic effect of Xiakucao Xiaoliu mixture on Lewis lung cancer mice. Methods 30 mice with C57BL/6 mouse Lewis lung cancer xenograft model were randomly divided into three groups: model control group, Xiakucao Xiaoliu mixture group (M group), cisplatin group (DDP group). M group and DDP group were administered continuously for 14 days. Through the general observation of Lewis lung cancer mice, tumor size was determined, HE staining method was used to determine the histopathological changes of tumors, and the expression of CyclinD1 and P16 in tumor tissues was determined by immunohistochemistry. Results The tumor weight of the model control group was the heaviest, and the difference was statistically significant compared with other groups. (P<0.05). Survival state and quality of life of mice had been improved to some extent in M group. The results of tumor growth curve and HE staining in each group of mice showed that the growth of tumor cells had been inhibited and normal cells had been protected. The positive expression of CyclinD1 was significantly decreased in M group and DDP group (P<0.01), but the effect of M group on the improvement of P16 positive expression was not significant. Conclusion Xiakucao Xiaoliu mixture had a good effect on inhibiting lung tumor growth.
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Objective:To summarize the echocardiography and pathological features of fetal Kabuki syndrome.Methods:This study retrospectively analyzed the echocardiography and pathological features of seven fetuses with KMT2D pathogenic variants confirmed by copy number variation sequencing, and who were identified as complex congenital heart disease by fetal echocardiography, at Beijing Anzhen Hospital, Capital Medical University and other multi-center collaborative hospitals on fetal congenital heart diseases from January 2013 to May 2018. All the seven fetuses were artificially aborted. Descriptive statistics were used for data analysis. Results:(1) The seven pregnant women aged 29 (27-32) years and had an abortion at 23 (22-25) gestational weeks. There were three male and four female fetuses. (2) Pathogenic mutations in KMT2D gene were detected in all seven cases, including one nonsense mutation and six frameshift mutations. (3) All fetuses had left heart obstruction with or without aortic arch dysplasia/interruption of the aortic arch. There were three with hypoplastic left heart syndrome, two with a single ventricle, one with aortic atresia, and one with severe mitral valve dysplasia. Other cardiovascular abnormalities included aortic arch branch abnormalities, double-outlet of the right ventricle, ventricular septal defect, tricuspid atresia, pulmonary valve stenosis (nearly atresia) complicated by pulmonary dysplasia, persistent left superior vena cava, and patent or closed foramen ovale. Secondary changes included enlargement of the right atrium and right ventricle, and dilatation of the pulmonary artery or ductus arteriosus. (4) Four of the seven fetuses showed multiple extracardiac system abnormalities, including facial deformities (two cases), pulmonary dysplasia (two cases), digestive abnormalities(two cases), and urogenital system abnormalities (two cases). Conclusions:The main features of echocardiography for fetal Kabuki syndrome are left heart obstruction, often complicated by other congenital cardiovascular abnormalities.
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Objective@#To explore the use of supporting guide wire to exclude the PICC catheter refolding malposition,and reduce the number of the catheter resetting and the average time of catheter resetting,while reducing the mechanicalness phlebitis and the incidence of symptomatic thrombosis.@*Methods@#A total of 3 513 patients who received PICC from September 2016 to August 2018 were enrolled. The patients were divided into control group (1 757 cases) and observation group (1 756 cases) by random number table method.The control group was treated with conventional B-ultrasound guided modified Sadinger technique PICC. After the observation group was finished on the basis of the control group, the support guide wire was partially withdrawn and re-sent, according to whether the guide wire was re-supplied or not, to determine whether the catheter has a partial fold in the body. The incidence of catheter refolding malposition, the number of reductions, the time of reduction, and the incidence of mechanicalness phlebitis and symptomatic thrombosis were compared between the two groups.@*Results@#The refolding malposition rate of the observation group and the control group were 0 and 3.47%(61/1 757), respectively. The difference was statistically significant (χ2=59.943, P<0.01). Among the 74 patients in the observation group who underwent catheter resetting, 63 patients were reset ≤1 times, 9 patients were reset twice, 2 patients were reset≥third; among the 61 patients in the control group who underwent catheter resetting, 24 patients were reset≤1 times, 6 patients were reset twice, 31 patients were reset≥third, the number of the resetting in two groups were compared,the difference was statistically significant(χ2=42.712, P<0.05). The average reset time of the observation group was (49.66±25.45) s, and the average reset time of the control group was (610.41±206.23) s, the difference was statistically significant (t=18.636, P<0.01).The incidence of mechanical phlebitis in the observation group and the control group were 1.31%(23/1 756) and 3.76%(66/1 757), respectively. The incidence of mechanical phlebitis in the two groups was statistically significant (χ2=20.241, P<0.01). The incidence of symptomatic thrombosis in the observation group and the control group were 0.34%(6/1 756), 1.20%(21/1 757), respectively. The incidence of symptomatic thrombosis in the two groups was statistically significant (χ2=8.261, P<0.05).@*Conclusions@#The use of the supportting guide wire to withdraw and re-feed during the catheterization process can effectively eliminate the PICC catheter refolding malposition, reduce the number of catheter reposition and the average reposition time, and reduce the incidence of mechanicalness phlebitis and symptomatic thrombosis. This method is simple and easy to use, it is worthy of clinical application.
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Objective@#To summarize the pathology and ultrasonic characteristics of fetal mitral valve diseases and improve their prenatal diagnostic accuracy by ultrasound.@*Methods@#Ultrasonic data of fetuses with mitral valve diseases, diagnosed by autopsy from January 2011 to December 2017 in Fetal Heart Disease Maternal Fetal Medicine Research Important Laboratories were retrospectively analyzed. Their ultrasound features and causes of missed diagnosis were analyzed.@*Results@#①The pathologic types included mitral atresia(22 cases, 59.5%), mitral valve dysplasia(13 cases, 35.1%) and mucoid degeneration[2 cases (1 case was diagnosed with Marfan syndrome with dilated aortic sinus and sinus of pulmonary trunk), 5.4%]. ②Fetal ultrasound could detect mitral atresia and mucoid degeneration of mitral valve. There were five cases of mitral valve dysplasia which were missed by ultrasound.And the accuracy rate of ultrasonic diagnosis was 86.5%(32/37). ③The missed subtypes of mitral valve dysplasia included mild-moderate mitral stenosis with coarctation of aorta (4 cases) and mitral valve dysplasia with functional aortic atresia(1 case).@*Conclusions@#Fetal mitral valve diseases involve a variety of anatomical abnormalities and the main types are mitral atresia and mitral valve dysplasia. Mucoid degeneration of mitral valve is rare and it may belong to Marfan syndrome when combined with dilated aortic sinus and sinus of pulmonary trunk. Fetal ultrasound can identify mitral atresia and mucoid degeneration of mitral valve, but it may miss the diagnosis of some subtypes of mitral valve dysplasia, such as mild-moderate mitral stenosis with aortic coarctation and mitral valve dysplasia with functional aortic atresia.
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Objective@#To analyze the feasibility of prenatal ultrasound quantitative measurement of the angles between trachea and bilateral bronchi as a new diagnostic tool for fetuses with heterotaxy syndrome.@*Methods@#The angles between trachea and bilateral bronchi were measured at 18-34+6 gestational weeks for 200 fetuses with normal ultrasound findings (normal group) and 41 fetuses with heterotaxy syndrome [35 right atrial isomerisms (right group) and six left atrial isomerisms (left group)] diagnosed by ultrasound and confirmed after abortion or induction (case group) in Chongqing Health Center for Women and Children from October 2015 to December 2018. Scatter plots of left/right bronchus angle (α/β) ratios were drawn. Differences in bilateral bronchus angles between the three groups were statistically analyzed using one-way analysis of variance and paired t-test.@*Results@#In the normal group, scatter plots showed the α/β ratios were relatively constant at 0.8-1.0 with larger β than α (t=-33.14, P<0.05), indicating that the right bronchus always went more steeply than the left one. In the case group, the α/β ratios were around 1.0. In the right group, the α value increased and was close to the β value [(153.90±5.43)° vs (156.02±5.59)°, t=-2.56, P>0.05] and presented as bilateral right bronchial angle; in the left group, the β value decreased and was close to the α value [(147.38±3.16)° vs (148.82±5.56)°, t=-1.18, P>0.05] and presented as bilateral left bronchial angle. There were significant differences in the α and β values among the normal group, the right and left groups (all P<0.05), and the bronchial angles of the right group were both greater than those of the left group (all P<0.05).@*Conclusions@#Prenatal ultrasound measurement of the angles between trachea and bilateral bronchi can be used as an indirect indicator for the diagnosis of heterotaxy syndrome.