Prenatal imaging classification and potential diseases of fetal abnormal sylvian fissure / 中华超声影像学杂志

Objective:To assess the ultrasonographic features and potential diseases of fetal abnormal sylvian fissure(SF), and to explore the value of whole-genome sequencing (WGS) in prenatal detection.Methods:A total of 28 fetuses with a sonographic diagnosis of abnormal SF in Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University between October 2018 and October 2020 were prospectively included. The fetal brain was evaluated by neuroultrasound and intrauterine MRI in detail. Amniotic fluid/cord blood obtained by amniocentesis or tissue samples from umbilical cord after birth were collected for WGS. Pregnancy outcomes and postnatal MRI were recorded, and neurodevelopment of live-born infants was followed up for more than 24 months after delivery.Results:During the study period, 28 fetuses with abnormal SF were identified, with a gestational age of 21.3-30.0 (24.8±2.0) weeks. Abnormal SF presented in MCD ( n=15, 53.6%), chromosomal anomalies ( n=3, 10.7%) or single-gene genetic syndromes ( n=3, 10.7%) with the affected fetuses showing developmental delay, hydrocephalus or leukomalacia ( n=4, 14.2%), corpus callosal agenesis with large interhemispheric cysts ( n=1, 3.6%), benign subarachnoid space enlargement with arachnoid cysts ( n=1, 3.6%), and multiple malformations ( n=1, 3.6%). Among the 15 cases with MCD, the most common pathology was lissencephaly/pachygyria, followed by schizencephaly, severe microcephaly, hemimegalencephaly with paraventricular heterotopia, and polymicrogyria. Abnormal SF presented bilaterally in 23 fetuses and unilaterally in 5. All cases were categorized into six types depending on SF morphology in the transthalamic section: no plateau-like or a small insula, linear type, irregular corrugated SF, Z-shaped, and cyst occupying type. In addition to abnormal SF, associated anomalies or mild variations were identified in all fetuses. There were 17 cases underwent intrauterine MRI, and 13 cases underwent postnatal MRI examination.And 25 pregnancies were terminated; 3 were born alive, and 2 had typical syndromic changes with poor neurodevelopmental prognosis. A related pathogenic genetic variant was detected in 57.1% (16/28) fetus, and the incidence of single nucleotide variants(SNVs) was 42.9% (12/28), among which de novo SNVs accounted for 91.7% (11/12). Conclusions:Fetal abnormal SF could be classified based on the ultrasonographic features of transthalamic section. Fetal abnormal SF may indicate MCD, some chromosomal abnormalities or single-gene genetic syndromes that may lead to poor neurodevelopmental outcomes, and may be affected by extra-cortical factors. It is suggested to carry out targeted prenatal genetic diagnosis for fetuses with abnormal SF.

Counting of fetal caudal vertebral body ossification center below terminal conus medullaris in the screening of the closed spine bifida and tethered cord syndrome / 中华超声影像学杂志

Objective:To assess the significance of counting the number of caudal vertebral ossification centers (OCN) below fetal terminal conus medullaris in the screening for closed spina bifida and tethered cord syndrome (TCS).Methods:The OCN was counted in 961 normal fetuses(normal group) between 17 and 41 gestational weeks and in 140 fetuses with closed spina bifida or tethered cord syndrome(abnormal group) from Jan.2013 to Dec.2020 in Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Women and Children′s Hospital, School of Medicine, Xiamen University and Maternity and Child Health Care of Guangxi Zhuang Autonomous Region. The OCN was counted in the dorsal mid-sagittal section of fetal caudal spine.The reliability and agreement test were evaluated by intraclass correlation coefficients in another 50 normal fetuses. The OCN was compared between two groups. ROC curve and the cut-off value were constructed and calculated.Results:In normal group, the N increased with the growing of gestational age.In the subgroup of 17-20 weeks, the OCN ranged from 5 to 7 in most fetuses. In the others subgroups, the OCN was equal to or greater than 6 in 99.9% cases and more than 6 in 97.1% cases. In abnormal group, OCN was less than 7 in 93.0% fetuses and less than 6 in 82.8% cases. There were statistical differences between the two groups except for the subgroup of 17-20 gestational weeks( P<0.05). With the cut-off value of 6.5, the specificity and sensitivity were 93.0% and 94.3% respectively for predicting the presence of closed spinal dysraphism or TCS. Conclusions:OCN is a simple way to evaluate the position of conus medullaris and to screen for the skin-covered spine dysraphism or TSC. OCN is more than 6 in most normal fetuses. Further evaluation of spine is required in fetuses with N less than or equal to 6.

Feasibility study of prenatal ultrasound in the evaluation of normal fetal sylvian fissure maturation by simplified grading / 中华超声影像学杂志

Objective:To observe the morphological changes of the sylvian fissure on the transthalamic section of fetal brain at 20-32 weeks, and grade the fetal sylvian fissure development by means of a simple scoring system and explore its clinical feasibility.Methods:From September 2018 to June 2020, 487 normal single fetuses of 20-32 weeks were examined in Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University. The sylvian fissure maturation was analyzed on the transthalamic section of fetal brain at 20-32 weeks and was graded from 0 to 5: un-visualized (grade 0), shallow arc (grade 1), obtuse-angled platform (grade 2), right-angled platform (grade 3), acute-angled platform (grade 4), and closed operculum (grade 5). The pregnancy outcomes and gestational age were recorded.Statistical analysis was performed by SPSS 20.0 software using box plot, Mann-Whitney U test, Weighted Kappa coefficient. Results:Left sylvian fissuer grades were obtained in 280 fetuses and right sylvian fissure grades were obtained in 247 fetuses. The fetal sylvian fissure maturation at 20-32 weeks was graded from 0 to 5, which increased with advancing gestation. Grade 0 only appeared in 3 fetuses at 20 weeks, and 99.4% fetuses at 20 weeks had grade ≥1. Grade 1 appeared in 20-22 weeks, grade 2 in 20-25 weeks, grade 3 in 22-26 weeks, grade 4 in 25-32 weeks, and grade 5 in 27-32 weeks. Box-plot and Mann-Whitney U test showed that gestational week distribution of sylvian fissure at all grades was symmetric on both sides ( P>0.05). The Weighted Kappa coefficients were 0.857(95% CI=0.750-0.957) and 0.939 (95% CI=0.859-1.000), respectively, with strong consistency regarding inter- and intra-observer agreements. Conclusions:Fetal sylvian fissure maturation at 20-32 weeks can be evaluated by means of a simple scoring system with symmetrical grading of both sides.

Research on the detection algorithm of electrocardiogram characteristic wave based on energy segmentation and stationary wavelet transform / 生物医学工程学杂志

The detection of electrocardiogram (ECG) characteristic wave is the basis of cardiovascular disease analysis and heart rate variability analysis. In order to solve the problems of low detection accuracy and poor real-time performance of ECG signal in the state of motion, this paper proposes a detection algorithm based on segmentation energy and stationary wavelet transform (SWT). Firstly, the energy of ECG signal is calculated by segmenting, and the energy candidate peak is obtained after moving average to detect QRS complex. Secondly, the QRS amplitude is set to zero and the fifth component of SWT is used to locate P wave and T wave. The experimental results show that compared with other algorithms, the algorithm in this paper has high accuracy in detecting QRS complex in different motion states. It only takes 0.22 s to detect QSR complex of a 30-minute ECG record, and the real-time performance is improved obviously. On the basis of QRS complex detection, the accuracy of P wave and T wave detection is higher than 95%. The results show that this method can improve the efficiency of ECG signal detection, and provide a new method for real-time ECG signal classification and cardiovascular disease diagnosis.

Analysis of value with early multi-indicators combined prediction of pancreatic fistula after pancreaticoduodenectomy in non-diabetic patients / 国际外科学杂志

Objective@#To explore the relationship between procalcitonin (PCT), C-reactive protein (CRP) and blood glucose (BG) levels and postoperative pancreatic fistula (POPF) in non-diabetic patients after pancreaticoduodenectomy (PD), and evaluate the clinical value of early multi-indicators combined prediction of pancreatic fistula.@*Methods@#The clinical data of 68 non-diabetic patients who underwent PD surgery from April 2016 to June 2018 in the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed, including 42 males and 26 females, with average age of 58 years, age range from 26 to 80 years. According to the diagnostic criteria of POPF, the patients were divided into the pancreatic fistula group (n=17) and the non-pancreatic fistula group (n=51). The surgical related indicators, health economic indicators and PCT, CRP, and BG levels on preoperative and postoperative day 1, 3 and 5(POD1, POD3, POD5) were compared between two groups. Multivariate logistic regression analysis was used to screen out independent risk factors associated with POPF, and a weighted predictive model (wScore M) for predicting pancreatic fistula in non-diabetic patients was established by combining independent risk factors. The receiver operating characteristic (ROC) curves of each independent risk factor and prediction model were plotted to determine the cutoff value, area under the ROC curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value, and individual risk factors were compared. And the predictive value of the multi-indicator combined prediction model.@*Results@#Univariate analysis showed that the pathological types of the tumor, the tumor size, the blood glucose level of POD3, the PCT level of POD1, POD3, POD5 and the CRP level of POD3, POD5 were statistically different (P<0.05). Multivariate analysis showed that PCT (P=0.004), CRP (P=0.031), and BG (P=0.005) levels of POD3 were independent risk factors of POPF. The AUC of the ROC were 0.967, 0.692, and 0.698, respectively. The sensitivity were 0.588, 0.706, and 0.647, respectively. The specificities were 0.863, 0.686, and 0.765, respectively. The positive predictive values were 52.9%, 70.6%, and 64.7%, respectively. The negative predictive values were 88.2%, 70.6%, and 76.5%; the AUC of the wScore M ROC curve was 0.877, the sensitivity was 0.706, the specificity was 0.863, the positive predictive value was 70.6%, and the negative predictive value was 86.3%. Compared with the non-pancreatic fistula group, the patients of the pancreatic fistula group with pancreatic fistula complications had prolonged hospitalization time and increased the total hospitalization cost, which were statistically different (P=0.039, 0.010).@*Conclusion@#PCT, CRP and BG are independent risk factors for POPF, and early combined prediction of multiple indicators (POD3)has good predictive value, which has significant clinical reference for optimal and effective interventions at early stage.

Analysis of value with early multi-indicators combined prediction of pancreatic fistula after pancreaticoduodenectomy in non-diabetic patients / 国际外科学杂志

Objective To explore the relationship between procalcitonin (PCT),C-reactive protein (CRP) and blood glucose (BG) levels and postoperative pancreatic fistula (POPF) in non-diabetic patients after pancreaticoduodenectomy (PD),and evaluate the clinical value of early multi-indicators combined prediction of pancreatic fistula.Methods The clinical data of 68 non-diabetic patients who underwent PD surgery from April 2016 to June 2018 in the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed,including 42 males and 26 females,with average age of 58 years,age range from 26 to 80 years.According to the diagnostic criteria of POPF,the patients were divided into the pancreatic fistula group (n =17) and the non-pancreatic fistula group (n =51).The surgical related indicators,health economic indicators and PCT,CRP,and BG levels on preoperative and postoperative day 1,3 and 5 (POD1,POD3,POD5) were compared between two groups.Multivariate logistic regression analysis was used to screen out independent risk factors associated with POPF,and a weighted predictive model (wScore M) for predicting pancreatic fistula in non-diabetic patients was established by combining independent risk factors.The receiver operating characteristic (ROC) curves of each independent risk factor and prediction model were plotted to determine the cutoff value,area under the ROC curve (AUC),sensitivity,specificity,positive predictive value,negative predictive value,and individual risk factors were compared.And the predictive value of the multi-indicator combined prediction model.Results Univariate analysis showed that the pathological types of the tumor,the tumor size,the blood glucose level of POD3,the PCT level of POD1,POD3,POD5 and the CRP level of POD3,POD5 were statistically different (P ＜ 0.05).Multivariate analysis showed that PCT (P =0.004),CRP (P =0.031),and BG (P =0.005) levels of POD3 were independent risk factors of POPF.The AUC of the ROC were 0.967,0.692,and 0.698,respectively.The sensitivity were 0.588,0.706,and 0.647,respectively.The specificities were 0.863,0.686,and O.765,respectively.The positive predictive values were 52.9％,70.6％,and 64.7％,respectively.The negative predictive values were 88.2％,70.6％,and 76.5％;the AUC of the wScore M ROC curve was 0.877,the sensitivity was 0.706,the specificity was 0.863,the positive predictive value was 70.6％,and the negative predictive value was 86.3％.Compared with the non-pancreatic fistula group,the patients of the pancreatic fistula group with pancreatic fistula complications had prolonged hospitalization time and increased the total hospitalization cost,which were statistically different (P =0.039,0.010).Conclusion PCT,CRP and BG are independent risk factors for POPF,and early combined prediction of multiple indicators (POD3) has good predictive value,which has significant clinical reference for optimal and effective interventions at early stage.

Three-dimensional ultrasound volume contrast imaging and tomography ultrasound imaging techniques in observing fetal tethered cord / 中国医学影像技术

Objective To evaluate the value of three-dimensional ultrasound volume contrast imaging (VCI) and tomo graphy ultrasound imaging (TUI) techniques in observing fetal spinal conus medullaris (CM) position and lumbar enlargement of spinal cord morphologic changes,for assessment of tethered cord (TC).Methods Totally 17 abnormal fetuses of spinal diseases combined with TC (abnormal group) were examined by three dimensional ultrasound VCI and TUI techniques.The position of CM was recorded,and the transverse and anteroposterior diameters of lumbar enlargement of spinal cord were measured and compared with 300 cases of normal fetuses (normal group).Results As the growth of the gestational age (CA),CM terminal position increased.All the ends of CM located at L3 or L3 above level in normal.The transverse and anteroposterior diameters of lumbar enlargement in normal group showed good linear relationship with GA.Transverse diameter (mm) =0.677+0.147 ×GA (R2 =0.836,P＜0.05),anteroposterior diameter (mm)-0.994+ 0.152× GA (R2=0.894,P＜0.05).Compared with the corresponding GA fetuses in normal group,the anteroposterior diameter of lumbar enlargement decreased in abnormal group (P=0.002),while no statistical difference of the transverse diameter was found between the two groups (P=0.082).Conclusion Position of CM and lumbar enlargement measure ment can provide valuable reference information for clinical prenatal diagnosis of fetal spinal TC.