Screening for fetal chromosomal and subchromosomal disorders

Screening for fetal chromosomal disorders has evolved greatly over the last four decades. Initially, only maternal age-related risks of aneuploidy were provided to patients. This was followed by screening with maternal serum analytes and ultrasound markers, followed by the introduction and rapid uptake of maternal plasma cell-free DNA-based screening. Studies continue to demonstrate that cfDNA screening for common aneuploidies has impressive detection rates with low false-positive rates. The technology continues to push the boundaries of prenatal screening as it is now possible to screen for less common aneuploidies and subchromosomal disorders. The optimal method for incorporating cfDNA screening into existing programs continues to be debated. It is important that obstetricians understand the biological foundations and limitations of this technology and provide patients with up-to-date information regarding cfDNA screening.     

Cesarean Scar Pregnancy: Comparing the Efficacy and Tolerability of Treatment with High-Intensity Focused Ultrasound and Uterine Artery Embolization

The aim of this study was to investigate the clinical efficacy of high-intensity focused ultrasound (HIFU) for the treatment of a cesarean scar pregnancy compared with uterine artery embolization (UAE) and intra-arterial methotrexate infusion combined with uterine curettage. In this retrospective cohort study, 31 patients were treated with HIFU (HIFU group), and 45 patients were treated with UAE (UAE group). We compared the treatment and recovery of the patients, including follow-up. After UAE treatment, serum levels of the β subunit of human chorionic gonadotropin declined significantly on the first day, and the residual lesions disappeared in 3–17 wk. One patient underwent hysterectomy; intrauterine adhesions were found by hysteroscopic examination after 6 mo in 2 patients, whose menstrual function did not return to normal. The remainder of the 42 patients recovered normal menstrual functioning during the 3- to 18-wk follow-up. In the patients who underwent HIFU treatment, serum β-HCG levels did not decline rapidly; serum β-HCG levels increased in many patients and then declined to normal steadily within 2–12 wk. Lesions detached in 3–14 wk in all patients, and menstrual functioning was recovered in 3–9 wk without uterine curettage. Compared with the UAE group, the HIFU group had less pain and fewer complications; the patients in the HIFU group were not hospitalized or anesthetized and had lower costs. HIFU is an efficient, tolerable and non-invasive treatment.     

Pulse pressure waveform estimation using distension profiling with contactless optical probe

The pulse pressure waveform has, for long, been known as a fundamental biomedical signal and its analysis is recognized as a non-invasive, simple, and resourceful technique for the assessment of arterial vessels condition observed in several diseases. In the current paper, waveforms from non-invasive optical probe that measures carotid artery distension profiles are compared with the waveforms of the pulse pressure acquired by intra-arterial catheter invasive measurement in the ascending aorta. Measurements were performed in a study population of 16 patients who had undergone cardiac catheterization. The hemodynamic parameters: area under the curve (AUC), the area during systole (AS) and the area during diastole (AD), their ratio (AD/AS) and the ejection time index (ETI), from invasive and non-invasive measurements were compared. The results show that the pressure waveforms obtained by the two methods are similar, with 13% of mean value of the root mean square error (RMSE). Moreover, the correlation coefficient demonstrates the strong correlation. The comparison between the AUCs allows the assessment of the differences between the phases of the cardiac cycle. In the systolic period the waveforms are almost equal, evidencing greatest clinical relevance during this period. Slight differences are found in diastole, probably due to the structural arterial differences. The optical probe has lower variability than the invasive system (13% vs 16%). This study validates the capability of acquiring the arterial pulse waveform with a non-invasive method, using a non-contact optical probe at the carotid site with residual differences from the aortic invasive measurements.     

磁共振成像在小儿心血管疾病中的应用价值

磁共振成像作为一种新型无创医学影像技术,具有无电离辐射、分辨率极佳、多方位成像、多参数成像、尚能进行形态、功能“一站式”检查等特点,在小儿心血管疾病诊断中越来越受到重视.该文就近几年磁共振成像在小儿心血管疾病诊断中的应用价值作一综述.     

两种无创正压机械通气模式在COPD急性加重期患者中的应用价值比较

目的比较两种无创正压机械通气模式在慢性阻塞性肺疾病急性加重期 (AECOPD)患者中的应用价值。方法将 98 例 AECOPD 患者随机分为研究组和对照组,各 49 例,分别行压力调节容量控制通气(PRVC)和双水平正压通气(Bi PAP)。记录人均每日带机时间(TA)、总人均带机时间(TB)及平均漏气量(Lleak),于通气前(T1)、通气 1h(T2)、6h(T3)、1d(T4)、3d (T5)、7d(T6)时检测患者动脉血气指标[p H、氧合指数(PaO_2/FiO_2)、动脉血二氧化碳分压(PaCO_2)],观察两组 T1 及 T6 时呼吸动力学指标[自主呼吸潮气量 (VT)、每分钟通气量 (VE)、呼吸频率(RR)、浅速呼吸指数(f/VT)、呼吸功(WORKP)]差异,记录气管插管率和并发症发生情况。结果研究组 TB、TA 均大于对照组 ,Lleak 则小于对照组 (P 均0.05)。 T1~T6 时 ,两组 pH、PaO_2/FiO_2均逐渐升高,PaCO_2则逐渐降低,但各时间上述指标组间比较,差异均无统计学意义(P 均0.05)。T6 时,两组 VT、VE 均较 T1 时上升,RR、f/VT、WORKP 则均较 T1 时降低 ,且研究组变化幅度大于对照组 (P 均0.05)。两组气管插管率和并发症发生率比较 ,差异均无统计学意义(P 均0.05)。结论 PRVC 和 BiPAP 在 AECOPD 治疗过程中均可有效改善血气指标,PRVC可显著提高人机协同性、改善氧合功能、减少呼吸肌做功、减少漏气,于 AECOPD 患者病情改善有利。     

微创肺表面活性物质及无创持续性气道压力在低体重早产儿呼吸窘迫综合征治疗中的应用

目的探讨微创肺表面活性物质(LISA)及无创持续性气道压力(ncpap)在低体重早产儿呼吸窘迫综合征(NRDS)治疗中的应用效果。方法回顾性选取2019年1月至2020年12月中山市博爱医院新生儿科收治的50例NRDS低体重早产儿为研究对象,根据治疗方案分为研究组(ncpap+LISA,n=22)和对照组(ncpap,n=28)。比较两组疗效、无创通气时间、住院时间、并发症发生率、治疗前、治疗1 d的血气分析等指标。结果研究组治疗总有效率高于对照组(95.45%vs.67.86%),而无创通气时间[(3.52±1.12)d vs.(4.36±1.39)d]、住院时间[(17.21±2.65)d vs.(19.87±3.43)d]则低于对照组(P0.05)。两组的并发症发生率比较,差异无统计学意义(P0.05)。与同组治疗前比较,两组治疗1 d的血氧分压(PaO_2)、pH值均升高,而同期氧合指数(OI)、二氧化碳分压(PaCO_2)均降低(P0.05)。研究组治疗1 d的PaO_2、pH值均高于对照组,而同期OI、PaCO_2则均低于对照组(P0.05)。结论 LISA及ncpap联合应用于低体重早产儿NRDS治疗中可改善疗效和缺氧状况,缩短无创通气时间并促进患儿康复,且安全可靠。     

Differential effects of bifrontal tDCS on arousal and sleep duration in insomnia patients and healthy controls

Background

Arousal and sleep represent basic domains of behavior, and alterations are of high clinical importance.

视神经鞘超声评估颅内高压的研究进展

颅内高压是临床常见的危重急症之一，严重影响患者脑功能甚至危及患者生命。故需迅速、准确的颅内压评估方法以及时采取临床干预和对后续治疗效果的评估。有创监测仍然是评估颅内压的金标准,然而,该方法存在如感染和出血等潜在风险。以往文献报道视神经鞘超声检查可以无创评估颅内高压。本文就此综述如下。