Managing the difficult case of fetal anemia

Objectives.?To describe a series of complex fetal anemia cases, detail the appropriate investigations and management, and review the literature.

Methods.?Four cases of non-red cell alloimmunization or infective cases of fetal anemia are presented.

Results.?Of the four cases presented, one was a neonatal death, one pregnancy was terminated, one case was diagnosed with Diamond Blackfan anemia, and one case was due to recurrent feto-maternal hemorrhages despite negative Kleihauer tests.

Conclusions.?Non-alloimmune causes of fetal anemia can be difficult to manage. Some cases require repeated and frequent intrauterine transfusions. The perinatal mortality and preterm delivery rates are increased, and some cases require considerable long-term treatment including regular transfusions. We present our experience of a series of non-immune fetal anemia managed in a tertiary unit, review the literature, and suggest appropriate management.     

An update on medication management of women with schizophrenia in pregnancy

Introduction: Women with schizophrenia and their babies are at high risk of adverse outcomes in pregnancy and childbirth. A better understanding of the specific risks conferred by the illness itself and by the treatment provided will help guide more effective care of these women.

Areas covered: Herein, the authors review genetic, demographic, socioeconomic, nutritional and lifestyle risks associated with schizophrenia in pregnancy. They also cover specific risks associated with typical antipsychotic medications, specific risks associated with atypical antipsychotic medications, risks associated with polypharmacy and risks of developmental delay in children exposed to antipsychotic medications in utero.

Expert opinion: Our understanding of the risks that women with schizophrenia face in pregnancy from their illness and from the treatment they receive continues to evolve. As our ability to analyze data progresses, the risks conferred by antipsychotic medication treatment appear to lessen in clinical and statistical significance, whilst the true risks to these women and their babies from their experience of disadvantage continue to set them aside from the general population. Reducing polypharmacy and providing comprehensive and supportive care can minimize harm to women with schizophrenia and their babies.     

人新饱食分子蛋白1在妊娠期代谢异常中的研究进展

人新饱食分子蛋白1(Nesfatin-1)是一种分泌性肽,与抑食功能有关,但其作用机制尚未完全阐明。国内外学者研究发现,Nesfatin-1不仅影响抑食功能,还参与能量代谢。目前,Nesfatin-1在2型糖尿病、代谢综合征、妊娠期糖尿病及摄食行为中的研究较多,而在妊娠期代谢异常等方面涉及甚少。该文就Nesfatin-1在妊娠期代谢异常的研究进展作一综述。     

Methods for identifying subject‐specific abnormalities in neuroimaging data

Algorithms that are capable of capturing subject‐specific abnormalities (SSA) in neuroimaging data have long been an area of focus for diverse neuropsychiatric conditions such as multiple sclerosis, schizophrenia, and traumatic brain injury. Several algorithms have been proposed that define SSA in patients (i.e., comparison group) relative to image intensity levels derived from healthy controls (HC) (i.e., reference group) based on extreme values. However, the assumptions underlying these approaches have not always been fully validated, and may be dependent on the statistical distributions of the transformed data. The current study evaluated variations of two commonly used techniques (“pothole” method and standardization with an independent reference group) for identifying SSA using simulated data (derived from normal, t and chi‐square distributions) and fractional anisotropy maps derived from 50 HC. Results indicated substantial group‐wise bias in the estimation of extreme data points using the pothole method, with the degree of bias being inversely related to sample size. Statistical theory was utilized to develop a distribution‐corrected z‐score (DisCo‐Z) threshold, with additional simulations demonstrating elimination of the bias and a more consistent estimation of extremes based on expected distributional properties. Data from previously published studies examining SSA in mild traumatic brain injury were then re‐analyzed using the DisCo‐Z method, with results confirming the evidence of group‐wise bias. We conclude that the benefits of identifying SSA in neuropsychiatric research are substantial, but that proposed SSA approaches require careful implementation under the different distributional properties that characterize neuroimaging data. Hum Brain Mapp 35:5457–5470, 2014. © 2014 Wiley Periodicals, Inc.     

Subharmonic,Non-linear Fundamental and Ultraharmonic Imaging of Microbubble Contrast at High Frequencies

There is increasing use of ultrasound contrast agent in high-frequency ultrasound imaging. However, conventional contrast detection methods perform poorly at high frequencies. We performed systematic in vitro comparisons of subharmonic, non-linear fundamental and ultraharmonic imaging for different depths and ultrasound contrast agent concentrations (Vevo 2100 system with MS250 probe and MicroMarker ultrasound contrast agent, VisualSonics, Toronto, ON, Canada). We investigated 4-, 6- and 10-cycle bursts at three power levels with the following pulse sequences: B-mode, amplitude modulation, pulse inversion and combined pulse inversion/amplitude modulation. The contrast-to-tissue (CTR) and contrast-to-artifact (CAR) ratios were calculated. At a depth of 8 mm, subharmonic pulse-inversion imaging performed the best (CTR = 26 dB, CAR = 18 dB) and at 16 mm, non-linear amplitude modulation imaging was the best contrast imaging method (CTR = 10 dB). Ultraharmonic imaging did not result in acceptable CTRs and CARs. The best candidates from the in vitro study were tested in vivo in chicken embryo and mouse models, and the results were in a good agreement with the in vitro findings.