Causal association between gut microbiota and intrahepatic cholestasis of pregnancy: mendelian randomization study.

BACKGROUND: Previous observational cohort studies have shown that the composition of the gut microbiota is related to the risk of intrahepatic cholestasis of pregnancy (ICP), although it is unclear if the association is causative. This study used Mendelian randomization (MR) to systematically examine whether the gut microbiota was causally linked to ICP. METHODS: We obtained the genome-wide association study (GWAS) summary statistics of gut microbiota and ICP from published GWASs. Maximum likelihood (ML), MR-Egger regression, weighted median, inverse variance weighted (IVW), and weighted model were used to investigate the causal association between gut microbiota and ICP. We further conducted a series of sensitivity analyses to confirm the robustness of the primary results of the MR analyses. Reverse MR analysis was performed on the bacterial taxa that were reported to be causally linked to ICP risk in forwarding MR analysis to evaluate the possibility of reverse causation. RESULTS: MR analysis revealed that phylum Tenericutes (OR: 1.670, 95%CI: 1.073-2.598, P = 0.023), class Bacteroidia (OR: 1.644, 95%CI: 1.031-2.622, P = 0.037), class Mollicutes (OR: 1.670, 95%CI: 1.073-2.598, P = 0.023), and order Bacteroidales (OR: 1.644, 95%CI: 1.031-2.622, P = 0.037), and were positively associated with the risk of ICP. And we identified that the relative abundance of genus Dialister (OR: 0.562, 95%CI: 0.323-0.977, P = 0.041), genus Erysipelatoclostridium (OR: 0.695, 95%CI: 0.490-0.987, P = 0.042), genus Eubacterium (brachy group) (OR: 0.661, 95%CI: 0.497-0.880, P = 0.005), genus Eubacterium (hallii group) (OR: 0.664, 95%CI: 0.451-0.977, P = 0.037), genus Holdemania (OR: 0.590, 95%CI: 0.414-0.840, P = 0.003), genus Ruminococcus (torques group) (OR: 0.448, 95%CI: 0.235-0.854, P = 0.015), and genus Veillonella (OR: 0.513, 95%CI: 0.294-0.893, P = 0.018) were related to a lower risk of ICP. Additional sensitivity analyses confirmed the robustness of the association between specific gut microbiota composition and ICP. No evidence of reverse causality from ICP to identified bacterial taxa was found in the findings of the reverse MR analyses. CONCLUSIONS: Under MR assumptions, our findings propose new evidence of the relationship between gut microbiota and ICP risk. Our results show that the gut microbiota may be useful target of intervention for ICP.

MIUH Inhibits the Hippocampal Neuron Growth in Fetal Rat by Affecting the PTEN Pathway.

Mild intrauterine hypoperfusion (MIUH) can induce placental dysfunction and lead to long-term changes during the process of brain development. A better understanding of the mechanism of MIUH will help in the development of new neuroprotective strategies for the placental chamber. To better understand the mechanism of the effect of MIUH on the neural development of offspring, we constructed a model of MIUH in pregnant rats. The proliferation, apoptosis, and autophagy of hippocampal neurons in fetal rats were studied via flow cytometry, immunofluorescence staining, JC-1 staining, western blotting, and real-time polymerase chain reaction at different time points (6, 24, 48, and 72 h). The results showed that MIUH significantly inhibited the proliferation of hippocampal neurons and promoted their apoptosis and autophagy. Simultaneously, MIUH could promote PTEN expression and affect the PTEN signaling pathway. bpV, an inhibitor of PTEN, could restore the inhibition of hippocampal nerve cell growth caused by MIUH. MIUH may inhibit neuronal proliferation and promote neuronal apoptosis and autophagy by regulating the PTEN signaling pathway.

Pregnancy and parenting experiences of women with twin-to-twin transfusion syndrome: a qualitative study.

BACKGROUND: Qualitative research can reflect the actual thoughts and experience of research subjects and can be used to explore the experiences of women presenting with twin-to-twin transfusion syndrome (TTTS) to facilitate the provision of targeted psychological support. METHODS: A semi-structured interview method was used to assess the pregnancy and parenting experiences of women with TTTS. Colaizzi method was used for data analysis. RESULTS: Eighteen women participated in the study. We found that women with TTTS during pregnancy experienced persistent worry about their children's health from the disease diagnosis to the subsequent parenting processes, even in case of minor changes in their children's health. The lack of an efficient referral process and health information increased their uncertainty about their children's health. CONCLUSION: In addition to the children's health, other difficulties encountered during pregnancy and parenting may aggravate the pressure. Clinicians in the first-visit hospital and foetal medicine centre should improve the referral process and establish a follow-up system to provide women with health information and psychological support.

ALG3-CDG: lethal phenotype and novel variants in Chinese siblings.

Congenital disorders of glycosylation (CDG) are a group of genetic, mostly multisystem disorders, which often involve the central nervous system. ALG3-CDG is one the some 130 known CDG. Here we report two siblings with a severe phenotype and intrauterine death. Whole-exome sequencing revealed two novel variants in ALG3: NM_005787.6:c.512G>T (p.Arg171Leu) inherited from the mother and NM_005787.6:c.511C>T (p.Arg171Trp) inherited from the father.

[Analysis of prenatal phenotype and pathogenetic variant in a fetus with Papillorenal syndrome].

OBJECTIVE: To diagnose a fetus with Papillorenal syndrome by prenatal ultrasonography and genetic testing, and to correlate its genotype with phenotype. METHODS: Ultrasound finding of the fetus was reviewed. Muscle sample of the abortus was taken, and genetic variant related to the clinical phenotype was screened by whole exome sequencing (WES). Suspected pathogenic variant was verified by Sanger sequencing. RESULTS: Prenatal ultrasound revealed severe dysplasia of the fetal kidneys and oligohydramnios. WES revealed that the fetus has carried a c.736G>T (p.Glu246Ter) nonsense variant of the PAX2 gene, which was unreported previously. The result of Sanger sequencing was consistent with that of WES. Both parents of the fetus were of the wild-type, suggesting a de novo origin of the fetal variant. CONCLUSION: The novel heterozygous c.736G>T (p.Glu246Ter) variant of the PAX2 gene probably underlay the Papillorenal syndrome in the fetus. Above finding has provided a basis for genetic counseling and clinical decision-making.

Mid-gestational sevoflurane exposure inhibits fetal neural stem cell proliferation and impairs postnatal learning and memory function in a dose-dependent manner.

Advancements in fetal intervention procedures have led to increases in the number of pregnant women undergoing general anesthesia during the second trimester-a period characterized by extensive proliferation of fetal neural stem cells (NSCs). However, few studies have investigated the effects of mid-gestational sevoflurane exposure on fetal NSC proliferation or postnatal learning and memory function. In the present study, pregnant rats were randomly assigned to a control group (C group), a low sevoflurane concentration group (2%; L group), a high sevoflurane concentration group (3.5%; H group), a high sevoflurane concentration plus lithium chloride group (H + Li group), and a lithium chloride group (Li group) at gestational day 14. Rats received different concentrations of sevoflurane anesthesia for 2 h. The offspring rats were weaned at 28 days for behavioral testing (i.e., Morris Water Maze [MWM]), and fetal brains or postnatal hippocampal tissues were harvested for immunofluorescence staining, real-time PCR, and Western blotting analyses in order to determine the effect of sevoflurane exposure on NSC proliferation and the Wnt/ß-catenin signaling pathway. Our results indicated that maternal exposure to 3.5% sevoflurane (H group) during the mid-gestational period impaired the performance of offspring rats in the MWM test, reduced NSC proliferation, and increased protein levels of fetal glycogen synthase kinase-3 beta (GSK-3ß). Such treatment also decreased levels of ß-catenin protein, CD44 RNA, and Cyclin D1 RNA relative to those observed in the C group. However, these effects were transiently attenuated by treatment with lithium chloride. Conversely, maternal exposure to 2% sevoflurane (L group) did not influence NSC proliferation or the Wnt signaling pathway. Our results suggest that sevoflurane exposure during the second trimester inhibits fetal NSC proliferation via the Wnt/ß-catenin pathway and impairs postnatal learning and memory function in a dose-dependent manner.

Three-dimensional power Doppler ultrasound evaluation of placental blood flow in normal monochorionic diamniotic twin pregnancies.

BACKGROUND: Monochorionic diamniotic (MCDA) twin pregnancies are at higher risk of adverse outcomes and complications, which are attributed to the influence of placental morphology in MCDA twins. Monitoring of placental function is an important index for clinical decisions. The aim of our study was to evaluate the placental blood flow estimated using three-dimensional power Doppler (3D-PD) ultrasound and the vascular indices distribution with gestational age (GA) in normal MCDA twin pregnancies. METHODS: One hundred four MCDA twin pregnancies and 106 singleton pregnancies (GA range, 14-32 weeks) were included in this prospective study. 3D-PD volume data of each fetus was obtained separately from the placenta at the site of umbilical cord insertion. We analyzed the volume data using sonobiopsy technique. The placental vascularization index (VI), flow index (FI) and vascularizationflow index (VFI), were auto-calculated. The means and standard deviation values of three vascular indices per fetus were calculated and regression analysis of the vascular indices as a function of GA was performed in twin pregnancies. The vascular indices of twin and singleton pregnancies were compared using independent t-test. RESULTS: There were no significant differences in VI, FI or VFI among the fetuses of twins (p > 0.05). These vascular indices increased over the course of pregnancy (p < 0.05). We obtained the regression equations for the indices as a function of GA in days: VI = exp. (4.369-28.533/GA) (R2 = 0.699, p < 0.05), FI = exp. (3.916-13.003/GA) (R2 = 0.511, p < 0.05), and VFI = exp. (3.577-37.468/GA) (R2 = 0.675, p < 0.05). There were no significant differences in three vascular indices between MCDA twin and singleton groups (p > 0.05). CONCLUSIONS: 3D-PD placental data using sonobiopsy technique could reflect the placental blood flow of each twin, which could be applied to the study of placental perfusion in MCDA twin pregnancies. This study also presented the vascular indices distribution with GA in normal twin pregnancies, which might be useful for early detection of MCDA complications.

[Prenatal diagnosis and intervention to fetal hydrothorax: five cases analysis].

OBJECTIVE: To research the important of prenatal diagnosis and effect of intervention to fetal hydrothorax. METHODS: The cases of fetal hydrothorax (n=5) were obtained from the Shengjing Hospital, China Medical University between December 2014 and May 2015. All pregnancies were uncomplicated, excluded congenital organic and chromosomal abnormalities during prenatal diagnosis and with a 37 average gestational weeks. The case 1, 2, 4 were unilateral hydrothorax and the case 3, 5 were bilateral. We performed an antenatal thracocentesis to case 1, 2, 3. In case1, the hydrothorax increased rapidly after 5 days, and the patient underwent a cesarean section and ex utero intrapartum treatment (EXIT); in case 2, the fetal heart rate was decreased to 40-50 bpm suddenly during thracocentesis, and we performed an emergent cesarean section and EXIT for the patient; in case 3, the patient underwent thracocentesis and a meanwhile cesarean section and EXIT procedure. We performed a conservative management to case 4, 5, the hydrothorax resolved spontaneously during the pregnancy and after birth, both patients underwent cesarean section. RESULTS: All fetuses were survived, the neonates of case 1, 2 and 3 underwent assited mechanical ventilation, thoracic close drainage, then discharged after hydrothorax resolved and feeding tolerance; in case 4, there was no respiratory distress and hospital treatment; in case 5, the neonate underwent assited mechanical ventilation and conservative management, the hydrothorax has resolved gradually. CONCLUSIONS: The prenatal diagnosis and antenatal intervention (thracocentesis) may play an important role in fetal hydrothorax treatment. In clinical, we should choose different plan according to the gestation weeks and classification of hydrothorax of the patient.

[Analysis of clinical outcome and impact factors of twin-to-twin transfusion syndrome with anterior placenta treated by fetoscopic laser photocoagulation].

OBJECTIVE: To analyze the clinical outcome and impact factors of twin-to-twin transfusion syndrome (TTTS) with anterior placenta treated by fetoscopic selective laser coagulation of placental vessels (SLCPV). METHODS: Ten cases of TTTS with anterior placenta and 8 cases with posterior placenta were treated by SLCPV in Shengjing Hospital from July 2011 to April 2014. Clinical data were analyzed retrospectively. Some cases were at Quintero stage II or higher stage, others were at Quintero stage I but with cardiovascular score ≥ 5 according to the scoring system of Children's Hospital of Philadelphia. The anterior placenta cases were treated by curve fetoscopy and the posterior placenta cases were treated by straight fetoscopy. RESULTS: (1) Of all the 18 cases, the mean gestational age at SLCPV was 24.1 weeks (17(+5) to 27(+4) weeks). There were 2 cases at Quintero stage I, 4 at stage II and 12 at stage III. The mean gestational age of anterior placenta cases at SLCPV was 25.2 weeks (22 to 27(+4) weeks), with 2 cases at Quintero stage I, 2 cases at stage II and 6 at stage III; 5 cases had preterm prelabour rupture of the membranes (PPROM) and 1 case had maternal intestinal obstruction after the operation; the average operation time was 40 minutes. Of the posterior placenta cases, the mean gestational age at SLCPV was 22.7 weeks (17(+5) to 27(+4) weeks); 2 cases were at Quintero stage II and 6 cases at stage III. PPROM happened in one case; one case had maternal enterobacter cloacae septicemia; the average operation time was 28 minutes. All the 18 cases could tolerate the operations. There was no intraoperative complication. (2) One anterior placenta case had maternal intestinal obstruction and miscarriage; and one posterior placenta case had enterobacter cloacae septicemia. Karyotype analyses of the all the twins were normal. (3) 17 cases delivered already, including all the 10 anterior placenta cases and 7 posterior placenta cases. One infant had corpus callosum agenesis, but its co-twin was normal. The average gestational age at delivery for anterior placenta cases was 32.6 weeks (24 to 37(+1) weeks), an was 28.2 weeks (25(+6) to 36(+2) weeks) for posterior placenta cases. The fetuses survival rate was 13/17 (one case was still in pregnancy) for at least one twin, and 10/17 for both twins. Both twins survival rates were 5/10, 5/7 for anterior placenta cases and posterior placenta cases, respectively. At least one twin survival rates were 8/10, 5/7 for the two groups respectively. CONCLUSION: SLCPV is suitable for the treatment of TTTS, no matter the placenta is on the anterior wall or posterior wall. The treatment had good outcomes, but more PPROM happened in the anterior placenta cases, which may be associated with operation time and the range of operation.

Plasmonic imaging of electrochemical oxidation of single nanoparticles.

Measuring electrochemical activities of nanomaterials is critical for creating novel catalysts, for developing ultrasensitive sensors, and for understanding fundamental nanoelectrochemistry. However, traditional electrochemical methods measure a large number of nanoparticles, which wash out the properties of individual nanoparticles. We report here a study of transient electrochemical oxidation of single Ag nanoparticles during collision with an electrode and voltammetry of single nanoparticles immobilized on the electrode using a plasmonic-based electrochemical current microscopy. This technique images both electrochemical reaction and size of the same individual nanoparticle, enabling quantitative examination of size-dependent electrochemical activities at single nanoparticle level. The imaging capability further allows detection of the reaction kinetics of each individual nanoparticle and analysis of the average behaviors of multiple nanoparticles. The average kinetics and size dependence can be accurately described by the Tafel equation, but there is a large variability between different nanoparticles, which underscores the importance of single nanoparticle analysis.

[Clinical management and perinatal outcome of twin reversed arterial perfusion sequence in different stage].

OBJECTIVE: To discuss the methods and outcomes of twin reversed arterial perfusion sequence in different stage. METHODS: From August 2012 to December 2013, 11 cases were diagnosed with twin reversed arterial perfusion sequence (TRAP) by 3d color Doppler ultrasound in the Maternal ang Fetal Medicine Center, Affiliated Shengjing Hospital, China Medical University, including 3 cases in stage I a, 7 in stage II a and 1 case in stage II b. We performed expected therapy to 3 cases in stage I a and 4 cases in stage II a [1 case (case 9) in stage II a developed to stage II b and was terminated by emergency cesarean section], radio frequency ablation (RFA) selective reduction to 3 cases in stage II a, emergency cesarean section to 1 case in stage II b. All cases except case 1, 4 took cesarean section to terminate pregnancy and would be followed up on the aspect of infant's growth. RESULTS: (1) 3 cases in stage I a were monitored by sequential ultrasound examination, all donors grew normally, in which 2 acardias arised spontaneous cessation of flow and were implemented of cesarean section after the normal period of gestation; 1 case suffered premature rupture of membrane and experienced the natural childbirth at 34 gestation weeks plus 5 days. The survived average labor weight was 2 923 g. (2) In the 7 stage II a cases, 3 cases were implemented of RFA selective reduction, 2 cases survived and the average labor gestation was 35 weeks plus 1 day and average labor weight was 2 050 g; in 3 expected therapy cases, 1 case suffered premature rupture of membrane at 34 gestation weeks plus 5 days and experienced cesarean section; 1 case was observed for 3 weeks and the donor was stillborn; 1 case progressed to stage II b and experienced cesarean section at 34 gestation weeks plus 5 days; and 1 case was lost of follow up. (3) For 2 cases of stage II b cases, one was progressed from stage II a during expected therapy; the other one had been already in stage II b since visiting and experimented an emergency cesarean section, but the neonate died of heart failure two days after labor. (4) 7 survived neonates were followed up, all had a normal condition compared to kids of the same age, except one suffering a congenital heart disease, patent ductus arteriosus and atrial septal defect and whose weight (6 kg at 7 months) was lighter. CONCLUSIONS: We should make the diagnosis of TRAP as early as soon and choose appropriate therapy according to the stage. According to our research, cases in stage I a can undergo an expected therapy under a sequential ultrasound examination; cases in stage II a can undergo a RFA selective reduction to improve the prognosis of the donor, which can make a good perinatal outcome.

Prevention of Preterm Birth by Cervical Pessary Combined with Vaginal Progesterone: a Systematic Review and Meta-analysis with Trial Sequential Analysis.

This study was to assess the effectiveness of cervical pessary combined with vaginal progesterone for the prevention of preterm birth (PTB). Ten studies about singleton [five randomized controlled trials (RCTs), vs vaginal progesterone; four cohorts, vs vaginal progesterone; two cohorts, vs cervical cerclage + vaginal progesterone] and two cohort studies about multiple pregnancies (vs vaginal progesterone) were included after searching electronic databases. For singleton pregnancies, the meta-analysis of three non-RCTs [relative risk (RR) = 0.41, p = 0.001] or total trials in non-Asian country (RR = 0.56, p = 0.03) revealed that compared with vaginal progesterone alone, cervical pessary + vaginal progesterone treatment had significant effectiveness on preventing PTB < 34 weeks, but not for five RCTs; meta-analysis of two trials showed that cervical pessary + vaginal progesterone had no significant prevention effects of PTB compared with cervical cerclage + vaginal progesterone. For multiple pregnancies, meta-analysis of two trials showed that compared with vaginal progesterone, cervical pessary + vaginal progesterone treatment increased neonatal birth weight (standardized mean difference = 0.50, p = 0.01). Trial sequential analysis implied additional studies were required. Four studies vs other controls (pessary, three-combined, tocolysis, conservative or no treatment; one study, each) were selected for systematic review. In conclusion, cervical pessary combined with vaginal progesterone may be safe and effective to prevent PTB in singleton pregnancies and increase neonatal birth weight in the multiple pregnancies compared with vaginal progesterone alone.

Trimester-specific associations of maternal dietary patterns with preterm birth: China Medical University birth cohort study.

The trimester-specific associations of maternal dietary patterns with preterm birth (PTB) are unclear. In a prospective prebirth cohort study, we aimed to examine the critical time window of maternal prenatal dietary patterns and the risk of PTB. We assessed prenatal dietary intake among 1500 pregnant women with validated food frequency questionnaires during the 1st, 2nd and 3rd trimester, respectively. We used logistic regression models and generalized estimating equation models to examine the trimester-specific associations and longitudinal associations between maternal dietary patterns in relation to risk of PTB and PTB subtypes. The incidence rate of PTB was 11.9% (179 out of 1500 pregnant women) in the present study. We observed that maternal adherence to a fish-seafood pattern in the 1st trimester was associated with higher risk of PTB [tertile 3 (T3) vs. tertile 1 (T1): OR = 2.29, 95% CI: 1.32-3.96] and iatrogenic preterm birth (IPTB) (T3 vs. T1: OR = 2.26, 95% CI: 1.21-4.20), while a fish-seafood pattern in the 2nd trimester was associated with lower risk of PTB (T3 vs. T1: OR = 0.49, 95% CI: 0.25-0.93). Maternal adherence to a dairy-egg pattern in the 2nd or 3rd trimester was associated with higher risks of PTB and IPTB. No dietary patterns were associated with spontaneous preterm birth. Our findings provide new evidence that specific dietary patterns during different trimesters may have different and even inverse health effects on pregnant women. This supports the necessity of guiding the maternal diet according to different periods of pregnancy to prevent PTB.

The Role of PDZ Binding Kinase as a Potential Prognostic and Diagnostic Biomarker in Ovarian Cancer.

Background: As one of the three malignant genital tumors, mortality in women with ovarian cancer is consistently high worldwide. It is of great importance to find prognostic markers for diagnosis and treatment of ovarian cancer. In this study, the authors utilized the bioinformatics analysis to identify the potential key genes to reveal the potential mechanism for ovarian cancer. Materials and Methods: The authors used the gene expression profile (GSE14407) to perform differentially expressed gene (DEG) analysis and the weighted gene co-expression network analysis. They selected the key module and performed the gene ontology (GO) annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis for the genes in the hub module. Then they screened the key genes in the hub module, and further validated their expression level. Results: A total of 3124 DEGs were detected after differential gene expression analysis; of these, 433 were upregulated genes and 2691 were downregulated genes. The authors selected the brown module that is significantly associated with the BRCA gene expression. Then they selected 30 hub genes from the protein-protein interaction network. The authors identified the PDZ binding kinase (PBK) as the prognosis-associated hub gene whose expression was significantly high in the ovarian cancer tissue. Conclusions: The bioinformatics analysis for the DEGs could be important to understand the pathogenesis for ovarian cancer. In this study, PBK is identified as a potential marker that might improve the understanding of the molecular mechanism and the diagnosis level for ovarian cancer.

Enriched environment for offspring improves learning and memory impairments induced by sevoflurane exposure during the second trimester of pregnancy.

Studies in animals indicate that sevoflurane exposure in the second trimester of pregnancy has harmful effects on the learning and memory of offspring. Whether an enriched environment can reverse the damage of sevoflurane exposure in the second trimester of pregnancy on the learning and memory of rat offspring remains unclear. In this study, rats at 14 days of pregnancy were exposed to 3.5% sevoflurane for 2 hours and their offspring were treated with an enriched environment for 20 successive days. We found that the enriched environment for offspring increased nestin and Ki67 levels in hippocampal tissue, increased hippocampal neurogenesis, inhibited glycogen synthase kinase 3ß activity, and increased the expression of cell proliferation-related ß-catenin and apoptosis-related Bcl-2, indicating that an enriched environment reduces sevoflurane-induced damage by increasing the proliferation of stem cells in the hippocampus. These findings suggest that an enriched environment can reverse the effects of sevoflurane inhaled by rats during the second trimester of pregnancy on learning and memory of offspring. This study was approved by the Animal Ethics Committee of Shengjing Hospital of China Medical University (approval No. 2018PS07K) on January 2, 2018.

A new approach to automatic measure fetal head circumference in ultrasound images using convolutional neural networks.

Fetal head circumference (HC) is an important biological index in prenatal ultrasound screening. In the clinic, fetal HC is usually measured manually by sonographers in two dimensional (2D) ultrasound images. The manual method is significantly affected by the inter/intra-observer difference and the process of manual measurement is inconvenient and time-consuming for sonographers. Although several artificial intelligence (AI) approaches had been applied to fetal HC measurement, they had weak generalization ability, especially for the incomplete or blurred skull edge. In this study, a fast and accurate method for fetal HC auto-measurement was proposed. Different from the common region segmentation method, an end-to-end convolutional neural network (CNN) for fetal skull boundary segmentation in 2D ultrasound images is proposed, which is an efficient method to directly segment the boundary of fetal skull by using the proposed double-branch structure. The segmentation results can be directly used to calculate fetal HC without complex post-processing. The proposed approach achieved excellent results: Mean Dice Sore (MDS)±std: 97.98 ± 1.30, Mean Hausdorff Distance (MHD)±std: 1.20 ± 0.68 mm, Mean Absolute Difference (MAD)±std: 1.75 ± 1.60 mm, Mean Difference (MD)±std: 0.08 ± 2.37 mm. Additionally, we drew a Bland-Altman plot to demonstrate that HC measured by the proposed approach has high agreement with the real value. Comprehensive results show that the proposed approach is comparable to the state-of-the-art methods for fetal HC measurement. Meanwhile, our approach belongs to a lightweight network with less parameters, which is convenient for deployment. We hope it could provide help for precision medicine in prenatal ultrasound screening.

RDHCformer: Fusing ResDCN and Transformers for Fetal Head Circumference Automatic Measurement in 2D Ultrasound Images.

Fetal head circumference (HC) is an important biological parameter to monitor the healthy development of the fetus. Since there are some HC measurement errors that affected by the skill and experience of the sonographers, a rapid, accurate and automatic measurement for fetal HC in prenatal ultrasound is of great significance. We proposed a new one-stage network for rotating elliptic object detection based on anchor-free method, which is also an end-to-end network for fetal HC auto-measurement that no need for any post-processing. The network structure used simple transformer structure combined with convolutional neural network (CNN) for a lightweight design, meanwhile, made full use of powerful global feature extraction ability of transformer and local feature extraction ability of CNN to extract continuous and complete skull edge information. The two complement each other for promoting detection precision of fetal HC without significantly increasing the amount of computation. In order to reduce the large variation of intersection over union (IOU) in rotating elliptic object detection caused by slight angle deviation, we used soft stage-wise regression (SSR) strategy for angle regression and added KLD that is approximate to IOU loss into total loss function. The proposed method achieved good results on the HC18 dataset to prove its effectiveness. This study is expected to help less experienced sonographers, provide help for precision medicine, and relieve the shortage of sonographers for prenatal ultrasound in worldwide.

Contribution of MRI to detect further anomalies in fetal ventriculomegaly.

OBJECTIVES: The purpose of this study was to determine the contribution of magnetic resonance imaging (MRI) in detecting further anomalies in fetal ventriculomegaly (VM). METHODS: From March 2006 to March 2008, fasting MRI scanning was performed on 70 women in whom ultrasonography (US) diagnosed fetal VM at Shengjing Hospital affiliated to the China Medical University. The US and MRIs were then compared. RESULT: US diagnosed 41 cases of unilateral VM and 29 cases of bilateral VM; 51 cases (72.86%) being mild, 17 cases moderate and 2 cases severe VM. Eight fetuses showed additional brain hemorrhage and other anomalies on MRI. Among these 8 cases, 1 (2.44%, 1/41) had unilateral VM, whereas 7 (24.13%, 7/29) had bilateral VM (Fisher's exact test, p = 0.007). On the other hand, 2 of 8 cases (25%) had mild VM, whereas 6 of 8 cases (75%) had moderate/severe VM (Fisher's exact test, p = 0.002). CONCLUSION: MRI mainly modified the US diagnoses when the fetus had bilateral VM or moderate/severe VM. The most common additional diagnosis was brain hemorrhage.

[Fetal ventriculomegaly: diagnosis using magnetic resonance imaging and its prognosis].

OBJECTIVE: To evaluate the diagnostic value of magnetic resonance imaging (MRI) on fetal ventriculomegaly identified through prenatal ultrasonography and the outcomes of these newborns were followed up. METHODS: From March 2006 to July 2008, MRI was performed on 135 pregnant women whose fetuses diagnosed as fetal ventriculomegaly at an average of 32 gestational weeks in Shengjing Hospital Affiliated to China Medical University. Mild ventriculomegaly was defined when the width of unilateral or bilateral fetal cerebral ventricle triangle was 10-15 mm, moderate ventriculomegaly 16-20 mm and severe ventriculomegaly >20 mm. We introduced the Denver developmental screening test (DDST) to follow-up the mild ventriculomegaly and normal babies, confirmed by MRI, at 6-12 months after birth and a case-control study was conducted. The intelligence and growth of these infants were analyzed. RESULTS: (1) Diagnostic rate of fetal ventriculomegaly through MRI: Among the 135 gravidas, 60 (44.4%) showed isolated ventriculomegaly, 5(3.7%) complicated with ventricular hemorrhage; 12 (8.9%) complicated with agenesis of corpus callosum (ACC) and 2 (1.5%) complicated with cerebellar hypoplasia, while 56 (41.5%) were normal. Seventy-nine cases had fetal ventriculomegaly on MRI and 15.2% (n = 12) of them complicated with ACC. (2) Degree of fetal ventriculomegaly on MRI: Among the 60 isolated ventriculomegaly cases, 55 (91.7%) were mild and 5 (8.3%) moderate ones. Among the 5 cases complicated with ventricular hemorrhage, one was mild ventriculomegaly, and 4 moderate or severe cases. Among the 12 cases with ACC, 8 (66.7%) were moderate ventriculomegaly and 4 (33.3%) severe cases. The 2 cases with cerebellar hypoplasia were both moderate ventriculomegaly fetuses. (3) Follow-up at 6-12 months after birth: thirty out (case group) of the 55 isolated ventriculomegaly cases, 38 out of the 56 normal babies and 42 babies with normal MRI results were followed up, and the later 80 cases were taken as control. Four infants (13.3%) in the case group and 10 (12.5%) in the control group showed abnormal or suspected results in DDST (P > 0.05), the rest babies were all normal. (4) Clinical outcomes of the 79 ventriculomegaly fetuses diagnosed by MRI: thirty mild ventriculomegaly babies and 5 moderate ones were born at term and showed normal at follow ups. However, 7 gravidas were not compliant, 6 pregnancies were terminated, and 12 were lost. Three of the 12 cases with ACC continued the pregnancy, and postnatal MRI of the babies showed the same with the prenatal MRI, 8 pregnancies were induced and one was lost. All of the 5 fetuses with ventricular hemorrhage were induced and the prenatal diagnosis was confirmed by autopsy. One of the 2 fetuses with cerebellar hypoplasia was term delivered and diagnosed as cerebral palsy at the age of 6 months, and the other one was induced. CONCLUSIONS: MRI is an indispensable complementary diagnostic method for fetal ventriculomegaly diagnosed through ultrasound. The development of intelligence and growth of babies born with mild isolated ventriculomegaly is the same as normal ones.