Improving fetal congenital heart disease screening using a checklist-based approach

To determine if using a checklist of specific ultrasound image criteria to screen the fetal heart improves the cardiac exam completion rate, defined as the ability to classify the heart as normal or abnormal. This is a retrospective cohort study of patients with singleton pregnancies who underwent a fetal anatomy survey between 18 and 28 weeks' gestation. A checklist was used from 1 September 2015 to 31 March 2016 to categorize exams as complete-normal, complete-abnormal, or incomplete. Performance was compared with a 7-month period prior to checklist introduction (1 December 2014 to 30 June 2015). Checklist utilization improved the cardiac exam completion rate by 8.9%. With the checklist, 1083 of 1202 exams (90.1%) were completed compared to 987 of 1193 (82.7%) pre-checklist, P < .001. We did not detect a change in cases classified as abnormal and referred for echocardiography: 25 (2.1%) with the checklist and 16 (1.3%) pre-checklist, P = .16. We did not detect more congenital heart disease (CHD), 12 (1.0%) with checklist screening, 5 (0.4%) pre-checklist, P = .14. Critical CHD was not missed in either group. Using the checklist improved the cardiac exam completion rate. There was no change in congenital heart disease detection.     

不同认知风格大学生艾宾浩斯错觉的实验研究

文章以34名大学生为被试,采用2(150%,50%)×2(场独立,场依存)被试间实验设计探讨了不同认知风格大学生艾宾浩斯错觉的眼动特点。结果表明:(1)不同的认知风格对艾宾浩斯错觉判断正确量有影响,并且在眼动指标上存在差异;(2)测验成分和诱导成分之间的大小比例对艾宾浩斯错觉正确量有影响,并且在眼动指标上存在差异;(3)诱导成分和测验成分之间距离不同时对艾宾浩斯错觉正确量无显著影响,并且在眼动指标上也不存在显著差异。     

Prenatal diagnosis of a craniopharyngioma using ultrasonography and magnetic resonance imaging

We report an infant with a craniopharyngioma which was detected in utero. Maternal uterine ultrasonography, done at 27 weeks because of polyhydramnios, revealed a 4 cm midline mass near the base of the fetal skull. At 31 weeks, magnetic resonance imaging of the maternal abdomen confirmed the presence of a mass in the region of the third ventricle and revealed hydrocephalus. Two days post-partum a computed tomography (CT)-guided needle biopsy of the mass was performed and recovered tissue which was histologically consistent with a craniopharyngioma. The infant' s postnatal period was complicated by seizures, which were treated with phenobarbital, and by progressive hydrocephalus, necessitating placement of a ventriculo-peritoneal shunt. He also received therapy for central hypothyroidism and diabetes insipidus. The infant' s parents refused permission for attempted resection of the tumour and he died at 8 weeks of age. This represents the second reported case of an antenatally detected craniopharyngioma. Four other cases of different intracranial tumours have been detected in utero using ultrasound, with no reported survivors past 3 days of age. There is a uniformly poor prognosis of such infants, but earlier diagnosis and intervention may change this result.     

The nuchal translucency and the fetal heart: a literature review

In this overview the current knowledge of the relationship between an increased nuchal translucency (NT) measurement and fetal heart structure and function in chromosomally normal fetuses is reviewed. Relevant pathophysiological theories behind the increased NT are discussed. Fetuses with an increased NT have an increased risk for congenital heart disease (CHD) with no particular bias for one form of CHD over another. This risk increases with increasing NT measurement. Although the NT measurement is only a modestly effective screening tool for all CHD when used alone, it may indeed be effective in identifying specific CHD “likely to benefit” from prenatal diagnosis. The combination of an increased NT, tricuspid regurgitation and an abnormal ductus venosus (DV) Doppler flow profile, is a strong marker for CHD. A fetal echocardiogram should be performed at 20 weeks' gestation in fetuses with an NT ≥ 95th percentile but < 99th percentile. When the NT measurement is ≥ 99th percentile, or when tricuspid regurgitation and/or an abnormal DV flow pattern is found along with the increased NT, an earlier echocardiogram is indicated, followed by a repeat scan at around 20 weeks' gestation. The resultant increased demand for early fetal echocardiography and sonographers with this special expertise needs to be planned and provided for. Copyright © 2009 John Wiley & Sons, Ltd.     

地下水渗流沉降的三维耦合模型及程序的研制

研制可合理模拟预测基坑降水过程中引起地面沉降的计算机程序,并提出最优化降水方案.基于三维全耦合数值模型,笔者开发了GWS软件.GWS软件是以比奥固结理论为基础,将土体的非线性特征及土的渗透性随应力状态的动态变化考虑进去,通过耦合地下水渗流场和土体应力场进行模拟预测基坑降水过程中渗流场及地面沉降的变化.以一个实际基坑降水工程为例,经GWS软件计算得出5口井联合抽水方案,后续工程证明此方案正确、可靠.以三维全耦合数值理论为基础的GWS软件,可以为基坑降水工程引起的地下水渗流场变化及地面沉降量提供可靠的预测.