Künstliche Wirbelsäule: Selbstheilende mechanische Strukturen aus millimetergroßen Perlen wurden nach dem Vorbild des Wirbeltier‐Rückgrates aufgebaut. Die Einheiten sind auf Elastomerfäden aufgereiht und über Lötstellen miteinander verbunden. Nach Bruch oder Ausrenken heilen die Aggregate spontan unter Wiederherstellung der ursprünglichen linearen Anordnung (siehe Bild).
Objectives: To analyze the methods and echocardiographic characteristics of all kinds of aortic arch anomalies and to improve prenatal diagnostic accuracy. Methods: From 2004 to 2007, third-trimester screening of 41900 fetuses were performed in our hospital. 486 fetuses with congenital heart anomalies were diagnosed including 73 fetuses with congenital aortic arch anomalies. 73 fetuses with aortic arch abnormalities were classified by three aspects: aortic arch position anomalies relative to the trachea, the number of aortic arch anomalies, abnormal aortic arch diameter anomalies and aortic arch branch anomalies. We use different view to diagnosis aortic arch anomalies, including three vascular trachea view (3VT), trachea coronal view, thoracic aorta coronal view, longitudinal view of the aortic arch and longitudinal view of the ductus arch. Results: The details of 73 cases with congenital aortic arch anomalies were: 32 fetuses with malposition of aortic arch, 1 fetus with double aortic arch, 9 fetuses with normal left aortic arch and aberrant left subclavian artery, 5 fetuses with interrupted aortic arch, 26 fetuses with coarctation of aortic arch. 16 cases of 73 cases were done a chromosome examination, 7 cases which found chromosome abnormal were all 18-trisomy syndrome. The accuracy rate of prenatal sonographic diagnosis of congenital aortic arch anomalies was 86.36%. Conclusions: All kinds of aortic arch anomalies have typical sonographic image. If we know characteristics of all kinds of aortic arch anomalies, we could improve prenatal diagnostic accuracy. It is very useful to find and diagnosis aortic anomalies by using 3VT and trachea coronal view. It is also important to diagnosis interrupted aortic arch and coarctation of aortic arch by using color Doppler flow imaging. But coarctation of aortic arch was difficult diagnosed by prenatal ultrasound examination. Because it was very difficult to distinguish from interrupted aortic arch. OP35.10Pulmonary atresia/critical stenosis with intact ventricular septum: prediction of outcome in the second trimester of pregnancy Objectives: To determine which cardiac parameters provide the best prediction of postnatal outcome -biventricular (BV) vs. non-BV circulation-in fetuses with pulmonary atresia-critical stenosis with intact ventricular septum (PA/CS-IVS). Methods: Retrospective study of cases of PA/CS-IVS prenatally diagnosed between 20 and 28 weeks and with complete postnatal follow-up. A scoring system based on the diagnostic accuracy of morphological and functional cardiac features was constructed for predicting the postnatal outcome and this was compared with previous predictive models. Results: The study group included 16 liveborn fetuses (9 PA, 7 CS). Twelve fetuses had a BV outcome, and 4, all with PA, had non-BV repair. The mean gestational age at diagnosis was 23.1 ± 3.5 weeks (range, 20-28). The right cardiac dimensions, the ratio between right and left structures and the right ventricular inflow related to the cardiac cycle length were significantly ...
Study question What is the effect of the changes of the endometrium following progesterone exposure on uterine peristalsis? Summary answer Uteri with a greater increase endometrial thickness after progesterone exposure have significantly greater uterine peristalsis (UP). Therefore, endometrial compaction is associated with quieter uteri. What is known already Endometrial compaction is considered a sign of adequate response to progesterone. However, it is not always possible to visualize it. Little is known about endometrial switch following progesterone and its consequences after frozen embryo transfer, although it is hypothesized that increased endometrial growth after the window of implantation may be related to an increase in endogenous or exogenous oestrogen causing impairment of progesterone function. On the other hand, the role of progesterone in inhibiting endometrial contractile function is well known. Consequently, both the change in endometrial thickness and uterine contractility are indicators of progesterone function. Study design, size, duration This retrospective observational was carried out in Instituto Bernabeu of Alicante. The study included 215 patients with at least three previous implantation failures after egg donation treatment, which underwent uterine peristalsis assessment the day of embryo transfer from June 2017 to December 2021. Participants/materials, setting, methods UP assessment was performed using 4D ultrasound, recording a video for 6 minutes. UP variable was split in quartiles, and then the last quartile (UP ≥ 1,5 contractions per minute) was considered the hypercontractility group. All patients had performed an ultrasound to assess endometrial thickness between 7 to 10 days before embryo transfer. Endometrial compaction has been considered when it has decreased. Endometrial switch (ES) is considered the percentage between both endometrial measures. Main results and the role of chance The mean age of patients was 40,11 years who underwent an average of 3,75 embryo transfers. The average UP was 1,09 contractions per minute. The average ES was 9% of increased endometrium. Only 83 (38,6%) patients had endometrial compaction. To assess the association between UP and endometrial switch after progesterone exposure a univariate assessment was performed using Pearson’s correlation resulting in a negative correlation (r=-0,16; p = 0,019). It was used the hypercontractility group for performing bivariate logistic regression was performed to examine the effect of independent variables (previous miscarriages, previous pregnancies, C-section, endometriosis, adenomyosis, myomatosis and endometrial preparation) on ES. Greater ES is statistically associated to greater UP with OR 1,013 (95%IC: 1,002 to 1,025; p = 0,041). Limitations, reasons for caution It is a retrospective study based in patients with multiple implantation failure. It is possible that our conclusions couldn't be the same in patients with good prognosis. Wider implications of the findings Assessment of endometrial changes and uterine peristalsis provide information about the response of the uterus to progesterone exposure. However, more studies assessing it prospectively both would be interesting to define which population has high risk to develop situations with inadequate progesterone response. Trial registration number Not applicable
Marfan syndrome (MS) is a rare disease of the connective tissue. Neonatal MS is even rarer, and rarer still is its prenatal ultrasound diagnosis with 7 cases reported and only 1 surviving patient. We describe 2 new cases. Both had no relevant family history, had normal scans in the first half of pregnancy, were referred because of fetal cardiomegaly at 28 and 35 weeks respectively, and were delivered at term. Case 1: Fetal echocardiography showed severe cardiomegaly, dilation of the initial portion of the great vessels and mild prolapse of the atrioventricular (AV) valve leaflets. Postnatally, a marfanoid habitus was found and a moderate insufficiency of the AV and semilunar valves was also seen. The neonate was discharged on the 7 th day and an angiotensin II receptor antagonist (Losartan) was prescribed to prevent aortic root dilation. Echocardiography at 2 months revealed severe AV valve insufficiency. Rapid worsening required AV valve surgical repair, but the patient died 5 days later. A heterozygous mutation of the fibrillin-1 (FBN1) gene was found. Case 2: Fetal echocardiography showed dilation of the outflow tracts, AV valve insufficiency and redundant AV cusps protruding in the atria during systole. Enlarged and hiperflexed hands and feet were observed. A scan 2 weeks later revealed aortic insufficiency. Postnatally, the same marfanoid habitus was noted. The patient was discharged at 31 days, with Losartan. Two weeks later the patient was readmitted, chest X-ray revealed severe cardiomegaly and emphysematous lungs, and death occurred soon after due to cardiorespiratory arrest. A new mutation of the FBN1 gene was found. The combination of cardiomegaly, enlargement of great vessels and multivalvular regurgitation in the second half of pregnancy may lead to suspect neonatal MF. These valve problems progress relentlessly, leading to heart failure and early death in most cases. This information may be helpful to provide the parents the most accurate counseling. Craniosynostosis is defined as the premature closure of the calvarial sutures and is a feature of many syndromes. Prenatal diagnosis of the syndromic association depends on associated anomalies and molecular analysis of fetal DNA. Abnormal skull shape is the first clue; the earliest reported was at 19 weeks. Carpenter syndrome (CS) is very rare autosomal recessive disorder. We are reporting a case of prenatal diagnosis of CS utilizing 3D ultrasound (3DUS) at 16 weeks of gestation that manifested with craniosynostosis in a family not at risk. A primigravida, first cousin marriage, was referred at 16 weeks of gestation due to marked subcutaneous edema and anomalies. Fetal assessment showed: nuchal thickness of 1.5 cm, abnormal head shape (trapezoid) with suspicion of craniosynostosis. 3D US on skeletal mode suggested premature fusion of metopic and also coronal sutures. It also showed dysmorphic facies-Proptosis, depressed nasal bridge, micrognathia, low set ears, midfacial hypoplasia resulting in abnormal profile. The associated anomalies were: huge o...
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