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Purpose This study evaluated the elastic characteristics of the pulmonary trunk and distal branches in fetuses diagnosed with tetralogy of Fallot (TOF) using Doppler echocardiography. Methods Data on 42 fetuses diagnosed with TOF and 84 gestational age–matched normal fetuses were prospectively collected from the Second Xiangya Hospital of Central South University between August 2022 and January 2023. The severity of TOF was classified into three categories based on the z-score of the pulmonary annulus diameter: mild (z-score ≥-2), moderate (-40.05). Conclusion Fetuses diagnosed with TOF exhibited increased vascular stiffness in the MPA and reduced stiffness in the distal pulmonary artery (PA). Larger-scale follow-up studies are required to elucidate the relationships between these changes in vascular stiffness and PA development in patients with TOF.

BackgroundPrevious observational clinical studies and meta-analyses have yielded inconsistent results regarding the relationship between vitamin D and headache, and the causal relationship remains unclear. The aim of this study was to investigate the causal relationship between vitamin D and headache by bidirectional two-sample Mendelian randomisation (MR) analysis.MethodsThe relationship between high levels of vitamin D and headache was investigated by two-sample MR analysis using publicly available genome-wide association study (GWAS) data. The primary method was inverse variance weighting (IVW), and secondary methods were weighted median and MR-Egger methods. No heterogeneity or horizontal multidirectionality was found in the MR results. The robustness and validity of the findings were assessed using the leave-behind method.ResultsA significant causal relationship was found between high vitamin D levels and headache using the IVW method (OR = 0.848; p = 0.007; 95% CI = 0.752–0.956). However, in a reverse analysis, no evidence of a causal relationship between headache and high levels of vitamin D was found using the IVW method (OR = 1.001; p = 0.906; 95% CI = 0.994–1.006). Our MR analyses showed no significant horizontal multidimensionality or heterogeneity (p > 0.05). Sensitivity analyses confirmed that MR estimates were not affected by single nucleotide polymorphisms (SNPs). Confirmation that our results are robust and valid has been obtained by the leave-one-out method.ConclusionOur study suggests that high levels of vitamin D prevent the risk of headache. However, there is no evidence of a causal relationship between headache and high levels of vitamin D. Vitamin D may reduce the risk of headache.

Abstract Background We investigated the synergistic effect of stress and habitual salt preference (SP) on blood pressure (BP) in the hospitalized Omicron-infected patients. Methods From 15,185 hospitalized Omicron-infected patients who reported having high BP or hypertension, we recruited 662 patients. All patients completed an electronic questionnaire on diet and stress, and were required to complete morning BP monitoring at least three times. Results The hypertensive group (n = 309) had higher habitual SP (P = 0.015) and COVID-19 related stress (P

Abstract Background Sepsis is a life‐threatening organ dysfunction caused by a dysregulated host response to infection and progressive immunosuppression with high mortality. HLA‐DR, CD64, and PD‐1 were assumed to be useful biomarkers for sepsis prediction. However, the ability of a combination of these biomarkers has not been clarified. Methods An observational case‐control study was conducted that included 30 sepsis patients, 30 critically ill patients without sepsis admitted to the intensive care unit (ICU), and 32 healthy individuals. The levels of HLA‐DR, CD64, and PD‐1 expression in peripheral blood immune cells and subsets was assayed on Days 1, 3, and 5, and the clinical information of patients was collected. We compared these biomarkers between groups and evaluated the predictive validity of single and combined biomarkers on sepsis mortality. Results The results indicate that PD‐1 expression on CD4−CD8−T (PD‐1+CD4−CD8−T) (19.19% ± 10.78% vs. 9.88% ± 1.79%, p = .004) cells and neutrophil CD64 index (nCD64 index) (9.15 ± 5.46 vs. 5.33 ± 2.34, p = .001) of sepsis patients were significantly increased, and HLA‐DR expression on monocytes (mHLA‐DR+) was significantly reduced (13.26% ± 8.06% vs. 30.17% ± 21.42%, p = 2.54 × 10−4) compared with nonsepsis critically ill patients on the first day. Importantly, the expression of PD‐1+CD4−CD8−T (OR = 0.622, 95% CI = 0.423–0.916, p = .016) and mHLA‐DR+ (OR = 1.146, 95% CI = 1.014–1.295, p = .029) were significantly associated with sepsis mortality. For sepsis diagnosis, the mHLA‐DR+, PD‐1+CD4−CD8−T, and nCD64 index showed the moderate individual performance, and combinations of the three biomarkers achieved greater diagnostic value (AUC = 0.899, 95% CI = 0.792–0.962). When adding PCT into the combined model, the AUC increased to 0.936 (95% CI = 0.840–0.983). For sepsis mortality, combinations of PD‐1+CD4−CD8−T and mHLA‐DR+, have a good ability to predict the prognosis of sepsis patients, with an AUC = 0.921 (95% CI = 0.762–0.987). Conclusion These findings indicate that the combinations of HLA‐DR, CD64, and PD‐1 outperformed each of the single indicator in diagnosis and predicting prognosis of sepsis.

BackgroundEndovascular or surgical treatment of wide-neck, large basilar apex aneurysms is challenging. We present a novel concept for the treatment of complex basilar apex aneurysms using flow-diverter devices combined with the flow-T stenting-assisted coiling technique. Assess the efficacy and safety profile of the technique in this complex aneurysm.Case descriptionA patient with multiple unruptured intracranial aneurysms underwent staged treatment. A large basilar apex aneurysm was treated with a flow-diverter stent combined with a flow-T stenting-assisted coiling technique in the first stage, and a giant supraclinoid aneurysm was treated with a flow-diverter stent applied in the second stage. Clinical presentations, technical details, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a 9-month follow-up.ResultsThe patient achieved full neurologic recovery postoperatively. Cerebral angiography performed postoperatively showed revascularization, good laminar flow, and no in-stent or adjacent stenosis.ConclusionFlow-diverter stents combined with flow-T stenting-assisted coiling for the treatment of giant basilar apex aneurysms is a feasible technique with efficacy demonstrated at a 9-month follow-up. Staged endovascular treatment of multiple intracranial aneurysms may be a safe and viable option.

Abstract Integrating nanomaterials into the polymer matrix is an effective strategy to optimize the performance of polymer‐based piezoelectric devices. Nevertheless, the trade‐off between the output enhancement and stability maintenance of piezoelectric composites usually leads to an unsatisfied overall performance for the high‐strength operation of devices. Here, by setting liquid metal (LM) nanodroplets as the nanofillers in a poly(vinylidene difluoride) (PVDF) matrix, the as‐formed liquid‐solid/conductive‐dielectric interfaces significantly promote the piezoelectric output and the reliability of this piezoelectric composite. A giant performance improvement featured is obtained with, nearly 1000% boosting on the output voltage (as high as 212 V), 270% increment on the piezoelectric coefficient (d33∼51.1 pC N−1) and long‐term reliability on both structure and output (over 36 000 cycles). The design of a novel heterogenous interface with both mechanical matching and electric coupling can be the new orientation for developing high performance piezoelectric composite‐based devices.

ObjectiveImpaired elasticity of aorta has been observed in fetuses with congenital cardiac disease, while the orientation of left ventricle outflow tract has been found to influence the blood flow in the ascending aorta. Therefore, the objective of this study is to examine the left ventricle inflow and outflow tract angle (LIOA) in healthy fetuses.MethodA total of 668 fetuses were enrolled in this prospective study. The LIOA were measured with two-line method at left ventricle inflow and outflow tract view. Pearson's correlation coefficient was utilized to assess the associations between LIOA and estimated fetal weight (EFW) and cardiac dimensions, including cardiac axis and diameters of aortic valve (AV), pulmonary artery valve (PAV), mitral valve (MV) and tricuspid valve (TV).ResultsThe LIOA was determined to be 44 ± 7.5° (mean ± SD). No significant difference was observed in the LIOA across different gestational ages (GAs). A mild positive correlation was observed between LIOA and cardiac axis. However, no significant associations were found between LIOA and parameters such as EFW, as well as diameters of AV, PAV, MV and TV.ConclusionThe LIOA remained constant during the mid-third trimester and was mildly positively correlated with cardiac axis in normal fetuses.

Abstract Background Giant hepatic hemangiomas are rare and can cause serious complications that contribute to a high risk of perinatal mortality. The purpose of this article is to review the prenatal imaging features, treatment, pathology, and prognosis of an atypical fetal giant hepatic hemangioma and to discuss the differential diagnosis of fetal hepatic masses. Case presentation A gravida 9, para 0 woman at 32 gestational weeks came to our institution for prenatal ultrasound diagnosis. A complex, heterogeneous hepatic mass measuring 5.2 × 4.1 × 3.7 cm was discovered in the fetus using conventional two-dimensional ultrasound. The mass was solid and had both a high peak systolic velocity (PSV) of the feeding artery and intratumoral venous flow. Fetal magnetic resonance imaging (MRI) revealed a clear, hypointense T1-W and hyperintense T2-W solid hepatic mass. Prenatal diagnosis was very difficult due to the overlap of benign and malignant imaging features on prenatal ultrasound and MRI. Even postnatally, neither contrast-enhanced MRI nor contrast-enhanced computed tomography (CT) was useful in accurately diagnosing this hepatic mass. Due to persistently elevated Alpha-fetoprotein (AFP), a laparotomy was performed. Histopathological examination of the mass showed atypical features such as hepatic sinus dilation, hyperemia, and hepatic chordal hyperplasia. The patient was ultimately diagnosed with a giant hemangioma, and the prognosis was satisfactory. Conclusions When a hepatic vascular mass is found in a third trimester fetus a hemangioma should be considered as a possible diagnosis. However, prenatal diagnosis of fetal hepatic hemangiomas can be challenging due to atypical histopathological findings. Imaging and histopathological assays can provide useful information for the diagnosis and treatment of fetal hepatic masses.

Background Increased aortic wall stiffness, which even persists after repair, has been reported in patients with tetralogy of Fallot (TOF). We aimed to observe the distensibility of the ascending aorta and descending aorta in fetuses with TOF and explore its relation with aortic blood flow volume and aortic and pulmonary annular size. Methods and Results Twenty‐three fetuses with TOF and 23 gestational age–matched normal fetuses were included in this prospective cross‐sectional study. The distensibilities of the ascending aorta and descending aorta were assessed by aortic strain (AS), which was defined as follows: 100×(maximum internal diameter in the systolic phase–minimum internal diameter in the diastolic phase)/minimum internal diameter in the diastolic phase. The maximum internal diameter in the systolic phase and minimum internal diameter in the diastolic phase of the ascending aorta and descending aorta were measured by M‐mode echocardiography. Associations between AS and aortic blood flow volume and aortic and pulmonary valve diameters were assessed in both groups. AS of the ascending aorta in TOF group was lower than that in controls (20.48%±4.19% versus 28.17%±4.54%; P

ObjectiveThis study aims to observe the changes of the umbilical venous–arterial index (VAI) and investigate its predictive power for fetal outcome during the second half of pregnancy.MethodsFetuses with gestational age (GA) at 24–39 weeks were collected. According to the outcome score, neonates with outcome scores of 0, 1, or 2 were assigned to the control group, whereas those with scores of 3–12 were assigned to the compromised group. VAI was calculated as the ratio of normalized umbilical vein blood flow volume and umbilical artery pulsatility index. Regression analysis was performed to obtain the best-fitting curves between VAI and GA in the controls. Doppler parameters and perinatal outcomes were compared in both groups. Receiver operating characteristic analysis was used to assess the diagnostic performance of the VAI.ResultsA total of 833 (95%) fetuses had Doppler parameters and pregnancy outcomes documented. Compared with the controls, the VAI was significantly lower in the compromised group (83.2 vs. 184.8 ml/min/kg, p

Background Abnormal aortic elastic properties are major notable vasculopathy involved in coarctation of the aorta (CoA). However, there are no reports on aortic wall elastic characteristics in fetuses with CoA. Methods and Results Fifty‐six fetuses with CoA and 56 normal controls were included in this prospective case–control study. The dimensions of the cardiac chamber, the size of the aorta, left ventricular myocardial performance indexes, and aortic elastic properties, including the global circumferential strain, fractional area change and mean longitudinal strain, were measured serially in utero. The global circumferential strain, fractional area change, and mean longitudinal strain in fetuses with CoA were smaller than those in the normal group at both the first and last examinations (18.50% versus 37.73% for global circumferential strain, 38.90% versus 57.55% for fractional area change, 6.61% versus 11.81% for mean longitudinal strain at first scan, 16.62% versus 42.05% for global circumferential strain, 36.54% versus 59.7% for fractional area change, 6.2% versus 11.46% for mean longitudinal strain at last scan, all P

ObjectiveThe purpose of this study is to establish Z-scores models of normal fetal ascending aorta diameter and diameter distensibility.MethodsThe maximum systolic diameter (Dmax), minimum diastolic diameter (Dmin), and diameter distensibility of the sinotubular junction were measured and taken as dependent variables in 490 normal fetuses at 18–40 gestational weeks, and gestational age (GA), biparietal diameter (BPD), and femoral length (FL) were taken as independent variables. The data were subjected to regression analysis, and the best-fitting equations for the dependent variables based on the independent variables were determined. The fitting equations were then applied to construct the Z-scores models.ResultsThe Dmax, Dmin and Diameter Distensibility in normal fetuses between 18 and 40 weeks of GA could be evaluated by utilizing the Z-scores models. Dmax and Dmin increased significantly with increasing GA, BPD, and FL. Diameter distensibility, assessed as (Dmax–Dmin)/Dmin, decreased significantly with increasing GA, BPD, and FL.ConclusionThe Z-scores are valuable, and can be utilized as a potent supplement to the conventional approach as they can indirectly reflect the development of fetal ascending aortic elastic property.

Surface roughness is a key indicator of the quality of mechanical products, which can precisely portray the fatigue strength, wear resistance, surface hardness and other properties of the products. The convergence of current machine-learning-based surface roughness prediction methods to local minima may lead to poor model generalization or results that violate existing physical laws. Therefore, this paper combined physical knowledge with deep learning to propose a physics-informed deep learning method (PIDL) for milling surface roughness predictions under the constraints of physical laws. This method introduced physical knowledge in the input phase and training phase of deep learning. Data augmentation was performed on the limited experimental data by constructing surface roughness mechanism models with tolerable accuracy prior to training. In the training, a physically guided loss function was constructed to guide the training process of the model with physical knowledge. Considering the excellent feature extraction capability of convolutional neural networks (CNNs) and gated recurrent units (GRUs) in the spatial and temporal scales, a CNN–GRU model was adopted as the main model for milling surface roughness predictions. Meanwhile, a bi-directional gated recurrent unit and a multi-headed self-attentive mechanism were introduced to enhance data correlation. In this paper, surface roughness prediction experiments were conducted on the open-source datasets S45C and GAMHE 5.0. In comparison with the results of state-of-the-art methods, the proposed model has the highest prediction accuracy on both datasets, and the mean absolute percentage error on the test set was reduced by 3.029% on average compared to the best comparison method. Physical-model-guided machine learning prediction methods may be a future pathway for machine learning evolution.

Abstract Objective The objective of this study was to determine fetal foramen ovale blood flow utilizing pulsed Doppler combined with spatiotemporal image correlation. Methods A cross-sectional study was performed in 440 normal fetuses between 20 and 40 weeks of gestation. In order to calculate foramen ovale blood flow, the foramen ovale flow velocity–time integral was obtained by pulsed Doppler ultrasonography, and the foramen ovale area was measured by using spatiotemporal image correlation rendering mode. Foramen ovale blood flow was calculated as the product of the foramen ovale area and the velocity–time integral. Results Gestational age-specific reference ranges are given for the absolute blood flow (ml/min) of foramen ovale, showing an exponential increase from 20 to 30 weeks of gestation, and a flat growth trend during the last trimester, while the weight-indexed flow (ml/min/kg) of foramen ovale decreased significantly. The median weight-indexed foramen ovale blood flow was 320.82 ml/min/kg (mean 319.1 ml/min/kg; SD 106.33 ml/min/kg). Conclusions The reference range for fetal foramen ovale blood flow was determined from 20 to 40 weeks of gestation. The present data show that the volume of foramen ovale blood flow might have a limited capacity to increase during the last trimester.

Nemaline myopathy (NM) is a rare, hereditary heterogeneous myopathy. Fetal NM has a more severe disease course and a poorer prognosis and is usually lethal during the first few months of life. Hence, early prenatal diagnosis is especially important for clinical interventions and patient counseling. We report the case of a fetus with NM due to KLHL40 gene variation leading to arthrogryposis multiplex congenita (AMC). The ultrasonography and histopathology results revealed an enhanced echo intensity and decreased muscle thickness, which may be novel features providing early clues for the prenatal diagnosis of NM. Moreover, to our knowledge, this article is the first report to describe a case of NM associated with complex congenital heart disease (CHD).

Methods for diagnosing prostate cancer (PCa) are developing in the direction of imaging. Advanced ultrasound examination modes include micro-Doppler, computerized-transrectal ultrasound, elastography, contrast-enhanced ultrasound and microultrasound. When two or more of these modes are used in PCa diagnosis, the combined technique is called multiparameter ultrasound (mp-US). Mp-US provides complementary information to multiparameter magnetic resonance imaging (mp-MRI) for diagnosing PCa. At present, no study has attempted to combine the characteristics of different ultrasound modes with advanced classification systems similar to the PIRADS system in mpMRI for the diagnosis of PCa. As an imaging method, mp-US has great potential in the diagnosis of PCa.

ObjectiveThe purpose of the study was to observe the elasticity of the ascending aorta (AAo) in normal fetuses and fetuses with coarctation of the aorta (CoA) by M-mode echocardiography.MethodsThis was a prospective clinical study performed on 16 fetuses with CoA and 48 gestational-age matched normal fetuses. The minimum internal diameter in the diastolic phase (Dmin) and the maximum internal diameter in the systolic phase (Dmax) of the AAo were measured by M-mode echocardiography. The aortic strain was calculated using the formula 100 × (Dmax−Dmin)/Dmin). Doppler echocardiography was performed to measure the cardiac function parameters. Correlations between aortic strain and cardiac function were assessed in fetuses with CoA.ResultsThe aortic strain of the ascending aorta in the fetuses with CoA was significantly lower than that in normal fetuses (18.12 ± 4.88% vs. 25.22 ± 4.92%, p < 0.01). The fetuses with CoA showed significantly higher combined cardiac output than the controls (471.89 ± 93.98 vs. 411.57 ± 46.35 ml/min/kg, p < 0.05). Compared with the normal group, the early diastolic velocities (E') and peak systolic velocities (S') of the left side were obviously decreased in the CoA group (p < 0.05), while the left early diastolic velocity ratio (E/E') was significantly increased in the fetuses with CoA (p < 0.01). For the fetuses with CoA, the aortic strain of the AAo was correlated with the left E/E' and S' (r = −0.522 and 0.504, respectively, P < 0.05).ConclusionsThe aortic strain of the ascending aorta was significantly decreased in fetuses with CoA in middle-late gestation. The impaired strain of the ascending aorta was correlated with the left ventricle function in the fetuses with CoA. These findings imply that the abnormalities of the intrinsic aortic wall of CoA might develop early in utero.

Abstract Background The fetal adrenal gland is a highly vascularized organs and develops two recognizable distinct zones in uetro, inner fetal zone (FZ) and outer definitive zone (DZ). Based on the region supplied, middle adrenal artery (MAA) mainly contribute to FZ while inferior adrenal artery (IAA) mainly to the inferior part of DZ. The purpose of this study was to establish reference ranges of adrenal artery Doppler indices of IAA and MAA, and assess zonal difference of blood supply to fetal adrenal gland. Methods The pulsatility index (PI), resistance index (RI), and systolic:diastolic ratio (S/D) of the IAA and MAA were obtained serially at 4-week intervals in normal fetuses. The MAA and IAA were referred based on the course and location in the gland: IAA referring the artery that mainly branches from the renal artery and walks along the renal upper pole, distributing the inferoposterior part of DZ in the adrenal gland while MAA as arterial blood flowing along the single central adrenal vein in the medial part of the gland. Multilevel modeling was performed to establish the gestational age-associated reference ranges for IAA and MAA. Differences in Doppler indices between the IAA and MAA were assessed. Results One hundred sixty-eight fetuses with 843 observations were included. The IAA had a higher detection rate than the MAA (100% vs 89.2%, p

In this study, a carrageenan-induced thrombus model was established in mice to observe the ability of Lactobacillus plantarum KFY05 (LP-KFY05) to inhibit thrombosis through an NF-κB-associated pathway. Biochemical analysis, microscopical observations, quantitative polymerase chain reactions (qPCR) and western blot analysis were used to examine relevant serum and tissue indexes, and the composition of intestinal microorganisms was determined by examining the abundance of microorganisms in feces. The results showed that LP-KFY05 could markedly reduce the degree of black tail in thrombotic mice; increase the activated partial thromboplastin time (APTT); and decrease the thrombin time (TT), fibrinogen (FIB) level, and prothrombin time (PT). LP-KFY05 could also reduce tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 beta (IL-1β) levels in sera and renal tissues of thrombotic mice. Hematoxylin and eosin staining showed that LP-KFY05 could alleviate renal tissue lesions and tail vein thrombosis. qPCR results showed that LP-KFY05 could down-regulate nuclear factor kappa-B (NF-κB) p65, IL-6, TNF-α, and interferon γ (IFN-γ) mRNA expression in renal tissues, as well as NF-κB p65, intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin mRNA expression in tail vein vascular tissues of thrombotic mice. Western blot analysis showed that LP-KFY05 also down-regulated NF-κB protein expression in renal and tail vein vascular tissues of thrombotic mice. Lastly, LP-KFY05 increased the abundances of Bacteroidetes, Lactobacillus, and Bifidobacterium, as well as decreased the abundance of Firmicutes. These results show that LP-KFY05 can reduce inflammation and inhibit thrombosis in thrombotic mice, and the effects of high concentrations of LP-KFY05 were most pronounced, which were similar to the effects of dipyridamole.

ObjectiveThis study aimed to assess the circumferential and longitudinal strain of the fetal ascending aortic (AA) wall and establish a gestational age-associated longitudinal reference for aortic wall strain during the second half of pregnancy.MethodsSingleton fetuses with gestational age (GA) at 20 + 0 to 24 + 6 weeks were prospectively collected from a low-risk population. Global circumferential strain (GCS) and mean longitudinal strain (MLS) of the ascending aorta were measured serially at 4-week intervals using the velocity vector imaging (VVI) technique. Fractional polynomials were conducted to obtain the best-fitting curves between GA and AA strains. GA-specific reference percentiles of GCS and MLS were established by multilevel modeling.ResultsA total of 223 fetuses with a total of 1,127 serial observations were enrolled. GCS presented a second-degree fractional polynomial smoothing regression along GA (R2 = 0.635, P < 0.05). Fetal aortic GCS remained unchanged at ~27.29% (20.36–35.6%) before 31 weeks and increased significantly from 31.36% (26.38–37.12%) at 31 weeks to 43.29% (30.5–56.78%) at term. MLS presented a third-degree fractional polynomial smoothing regression along GA (R2 = 0.465, P < 0.05). MLS remained steady at ~10.03% (3.28–17.62%) between 20 and 31 weeks and then increased significantly from 12.68% (7.42–20.1%) at 32 weeks to 17.5% (9.67–25.34%) at term. The GCS was significantly higher than the MLS in the ascending aorta wall (p < 0.001).ConclusionThe fetal ascending aorta wall demonstrates obviously greater circumferential strain than longitudinal strain. Both strains remained steady before the late trimester and then gradually increased until delivery, suggesting progressive maturation of aortic elasticity mechanics.

Abstract Background Fetal double aortic arch (DAA) malformation is a rare congenital heart disease with few reported cases in the literature. We aimed to investigate the characteristics of prenatal ultrasound and postnatal computed tomography angiography (CTA) of DAA and to describe the associated anomalies and clinical outcomes to improve prenatal diagnosis and assist in perinatal management. Methods The obstetric ultrasound imaging databases of seven tertiary referral centers were reviewed retrospectively to identify fetuses with a prenatal diagnosis of DAA between January 2013 and December 2018. Ultrasonographic findings, associated anomalies, genetic abnormalities, postnatal CTA images, and long-term postnatal outcomes were evaluated. Results A total of 36 cases out of 40 prenatally diagnosed DAA fetuses were confirmed by postnatal diagnosis (fetal autopsy, CTA, and surgery). In this cohort of 36 confirmed cases, 24 (67%) were isolated anomalies, while 12 (33%) were associated with intracardiac or extracardiac anomalies, and 2 (6%) had a 22q11.2 chromosome deletion. Among nine cases of pregnancy termination with a fetal autopsy, 7 had other abnormalities. Among the remaining 27 live births, 16 (59%) were asymptomatic and 11 (41%) received surgical treatment due to tracheal or esophageal compression symptoms, all with satisfactory outcomes. Prenatal echocardiography showed that DAA was mainly characterized by a bifurcation of the ascending aorta into the right and left aortic arch and the formation of a complete O-shaped vascular ring around the trachea on the three-vessel tracheal view. A variant in the aortic arch branching pattern was found for the first time. The airway obstruction, branching pattern, and atretic arch of DAA were clearly shown by postnatal CTA. Conclusions Fetal DAA has unique features on prenatal echocardiography and postnatal CTA, and systematic prenatal examination and timely postnatal CTA evaluation are required. A certain proportion of intracardiac and extracardiac abnormalities are associated with DAA, but the probability of chromosome abnormalities is low, especially for isolated DAA.The clinical outcomes of isolated DAA are favorable, even if surgery is performed due to symptoms. Determining whether other malformations or chromosomal anomalies exist is crucial for prognosis evaluation and prenatal counseling.

Abstract Background To observe myocardial deformations in fetuses with isolated lower urinary tract obstruction (LUTO) and identify the correlation between myocardial deformation and the severity of obstruction. Methods The strain (S), strain rate in systole (SRs) and strain rate in diastole (SRd) of the left and right ventricles at the first examination were prospectively analyzed and compared between fetuses with isolated LUTO and gestational age (GA)-matched normal control fetuses. Multiple regression analyses were used to assess the obstructive factors for impaired strain and strain rate, and the independent variables included bladder volume, sum of the bilateral pelvic diameters, sum of the bilateral ureteral diameters, mean bilateral renal artery pulsatility index, and amniotic fluid index. Results Thirty-six fetuses with isolated LUTO and 36 normal controls were enrolled. Overall, decreased S, SRs and SRd of both ventricles were noted in fetuses with LUTO (p

Abstract Background Hypoxia delays brain maturation and contributes to neurodevelopmental morbidity in fetuses with congenital heart defects (CHDs). Maternal hyperoxygenation (MH) can, in theory, promote oxygen/nutrient delivery to the fetal brain, owing to an improved heart structure/function and increased fetal oxygen content. We aimed to determine whether MH alters fetal cerebral hemodynamics in fetuses with CHD. Methods Twenty-eight fetuses with borderline small left hearts and 28 age-matched normal fetuses were enrolled and subdivided by gestational age (GA): 23+ 0 ~ 27+ 6 weeks and 28+ 0 ~ 36+ 6 weeks. The middle cerebral artery pulsatility index (MCA-PI), vascular index (VI), flow index (FI) and vascular/flow index (VFI) were measured with baseline room air, after 10 min of MH and after 10 min of recovery for all subjects. Results MCA-PI, VI, FI and VFI did not differ with MH in the normal fetuses. In fetuses with borderline small left hearts, MCA-PI increased and VI, FI and VFI significantly decreased during the 3rd trimester (from 1.44 ± 0.27, 3.19 ± 0.87, 56.91 ± 9.19, and 1.30 ± 0.33 at baseline to 1.62 ± 0.15, 2.37 ± 0.37, 45.73 ± 4.59, and 0.94 ± 0.15 during MH, respectively, P 0.05). These parameters returned to the baseline levels during the recovery phase. The change in cerebral perfusion depended on the baseline MCA-PI and increased the combined cardiac index (CCOi). Conclusions MH alters the cerebral hemodynamics of fetuses with borderline small left hearts during the third trimester. Further investigation is needed to determine whether MH may benefit brain growth and neurodevelopment in this high-risk population.

Abstract Backgroud Fetus in fetu (FIF) is a rare malformation in which a parasitic twin within its more mature twin. Most of the FIF locate in the retroperitoneum and are acardiac and anencephalic. Case presentation Here, we describe a unique case of oropharyngeal fetus in fetu with a rudimentary two-chambered heart detected by prenatal ultrasonography. The parents terminated this pregnancy after counseling. Macroscopic examination found a solid mass between the oral and fetal chest, with a rudimentary two-chambered heart at the lowest part of the mass. Microscopic findings showed amniotic membrane, skin, cartilage, gastrointestinal and neural tissue. Conclusions Prenatal ultrasound can identify rudimentary organs suspecting FIF from early pregnancy. Detection of fetal heart beat facilitates differential diagnosis with teratomas, providing essential information for parental consulting and management.

The rapid development towards automated construction has been witnessed in recent years mainly due to the growing shortage of skilled labor. Against that backdrop, an accelerated method, with the aid of robotic cranes, is emerging in China to speed up the construction of industrial facilities such as warehouse structures. This method requires that the steel bars in the precast beams do not extend beyond the beam ends to facilitate the temporary fixation of the robotic crane at the top of cast-in-place columns. This, nonetheless, brings a series of new problems, one of which is how to choose a suitable anchoring type for the beam bottom bars. To address this issue, three large-scale exterior beam-to-column connections were fabricated and tested under lateral load reversals. Two anchorage forms, namely, mechanical splices and grouted sleeves, were adopted and compared with the monolithically cast specimen. The test results showed that the specimen using the grouted sleeves had similar seismic performance to that of the cast-in-place specimen, whereas the specimen using the mechanical splices presented significant post-peak deterioration under positive beam bending moments. This happened because the congestion of steel bars within the joint core made it difficult to fully tighten the beam bottom bars into the threaded couplers; consequently, a “slop” was formed which could substantially impair the cyclic behavior of the specimen. As such, it is suggested that grouted sleeves should be more applicable and reliable for the new construction method. This counter-intuitive finding also indicates that, for intelligent construction, no detail should be taken for granted, but rather needs due consideration.

As it is known, uranium enrichment is carried out on industrial scale by means of multistage separation facilities, i.e., separation cascades in which gas centrifuges (GCs) are connected in series and parallel. Design and construction of these facilities require significant investment. So, the problem of calculation and optimization of cascade working parameters is still relevant today. At the same time, in many cases, the minimum unit cost of a product is related to the cascade having the smallest possible number of separation elements/GCs. Also, in theoretical studies, it is often acceptable to apply as an efficiency criterion the minimum total flow to supply cascade stages instead of the abovementioned minimum unit cost or the number of separation elements. In this article, cascades with working parameter of a single GC changing from stage to stage are optimized by two of the abovementioned performance criteria and are compared. The results obtained allow us to make a conclusion about their differences.

Abstract Background To investigate the differences in cardiovascular disease, extracardiac anomalies and outcomes between fetuses with levocardia and dextrocardia. Methods Clinical demographics, prenatal features, postnatal characteristics and the outcomes of fetuses with levocardia or dextrocardia were recorded and analyzed. Results Sixty-five fetuses with dextrocardia and thirty-eight fetuses with levocardia were enrolled. Right ventricle outlet obstruction, atrioventricular septal defect and intestinal malrotation were common in both groups. Univentricular physiology, transposition of the great arteries and esophageal atresia were more frequent in fetuses with levocardia, whereas abnormal pulmonary venous connection, double outlet of right ventricle, left ventricle outlet obstruction and brain abnormalities were more frequent in the dextrocardia group. The accuracy of evaluating cardiac malformations was high, but the sensitivity in assessing extracardiac abnormalities was low. Conclusions Although the disorders have certain overlapping features, there are several differences between fetuses with levocardia and dextrocardia. These findings might improve patient counseling and perinatal management.

The quantum metric of single-particle wave functions in topological flat bands plays a crucial role in determining the stability of fractional Chern insulating (FCI) states. Here, we unravel that the quantum metric causes the many-body Chern number of the FCI states to deviate sharply from the expected value associated with partial filling of the single-particle topological flat band. Furthermore, the variation of the quantum metric in momentum space induces band dispersion through interactions, affecting the stability of the FCI states. This causes a reentrant transition into the Fermi liquid from the FCI phase as the interaction strength increases.

Abstract Congenital arteriovenous fistulas involved with the abdominal aorta are very rare. Left-sided subrenal inferior vena cava (IVC) with normal connection to the heart is also rare and has not been reported prenatally. In this article, we described a fetus with aorta-porto-umbilical vein fistulas combined with a left-sided IVC.

Knowledge discovery about people and cities from emerging location data has been an active research field but is still relatively unexplored. In recent years, a considerable amount of work has been developed around the use of social media data, most of which focusses on mining the content, with comparatively less attention given to the location information. Furthermore, what aggregated scale spatial patterns show still needs extensive discussion. This paper proposes a tweet-topic-function-structure framework to reveal spatial patterns from individual tweets at aggregated spatial levels, combining an unsupervised learning algorithm with spatial measures. Two-year geo-tweets collected in Greater London were analyzed as a demonstrator of the framework and as a case study. The results indicate, at a disaggregated level, that the distribution of topics possess a fair degree of spatial randomness related to tweeting behavior. When aggregating tweets by zones, the areas with the same topics form spatial clusters but of entangled urban functions. Furthermore, hierarchical clustering generates a clear spatial structure with orders of centers. Our work demonstrates that although uncertainties exist, geo-tweets should still be a useful resource for informing spatial planning, especially for the strategic planning of economic clusters.