BACKGROUND By comprehensively analyzing the blood flow parameters of the umbilical and middle cerebral arteries,doctors can more accurately identify fetal intrauterine distress,as well as assess its severity,so that t...BACKGROUND By comprehensively analyzing the blood flow parameters of the umbilical and middle cerebral arteries,doctors can more accurately identify fetal intrauterine distress,as well as assess its severity,so that timely interventions can be implemented to safeguard the health and safety of the fetus.AIM To identify the relationship between ultrasound parameters of the umbilical and middle cerebral arteries and intrauterine distress.METHODS Clinical data of pregnant women admitted between January 2021 and January 2023 were collected and divided into the observation and control groups(n=50 each),according to the presence or absence of intrauterine distress.The ultrasound hemodynamic parameters of the uterine artery(UtA),fetal middle cerebral artery(MCA),and umbilical artery(UmA)were compared with neonatal outcomes and occurrence of intrauterine distress in the two groups.RESULTS Comparison of ultrasonic hemodynamic parameters,resistance index(RI),pulsatility index(PI),and systolic maximal blood flow velocity of UmA compared to diastolic blood flow velocity(S/D),revealed higher values of fetal MCA,PI,and S/D of UmA in pregnant women with UtA compared to controls(P<0.05),while there was no difference between the two groups in terms of RI(P<0.05)The incidence of a neonatal Apgar score of 8-10 points was lower in the observation group(66.7%)than in the control group(90.0%),and neonatal weight(2675.5±27.6 g)was lower than in the control group(3117.5±31.2 g).Further,cesarean section rate was higher in the observation group(70.0%)than in the control group(11.7%),and preterm labor rate was higher in the observation group(40.0%)than in the control group(10.0%).The incidence of fetal distress,neonatal growth restriction and neonatal asphyxia were also higher in the observation group(all P<0.05).CONCLUSION Fetal MCA,UmA,and maternal UtA hemodynamic abnormalities all develop in pregnant women with intrauterine distress during late pregnancy,which suggests that clinical attention should be paid to them,and monitoring should be strengthened to provide guidance for clinical intervention.展开更多
背景:现子宫内膜结构及子宫螺旋动脉血流参数对夫精宫腔内人工授精(artificial insemination by husband,AIH)妊娠率的影响水平尚不明确,该研究通过校准其他混杂因素后,确定了其独立影响因素,并构建了预测模型,具有较好的临床应用效能...背景:现子宫内膜结构及子宫螺旋动脉血流参数对夫精宫腔内人工授精(artificial insemination by husband,AIH)妊娠率的影响水平尚不明确,该研究通过校准其他混杂因素后,确定了其独立影响因素,并构建了预测模型,具有较好的临床应用效能。目的:基于子宫内膜结构及子宫螺旋动脉血流参数构建AIH临床妊娠预测模型及验证。方法:回顾性分析2017年1月至2021年1月于常州市妇幼保健院接受AIH助孕治疗患者共1299例,将其中1182例未临床妊娠者纳入未妊娠组,117例临床妊娠者纳入妊娠组;通过1∶1倾向评分匹配,妊娠组与未妊娠组各匹配成功93例;采用单、多因素分析筛选子宫内膜结构及子宫螺旋动脉血流参数对AIH结局的影响因素,通过受试者工作曲线确定各独立影响因素的最佳截断值,限制性立方样条法分析各独立影响因素对AIH妊娠影响的风险趋势,临床决策曲线与临床影响曲线对该联合预测模型的临床应用效能进行检验。结果与结论:①倾向评分后妊娠组与未妊娠组各非内膜因素均无显著统计学意义,数据具有较好的均衡性(P>0.05);②单因素分析结果显示,内膜下血管化指数、血流指数、血管化血流指数、子宫动脉阻力指数、子宫动脉搏动指数、收缩期最高血流速度/舒张期末血流速度、基底子宫内膜到外子宫肌层内层平均交界区、最大交界区厚度为AIH妊娠的影响因素(P<0.05);③多因素Logistic回归结果显示,基底子宫内膜到外子宫肌层内层平均交界区厚度、子宫动脉搏动指数、血管化血流指数为AIH妊娠的独立影响因素,影响大小依次为血管化血流指数>基底子宫内膜到外子宫肌层内层平均交界区厚度>子宫动脉搏动指数;④受试者工作曲线显示,血管化血流指数的曲线下面积为0.704(0.629,0.779),最佳截断值为6.26;基底子宫内膜到外子宫肌层内层平均交界区厚度的曲线下面积为0.660(0.582,0.739),最佳截断值为6.38;子宫动脉搏动指数的曲线下面积为0.642(0.563,0.721),最佳截断值为1.18;⑤限制性立方样条曲线显示,当血管化血流指数>6.24时,其对AIH妊娠具有显著的正影响趋势;基底子宫内膜到外子宫肌层内层平均交界区厚度≤6.55 mm时,其对AIH妊娠具有显著的正影响趋势;当子宫动脉搏动指数>1.27时,其对AIH妊娠具有负影响风险;⑥临床决策曲线与临床影响曲线显示,该联合预测模型在阈概率值为0.17-0.93时具有临床最大净获益,且在该阈概率范围内损失与获益的比值始终小于1,显示出该联合预测模型具有较好的临床效能;⑦结果表明,通过倾向评分与多因素Logistic回归校正子宫内膜外其他混杂因素后,基底子宫内膜到外子宫肌层内层平均交界区厚度、子宫动脉搏动指数、血管化血流指数为AIH妊娠的独立影响因素,通过对其最佳截断值的确定与风险趋势性评估,证实该联合预测模型具有较好的预测价值与临床应用效能。展开更多
Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many...Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43-93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth Peoples Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).展开更多
文摘BACKGROUND By comprehensively analyzing the blood flow parameters of the umbilical and middle cerebral arteries,doctors can more accurately identify fetal intrauterine distress,as well as assess its severity,so that timely interventions can be implemented to safeguard the health and safety of the fetus.AIM To identify the relationship between ultrasound parameters of the umbilical and middle cerebral arteries and intrauterine distress.METHODS Clinical data of pregnant women admitted between January 2021 and January 2023 were collected and divided into the observation and control groups(n=50 each),according to the presence or absence of intrauterine distress.The ultrasound hemodynamic parameters of the uterine artery(UtA),fetal middle cerebral artery(MCA),and umbilical artery(UmA)were compared with neonatal outcomes and occurrence of intrauterine distress in the two groups.RESULTS Comparison of ultrasonic hemodynamic parameters,resistance index(RI),pulsatility index(PI),and systolic maximal blood flow velocity of UmA compared to diastolic blood flow velocity(S/D),revealed higher values of fetal MCA,PI,and S/D of UmA in pregnant women with UtA compared to controls(P<0.05),while there was no difference between the two groups in terms of RI(P<0.05)The incidence of a neonatal Apgar score of 8-10 points was lower in the observation group(66.7%)than in the control group(90.0%),and neonatal weight(2675.5±27.6 g)was lower than in the control group(3117.5±31.2 g).Further,cesarean section rate was higher in the observation group(70.0%)than in the control group(11.7%),and preterm labor rate was higher in the observation group(40.0%)than in the control group(10.0%).The incidence of fetal distress,neonatal growth restriction and neonatal asphyxia were also higher in the observation group(all P<0.05).CONCLUSION Fetal MCA,UmA,and maternal UtA hemodynamic abnormalities all develop in pregnant women with intrauterine distress during late pregnancy,which suggests that clinical attention should be paid to them,and monitoring should be strengthened to provide guidance for clinical intervention.
文摘背景:现子宫内膜结构及子宫螺旋动脉血流参数对夫精宫腔内人工授精(artificial insemination by husband,AIH)妊娠率的影响水平尚不明确,该研究通过校准其他混杂因素后,确定了其独立影响因素,并构建了预测模型,具有较好的临床应用效能。目的:基于子宫内膜结构及子宫螺旋动脉血流参数构建AIH临床妊娠预测模型及验证。方法:回顾性分析2017年1月至2021年1月于常州市妇幼保健院接受AIH助孕治疗患者共1299例,将其中1182例未临床妊娠者纳入未妊娠组,117例临床妊娠者纳入妊娠组;通过1∶1倾向评分匹配,妊娠组与未妊娠组各匹配成功93例;采用单、多因素分析筛选子宫内膜结构及子宫螺旋动脉血流参数对AIH结局的影响因素,通过受试者工作曲线确定各独立影响因素的最佳截断值,限制性立方样条法分析各独立影响因素对AIH妊娠影响的风险趋势,临床决策曲线与临床影响曲线对该联合预测模型的临床应用效能进行检验。结果与结论:①倾向评分后妊娠组与未妊娠组各非内膜因素均无显著统计学意义,数据具有较好的均衡性(P>0.05);②单因素分析结果显示,内膜下血管化指数、血流指数、血管化血流指数、子宫动脉阻力指数、子宫动脉搏动指数、收缩期最高血流速度/舒张期末血流速度、基底子宫内膜到外子宫肌层内层平均交界区、最大交界区厚度为AIH妊娠的影响因素(P<0.05);③多因素Logistic回归结果显示,基底子宫内膜到外子宫肌层内层平均交界区厚度、子宫动脉搏动指数、血管化血流指数为AIH妊娠的独立影响因素,影响大小依次为血管化血流指数>基底子宫内膜到外子宫肌层内层平均交界区厚度>子宫动脉搏动指数;④受试者工作曲线显示,血管化血流指数的曲线下面积为0.704(0.629,0.779),最佳截断值为6.26;基底子宫内膜到外子宫肌层内层平均交界区厚度的曲线下面积为0.660(0.582,0.739),最佳截断值为6.38;子宫动脉搏动指数的曲线下面积为0.642(0.563,0.721),最佳截断值为1.18;⑤限制性立方样条曲线显示,当血管化血流指数>6.24时,其对AIH妊娠具有显著的正影响趋势;基底子宫内膜到外子宫肌层内层平均交界区厚度≤6.55 mm时,其对AIH妊娠具有显著的正影响趋势;当子宫动脉搏动指数>1.27时,其对AIH妊娠具有负影响风险;⑥临床决策曲线与临床影响曲线显示,该联合预测模型在阈概率值为0.17-0.93时具有临床最大净获益,且在该阈概率范围内损失与获益的比值始终小于1,显示出该联合预测模型具有较好的临床效能;⑦结果表明,通过倾向评分与多因素Logistic回归校正子宫内膜外其他混杂因素后,基底子宫内膜到外子宫肌层内层平均交界区厚度、子宫动脉搏动指数、血管化血流指数为AIH妊娠的独立影响因素,通过对其最佳截断值的确定与风险趋势性评估,证实该联合预测模型具有较好的预测价值与临床应用效能。
文摘Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43-93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth Peoples Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).
