Fontan operation is still a main procedure for treatment of complex congenital heart disease, such as univentricular heart. Fontan procedure has undergone many revisions since its introduction in 1968. The earlyapplied atriumpulmonary connection has been replaced by total cavopulmonary connection. The midterm and late results of both the intraatrial lateral tunnel and extracardiac total cavopulmonary connections were compared and analyzed in this article. Extracardiac conduit is better. The Fontan circulation failure would appear at last because of nopump function of the right ventricle. Once Fontan circulation failure occurred and could not recover by medicine, heart transplantation is mandatory, but the source of donor heart is lacking. The study of mechanical cavopulmonary assist device, to “biventricularize” the univentricular Fontan circulation, has been developed, which is quite promising. Following the development of diagnostic and treatment techniques for fetal heart disease, the treatment procedure of complex congenital heart disease has been broadened in recent years, such as to prevent the severe aortic stenosis from developing into hypoplastic left heart syndrome with fetal cardiac intervention so as to increase the chance of biventricular repair, and to terminate gestation to decrease its birth rate of complex heart abnormalities, which could not be completely repaired to date.
Objective To summarize the clinical experience of cardiac surgery during pregnancy in a single center for the past 11 years. MethodsThe clinical data of 26 pregnant patients (mean age 28.6±4.9 years) complicated with heart diseases who underwent non-emergency cardiac surgery with cardiopulmonary bypass from 2010 to 2020 in Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were divided into two groups according to the gestational age at the time of surgery: a change group (gestational age<21 weeks) and a stable group (gestational age≥21 weeks). The hospitalization data and follow-up data of the patients were collected. ResultsMean gestational age at surgery was 23.4±4.2 weeks. Eleven patients had congenital heart diseases and fifteen had valvular heart diseases. Meanpostoperative ICU stay was 2.5±2.4 d, and mean total hospital stay was 22.5±9.5 d. There were 5 postoperative fetal losses. There was no maternal death during follow-up. No statistical difference in the maternal postoperative outcomes between two groups. ConclusionThe number of patients undergoing cardiac surgery during pregnancy is increasing. The maternal mortality rate is low and the prognosis is good, but the fetal loss remains concern. Cardiac surgery performed before or after the establishment of cardiopulmonary adjustment in pregnancy does not change the maternal postoperative outcomes.
In the extraction of fetal electrocardiogram (ECG) signal, due to the unicity of the scale of the U-Net same-level convolution encoder, the size and shape difference of the ECG characteristic wave between mother and fetus are ignored, and the time information of ECG signals is not used in the threshold learning process of the encoder’s residual shrinkage module. In this paper, a method of extracting fetal ECG signal based on multi-scale residual shrinkage U-Net model is proposed. First, the Inception and time domain attention were introduced into the residual shrinkage module to enhance the multi-scale feature extraction ability of the same level convolution encoder and the utilization of the time domain information of fetal ECG signal. In order to maintain more local details of ECG waveform, the maximum pooling in U-Net was replaced by Softpool. Finally, the decoder composed of the residual module and up-sampling gradually generated fetal ECG signals. In this paper, clinical ECG signals were used for experiments. The final results showed that compared with other fetal ECG extraction algorithms, the method proposed in this paper could extract clearer fetal ECG signals. The sensitivity, positive predictive value, and F1 scores in the 2013 competition data set reached 93.33%, 99.36%, and 96.09%, respectively, indicating that this method can effectively extract fetal ECG signals and has certain application values for perinatal fetal health monitoring.
目的 分析不同孕周正常胎儿静脉导管的频谱特征及血流频谱参数，得到不同孕周胎儿各频谱参数的正常参考值范围。 方法 2011年6月－9月检测记录不同孕周胎儿的静脉导管波形及各频谱参数，统计各频谱参数的正常参考值范围，并评估与其孕周的相关性。 结果 胎儿静脉导管的频谱速度参数与孕周呈正相关，阻力参数与孕周呈负相关，均以11～20周变化趋势较明显，其中3.59%的胎儿静脉导管频谱出现异常。 结论 正常胎儿的静脉导管血流参数与孕周有较好的相关性，静脉导管频谱在孕16周前可出现生理性的异常。
PURPOSES:To investigate the time of neuronie apoptosis in the retinas of Imman fetuses,and its relations with neuronie proliferation and differentiation, METHODS:The retinas of 27 human fetuses from 8th to 38th week of R,~til- ization age and 3 adults were studied by TdT-mediated dUTP nick end labelling(TUNEL) method. RESULTS:Tbe nuctei of labeled apoptotic cells were charaeterised by nuclear marginization,ehromatln condensation and cleseent shape,and some apoptotie bodies were visible in the specimens. The apoptosis of neuroepithelium of fetal rclina took place during 8th to 18th week, Apoptosis of ganglion cells were observed from 1256 to 18th week. The apoptos[s of pholorec, plors were formd from 14th to 2Ist week ,while thai of bipolar neurones and M~ller cells were found from ldth to 28th week. No apoptosb of ocstones were observed in the retinas after 28th week of fertilization age and within the retinas of adults. CONCLUSION:The proliferating cells of neuroepithelium and Ihe neurones which just differetiated from fetal retina might partly undergo apoptosis. The time of apoptosls of differentiated neurones was consistent with the time of the synapses formation between neurones and their targel cells. （Chin J Ocul Fundus Dis,1997,13:67 -69 ）
Fetal electrocardiogram (ECG) signals provide important clinical information for early diagnosis and intervention of fetal abnormalities. In this paper, we propose a new method for fetal ECG signal extraction and analysis. Firstly, an improved fast independent component analysis method and singular value decomposition algorithm are combined to extract high-quality fetal ECG signals and solve the waveform missing problem. Secondly, a novel convolutional neural network model is applied to identify the QRS complex waves of fetal ECG signals and effectively solve the waveform overlap problem. Finally, high quality extraction of fetal ECG signals and intelligent recognition of fetal QRS complex waves are achieved. The method proposed in this paper was validated with the data from the PhysioNet computing in cardiology challenge 2013 database of the Complex Physiological Signals Research Resource Network. The results show that the average sensitivity and positive prediction values of the extraction algorithm are 98.21% and 99.52%, respectively, and the average sensitivity and positive prediction values of the QRS complex waves recognition algorithm are 94.14% and 95.80%, respectively, which are better than those of other research results. In conclusion, the algorithm and model proposed in this paper have some practical significance and may provide a theoretical basis for clinical medical decision making in the future.
OBJECTIVE To investigate the clinical results used fetal bone repairing the defect after osteoma resection. METHODS In 8 hours after abortion, the fetal bones of four limbs were cut and kept in the normal saline with gentamycin. Then the graft was storaged under 6 degrees C-8 degrees C and the longest storage time was 48 hours. Since 1990, seven cases of osteoma had been cured with fetal bone graft. Among them, there were 5 males and 2 females, aged from 6 to 38 years, the bone defect volume ranged from 5.5 cm x 3.6 cm x 2.5 cm to 9.0 cm x 4.3 cm x 3.2 cm. During operation, the osteoma was resected radically, then the defected cavity was impacted with prepared fetal bone. RESULTS After operation, the general condition was good, all the incision wound healed primarily. Sixteen weeks after operation, the defected cavity was repaired completely and the medullary cavity reopened. Follow-up for 8 months to 5 years, no recurrence or side-effect were observed. CONCLUSION Because of the more rapid expansion and replacement effect, the ber osteoinduction, and the lower immune response, the fetal bone is practical material for repairing the bone defect in osteoma resection.