- 作者列表："Byrne JJ","Morgan JL","Twickler DM","McIntire DD","Dashe JS
BACKGROUND:In 2014, the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Imaging Workshop consensus recommended that sonograms be offered routinely to all pregnant women. In the absence of another indication, this examination is recommended at 18-22 weeks of gestation. Studies of anomaly detection often focus on pregnancies at risk for anomalies and on the yield of detailed sonography, topics less applicable to counseling low-risk pregnancies about the benefits and limitations of standard sonography. The clinical utility of follow-up sonogram in low-risk pregnancies for the purpose of fetal anomaly detection has not been established. OBJECTIVE:The objective of the study was to evaluate the utility of follow-up standard sonography for anomaly detection among low-risk pregnancies in a nonreferred population. STUDY DESIGN:We performed a retrospective cohort study of singleton pregnancies that underwent standard sonography at 18-21 6/7 weeks of gestation from October 2011 through March 2018 with subsequent delivery of a live-born infant at our hospital. Pregnancies with indications for detailed sonography in our system were excluded to evaluate fetal anomalies first identified with standard sonography. Anomalies were categorized according to the European Registration of Congenital Anomalies and Twins (EUROCAT) system, with confirmation based on neonatal evaluation. Among those with no anomaly detected initially, we evaluated the rate of subsequent detection according to number of follow-up sonograms, gestational age at sonography, organ system(s) affected, and anomaly severity. Statistical analyses were performed using χ2 and a Mantel-Haenszel test. RESULTS:Standard sonography was performed in 40,335 pregnancies at 18-21 6/7 weeks, and 11,770 (29%) had at least 1 follow-up sonogram, with a second follow-up sonogram in 3520 (9%). Major abnormalities were confirmed in 387 infants (1%), with 248 (64%) detected initially and 28 (7%) and 5 (1%) detected on the first and second follow-up sonograms. Detection of residual anomalies on follow-up sonograms was significantly lower than detection on the initial standard examination: 64% on initial examination, 45% for first follow-up, and 45% for second follow-up (P < .01). A larger number of follow-up examinations were required per anomalous fetus detected: 163 examinations per anomalous fetus detected initially, 420 per fetus detected at the first follow-up examination, and 705 per fetus detected at the second follow-up sonogram (P < .01). The number of follow-up examinations to detect each additional anomalous fetus was not affected by gestational age (P = .7). Survival to hospital discharge was significantly lower for fetuses with anomalies detected on initial (88%) than for fetuses with anomalies undetected until delivery (90 of 91, 99%; P < .002). CONCLUSION:In a low-risk, nonreferred cohort with fetal anomaly prevalence of 1%, follow-up sonography resulted in detection of 45% of fetal anomalies that had not been identified during the initial standard sonogram. Significantly more follow-up sonograms were required to detect each additional anomalous fetus.
背景: 2014，尤尼斯 · 肯尼迪 · 施莱佛国家儿童健康和人类发育研究所胎儿成像研讨会共识建议常规向所有孕妇提供声像图。在没有其他适应症的情况下，建议在妊娠 18-22 周进行这项检查。异常检测的研究通常集中在有异常风险的妊娠和详细超声的产量上，不太适用于咨询低风险妊娠关于标准超声的益处和局限性的主题。随访声像图在低危妊娠中用于胎儿异常检测的临床效用尚未确定。 目的: 本研究的目的是评价随访标准超声检查在非转诊人群低危妊娠中异常检测的效用。 研究设计: 我们对 2011 年 10 月至 2018 年 3 月在孕 18-21 6/7 周接受标准超声检查的单胎妊娠进行了回顾性队列研究，随后在我院分娩了一名活产婴儿。排除在我们系统中有详细超声检查指征的妊娠，以评估首先用标准超声检查确定的胎儿异常。根据欧洲先天性异常登记和双胞胎 (EUROCAT) 系统对异常进行分类，确认基于新生儿评估。在最初未检测到异常的tho s e中，我们根据随访s onogram s的数量、s onogram上的ge s tation age来评价s ub s equent检测率。器官s y s透射电子显微镜 (tem) (s) 的影响，其中异常s everity.统计分析采用 χ2 和Mantel-Haenszel test. 结果: 标准超声检查 40,335 例孕妇在 1 8-2 1 6/7 周，1 1，770 (29%) 至少 1 随访声像图，第二次随访声像图 3520 (9%)。在 387 例婴儿 (1% )) 中证实了主要异常，最初检测到 248 例 (64%)，第一次和第二次随访声像图检测到 28 例 (7%) 和 5 例 (1%)。随访声像图残余异常的检测明显低于初始标准检查的检测: 初始检查为 64%，首次随访为 45%，第二次随访为 45% (P <.01)。每个检测到的异常胎儿需要更多的随访检查: 每个最初检测到的异常胎儿需要 163 次检查，第一次随访检查时每个胎儿需要 420 次检查，和 705 每胎儿在第二次随访声像图检测 (P <.01)。检测每个额外异常胎儿的随访检查次数不受孕周的影响 (P = .7)。初始检测到异常的胎儿的存活率 (88%) 显著低于分娩前未检测到异常的胎儿 (90，99%; P <.002)。 结论: 在胎儿异常患病率为 1% 的低风险、无转诊队列中，随访超声检查发现了 45% 在初始标准声像图中未发现的胎儿异常。需要更多的随访声像图来检测每个额外的异常胎儿。
METHODS::Impairments in social cognition have been frequently described in 22q11.2 deletion syndrome (22q11.2DS) and are thought to be a hallmark of difficulties in social interactions. The present study addresses aspects that are critical for everyday social cognitive functioning but have received little attention so far. Sixteen children with 22q11.2DS and 22 controls completed 1 task of facial expression recognition, 1 task of attribution of facial expressions to faceless characters involved in visually presented social interactions, and 1 task of attribution of facial expressions to characters involved in aurally presented dialogues. All three tasks have in common to involve processing of emotions. All participants also completed two tasks of attention and two tasks of visual spatial perception, and their parents completed some scales regarding behavioural problems of their children. Patients performed worse than controls in all three tasks of emotion processing, and even worse in the second and third tasks. However, they performed above chance level in all three tasks, and the results were independent of IQ, age and gender. The analysis of error patterns suggests that patients tend to coarsely categorize situations as either attractive or repulsive and also that they have difficulties in differentiating emotions that are associated with threats. An isolated association between the tasks of emotion and behaviour was found, showing that the more frequently patients with 22q11.2DS perceive happiness where there is not, the less they exhibit aggressive behaviour.
METHODS:BACKGROUND:We describe the first radiographic clinic in the literature for DDH and how this novel clinic can significantly improve the efficiency and cost-effectiveness of service in a tertiary referral centre. AIMS:A radiographic clinic for the management of developmental dysplasia of the hip was introduced in 2017 in our institution. We performed a detailed cost analysis to assess the economic savings made with the introduction of this new clinic. We assessed the efficiency of the service by identifying how many unnecessary outpatient visits were prevented. We also assessed the difference in times from referral to review between the two clinics. METHODS:Analysis of the clinic activity in 2017 was possible as all data was collected prospectively by the DDH CNS and stored in our database. Cost analysis was performed, and the savings made per patient along with the financial benefit to our institution was recorded. RESULTS:The new radiographic clinic reduced the cost of reviewing one patient by €162.51 per patient. There was a 73% discharge rate from the clinic which prevented 251 unnecessary patient visits to the outpatient department over the course of the year. There was a significant 11-day reduction in waiting times between referral and review when comparing the radiographic to the conventional clinic (p < 0.05). CONCLUSIONS:A radiographic clinic for the management of developmental dysplasia of the hip has a significant effect on the efficiency and overall cost-effectiveness of service provision in a tertiary referral centre.
METHODS:INTRODUCTION:Triple pelvic osteotomy (TPO) involves periacetabular osteotomies of the ilium, ischium, and pubis to reorient the acetabulum. This operation is indicated in certain situations for the treatment of developmental dysplasia of the hip, dysplastic neuromuscular hips, and for containment of the femoral head in cases of Legg-Calvé-Perthes disease. METHODS:This retrospective cohort study compares radiographic outcomes of patients who underwent TPO using two different techniques and describes a novel single-incision direct lateral approach. TPO was performed on 22 patients by the senior author. The first 10 patients underwent TPO through a single-incision anterolateral approach. The last 12 patients underwent TPO using the direct lateral approach. Preoperative and postoperative pelvic radiographs were reviewed for each patient, and the migration index and center-edge angle were recorded. RESULTS:The migration index and center-edge angle were evaluated and were not found to be significantly different between the anterolateral and direct lateral groups. The direct lateral approach is described. CONCLUSION:The direct lateral approach for TPO is equivalent to the anterolateral approach on radiographic evaluation. Advantages of the direct lateral approach include direct visualization of the ischial osteotomy, effective mobilization of the acetabulum, and safety of the sciatic nerve.