7 research outputs found
New first trimester crown-rump length's equations optimized by structured data collection from a French general population
--- Objectives --- Prior to foetal karyotyping, the likelihood of Down's
syndrome is often determined combining maternal age, serum free beta-HCG,
PAPP-A levels and embryonic measurements of crown-rump length and nuchal
translucency for gestational ages between 11 and 13 weeks. It appeared
important to get a precise knowledge of these scan parameters' normal values
during the first trimester. This paper focused on crown-rump length. ---
METHODS --- 402 pregnancies from in-vitro fertilization allowing a precise
estimation of foetal ages (FA) were used to determine the best model that
describes crown-rump length (CRL) as a function of FA. Scan measures by a
single operator from 3846 spontaneous pregnancies representative of the general
population from Northern France were used to build a mathematical model linking
FA and CRL in a context as close as possible to normal scan screening used in
Down's syndrome likelihood determination. We modeled both CRL as a function of
FA and FA as a function of CRL. For this, we used a clear methodology and
performed regressions with heteroskedastic corrections and robust regressions.
The results were compared by cross-validation to retain the equations with the
best predictive power. We also studied the errors between observed and
predicted values. --- Results --- Data from 513 spontaneous pregnancies allowed
to model CRL as a function of age of foetal age. The best model was a
polynomial of degree 2. Datation with our equation that models spontaneous
pregnancies from a general population was in quite agreement with objective
datations obtained from 402 IVF pregnancies and thus support the validity of
our model. The most precise measure of CRL was when the SD was minimal
(1.83mm), for a CRL of 23.6 mm where our model predicted a 49.4 days of foetal
age. Our study allowed to model the SD from 30 to 90 days of foetal age and
offers the opportunity of using Zscores in the future to detect growth
abnormalities. --- Conclusion --- With powerful statistical tools we report a
good modeling of the first trimester embryonic growth in the general population
allowing a better knowledge of the date of fertilization useful in the
ultrasound screening of Down's syndrome. The optimal period to measure CRL and
predict foetal age was 49.4 days (9 weeks of gestational age). Our results open
the way to the detection of foetal growth abnormalities using CRL Zscores
throughout the first trimester
Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels: Reliability of standard radiographs, CT scans, and 3D virtual reality images
Background and purpose: Non-anatomic bone tunnel placement is the most common cause of a failed ACL reconstruction. Accurate and reproducible methods to visualize and document bone tunnel placement are therefore important. We evaluated the reliability of standard radiographs, CT scans, and a 3-dimensional (3D) virtual reality (VR) approach in visualizing and measuring ACL reconstruction bone tunnel placement. Methods: 50 consecutive patients who underwent single-bundle ACL reconstructions were evaluated postoperatively by standard radiographs, CT scans, and 3D VR images. Tibial and femoral tunnel positions were measured by 2 observers using the traditional methods of Amis, Aglietti, Hoser, Stubli, and the method of Benereau for the VR approach. Results: The tunnel was visualized in 50-82% of the standard radiographs and in 100% of the CT scans and 3D VR images. Using the intraclass correlation coefficient (ICC), the inter- and intraobserver agreement was between 0.39 and 0.83 for the standard femoral and tibial radiographs. CT scans showed an ICC range of 0.49-0.76 for the inter- and intraobserver agreement. The agreement in 3D VR was almost perfect, with an ICC of 0.83 for the femur and 0.95 for the tibia. Interpretation: CT scans and 3D VR images are more reliable in assessing postoperative bone tunnel placement following ACL reconstruction than standard radiographs. Copyright
Early first trimester maternal ‘high fish and olive oil and low meat’ dietary pattern is associated with accelerated human embryonic development
Background/objectives: Maternal dietary patterns were associated with embryonic growth and congenital anomalies. We aim to evaluate associations between early first trimester maternal dietary patterns and embryonic morphological development among pregnancies with non-malformed outcome. Subjects/methods: A total of 228 strictly dated, singleton pregnancies without congenital malformations were enrolled in a periconceptional hospital-based cohort. Principal component analysis was performed to extract early first trimester maternal dietary patterns from food frequency questionnaires. Serial transvaginal three-dimensional ultrasound (3D US) scans were performed between 6+0 and 10+2 gestational weeks and internal and external morphological criteria were used to define Carnegie stages in a virtual reality system. Associations between dietary patterns and Carnegie stages were investigated using linear mixed models. Results: A total of 726 3D US scans were included (median: three scans per pregnancy). The ‘high fish and olive oil and low meat’ dietary pattern was associated with accelerated embryonic development in the study population (β = 0.12 (95%CI: 0.00; 0.24), p < 0.05). Weak adherence to this dietary pattern delayed embryonic development by 2.1 days (95%CI: 1.6; 2.6) compared to strong adherence. The ‘high vegetables, fruit and grain’ dietary pattern accelerated embryonic development in the strictly dated spontaneous pregnancy subgroup without adjustment for energy intake. Conclusions: Early first trimester maternal dietary patterns impacts human embryonic morphological development among pregnancies without congenital malformations. The clinical meaning of delayed embryonic development needs further investigation