939 research outputs found

    High sensitivity and specificity in fetal gender identification in the first trimester, using ultrasound and Noninvasive Prenatal Screening (NIPS) in twin pregnancies, a prospective study

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    Abstract Introduction Determination of the fetal gender in the first trimester is important in twin pregnancy cases of familial X-linked genetic syndromes and helps determine chorionicity. We assessed and compared the accuracy of first-trimester ultrasound scans, and cell-free fetal DNA (CfDNA) in determining fetal gender in the first trimester of twin pregnancies. Methods Women with twin pregnancies were recruited prospectively during the first trimester. Fetal gender was determined using both ultrasound scans and CfDNA screening. Both results were compared to the newborn gender after delivery. Results A total of 113 women with twin pregnancies were enrolled. There was 100% sensitivity and specificity in Y chromosome detection using CfDNA. Gender assignment using ultrasound in any first-trimester scans was 79.7%. Accuracy level increased from 54.2% in CRL 45-54 mm to 87.7% in CRL 55-67 mm and 91.5% in CRL 67-87 mm. Male fetuses had significantly higher chances of a gender assignment error compared to female fetuses, odds ratio‚ÄČ=‚ÄČ23.574 (CI 7.346 - 75.656). Conclusions CfDNA is highly sensitive and specific in determining the presence of the Y chromosome in twin pregnancies in the first trimester. Between CRL 55-87 mm, ultrasound scanning offers a highly accurate determination of fetal gender in twin pregnancies

    Incidence and causes of perinatal death in prenataly diagnosed Vasa Previa: A systematic review and meta-analysis

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    To estimate the perinatal mortality associated with prenatally diagnosed vasa previa, and to determine what proportion of those perinatal deaths are directly attributable to vasa previa. PubMed, Scopus, Web of Science, and Embase databases from January 1, 1987 to January 1, 2023. We included all studies (cohort studies and case reports/series) that had patients in which a prenatal diagnosis of vasa previa was made. Case series/reports were excluded from the meta-analysis. All cases in which prenatal diagnosis was not made were excluded from the study. The programming language software R (version 4.2.2) was used to conduct the meta-analysis. The data was logit-transformed and pooled using the fixed-effects model. The between-study heterogeneity was reported by I . The publication bias was evaluated by funnel plot and Peters' regression test. The Newcastle-Ottawa scale was used to assess the risk of bias. Overall, 113 studies with a cumulative sample size of 1297 pregnant individuals were included. There included 25 cohort studies with 1167 pregnancies and 88 case series/reports with 130 pregnancies. Thirteen perinatal deaths occurred among these pregnancies, consisting of two stillbirths and 11 neonatal deaths. Among the cohort studies, the overall perinatal mortality was 0.94% (95% CI: 0.52-1.70, I = 0.0%). The pooled perinatal mortality attributed to vasa previa was 0.51% (95% CI: 0.23-1.14, I = 0.0%). Stillbirth and neonatal death were reported in 0.20% (95% CI: 0.05-0.80, I = 0.0%) and 0.77% (95% CI: 0.40-1.48, I = 0.0%) of pregnancies, respectively. Perinatal death is uncommon after a prenatal diagnosis of vasa previa. About half of the cases of perinatal mortality are not directly attributable to vasa previa. This information will help in guiding physicians in counseling and will provide reassurance to pregnant individuals with a prenatal diagnosis of vasa previa. [Abstract copyright: Copyright © 2023 Elsevier Inc. All rights reserved.

    Study of speaker localization with binaural microphone array incorporating auditory filters and lateral angle estimation

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    Speaker localization for binaural microphone arrays has been widely studied for applications such as speech communication, video conferencing, and robot audition. Many methods developed for this task, including the direct path dominance (DPD) test, share common stages in their processing, which include transformation using the short-time Fourier transform (STFT), and a direction of arrival (DOA) search that is based on the head related transfer function (HRTF) set. In this paper, alternatives to these processing stages, motivated by human hearing, are proposed. These include incorporating an auditory filter bank to replace the STFT, and a new DOA search based on transformed HRTF as steering vectors. A simulation study and an experimental study are conducted to validate the proposed alternatives, and both are applied to two binaural DOA estimation methods; the results show that the proposed method compares favorably with current methods

    Walk the plank! Using mobile electroencephalography to investigate emotional lateralization of immersive fear in virtual reality

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    Most studies on emotion processing induce emotions through images or films. However, this method lacks ecological validity, limiting generalization to real-life emotion processing. More realistic paradigms using virtual reality (VR) may be better suited to investigate authentic emotional states and their neuronal correlates. This pre-registered study examines the neuronal underpinnings of naturalistic fear, measured using mobile electroencephalography (EEG). Seventy-five healthy participants walked across a virtual plank which extended from the side of a skyscraper-either 80 storeys up (the negative condition) or at street level (the neutral condition). Subjective ratings showed that the negative condition induced feelings of fear. Following the VR experience, participants passively viewed negative and neutral images from the international affective picture system (IAPS) outside of VR. We compared frontal alpha asymmetry between the plank and IAPS task and across valence of the conditions. Asymmetry indices in the plank task revealed greater right-hemispheric lateralization during the negative VR condition, relative to the neutral VR condition and to IAPS viewing. Within the IAPS task, no significant asymmetries were detected. In summary, our findings indicate that immersive technologies such as VR can advance emotion research by providing more ecologically valid ways to induce emotion

    First-trimester cesarean scar pregnancy: a comparative analysis of treatment options from the international registry

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    Background: A cesarean scar pregnancy is an iatrogenic consequence of a previous cesarean delivery. The gestational sac implants into a niche created by the incision of the previous cesarean delivery, and this carries a substantial risk for major maternal complications. The aim of this study was to report, analyze, and compare the effectiveness and safety of different treatments options for cesarean scar pregnancies managed in the first trimester through a registry. Objective: This study aimed to evaluated the ultrasound findings, disease behavior, and management of first-trimester cesarean scar pregnancies. Study design: We created an international registry of cesarean scar pregnancy cases to study the ultrasound findings, disease behavior, and management of cesarean scar pregnancies. The Cesarean Scar Pregnancy Registry collects anonymized ultrasound and clinical data of individual patients with a cesarean scar pregnancy on a secure, digital information platform. Cases were uploaded by 31 participating centers across 19 countries. In this study, we only included live and failing cesarean scar pregnancies (with or without a positive fetal heart beat) that received active treatment (medical or surgical) before 12+6 weeks' gestation to evaluate the effectiveness and safety of the different management options. Patients managed expectantly were not included in this study and will be reported separately. Treatment was classified as successful if it led to a complete resolution of the pregnancy without the need for any additional medical interventions. Results: Between August 29, 2018, and February 28, 2023, we recorded 460 patients with cesarean scar pregnancies (281 live, 179 failing cesarean scar pregnancy) who fulfilled the inclusion criteria and were registered. A total of 270 of 460 (58.7%) patients were managed surgically, 123 of 460 (26.7%) patients underwent medical management, 46 of 460 (10%) patients underwent balloon management, and 21 of 460 (4.6%) patients received other, less frequently used treatment options. Suction evacuation was very effective with a success rate of 202 of 221 (91.5%; 95% confidence interval, 87.8-95.2), whereas systemic methotrexate was least effective with only 38 of 64 (59.4%; 95% confidence interval, 48.4-70.4) patients not requiring additional treatment. Overall, surgical treatment of cesarean scar pregnancies was successful in 236 of 258 (91.5%, 95% confidence interval, 88.4-94.5) patients and complications were observed in 24 of 258 patients (9.3%; 95% confidence interval, 6.6-11.9). Conclusion: A cesarean scar pregnancy can be managed effectively in the first trimester of pregnancy in more than 90% of cases with either suction evacuation, balloon treatment, or surgical excision. The effectiveness of all treatment options decreases with advancing gestational age, and cesarean scar pregnancies should be treated as early as possible after confirmation of the diagnosis. Local medical treatment with potassium chloride or methotrexate is less efficient and has higher rates of complications than the other treatment options. Systemic methotrexate has a substantial risk of failing and a higher complication rate and should not be recommended as first-line treatment

    Comparison between a prenatal sonographic scoring system and a clinical grading at delivery for Placenta Accreta Spectrum disorders

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    OBJECTIVE: Placenta Accreta Spectrum (PAS) disorders have become a major iatrogenic obstetric complication worldwide. Data on the accuracy of ultrasound examination diagnosis are limited by incomplete confirmation and variability in the description of the different grades of PAS at delivery. The aim of this study was to compare our prenatal routine sonographic screening and diagnostic scoring system with a standardized clinical grading system at birth in patient at risk of PAS. STUDY DESIGN: This is a retrospective cohort study of 607 pregnant patients with at least one prior cesarean delivery between December 2013 and December 2018. All patients were assessed for PAS using our institutional prenatal sonographic scoring system and the corresponding ultrasound findings were compared with those of a standardized clinical intra-operative macroscopic grading system of the degree of accreta placentation at vaginal birth or laparotomy. RESULTS: PAS was diagnosed clinically at birth in 50 (8.2%) cases, 17 of which were confirmed by histopathology. A low (score ‚ȧ 5), medium (score 6-7), high (score ‚Č• 8) probability for PAS was reported in 502, 61 and 44 cases, respectively. The probability score increased significantly (p‚ÄČ<‚ÄČ.001) in women ‚Č•2 prior cesarean deliveries, with an anterior low-lying/placenta previa, with absent clear space, increased in retroplacental vascularity and with the size and numbers of lacunae. The number of cases classified clinically as grade 1 (non-PAS) and 3 (adherent PAS) was significantly (p‚ÄČ<‚ÄČ.001) lower in women with a high probability score whereas the rates of the other grades was significantly (p‚ÄČ<‚ÄČ.001) higher. The widest discrepancy between ultrasound probability score and clinical grade was found for grade 2 which, describes a partial placental adherence and grades 4 and 5 which, refer to placental percreta which describes tissue having invade trough the uterine serosa and beyond. CONCLUSIONS: Both ends of the spectrum of accreta placentation remain difficult to diagnose antenatal and clinically at birth, in particular when no histopathologic confirmation is available. There is a need to develop ultrasound accuracy score systems that can differentiate between the different grades of PAS and which are validated by standardized clinical and pathology protocols

    Prospective Evaluation of the Ultrasound Signs Proposed for the Description of Uterine Niche in Nonpregnant Women

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    OBJECTIVES: To evaluate the new ultrasound-based signs for the diagnosis of post-cesarean section uterine niche in nonpregnant women. METHODS: We investigated prospectively a cohort of 160 consecutive women with one previous term cesarean delivery (CD) between December 2019 and 2020. All women were separated into two subgroups according to different stages of labor at the time of their CD: subgroup A (n¬†=‚ÄČ109; 68.1%) for elective CD and CD performed in latent labor at a cervical dilatation (‚ȧ4‚ÄČcm) and subgroup B (n¬†=‚ÄČ51; 31.9%); for CD performed during the active stage of labor (>4‚ÄČcm). RESULTS: Overall, the incidence of a uterine niche was significantly (P¬†‚ÄČ3‚ÄČmm in subgroup A than in subgroup B and a significant negative relationship was found between the RMT and the cervical dilatation at CD (r¬†=‚ÄČ-0.22; P¬†=‚ÄČ.008). CONCLUSIONS: Sonographic cesarean section scar assessment indicates that the type of CD and the stage of labor at which the hysterotomy is performed have an impact on the location of the scar and the scarification process including the niche formation and RMT

    Characterization of <i>Colletotrichum</i> Isolates from Strawberry and Other Hosts with Reference to Cross-Inoculation Potential

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    Colletotrichum is an important phytopathogenic fungus that causes anthracnose disease in diverse agronomically important tropical food crops. Accurate pathogen identification is critical for early diagnosis and efficient management of anthracnose. ITS is not a reliable marker for this fungal genus due to its failure to phylogenetically resolve cryptic species. In this study, 36 Colletotrichum isolates belonging to the Acutatum, Boninense and Gloeosporioides species complexes were characterized using multigene phylogenetic analyses, morphology and pathogenicity assays. Additionally, the cross-inoculation potential of a representative subset of isolates was evaluated revealing that cross-infection potential is possible among the isolates belonging to the same species complex
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