1.
ИНТРАОПЕРАЦИОННАЯ ОЦЕНКА НЕПОСРЕДСТВЕННЫХ РЕЗУЛЬТАТОВ ПОСЛЕДОВАТЕЛЬНОГО КОРОНАРНОГО ШУНТИРОВАНИЯ
Rotar, М.; Тоdurov, B. М.; Demyanchuk, V. B. ...
Klinična hìrurgìâ (Kiïv),
07/2017
9
Journal Article
Цель. В настоящее время существуют разногласия относительно целесообразности использования кондуитов при операции коронарного шунтирования (КШ) с наложением последовательного или линейного шунта. ...
Цель исследования: оценить параметры кровотока в шунтах разной конструкции.
Материалы и методы. Обследованы 145 пациентов, у которых по поводу ишемической болезни сердца (ИБС) и многососудистого атеросклеротического поражения венечных артерий (ВА) в клинике выполнена операция КШ. Параметры кровотока в линейных и последовательных шунтах оценивали и сравнивали по данным флоуметрии.
Результаты. Во всех последовательных шунтах отмечены хорошие параметры объемной скорости кровотока (ОСК) – (70,6 ± 30,2) мл/мин, низкое сопротивление кровотока (пульсовой индекс – PІ 1,8); в линейных шунтах – соответственно ОСК – (37,5 ± 20,5) мл/мин, PI 2,1.
Обсуждение. Высокая частота ранней окклюзии шунтов часто обусловлена ошибочным выбором техники операции КШ. Флоуметрия является эффективным инструментом периоперационного контроля качества наложенных анастомозов, помогает избежать ранней окклюзии аутографта.
Выводы. Высокие показатели ОСК и низкое сопротивление кровотока по последовательным коронарным шунтам подтверждают целесообразность широкого применения метода при многососудистом КШ.
več
Dostopno za:
NUK, UL, UM, UPUK
2.
The ionisation hodoscope of the DIRAC experiment
Bitsadze, G.; Brekhovskikh, V.; Kuptsov, A. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
11/2004, Letnik:
533, Številka:
3
Journal Article
The ionisation hodoscope (IH) of the DIRAC (PS 212) experiment at CERN is optimised to separate ionisation signals produced by otherwise unresolved double tracks from ionisation signals produced by a ...
single particle. While its total thickness is only 1.5% of a radiation length, it consists of four planes and provides two measurements of ionisation loss in each of the two projections. It suppresses the background from single-track events by a factor 50 while keeping more than 80% of double-track events. The IH design and performance during data taking in 2001–2003 are described.
več
Dostopno za:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
3.
Module of electromagnetic secondary emission flight type calorimeter
Nuclear instruments and methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment/Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment
Journal Article
Dostopno za:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
4.
Role of Doppler ultrasound at time of diagnosis of late‐onset fetal growth restriction in predicting adverse perinatal outcome: prospective cohort study
Rizzo, G.; Mappa, I.; Bitsadze, V. ...
Ultrasound in obstetrics & gynecology,
June 2020, Letnik:
55, Številka:
6
Journal Article
ABSTRACT
Objective
Pregnancies complicated by late‐onset fetal growth restriction (FGR) are at increased risk of short‐ and long‐term morbidities. Despite this, identification of cases at higher risk ...
of adverse perinatal outcome, at the time of FGR diagnosis, is challenging. The aims of this study were to elucidate the strength of association between fetoplacental Doppler indices at the time of diagnosis of late‐onset FGR and adverse perinatal outcome, and to determine their predictive accuracy.
Methods
This was a prospective study of consecutive singleton pregnancies complicated by late‐onset FGR. Late‐onset FGR was defined as estimated fetal weight (EFW) or abdominal circumference (AC) < 3rd centile, or EFW or AC < 10th centile and umbilical artery (UA) pulsatility index (PI) > 95th centile or cerebroplacental ratio (CPR) < 5th centile, diagnosed after 32 weeks. EFW, uterine artery PI, UA‐PI, fetal middle cerebral artery (MCA) PI, CPR and umbilical vein blood flow normalized for fetal abdominal circumference (UVBF/AC) were recorded at the time of the diagnosis of FGR. Doppler variables were expressed as Z‐scores for gestational age. Composite adverse perinatal outcome was defined as the occurrence of at least one of emergency Cesarean section for fetal distress, 5‐min Apgar score < 7, umbilical artery pH < 7.10 and neonatal admission to the special care unit. Logistic regression analysis was used to elucidate the strength of association between different ultrasound parameters and composite adverse perinatal outcome, and receiver‐operating‐characteristics (ROC)‐curve analysis was used to determine their predictive accuracy.
Results
In total, 243 consecutive singleton pregnancies complicated by late‐onset FGR were included. Composite adverse perinatal outcome occurred in 32.5% (95% CI, 26.7–38.8%) of cases. In pregnancies with composite adverse perinatal outcome, compared with those without, mean uterine artery PI Z‐score (2.23 ± 1.34 vs 1.88 ± 0.89, P = 0.02) was higher, while Z‐scores of UVBF/AC (−1.93 ± 0.88 vs −0.89 ± 0.94, P ≤ 0.0001), MCA‐PI (−1.56 ± 0.93 vs −1.22 ± 0.84, P = 0.004) and CPR (−1.89 ± 1.12 vs −1.44 ± 1.02, P = 0.002) were lower. On multivariable logistic regression analysis, Z‐scores of mean uterine artery PI (P = 0.04), CPR (P = 0.002) and UVBF/AC (P = 0.001) were associated independently with composite adverse perinatal outcome. UVBF/AC Z‐score had an area under the ROC curve (AUC) of 0.723 (95% CI, 0.64–0.80) for composite adverse perinatal outcome, demonstrating better accuracy than that of mean uterine artery PI Z‐score (AUC, 0.593; 95% CI, 0.50–0.69) and CPR Z‐score (AUC, 0.615; 95% CI, 0.52–0.71). A multiparametric prediction model including Z‐scores of MCA‐PI, uterine artery PI and UVBF/AC had an AUC of 0.745 (95% CI, 0.66–0.83) for the prediction of composite adverse perinatal outcome.
Conclusion
While CPR and uterine artery PI assessed at the time of diagnosis are associated independently with composite adverse perinatal outcome in pregnancies complicated by late‐onset FGR, their diagnostic performance for composite adverse perinatal outcome is low. UVBF/AC showed better accuracy for prediction of composite adverse perinatal outcome, although its usefulness in clinical practice as a standalone predictor of adverse pregnancy outcome requires further research. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Papel de la ecografía Doppler en el momento del diagnóstico de la restricción del crecimiento fetal de aparición tardía para la predicción de resultados perinatales adversos: estudio prospectivo de cohortes
Objetivo
Los embarazos complicados por la restricción del crecimiento fetal (RCF) de aparición tardía tienen un mayor riesgo de morbilidad a corto y largo plazo. A pesar de ello, es difícil identificar los casos con mayor riesgo de resultados perinatales adversos en el momento del diagnóstico de RCF. Los objetivos de este estudio fueron dilucidar la fortaleza de la asociación entre los índices Doppler fetoplacentarios en el momento del diagnóstico de la RCF de aparición tardía y el resultado perinatal adverso, y determinar su precisión predictiva.
Métodos
Este fue un estudio prospectivo de embarazos consecutivos con feto único complicados por una RCF de aparición tardía. La aparición tardía de la RCF se definió como peso estimado del feto (PEF) o circunferencia abdominal (CA) <3er percentil, o PEF o CA <10o percentil junto con índice de pulsatilidad (IP) de la arteria umbilical (AU) >95o percentil, o una relación cerebroplacentaria (RCP) <5o percentil, diagnosticado después de las 32 semanas. El PEF, el IP de la arteria uterina (IP‐AU), el IP de la arteria cerebral media fetal (ACM), la RCP y el flujo sanguíneo de la vena umbilical normalizado para la circunferencia abdominal fetal (UVBF/AC, por sus siglas en inglés) se registraron en el momento del diagnóstico de RCF. Las variables Doppler se expresaron como puntuaciones Z para la edad gestacional. El resultado perinatal adverso compuesto se definió como la ocurrencia de al menos una cesárea de emergencia por sufrimiento fetal, test de Apgar a los 5 minutos <7, pH de la arteria umbilical <7,10 y el ingreso a la unidad de cuidados especiales de recién nacidos. Se utilizó el análisis de regresión logística para dilucidar la fortaleza de la asociación entre los diferentes parámetros de la ecografía y el resultado perinatal adverso compuesto, y se empleó el análisis de la curva de características operativas del receptor (ROC, por sus siglas en inglés) para determinar su precisión predictiva.
Resultados
En total, se incluyeron 243 embarazos con feto único consecutivos complicados por RCF de aparición tardía. El resultado perinatal adverso compuesto se produjo en el 32,5% (IC 95%, 26,7–38,8%) de los casos. En los embarazos con resultados perinatales adversos compuestos, en comparación con los que no los tuvieron, la puntuación Z del IP de la arteria uterina media (2,23±1,34 vs 1,88±0,89, P=0,02) fue mayor, mientras que las puntuaciones Z de UVBF/AC (–1,93±0,88 vs –0,89±0,94, P≤0,0001), IP‐ACM (–1,56±0,93 vs –1,22±0,84, P=0,004) y RCP (–1,89±1,12 vs –1,44±1,02, P=0,002) fueron más bajas. En el análisis de regresión logística multivariable, las puntuaciones Z del IP de la arteria uterina media (P=0,04), RCP (P=0,002) y UVBF/AC (P=0,001) estuvieron asociadas de forma independiente con el resultado perinatal adverso compuesto. La puntuación Z del UVBF/AC tuvo un área bajo la curva (ABC) ROC de 0,723 (IC 95%, 0,64–0,80) para el resultado perinatal adverso compuesto, demostrando una mejor precisión que la de la puntuación Z del IP de la arteria uterina media (ABC, 0,593; IC 95%, 0,50–0,69) y la de la puntuación Z de la RCP (ABC, 0,615; IC 95%, 0,52–0,71). Un modelo de predicción multiparamétrico que incluía las puntuaciones Z del IP‐ACM, el IP de la arteria uterina y el UVBF/AC resultó en un ABC de 0,745 (IC 95%, 0,66–0,83) para la predicción de un resultado perinatal adverso compuesto.
Conclusión
Aunque la RCP y el IP de la arteria uterina evaluados en el momento del diagnóstico están asociados de forma independiente con un resultado perinatal adverso compuesto en embarazos complicados por una RCF de aparición tardía, la eficacia del diagnóstico para el resultado perinatal adverso compuesto es baja. El UVBF/AC mostró una mayor precisión para la predicción de un resultado perinatal adverso compuesto, aunque su utilidad en la práctica clínica como parámetro indicativo independiente del resultado adverso del embarazo requiere más investigación. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
摘要
多普勒超声在诊断迟发性胎儿生长受限时预测不良围产儿结局中的作用:前瞻性队列研究
目标
妊娠合并迟发性胎儿生长受限(FGR)孕妇的短期长期发病风险增加。即便如此，在FGR诊断中确定高风险围产儿不良结局病例依然很困难。本研究旨在阐明迟发性胎儿生长受限诊断时胎儿胎盘多普勒指数与不良围产儿结局之间的关联强度，并确定其预测准确性。
方法
这是一项针对连续单胎妊娠合并迟发性胎儿生长受限的前瞻性研究。迟发性FGR定义为32周诊断发现估算胎儿体重(EFW)或腹围(AC)<第3百分位数，或EFW或AC<第10百分位数且脐动脉(UA)搏动指数(PI)>第95百分位数，或脑胎盘比率(CPR)<第5百分位数。FGR诊断过程中记录了EFW、子宫动脉PI、UA‐PI、胎儿大脑中动脉(MCA)PI、CPR，以及胎儿腹围脐静脉血流正常化(UVBF/AC)。以胎龄的Z评分表示多普勒变量。围产期综合不良结局定义为
发生至少1例胎儿窘迫急诊剖宫产、5分钟Apgar评分<7、脐动脉pH<7.10、新生儿入院接受特殊护理。通过逻辑回归分析探讨不同超声参数与围产期综合不良结局之间的关联强度，通过受体操作特征(ROC)曲线分析
确定其预测准确性。
结果
总共包括243例连续单胎妊娠并发迟发性FGR。32.5%(95%CI，26.7–38.8%)的病例出现复合不良围产期结局。相比那些并无复合不良围产期结局的孕妇，复合不良围产期结局孕妇的平均子宫动脉PI Z评分(2.23±1.34对1.88±0.89，P=0.02)较高，而UVBF/AC的Z评分(‐1.93±0.88对‐0.89±0.94，P≤0.0001)、MCA‐PI(‐1.56±0.93 对‐1.22±0.84，P=0.004)和CPR(‐1.89±1.12对‐1.44±1.02，P=0.002)较低。在多变量逻辑回归分析中，子宫动脉平均PI(P=0.04)、CPR(P=0.002)和UVBF/AC(P=0.001)的Z评分与复合不良围产期结局独立相关。UVBF/AC Z评分复合不良围产期结局ROC曲线下面积(AUC)为0.723(95%CI，0.64–0.80)，表明其准确性优于平均子宫动脉PI Z评分(AUC，0.593；95%CI，0.50‐0.69)和CPR Z评分(AUC，0.615； 95%CI，0.52‐0.71)。一个用于预测复合不良围产期结局且包括MCA‐PI、子宫动脉PI和UVBF/AC的Z评分在内的多参数预测模型，其AUC为0.745(95%CI，0.66‐0.83)。
结论
虽然在诊断时接受评估的CPR和子宫动脉PI与妊娠并发迟发性FGR复合不良围产期结局独立相关，但它们的复合不良围产期结局诊出性较低。UVBF/AC在复合不良围产期结局的预测上更加准确，虽然它作为不良妊娠结局的独立预测指标在临床实践中的有用性有待进一步研究确定。版权 © 2019 ISUOG。由威利父子公司(John Wiley & Sons Ltd)出版。
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več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
5.
Role of first‐trimester umbilical vein blood flow in predicting large‐for‐gestational age at birth
Rizzo, G.; Mappa, I.; Bitsadze, V. ...
Ultrasound in obstetrics & gynecology,
July 2020, 2020-07-00, 20200701, Letnik:
56, Številka:
1
Journal Article
ABSTRACT
Objectives
To describe umbilical vein (UV) hemodynamics at 11 + 0 to 13 + 6 weeks of gestation in pregnancies delivering a large‐for‐gestational‐age (LGA) neonate, and to build a ...
multiparametric model, including pregnancy and ultrasound characteristics in the first trimester, that is able to predict LGA at birth.
Methods
This was a matched case–control study, of singleton pregnancies that underwent ultrasound examination at 11 + 0 to 13 + 6 weeks for aneuploidy screening, at a single center over a 4‐year period. Cases were women who delivered a neonate with birth weight (BW) > 90th centile for gestational age and sex, according to local birth‐weight standards, while controls were those who delivered a neonate with BW ranging between the 10th and 90th centiles, matched for maternal and gestational age, at a ratio of 1:3. Each included case underwent Doppler assessment of the uterine arteries and UV, including measurement of its diameter, time‐averaged maximum velocity (TAMXV) and UV blood flow (UVBF). UVBF and its components were expressed as Z‐scores. Fisher's exact test and Mann–Whitney U‐test were used to compare differences in maternal biomarkers and ultrasound characteristics between pregnancies complicated by LGA and controls. Logistic regression and receiver‐operating‐characteristics (ROC) curve analyses were carried out to identify independent predictors of LGA and to build a multiparametric prediction model integrating different maternal, pregnancy and ultrasound characteristics. Subgroup analysis was also performed, considering women who delivered a neonate with BW > 4000 g.
Results
In total, 964 pregnancies (241 with LGA at birth and 723 without) were included in the study. In LGA pregnancies compared with controls, UV‐TAMXV Z‐score (0.8 (interquartile range (IQR), 0.4–1.5) vs 0.0 (IQR, −0.3 to 0.5); P ≤ 0.001) and UVBF Z‐score (1.3 (IQR, 0.8–1.9) vs 0.1 (IQR, −0.4 to 0.4); P ≤ 0.001) were higher, while there was no difference in median UV diameter Z‐score (P = 0.56). Median uterine artery pulsatility index multiples of the median (MoM; 0.94 (IQR, 0.78–1.12) vs 1.02 (IQR, 0.84–1.19); P = 0.04) was significantly lower in LGA pregnancies. On multivariate logistic regression analysis, maternal body mass index (BMI; adjusted odds ratio (aOR), 1.2 (95% CI, 1.1–1.7); P < 0.001), parity (aOR, 1.4 (95% CI, 1.2–1.6); P < 0.001), pregnancy‐associated plasma protein‐A (PAPP‐A) MoM (aOR, 1.1 (95% CI, 1.0–1.6); P = 0.04) and UVBF Z‐score (aOR, 1.6 (95% CI, 1.1–1.9); P < 0.001) were associated independently with LGA. A multiparametric model integrating parity, BMI and PAPP‐A MoM provided an area under the ROC curve (AUC) of 0.72 (95% CI, 0.67–0.76) for the prediction of LGA. The addition of UVBF Z‐score to this model significantly improved the prediction of LGA provided by maternal and biochemical factors, with an AUC of 0.79 (95% CI, 0.75–0.83; P = 0.03). Similarly, the model incorporating UVBF Z‐score predicted BW > 4000 g with an AUC of 0.83 (95% CI, 0.75–0.93).
Conclusions
UVBF measured at the time of the 11–14‐week scan is associated independently with, and is predictive of, LGA and BW > 4000 g. Adding measurement of UVBF to a multiparametric model that includes maternal (parity and BMI) and biochemical (PAPP‐A) parameters improves the diagnostic accuracy of prenatal screening for LGA at birth. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
6.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
7.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
8.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
9.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
10.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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