Diagnostic accuracy of prenatal ultrasound in coarctation of aorta: systematic review and individual participant data meta-analysis

OBJECTIVE

To determine the diagnostic accuracy of prenatal ultrasound in detecting coarctation of the aorta (CoA).

METHODS

An individual participant data meta-analysis was performed to report on the strength of association and diagnostic accuracy of different ultrasound signs in detecting CoA prenatally. MEDLINE, EMBASE and CINAHL were searched for studies published between January 2000 and November 2021. Inclusion criteria were fetuses with suspected isolated CoA, defined as ventricular and/or great vessel disproportion with right dominance on ultrasound assessment. Individual participant-level data were obtained by two leading teams. PRISMA-IPD and PRISMA-DTA guidelines were used for extracting data, and the QUADAS-2 tool was used for assessing quality and applicability. The reference standard was CoA, defined as narrowing of the aortic arch, diagnosed after birth. The most commonly evaluated parameters on ultrasound, both in B-mode and on Doppler, constituted the index test. Summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and likelihood ratios were computed using the hierarchical summary receiver-operating-characteristics model.

RESULTS

The initial search yielded 72 studies, of which 25 met the inclusion criteria. Seventeen studies (640 fetuses) were included. On random-effects logistic regression analysis, tricuspid valve/mitral valve diameter ratio > 1.4 and > 1.6, aortic isthmus/arterial duct diameter ratio < 0.7, hypoplastic aortic arch (all P < 0.001), aortic isthmus diameter Z-score of < -2 in the sagittal (P = 0.003) and three-vessel-and-trachea (P < 0.001) views, pulmonary artery/ascending aorta diameter ratio > 1.4 (P = 0.048) and bidirectional flow at the foramen ovale (P = 0.012) were independently associated with CoA. Redundant foramen ovale was inversely associated with CoA (P = 0.037). Regarding diagnostic accuracy, tricuspid valve/mitral valve diameter ratio > 1.4 had a sensitivity of 72.6% (95% CI, 48.2-88.3%), specificity of 65.4% (95% CI, 46.9-80.2%) and DOR of 5.02 (95% CI, 1.82-13.9). The sensitivity and specificity values were, respectively, 75.0% (95% CI, 61.1-86.0%) and 39.7% (95% CI, 27.0-53.4%) for pulmonary artery/ascending aorta diameter ratio > 1.4, 47.8% (95% CI, 14.6-83.0%) and 87.6% (95% CI, 27.3-99.3%) for aortic isthmus diameter Z-score of < -2 in the sagittal view and 74.1% (95% CI, 58.0-85.6%) and 62.0% (95% CI, 41.6-78.9%) for aortic isthmus diameter Z-score of < -2 in the three-vessel-and-trachea view. Hypoplastic aortic arch had a sensitivity of 70.0% (95% CI, 42.0-88.6%), specificity of 91.3% (95% CI, 78.6-96.8%) and DOR of 24.9 (95% CI, 6.18-100). The diagnostic yield of prenatal ultrasound in detecting CoA did not change significantly when considering multiple categorical parameters. Five of the 11 evaluated continuous parameters were independently associated with CoA (all P < 0.001) but all had low-to-moderate diagnostic yield.

CONCLUSIONS

Several prenatal ultrasound parameters are associated with an increased risk for postnatal CoA. However, diagnostic accuracy is only moderate, even when combinations of parameters are considered. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Impact of control measures including decolonization and hand hygiene for orthopaedic surgical site infection caused by MRSA at a Japanese tertiary-care hospital

BACKGROUND

Meticillin-resistant Staphylococcus aureus (MRSA) is the most common pathogen in orthopaedic surgical site infections (SSIs). However, few studies have investigated the transmission process of orthopaedic MRSA SSI.

AIM

To investigate the transmission process of orthopaedic MRSA SSI using epidemiological and molecular analyses and to determine a method to prevent MRSA SSI in nosocomial orthopaedic surgery.

METHODS

Active MRSA surveillance, preoperative decolonization and contact precautions for MRSA-positive cases was performed at our institution. Changes in epidemic strains were evaluated and the possibility of transmission from patients in an orthopaedic ward of a Japanese tertiary-care hospital was assessed by genotyping stored MRSA strains. In addition, data on the prevalence of MRSA SSI, MRSA colonization, and use of an alcohol antiseptic agent (mL/patient-days) during 2005-2022 were retrospectively assessed.

FINDINGS

SCCmec type II strain in the SSI group decreased over time, associated with fewer outbreaks. Even during a period of high infection rates, no cases of transmission-induced SSI from nasal MRSA carriers were identified. The infection rate correlated negatively with the use of an alcohol antiseptic agent (r = -0.82; P < 0.0001). Two cases among five nasal carriers developed MRSA SSI caused by strains different from those related to nasal colonization.

CONCLUSION

The infection control measures for transmission from the hospital reservoirs including strict adherence to hand hygiene and decolonization of carriers is likely to be important for the prevention of orthopaedic MRSA SSI. However, the need for contact precautions for decolonized nasal carriers might be low.

Intermittent pneumatic compression versus additional prophylaxis with enoxaparin for prevention of venous thromboembolism after laparoscopic surgery for gastric and colorectal malignancies: multicentre randomized clinical trial

Background

The role of antithrombotic chemoprophylaxis in prevention of venous thromboembolism (VTE) in laparoscopic surgery for gastric and colorectal malignancies is unknown. This study compared the addition of enoxaparin following intermittent pneumatic compression (IPC) with IPC alone in patients undergoing laparoscopic surgery for gastrointestinal malignancy.

Methods

In this multicentre RCT, eligible patients were older than 40 years and had a WHO performance status of 0 or 1. Exclusion criteria were prescription of antiplatelet or anticoagulant drugs and history of VTE. Patients were allocated to IPC or to ICP with enoxaparin in a 1 : 1 ratio. Stratification factors included sex, location of cancer, age 61 years and over, and institution. Enoxaparin was administered on days 1–7 after surgery. Primary outcome was VTE, evaluated by multidetector CT on day 7.

Results

Of 448 patients randomized, 208 in the IPC group and 182 in the IPC with enoxaparin group were evaluated. VTE occurred in ten patients (4·8 per cent) in the IPC group and six (3·3 per cent) in the IPC with enoxaparin group (P = 0·453). Proximal deep vein thrombosis and/or pulmonary embolism occurred in seven patients (3·4 per cent) in the IPC group and one patient (0·5 per cent) in the IPC with enoxaparin group (P = 0·050). All VTE events were asymptomatic and non‐fatal. Bleeding occurred in 11 of 202 patients in the IPC with enoxaparin group, and one patient needed a transfusion. All bleeding events were managed by discontinuation of the drug.

Conclusion

IPC with enoxaparin after laparoscopic surgery for gastric and colorectal malignancies did not reduce the rate of VTE. Registration number: UMIN000011667 ( https://www.umin.ac.jp/).

Spin Current as a Probe of the Z_{2}-Vortex Topological Transition in the Classical Heisenberg Antiferromagnet on the Triangular Lattice

We have theoretically investigated transport properties of the classical Heisenberg antiferromagnet on the triangular lattice, in which a binding-unbinding topological transition of Z_{2} vortices is predicted to occur at a finite temperature T_{v}. It is shown by means of the hybrid Monte Carlo and spin-dynamics simulations that the longitudinal spin-current conductivity exhibits a divergence at T_{v}, while the thermal conductivity only shows a monotonic temperature dependence with no clear anomaly at T_{v}. The significant enhancement of the spin-current conductivity is found to be due to the rapid growth of the spin-current-relaxation time toward T_{v}, which can be understood as a manifestation of the topological nature of the free Z_{2} vortex whose lifetime gets longer toward T_{v}. The result suggests that the spin-current measurement is a promising probe to detect the Z_{2}-vortex topological transition, which has remained elusive in experiments.

Effective multiple sideband generation using an electro-optic modulator for a multiple isotope magneto-optical trap

Herein, we report an effective method for the generation of radio-frequency (RF) sidebands in an electro-optic modulator for the simultaneous magneto-optical trapping of two isotopes. This is achieved by switching the RF signals alternately, which suppresses the generation of unwanted frequency signals and improves the laser power per sideband. The generated sidebands are successfully applied to a dual-rubidium-isotope magneto-optical trap (MOT), which results in an increased number of trapped atoms. This simple, flexible, and robust technique can be implemented in experiments that require a large number of atoms in multiple-isotope MOTs and for various applications.

Laser frequency locking with 46 GHz offset using an electro-optic modulator for magneto-optical trapping of francium atoms

We demonstrate frequency offset locking between two laser sources using a waveguide-type electro-optic modulator (EOM) with 10th-order sidebands for magneto-optical trapping of Fr atoms. The frequency locking error signal was successfully obtained by performing delayed self-homodyne detection of the beat signal between the repumping frequency and the 10th-order sideband component of the trapping light. Sweeping the trapping-light and repumping-light frequencies with keeping its frequency difference of 46 GHz was confirmed over 1 GHz by monitoring the Doppler absorption profile of I₂. This technique enables us to search for a resonance frequency of magneto-optical trapping of Fr.

Further improvement of the upper limit on the direct 3α decay from the Hoyle state in 12C

The direct 3α decay branch from the 02+ state at Ex=7.65  MeV in 12C, which is known as the Hoyle state, is considered to affect the triple-α reaction rate strongly and to give crucial information on its structure. We have performed a high-precision measurement of the 3α decay from this state using the 12C(12C,3α)12C reaction at E12C=110  MeV. The branching ratio of the direct 3α decay was under the detection limit in the present experiment. By comparing with Monte Carlo simulations for three decay mechanisms as the sequential decay through the ground state of ^{8}Be, the direct decay with equal energies of three α particles, and the direct decay to the phase space uniformly, we have obtained the upper limit of 0.2% on the direct 3α decay.

Radioactive ion beam transportation for the fundamental symmetry study with laser-trapped atoms

The search for the violation of the fundamental symmetry in a radioactive atom is the promising candidate for precision tests of the standard model and its possible extensions. The subtle signal arising from the symmetry violation is enhanced in heavy atoms, such as a francium (Fr). To realize high precision measurements, a large amount of radioactive isotopes is required. The Fr is produced via a nuclear fusion reaction using a melted gold target with a (18)O primary beam at Cyclotron and Radioisotope Center, Tohoku University. The maximum extraction efficiency of the Fr ion was achieved at approximately 35%. The beam line consists of an electrostatic deflector, three electrostatic quadrupole triplets to the measurement area at 10 m away from the reaction point, and several beam diagnosis systems. We optimized parameters of the beam line.

70 FIBROBLAST GROWTH FACTOR 4 PROMOTES THE DEVELOPMENT OF SOMATIC CELL NUCLEAR TRANSFER EMBRYOS IN MICE

Somatic cell nuclear transfer (SCNT) embryos can develop during the preimplantation period; however, most of these die after implantation period. A transcription factor, Cdx2, promotes differentiation of extraembryonic tissues and appears to be involved in the segregation of inner cell mass (ICM) and trophectoderm (TE) in preimplantation embryos. So far, we have demonstrated that the expression of Cdx2 in mouse SCNT embryos is delayed and its expression level is significantly lower than that in intracytoplasmic sperm injection (ICSI) embryos. Moreover, the ectopic expression of Oct-3/4 was observed in the TE tissues of SCNT blastocysts, but not in ICSI blastocysts. Fibroblast growth factor (FGF) receptor 2 (FGFR2) is specifically expressed in 8-cell to morula-stage embryos and trophectoderm (TE) and is essential for implantation; however, FGFR2 expression in SCNT embryos significantly decreases compared with IVF embryos. Therefore, it is likely that abnormality of differentiation that is controlled in development of pre-implantation in SCNT embryos leads to a rapid decrease of subsequent developmental ability. Then, we investigated the effects of FGF4 on development of SCNT embryos. Mouse SCNT embryos were produced according to the method reported previously (Wakayama et al. 1998). B6D2F1 and B6C3F1 female mice were used for the collection of recipient oocytes and donor cells, respectively. Data were analyzed by Student’s t-test. First, the timing to start adding FGF4 was decided by FGFR2 expression time about 54 h after cell injection and treated for 3, 6, 12, 24, and 42 h thereafter. In the case of FGF4 concentration at 25 ng mL-1 with treating time of 6 h from the 4- to 8-cell stages, SCNT embryos significantly promoted the development to morula and blastocyst stages (91 and 45%, respectively) compared with IVF embryos (80 and 30%, respectively; P < 0.05). However, longer treatment of 42 h with FGF4 made their morphology considerably worse. Then, concentrations of FGF4 at 5, 25, 50, 250, and 500 ng mL-1 with treating time of 6 h was examined. In case of FGF4 concentration at 25 and 50 ng mL-1, SCNT embryos significantly promoted the development to morula and blastocyst stages (P < 0.05). Immunohistochemical analysis showed segregation of the expression of Oct-3/4 and Cdx2 in ICM and TE, respectively, in FGF4-treated SCNT embryos, unlike in the case of nontreated SCNT embryos, which showed an ectopic expression of Oct-3/4 in TE tissues. Furthermore, after the transplantation of SCNT embryos treated with FGF4 at 50 ng mL-1 and the treating time of 6 h to recipient mice, most of the transferred embryos implanted and cloned mice were successfully produced as well as nontreated SCNT embryos. Therefore, FGF4 facilitates the development of SCNT embryos especially to the morula and blastocyst stages. This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science.

An immunohistological study on the nephritis in chicks experimentally produced with avian nephritis virus

One chick inoculated by a combined nasal and conjunctival sac route (in) and two chicks inoculated per os (io) died with visceral urate deposits at post inoculation days (dpi) 9 and 11. All infected chicks showed renal degeneration and inflammatory changes that originated from tubular cell necrosis. Avian nephritis virus (ANV) antigen was detected as cytoplasmic granules within the necrotic tubular epithelial cells. The serum uric acid was increased in in- and io-infected chicks 5 to 10 dpi and was coincident with the severity of the renal degeneration. Immunoglobulin (IgG and IgM)-containing cells were detected first in the renal lesion 5 and 7 dpi; they were coincident with the cell infiltration. IgG- and IgM-containing cells were demonstrated in the spleen 5 dpi and increased thereafter eight to 12 times more than those in non-infected control chicks. They were almost coincident with the detection of antibody against ANV. These findings suggested that ANV replication may stimulate the proliferative response of IgG- and IgM-containing cells in the spleen, and that the appearance of IgG- and IgM-containing cells in the kidney may also be closely associated with the clearance of ANV and regeneration of the renal lesion.