Uterine Synchronization Analysis During Pregnancy and Labor Using Graph Theory,Classification Based on Neural Network and Deep Learning

1) ObjectivesPreterm birth caused by preterm labor is one of the major health problems in the world. In this article, we present a new framework for dealing with this problem through the processing of electrohysterographic signals (EHG) that are recorded during labor and pregnancy. The objective in this research is to improve the classification between labor and pregnancy contractions by using a new approach that focuses on the connectivity analysis based on graph parameters, representative of uterine synchronization, and comparing neural network and machine learning methods in order to classify between labor and pregnancy.2) Material and methodsafter denoising of the 16 EHG signals recorded from pregnant women abdomen, we applied different connectivity methods to obtain connectivity matrices; then by using the graph theory, we extracted some graph parameters from the connectivity matrices; finally, we tested different neural network and machine learning methods on the features obtained from both graph and connectivity methods in order to classify between labor and pregnancy.3) ResultsThe best results were obtained by using the logistic regression method. We also evidence the power of graph parameters extracted from the connectivity matrices to improve the classification results.4) ConclusionThe use of graph analysis associated with machine learning methods can be a powerful tool to improve labor and pregnancy classification based on the analysis of EHG signals.     

Detection of Movement Artefacts and Contraction Bursts Using Accelerometer and Electrohysterograms for Home Monitoring of Pregnancy

Background

In developed countries, 10% of labors occur prematurely and are mainly due to contractions appearing too soon during the pregnancy. To detect such contractions, we developed a wearable device able to record both the electrical activity of the uterus, electrohysterograms (EHG), thanks to 18 electrodes, but also the mother movements, thanks to an embedded accelerometer.

Hyperglycemia is Associated With Increased Mortality in Critically Ill Patients With COVID-19

ObjectiveTo explore the relationship between hyperglycemia in the presence and absence of diabetes mellitus (DM) and adverse outcomes in critically ill patients with coronavirus disease 2019 (COVID-19).MethodsThe study included 133 patients with COVID-19 admitted to an intensive care unit (ICU) at an urban academic quaternary-care center between March 10 and April 8, 2020. Patients were categorized based on the presence or absence of DM and early-onset hyperglycemia (EHG), defined as a blood glucose >180 mg/dL during the first 2 days after ICU admission. The primary outcome was 14-day all-cause in-hospital mortality; also examined were 60-day all-cause in-hospital mortality and the levels of C-reactive protein, interleukin 6, procalcitonin, and lactate.ResultsCompared to non-DM patients without EHG, non-DM patients with EHG exhibited higher adjusted hazard ratios (HRs) for mortality at 14 days (HR 7.51, CI 1.70-33.24) and 60 days (HR 6.97, CI 1.86-26.13). Non-DM patients with EHG also featured higher levels of median C-reactive protein (306.3 mg/L, P = .036), procalcitonin (1.26 ng/mL, P = .028), and lactate (2.2 mmol/L, P = .023).ConclusionAmong critically ill COVID-19 patients, those without DM with EHG were at greatest risk of 14-day and 60-day in-hospital mortality. Our study was limited by its retrospective design and relatively small cohort. However, our results suggest the combination of elevated glucose and lactate may identify a specific cohort of individuals at high risk for mortality from COVID-19. Glucose testing and control are important in individuals with COVID-19, even those without preexisting diabetes.     

Improved multi-scale modeling of uterine electrical activity

ObjectiveWe aim to simulate the uterine electrical activity at the myometrium level and at the skin level where it can be recorded non-invasively.Material and methodsWe use 2D models both at the myometrium scale and for the volume conductor. The multi-scale model has been implemented in Python, as a complete package including the needed tools. To speedup the slowest step, we integrated parallel execution.ResultsWe obtain realistic simulations of EHG signals as recorded by an electrode array placed on the woman abdomen.ConclusionThese simulations are still generic, the next problem to address will be the identification of the model's parameters to obtain patient-specific simulations.     

Effects of the fetal-placental unit on uterine prostaglandin levels at term in the pregnant rat

Uterine prostaglandins (PGs) increase markedly at term in the pregnant rat. To assess the contribution of the fetal-placental unit (FUP) on uterine tissue and uterine venous blood PG concentrations, each uterine horn of 14 unilaterally pregnant rats at day 21 of pregnancy were compared. In addition, 7 bilaterally pregnant rats were studied. Uterine tissue and uterine venous plasma PGF, PGE, 6-Keto-PGF₁ (6KF) and thromboxane B₂ (TxB₂) and systematic plasma progesterone, estradiol and estrone were determined by radioimmunoassay. Uterine concentrations of PGs (ng/mg DNA) were always greater on the pregnant side of unilaterally pregnant rats (p<.05) although the PGF levels were elevated to a lesser extent than were PGE, TxB₂ or 6KF. However, no differences were detected between uterine tissue from the pregnant side of unilaterally pregnant compared to bilaterally pregnant rats. In addition, no differences were found in uterine venous plasma PGs adjacent or opposite the pregnant uterine horn and in systematic plasma progesterone, estradiol and estrone levels in unilaterally vs bilaterally pregnant rats. These data suggest that the presence of the FPU is associated with an increased capacity of uterine tissue to produce PGE, TxB₂ and 6KF, and to a lesser degree PGF, and thus may contribute to the increase in uterine PGs periparturition.     

Velocity and Directionality of the Electrohysterographic Signal Propagation

Objective

The initiation of treatment for women with threatening preterm labor requires effective distinction between true and false labor. The electrohysterogram (EHG) has shown great promise in estimating and classifying uterine activity. However, key issues remain unresolved and no clinically usable method has yet been presented using EHG. Recent studies have focused on the propagation velocity of the EHG signals as a potential discriminator between true and false labor. These studies have estimated the propagation velocity of individual spikes of the EHG signals. We therefore focus on estimating the propagation velocity of the entire EHG burst recorded during a contraction in two dimensions.

Study Design

EHG measurements were performed on six women in active labor at term, and a total of 35 contractions were used for the estimation of propagation velocity. The measurements were performed using a 16-channel two-dimensional electrode grid. The estimates were calculated with a maximum-likelihood approach.

Results

The estimated average propagation velocity was 2.18 (±0.68) cm/s. No single preferred direction of propagation was found.

Conclusion

The propagation velocities estimated in this study are similar to those reported in other studies but with a smaller intra- and inter-patient variation. Thus a potential tool has been established for further studies on true and false labor contractions.     

Application of wavelet coherence to the detection of uterine electrical activity synchronization in labor

This paper introduces the use of a method based on wavelet transform to detect the correlation between two uterine electrical activity bursts, recorded at different places on the pregnant abdomen during the same uterine contraction. The method used in this work is called wavelet coherence. The results of this study show that the wavelet analysis can successfully detect and quantify the temporal and spectral interactions between uterine bursts of electrical activity. They also indicate that the coherence is higher in the lower frequencies of the uterine electromyogram signal (EHG), and that it is possible to apply the method to non-segmented uterine signals. We find the method to give promising results permitting to evidence the coherence present in EHGs during a uterine contraction.     

不同声强超声对孕鼠子宫收缩及胎鼠神经损伤的影响及机制

目的:探讨不同声强超声对孕鼠子宫收缩及胎鼠神经损伤的影响及机制。方法:将32只孕鼠随机分为A(0)组、B(2)组、C(4)组、D(8)组,每组各8只,分别接受声强为0 W cm~(-2)、2 W cm~(-2)、4 W cm~(-2)和8 W cm~(-2)的超声辐照20 min。记录孕鼠子宫收缩及子宫平滑肌ATP酶的活力,检测胎鼠大脑皮层与海马神经元凋亡及胆碱能神经系统相关酶的活力。结果:超声增加孕鼠子宫收缩频率、收缩幅度、收缩张力和子宫活动度(P均0.05),降低孕鼠子宫平滑肌中钠钾ATP酶、钙ATP酶和钙镁ATP酶的活性(P均0.05)。超声降低胎鼠大脑皮层和海马中Bcl~(-2)水平(P0.05),增加Bax和Caspase-3水平(P均0.05)。以及促进乙酰胆碱酯酶活力,降低乙酰胆碱和乙酰胆碱转移酶水平(P均0.05)。且4 W cm~(-2)和8 W cm~(-2)的超声比2 W cm~(-2)超声对这些指标的作用更强。结论:4 W cm~(-2)和8 W cm~(-2)超声可能通过降低ATP酶的活性促进孕鼠子宫平滑肌收缩,并可引起胎鼠大脑皮层和海马神经元损伤,机制可能与胆碱能神经元系统失衡有关,2 W cm~(-2)声强的超声对胎鼠神经元损伤甚小。     

Hepatitis B Virus (HBV) Variants in Untreated and Tenofovir Treated Chronic Hepatitis B (CHB) Patients during Pregnancy and Post-Partum Follow-Up

BackgroundChronic hepatitis B (CHB) is a dynamic disease that may be affected by immune changes in pregnancy. Guidelines suggest consideration of nucleos/tide analogs (NA), i.e., tenofovir, (TDF) in highly viremic mothers to reduce vertical transmission risk. HBV variability affects CHB outcome, but little is known about HBV genetic changes in pregnancy due to immune or NA selection.ObjectivesTo evaluate HBV diversity in NA treated or untreated pregnant vs. post-partum CHB carriers.ResultsThe median age was 31 y, 71% Asian, 68% genotype B or C, 33% HBV eAg+, 5 received TDF (median HBV DNA 8.5 log IU/ml). In untreated mothers, median antepartum vs. post-partum ALT was 21 vs. 24 U/L and HBV DNA was 2.7 vs. 2.4 log(10) IU/ml. ALT and/or HBV DNA flares occurred during pregnant and/or post-partum period in 47% (10/21). Clonal sequencing antepartum showed the presence of minor “a determinant” and/or vaccine escape mutants (VEM) but drug resistant variants were infrequent. Analysis of pregnant vs. post-partum samples showed different HBV variants and viral diversity.ConclusionsDifferences in immune and/or by NA selective pressures during pregnancy may affect HBV evolution during pregnancy. The presence of minor VEM warrant infant follow-up.     

微丝电极阵列的参考电极内置与外置的对比研究*

目的: 通过对比内置和外置参考电极的微丝电极阵列在记录大鼠脑神经元放电过程中的优缺点,优化微丝电极阵列的制作与埋置,为多通道电生理实时记录系统提供更加实惠、优异的媒介工具。方法: 采用镍铬合金丝、电路板、电极引脚和地线(银线)制作16通道的微丝电极阵列,通过内置(参考电极与电极阵列并列排布)或外置(参考电极与地线分别焊接在电极一侧的两端)微丝电极阵列的参考电极,观察对比两种电极在记录大鼠ACC脑区神经元放电中的区别。实验大鼠分为内置组(8只)和外置组(9只),检测指标有信噪比(n=8)、放电幅度(n=380)和放电频率(n=54)。结果: 内置与外置参考电极的微丝电极阵列均可顺利记录出大鼠ACC脑区神经元的电信号;与外置组相比,内置组的神经元电信号具有信噪比高(P＜0.05)、背景信号幅度小、受噪音干扰小,和放电幅度大(P＜0.05)的优点;锋电位放电频率没有显著差异(P＞0.05)。结论: 在记录大鼠ACC脑区神经元电活动时,内置参考电极的微丝电极阵列记录到更高信噪比、更大放电幅度的电信号,为多通道电生理技术提供更加可靠的工具。     

Parameters extraction and monitoring in uterine EMG signals. Detection of preterm deliveries

The aim of this paper is to classify between labor contractions and pregnancy contractions. Various types of parameters have been extracted from the electrohysterogram (EHG), mainly from the original EHG or from different frequency bands. They have been computed from different signal databases obtained with different recording protocols. The results of these studies are sometime controversial. The aim of this paper is to compute 17 parameters selected from the literature on the same signal database, either on the original EHG or after wavelet packet decomposition, and then to compare their power to discriminate between contractions recorded during pregnancy and labor. We thus obtain a selection of parameters that allow the best discrimination between pregnancy and labor contractions, when computed on the same signals, either on the original EHG or on selected frequency bands.     

Fetal dose measurements and shielding efficiency assessment in a custom setup of 192Ir brachytherapy for a pregnant woman with breast cancer

PurposeTo assess the radiation dose to the fetus of a pregnant patient undergoing high-dose-rate (HDR) ¹⁹²Ir interstitial breast brachytherapy, and to design a new patient setup and lead shielding technique that minimizes the fetal dose.MethodsRadiochromic films were placed between the slices of an anthropomorphic phantom modeling the patient. The pregnant woman was seated in a chair with the breast over a table and inside a leaded box. Dose variation as a function of distance from the implant volume as well as dose homogeneity within a representative slice of the fetal position was evaluated without and with shielding.ResultsWith shielding, the peripheral dose after a complete treatment ranged from 50 cGy at 5 cm from the caudal edge of the breast to <0.1 cGy at 30 cm. The shielding reduces absorbed dose by a factor of two near the breast and more than an order of magnitude beyond 20 cm. The dose is heterogeneous within a given axial plane, with variations from the central region within 50%. Interstitial HDR ¹⁹²Ir brachytherapy with breast shielding can be more advantageous than external-beam radiotherapy (EBRT) from a radiation protection point of view, as long as the distance to the uterine fundus is higher than about 10 cm. Furthermore, the weight of the shielding here proposed is notably lower than that needed in EBRT.ConclusionsShielded breast brachytherapy may benefit pregnant patients needing localized radiotherapy, especially during the early gestational ages when the fetus is more sensitive to ionizing radiation.     

乳酸依沙吖啶联合子宫颈扩张单球囊对瘢痕子宫中期妊娠引产的应用效果

目的:研究乳酸依沙吖啶联合子宫颈扩张单球囊对瘢痕子宫中期妊娠引产的应用效果。方法:选择2014年4月~2016年12月在我院进行诊治的由于社会因素或者医学因素自愿要求终止妊娠并无任何引产禁忌证的110例健康中期妊娠(孕周14~27周)孕妇为研究对象,随机分为观察组与对照组,每组各55例。对照组采用常规方案进行引产,即口服米非司酮150 mg,并在B超引导下经腹壁行羊膜腔内注射100 mg乳酸依沙吖啶;观察组采用乳酸依沙吖啶联合子宫颈扩张单球囊进行引产。比较两组孕妇的引产成功率、产程时间、宫缩发动时间、胎儿娩出时间、产后2 h出血量、住院时间、引产并发症的发生情况以及多次剖宫产患者的引产成功率。结果:观察组孕妇的引产成功率为96.36%(53/55),明显高于对照组[83.64%(46/55)](P0.05),且观察组的产程时间、宫缩发动时间、产后2 h出血量以及住院时间均明显低于对照组(P0.05)。对照组多次剖宫产孕妇引产成功率为33.33%(2/6),观察组多次剖宫产孕妇引产成功率为100.00%(7/7),观察组明显高于对照组(P0.05)。对照组发生宫颈裂伤1例,会阴裂伤1例,两组孕妇均未出现羊水栓塞、子宫破裂以及感染等并发症。结论:乳酸依沙吖啶联合子宫颈扩张单球囊用于瘢痕子宫中期妊娠引产的应用效果明显优于口服米非司酮并在B超引导下经腹壁行羊膜腔内注射乳酸依沙吖啶,且安全性高。     

Decreased smooth muscle side effects with 16, 16-dimethyl-trans-Δ2-PGE1 methyl ester in Japanese monkey (Macaca fuscata fuscata)

The smooth muscle stimulating activity of a new PGE₁ analog, 16, 16-dimethyl-trans-Δ²-PGE₁ methyl ester (ONO-802) was evaluated by simulataneous;y recording the EMG of the uterus and intestines, along with urinary bladder pressure, and blood pressure in pregnant and non-pregnant Japanese monkeys ($\text{Macaca fuscata fuscata}$). Single intravenous injections of ONO-802 in increasing dosages (0.2–5 μg/kg) were found to be 50–100 times or more effective in inducing uterine contraction than PGF₂α and PGE₁. A mild, transient gastrointestinal muscle stimulating activity was observed, but change in urinary bladder pressure and blood pressure was not evident. ONO-802 induced uterine contractions in the pregnant animals were 10 times greater than in the non-pregnant animals. These results suggest that ONO-802 may be a suitable clinical prostaglandin for use in therapeutic abortion.     

Identifying the Functional Flexion-extension Axis of the Knee: An In-Vivo Kinematics Study

Purpose

This study aimed to calculate the flexion-extension axis (FEA) of the knee through in-vivo knee kinematics data, and then compare it with two major anatomical axes of the femoral condyles: the transepicondylar axis (TEA) defined by connecting the medial sulcus and lateral prominence, and the cylinder axis (CA) defined by connecting the centers of posterior condyles.

Methods

The knee kinematics data of 20 healthy subjects were acquired under weight-bearing condition using bi-planar x-ray imaging and 3D-2D registration techniques. By tracking the vertical coordinate change of all points on the surface of femur during knee flexion, the FEA was determined as the line connecting the points with the least vertical shift in the medial and lateral condyles respectively. Angular deviation and distance among the TEA, CA and FEA were measured.

Results

The TEA-FEA angular deviation was significantly larger than that of the CA-FEA in 3D and transverse plane (3.45° vs. 1.98°, p < 0.001; 2.72° vs. 1.19°, p = 0.002), but not in the coronal plane (1.61° vs. 0.83°, p = 0.076). The TEA-FEA distance was significantly greater than that of the CA-FEA in the medial side (6.7 mm vs. 1.9 mm, p < 0.001), but not in the lateral side (3.2 mm vs. 2.0 mm, p = 0.16).

Conclusion

The CA is closer to the FEA compared with the TEA; it can better serve as an anatomical surrogate for the functional knee axis.     

子宫颈机能不全孕妇血清松弛素、弹性蛋白表达意义及对妊娠结局的评估价值研究

摘要 目的：分析子宫颈机能不全孕妇血清松弛素、弹性蛋白表达意义及对妊娠结局的评估价值。方法：选择我院于2020年5月至2022年5月接诊的120例子宫颈机能不全孕妇作为观察组，另选同期的120例正常妊娠孕妇作为对照组。分析血清松弛素、弹性蛋白表达水平，及其与子宫颈机能不全孕妇宫口扩张宽度、宫颈长度的关系，观察血清松弛素、弹性蛋白在早产者与非早产者间的差异性，使用受试者工作特征曲线(ROC)下面积(AUC)评价血清松弛素联合弹性蛋白对早产及围产儿死亡的预测效能。结果：观察组血清松弛素水平较对照组高，弹性蛋白水平较对照组低（P＜0.05）；经Pearson相关性分析，子宫颈机能不全孕妇宫口扩张宽度与血清松弛素水平呈正相关，与弹性蛋白水平呈负相关（P＜0.05）；宫颈长度与血清松弛素水平呈负相关，与弹性蛋白水平呈正相关（P＜0.05）；在120例子宫颈机能不全孕妇中，早产42例、非早产78例；早产组血清松弛素水平高于非早产组，弹性蛋白水平低于非早产组（P＜0.05）；经ROC曲线分析，血清松弛素联合弹性蛋白预测子宫颈机能不全孕妇发生早产的AUC为0.910，预测围产儿死亡的AUC为0.943。结论：血清松弛素水平升高和弹性蛋白水平降低均与子宫颈机能不全有关，两者联合预测早产及围产儿死亡的效能较好，值得进一步研究应用。     

超声多参数在预测妊娠期糖尿病巨大儿分娩方式中的临床价值

摘要 目的：探究超声多参数在预测妊娠期糖尿病巨大儿分娩方式中的应用价值。方法：选择2016年2月至2020年9月于中国人民解放军联勤保障部队第九○一医院（我院）分娩的156例妊娠期糖尿病产妇为研究对象,回顾性分析其一般临床指标及多普勒超声检测参数,按照新生儿是否为巨大儿区分为巨大儿组（52例）和非巨大儿组（104例）,对比两组胎儿超声参数差异,评估胎儿双顶径（biparietal diameter,BPD）、头围（head circumference,HC）、腹围（abdominal circumference,AC）及股骨长度（femur length,FL）与新生儿体重的相关性,纳入年龄、宫高、孕妇腹围、孕妇体重、BPD、HC、AC、FL等指标评估巨大儿单因素影响因素,最后多因素Logistic回归分析探究巨大儿独立危险因素。结果：（1）比较显示巨大儿组胎儿BPD、HC、AC和HL均大于非巨大儿组（P<0.05）;（2）Spearman相关性分析显示BPD、HC、AC和HL均与新生儿体重呈正相关（P<0.05）;（3）分析显示产妇宫高、产妇腹围、孕期增重、BPD、HC、AC和HL均为巨大儿单因素影响因素（P<0.05）;（4）Logistic多因素回归分析显示孕妇宫高、BPD、HC、AC为巨大儿独立危险因素。结论：孕期使用超声多参数对妊娠期糖尿病产妇巨大儿发生情况具有较好的预测价值,可协助医师了解胎儿相关指标,并据此选择合适的分娩方式,值得临床推广应用。     

Control of knee coronal plane moment via modulation of center of pressure: a prospective gait analysis study

ObjectivesFootwear-generated biomechanical manipulations (e.g., wedge insoles) have been shown to reduce the magnitude of adduction moment about the knee. The theory behind wedged insoles is that a more laterally shifted location of the center of pressure reduces the distance between the ground reaction force and the center of the knee joint, thereby reducing adduction moment during gait. However, the relationship between the center of pressure and the knee adduction moment has not been studied previously. The aim of this study was to examine the association between the location of the center of pressure and the relative magnitude of the knee adduction moment during gait in healthy men.MethodsA novel foot-worn biomechanical device which allows controlled manipulation of the center of pressure location was utilized. Twelve healthy men underwent successive gait analysis testing in a controlled setting and with the device set to convey three different para-sagittal locations of the center of pressure: neutral, medial offset and lateral offset.ResultsThe knee adduction moment during the stance phase significantly correlated with the shift of the center of pressure from the functional neutral sagittal axis in the coronal plane (i.e., from medial to lateral). The moment was reduced with the lateral sagittal axis configuration and augmented with the medial sagittal axis configuration.ConclusionsThe study results confirm the hypothesis of a direct correlation between the coronal location of the center of pressure and the magnitude of the knee adduction moment.     

聚3，4乙烯二氧噻吩修饰的新型碳纳米管纤维电极及其电化学性能评价

目的 植入式脑机接口在神经疾病的治疗方面已经得到了广泛应用，治疗的效果依赖于与神经组织接触的电极。与刚性材料制作的电极相比，碳基微纤维电极尺度小、生物兼容性好、组织炎症反应小，可以减少植入后的异物反应，改善神经记录信号的信噪比，可以长期保持稳定的电极特性。方法 本文设计了一种柔性碳纳米管（carbon nanotubes，CNTs）纤维电极的修饰方法，该方法采用电化学聚合的方式可以将聚3,4-乙烯二氧噻吩（poly（3,4-ethylenedioxythiophene），PEDOT）薄膜沉积到CNTs纤维电极上，作为微电极涂层。为了证明修饰涂层在电极表面具有良好的机械稳定性，对修饰电极进行了超声处理。此外，本文将PEDOT薄膜沉积到ITO玻璃上，评价了PEDOT薄膜的生物相容性。结果 恒电流方式在CNTs纤维电极表面沉积的PEDOT涂层降低了电极的电化学阻抗，提高了电极的电化学性能，且PEDOT沉积的时间越长阻抗减少的幅度越明显。对电极进行超声处理后，电极的电化学阻抗没有产生显著变化，说明超声处理后PEDOT涂层剥离较少，证明了修饰涂层在电极表面具有良好的机械稳定性。最后，细胞实验表明，PEDOT薄膜具有与ITO导电玻璃相当的细胞相容性。结论 PEDOT薄膜可以提高CNTs纤维电极的稳定性，有望提高脑机接口系统的寿命和可靠性，具有应用于长时间记录神经电信号的前景。