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BackgroundNeonates with persistent pulmonary hypertension of the newborn (PPHN) can present with hypoxia and right ventricular dysfunction with resultant inadequate oxygen delivery and end-organ damage. This study describes the use of prostaglandin-E1 (PGE) for ductal patency to preserve right ventricular systolic function and limit afterload in newborns with PPHN.MethodsThis is a retrospective cohort study that follows the hemodynamics, markers of end-organ perfusion, length of therapeutics, and echocardiographic variables of 57 newborns who used prostglandin-E1 in the setting of PPHN.ResultsTachycardia, lactic acidosis, and supplemental oxygen use improved following PGE initiation. Fractional area change (FAC), to assess right ventricular systolic function, and pulmonary arterial acceleration time indexed to right ventricular ejection time (PAAT/RVET), to assess right ventricular afterload, also improved over three time points relative to PGE use (before, during, and after).ConclusionsOverall, we described the safety and utility of PGE in newborns with severe PPHN for stabilization while allowing natural disease progression.

Congenital heart disease (CHD) is the most common birth defect. Fetal screening ultrasound provides five views of the heart that together can detect 90% of complex CHD, but in practice, sensitivity is as low as 30%. Here, using 107,823 images from 1,326 retrospective echocardiograms and screening ultrasounds from 18- to 24-week fetuses, we trained an ensemble of neural networks to identify recommended cardiac views and distinguish between normal hearts and complex CHD. We also used segmentation models to calculate standard fetal cardiothoracic measurements. In an internal test set of 4,108 fetal surveys (0.9% CHD, >4.4 million images), the model achieved an area under the curve (AUC) of 0.99, 95% sensitivity (95% confidence interval (CI), 84-99%), 96% specificity (95% CI, 95-97%) and 100% negative predictive value in distinguishing normal from abnormal hearts. Model sensitivity was comparable to that of clinicians and remained robust on outside-hospital and lower-quality images. The model's decisions were based on clinically relevant features. Cardiac measurements correlated with reported measures for normal and abnormal hearts. Applied to guideline-recommended imaging, ensemble learning models could significantly improve detection of fetal CHD, a critical and global diagnostic challenge.

BackgroundThe clinical utility of echocardiography for the diagnosis of pulmonary vascular disease (PVD) in former preterm infants with bronchopulmonary dysplasia (BPD) is not established. Elevated pulmonary vascular resistance (PVR) rather than pulmonary artery pressure (PAP) is the hallmark of PVD. We evaluated the utility of echocardiography in infants with BPD in diagnosing pulmonary hypertension and PVD (PVR >3 Wood units × m2) assessed by cardiac catheterization.MethodsA retrospective single center study of 29 infants born ≤29 weeks of gestational age with BPD who underwent cardiac catheterization and echocardiography was performed. PVD was considered present by echocardiography if the tricuspid valve regurgitation jet peak velocity was >2.9 m/sec, post-tricuspid valve shunt systolic flow velocity estimated a right ventricular systolic pressure >35 mm Hg, or systolic septal flattening was present. The utility (accuracy, sensitivity, and positive predictive value [PPV]) of echocardiography in the diagnosis of PVD was tested. Subgroup analysis in patients without post-tricuspid valve shunts was performed. Echocardiographic estimations of right ventricular pressure, dimensions, function, and pulmonary flow measurements were evaluated for correlation with PVR.ResultsThe duration between echocardiography and cardiac catheterization was a median of 1 day (interquartile range, 1-4 days). Accuracy, sensitivity, and PPV of echocardiography in diagnosing PVD were 72%, 90.5%, and 76%, respectively. Accuracy, sensitivity, and PPV increased to 93%, 91.7%, and 100%, respectively, when infants with post-tricuspid valve shunts were excluded. Echocardiography had poor accuracy in estimating the degree of PAP elevation by cardiac catheterization. In infants without post-tricuspid valve shunts, there was moderate to good correlation between indexed PVR and right ventricular myocardial performance index (rho = 0.89, P = .005), systolic to diastolic time index (0.84, P

Objective To evaluate the effect of plasma-to-red blood cell transfusion ratio on clinical prognosis of patients undergoing blood transfusion during cardiac surgery. Methods Clinical data of 723 patients receiving blood transfusion during cardiac surgery were collected. According to the amount of blood transfusion, they were divided into the massive transfusion group (blood transfusion≥8 U,n = 282) and non-massive transfusion group (blood transfusion < 8 U,n = 441). Two groups were further divided into 2 subgroups according to the plasma-to-red blood cell transfusion ratio (high ratio subgroup： plasma-to-red blood cell ratio>1； low ratio subgroup： plasma-to-red blood cell transfusion ratio≤1), the influence of plasma-to-red blood cell transfusion ratio on clinical prognosis of patients was evaluated. Results In the massive transfusion group, the amount of postoperative plasma transfusion was significantly increased, postoperative hemoglobin level was significantly lower, postoperative activated partial thromboplastin time (APTT) was prolonged, postoperative international normalized ratio (INR) was lower, the length of postoperative hospital stay, postoperative ICU stay and postoperative mechanical ventilation time were significantly longer in the low ratio subgroup compared with those in the high ratio subgroup (all P < 0.05). In the non-massive transfusion group, postoperative hemoglobin level and hematocrit in the low ratio subgroup were significantly higher than those in the high ratio subgroup (both P < 0.05),but there were no significant difference between two subgroups about the length of postoperative hospital stay, postoperative ICU stay,postoperative mechanical ventilation time and in-hospital mortality rate(all P > 0.05). Conclusions For patients receiving massive blood transfusion during cardiac surgery, high plasma-to-red blood cell transfusion ratio is more conducive to clinical prognosis. For those with non-massive transfusion, there is no need for excessive plasma transfusion.

Evaluating sea surface temperature (SST) products is essential before their application in marine environmental monitoring and related studies. SSTs from the in situ SST Quality Monitor (iQuam) system, Advanced Microwave Scanning Radiometer 2 (AMSR2) aboard the Global Change Observation Mission 1st-Water, and the Microwave Radiation Imager (MWRI) aboard the Chinese Fengyun-3D satellite are intercompared utilizing extended triple collocation (ETC) and direct comparison methods. Additionally, error characteristic variations with respect to time, latitude, SST, sea surface wind speed, columnar water vapor, and columnar cloud liquid water are analyzed comprehensively. In contrast to the prevailing focus on SST validation accuracy, the random errors and the capability to detect SST variations are also evaluated in this study. The result of ETC analysis indicates that iQuam SST from ships exhibits the highest random error, above 0.83 °C, whereas tropical mooring SST displays the lowest random error, below 0.28 °C. SST measurements from drifters, tropical moorings, Argo floats, and high-resolution drifters, which possess random errors of less than 0.35 °C, are recommended for validating remotely sensed SST. The ability of iQuam, AMSR2, and MWRI to detect SST variations diminishes significantly in ocean areas between 0°N and 20°N latitude and latitudes greater than 50°N and 50°S. AMSR2 and iQuam demonstrate similar random errors and capabilities for detecting SST variations, whereas MWRI shows a high random error and weak capability. In comparison to iQuam SST, AMSR2 exhibits a root-mean-square error (RMSE) of about 0.51 °C with a bias of −0.05 °C, while MWRI shows an RMSE of about 1.26 °C with a bias of −0.14 °C. [ABSTRACT FROM AUTHOR]

Objective: Fetuses with complex congenital heart disease have altered physiology, contributing to abnormal neurodevelopment. The effects of altered physiology on brain development have not been well studied. We used multi‐modal imaging to study fetal circulatory physiology and brain development in hypoplastic left heart syndrome (HLHS) and d‐transposition of the great arteries (TGA). Methods: This prospective, cross‐sectional study investigated individuals with fetal congenital heart disease and controls undergoing fetal echocardiography and fetal brain MRI. MRI measured total brain volume and cerebral oxygenation by the MRI quantification method T2*. Indexed cardiac outputs (CCOi) and vascular impedances were calculated by fetal echocardiography. Descriptive statistics assessed MRI and echocardiogram measurement relationships by physiology. Results: Sixty‐six participants enrolled (control = 20; HLHS = 25; TGA = 21), mean gestational age 33.8 weeks (95% CI: 33.3–34.2). Total brain volume and T2* were significantly lower in fetuses with cardiac disease. CCOi was lower in HLHS, correlating with total brain volume ‐ for every 10% CCOi increase, volume increased 8 mm3 (95% CI: 1.78–14.1; p = 0.012). Echocardiography parameters and cerebral oxygenation showed no correlation. TGA showed no CCOi or aortic output correlation with MRI measures. Conclusions: In HLHS, lower cardiac output is deleterious to brain development. Our findings provide insight into the role of fetal cardiovascular physiology in brain health. Key points: What is already known about this topic? Fetuses with complex congenital heart disease are at risk of abnormal brain development and impaired neurodevelopmental outcomes.Causes of abnormal brain development in fetuses with congenital heart disease are multi‐factorial including abnormal cardiovascular physiology. What does this study add? Lower cardiac output measured by fetal echocardiography is associated with smaller total brain volume in hypoplastic left heart syndrome but not d‐transposition of the great arteries, providing new insight into the relationship between fetal physiology and brain development. [ABSTRACT FROM AUTHOR]

Deep convolutional neural networks have greatly enhanced the semantic segmentation of remote sensing images. However, most networks are primarily designed to process imagery with red, green, and blue bands. Although it is feasible to directly utilize established networks and pre-trained models for remotely sensed images, they suffer from imprecise land object contour localization and unsatisfactory segmentation results. These networks still need to explore the domain knowledge embedded in images. Therefore, we boost the segmentation performance of remote sensing images by augmenting the network input with multiple nonlinear spectral indices, such as vegetation and water indices, and introducing a novel holistic attention edge detection network (HAE-RNet). Experiments were conducted on the GID and Vaihingen datasets. The results showed that the NIR-NDWI/DSM-GNDVI-R-G-B (6C-2) band combination produced the best segmentation results for both datasets. The edge extraction block benefits better contour localization. The proposed network achieved a state-of-the-art performance in both the quantitative evaluation and visual inspection. [ABSTRACT FROM AUTHOR]