<strong>Introduction: </strong><span style="font-family:""><span style="font-family:Verdana;">Fetal heart rate monitoring during labor is used to study fetal well-being...<strong>Introduction: </strong><span style="font-family:""><span style="font-family:Verdana;">Fetal heart rate monitoring during labor is used to study fetal well-being and predict neonatal acidosis of newborn. Fetal heart rate monitoring is analyzed by the obstetrical team and categorized according to the FIGO guidelines. An important limitation of this diagnostic tool is an inter- and intra-observer variability, leading to subjective cardiotocography interpretation and classification. Our objective was to study the association between the categories of fetal heart rate analysis (according to FIGO classification) and neonatal acidosis of full-term newborns. </span><b><span style="font-family:Verdana;">Study design:</span></b><span style="font-family:Verdana;"> This is a multicenter retrospective cohort study conducted between 2014 and 2018 in the Grand-Est region. We searched and included retrospectively children hospitalized in a pediatric intensive care unit in one of the participating hospitals with an ICD-10 coding type “P91.6” corresponding to “Hypoxic Ischemic Encephalopathy”. Maternal, pregnancy, delivery, and newborn characteristics were collected and compared by univariate logistic regression with multiple imputation. Odds Ratio and 95% confidence intervals (CI) were calculated using the model and presented. Multiple imputation with m = 100 imputations was tested, using Rubin rules to combine the results. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">55 patients were included in the study. Fetal heart rate tracings classified in Category 3 as “pathological” according to FIGO guidelines were significantly associated with an increased risk of severe neonatal acidosis. Late decelerations and bradycardia during labor were associated with severe neonatal acidosis. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Severe neonatal acidosis may be suspected by interpretation of fetal heart rate during labor. Fetal bradycardia and late decelerations are predictive of the severity of neonatal acidosis. This study emphasizes the need to screen severe neonatal acidosis and allows the identification of populations most at risk. Repeated team training and upgrading of fetal heart rate study would further reduce the incidence of neonatal acidosis.</span></span>展开更多
Congenital heart defect,accounting for about 30%of congenital defects,is the most common one.Data shows that congenital heart defects have seriously affected the birth rate of healthy newborns.In Fetal andNeonatal Car...Congenital heart defect,accounting for about 30%of congenital defects,is the most common one.Data shows that congenital heart defects have seriously affected the birth rate of healthy newborns.In Fetal andNeonatal Cardiology,medical imaging technology(2D ultrasonic,MRI)has been proved to be helpful to detect congenital defects of the fetal heart and assists sonographers in prenatal diagnosis.It is a highly complex task to recognize 2D fetal heart ultrasonic standard plane(FHUSP)manually.Compared withmanual identification,automatic identification through artificial intelligence can save a lot of time,ensure the efficiency of diagnosis,and improve the accuracy of diagnosis.In this study,a feature extraction method based on texture features(Local Binary Pattern LBP and Histogram of Oriented Gradient HOG)and combined with Bag of Words(BOW)model is carried out,and then feature fusion is performed.Finally,it adopts Support VectorMachine(SVM)to realize automatic recognition and classification of FHUSP.The data includes 788 standard plane data sets and 448 normal and abnormal plane data sets.Compared with some other methods and the single method model,the classification accuracy of our model has been obviously improved,with the highest accuracy reaching 87.35%.Similarly,we also verify the performance of the model in normal and abnormal planes,and the average accuracy in classifying abnormal and normal planes is 84.92%.The experimental results show that thismethod can effectively classify and predict different FHUSP and can provide certain assistance for sonographers to diagnose fetal congenital heart disease.展开更多
This paper briefly introduces the collection and recognition of bio-medical sig nals, designs the method to collect FM signals. A detailed discussion on the sys tem hardware, structure and functions is also given. Und...This paper briefly introduces the collection and recognition of bio-medical sig nals, designs the method to collect FM signals. A detailed discussion on the sys tem hardware, structure and functions is also given. Under LabWindows/CVI,the ha rdware and the driver do compatible, the hardware equipment work properly active ly. The paper adopts multi threading technology for real-time analysis and make s use of latency time of CPU effectively, expedites program reflect speed, impro ve s the program to perform efficiency. One threading is collecting data; the other threading is analyzing data. Using the method, it is broaden to analyze the sig nal in real-time. Wavelet transform to remove the main interference in the FM a nd by adding time-window to recognize with BP network; Finally the results of c ollecting signals and BP networks are discussed.8 pregnant women’s signals of F M were collected successfully by using the sensor. The correct of BP network rec ognition is about 83.3% by using the above measure.展开更多
Objective To evaluate the fetal cardiac function in gestational diabetes mellitus （GDM） pregnancies under different maternal glycemic controls. Methods Forty four GDM mothers received 78 fetal echocardiographic eval...Objective To evaluate the fetal cardiac function in gestational diabetes mellitus （GDM） pregnancies under different maternal glycemic controls. Methods Forty four GDM mothers received 78 fetal echocardiographic evaluations at three gestational periods （〈28, 28-34 and ≥34 weeks） and were divided into poorly-（DM1） and well-（DM2） controlled groups according to their glycemic control at examination. Seventy uncomplicated mothers were selected as controls. Parameters of fetal cardiac anatomy and function were measured and analyzed. Results GDM fetuses＇ cardiac ventricular walls were thicker than controls＇, and the differences between DM1 and DM2 were not significant except for end-diastolic left ventricular walls. In both GDM groups, the aortic flow velocities increased earlier than pulmonary artery and DM1 fetuses changed earlier than DM2 ones. GDM fetuses＇ left atrial shortening fraction was smaller than the controls＇ in the period of ≥34 weeks and negatively correlated with thicknesses of left ventricular walls and interventricular septum in DM1 fetuses （r=-0.438 and -0.506）. The right ventricular diastolic function in DM1 and DM2 fetuses decreased after the period of 28-34 weeks and in the period of ≥34 weeks respectively. Tel index of both left and right ventricles increased in DM1 group after the period of 〈28 weeks and in DM2 group only in the period of ≥ 34 weeks, with no significant differences between DM1 and DM2 groups in this period. Conclusion Fetuses of GDM mothers showed cardiac function impairments. Good maternal glycemic control may delay the impairments, but cannot reduce the degree. Some cardiac changes in GDM fetuses were similar to those in pregestational diabetic pregnancies except for several parameters and their changing time.展开更多
Fetal heart rate (FHR) decelerations are the commonest aberrant feature on cardiotocograph (CTG) thus having a major influence on classification ofFHRpatterns into the three tier system. The unexplained paradox of ear...Fetal heart rate (FHR) decelerations are the commonest aberrant feature on cardiotocograph (CTG) thus having a major influence on classification ofFHRpatterns into the three tier system. The unexplained paradox of early decelerations (head compression—an invariable phenomenon in labor) being extremely rare [1] should prompt a debate about scientific validity of current categorization. This paper demonstrates that there appear to be major fallacies in the pathophysiological hypothesis (cord compression—baroreceptor mechanism) underpinning of vast majority of (variable?) decelerations. Rapid decelerations during contractions with nadir matching peak of contractions are consistent with “pure” vagal reflex (head compression) rather than result of fetal blood pressure or oxygenation changes from cord compression. Hence, many American authors have reported that the abrupt FHR decelerations attributed to cord compression are actually due to head compression [2-6]. The paper debates if there are major fundamental fallacies in current categorization of FHR decelerations based concomitantly on rate of descent (reflecting putative aetiology?) and time relationship to contractions. Decelerations with consistently early timing (constituting majority) seem to get classed as “variable” because of rapid descent. A distorted unscientific categorization of FHR decelerations could lead to clinically unhelpful three tier classification system. Hence, the current unphysiological classification needs a fresh debate with consideration of alternative models and re-evaluation of clinical studies to test these. Open debate improves patient care and safety. The clue to benign reflex versus hypoxic nature of decelerations seems to be in the timing rather than the rate of descent. Although the likelihood of fetal hypxemia is related to depth and duration ofFHRdecelerations, the cut-offs are likely to be different for early/late/variable decelerations and it seems to be of paramount importance to get this discrimination right for useful visual or computerized system of CTG interpretation.展开更多
Objective: To compare the diagnostic accuracy of Fetal Intelligent Navigation Echocardiography (FINE) method by Five-Dimensional Ultrasound in automated fetal heart examination to conventional fetal heart examination ...Objective: To compare the diagnostic accuracy of Fetal Intelligent Navigation Echocardiography (FINE) method by Five-Dimensional Ultrasound in automated fetal heart examination to conventional fetal heart examination by Two-Dimensional ultrasound in second trimester pregnancy. Methods: 90 normal singleton pregnancies at the second trimester were enrolled in this prospective study. Fetal heart was examined by Two-Dimensional Ultrasound (2D US) and Five-Dimensional Ultrasound (FINE). Paired numerical data were compared using the paired samples t test. Inter-method agreement for the rating of the quality of cardiac views by 2D US or 5D US was assessed by calculation of the prevalence-adjusted and bias-adjusted kappa coefficient (PABAK). Results: There was no statistical significant difference between fetal heart echocardiography assessment using 2DUS or 5DUS(FINE) (p-value > 0.05). The overall inter-method agreement between 2D US and 5D US was 0.92. The difference in % of satisfactory views between 2D and 5D US was 1.73%, (95% CI - 0.5% to 3.33%) (P-value = 0.144). Conclusion: Our findings indicate the accuracy of 5DUS (FINE) echocardiography in evaluation of normal heart in the second trimester of pregnancy.展开更多
Objective: To test the reproducibility of British experts’ (eFM, K2MS, Gibb and Arulkumaran) [1-3] illustrations of fetal heart rate (FHR) decelerations by trained British Obstetricians and midwives. To analyze reaso...Objective: To test the reproducibility of British experts’ (eFM, K2MS, Gibb and Arulkumaran) [1-3] illustrations of fetal heart rate (FHR) decelerations by trained British Obstetricians and midwives. To analyze reasons for any discrepancies by examining factors relating to the participants, British experts’ descriptions and NICE guidelines [4]. Design: Prospective observational study. Setting: National Health Service (NHS) Hospitals. Participants: 38 Obstetric Consultants, 49 registrars and 45 midwives. Methods: Printed questionnaire. Statistical Analysis: Fisher’s Exact test. Results: This largest study of its kind showed almost unbelievably high disconnect between CTG interpretation by experts and participants. 98% - 100% midwives, 80% - 100% Registrars and 74% - 100% Consultants categorized FHR decelerations differently from the five experts’ illustrations/interpretations (p < 0.0001). Remarkably, the three experts’ illustrations of early (supposedly most benign) decelerations were classed as atypical variable by 56% Consultants, 78% Registrars and 99% midwives and the CTGs as pathological by 85% of the participants. Conclusions: The high degree of disagreement with the experts’ illustrations (p < 0.0001) did not appear to be due to participant factors. The immediate reasons seemed to be the conflicting illustrations and heterogeneity of experts’ descriptions. But most importantly, these appeared to stem from non-standardized ambiguous definitions of FHR decelerations and many intrinsic systemic flaws in the current NICE guidelines [4]. The NICE concept of “true uniform” (identical) early and late decelerations seems biologically implausible (a myth) and no examples can be found. Another myth seems to be that early and late decelerations should be gradual. Only very shallow decelerations will look “gradual” on the British CTG. These systemic flaws lead to dysfunctional CTG interpretation increasing intervention as well as impairing diagnosis of fetal hypoxemia. This is because the vast majority of FHR decelerations fall in a single heterogeneous “variable” group with many further classed as “atypical” (pathological) based on disproven and discredited criteria [5-7]. There is increasing evidence in USA that a system with variable decelerations as the majority is clinically unhelpful because of loss of information [5-9]. In the interest of patient care and safety, open debate is necessary regarding a better way forward. Classification of FHR decelerations based primarily and solely on time relationship to contractions appears more scientific and clinically useful.展开更多
Objective:To use fetal heart quantification(fetal HQ)technology to compare the coarctation of the aorta(CoA)and normal fetal heart structure and systolic function and to assess whether there are abnormalities in the f...Objective:To use fetal heart quantification(fetal HQ)technology to compare the coarctation of the aorta(CoA)and normal fetal heart structure and systolic function and to assess whether there are abnormalities in the fetal heart structure and systolic function associated with CoA.Methods:This prospective cohort study was conducted from May 2020 to December 2022 and involved 18–40-week-old singleton pregnancies and 30 fetuses diagnosed with CoA using fetal echocardiography at the General Hospital of Ningxia Medical University and Peking University First Hospital Ningxia Women’s andChildren’s Hospital,China.The control group contained 60 normal fetuses.The following parameters were recorded and analyzed statistically:four-chamber view(4CV)end-diastolic long diameter,4CV epicardial–contralateral epicardial transverse maximum diameter,4CV global sphericity index(GSI),left ventricular(LV)and right ventricular(RV)24-segment end-diastolic diameter(EDD),24-segment sphericity index(SI),LV-fractional area change(LV-FAC),LV-longitudinal strain(LV-LS),RV-fractional area change(RV-FAC),RV-longitudinal strain(RV-LS),and LV and RV 24-segment transverse fractional shortening(FS).Measurement data were compared between the two groups using an independent sample t test,with P<0.05 indicating statistically significant differences.Moreover,the correlation between gestational age and GSI,LV-FAC,LV-LS,RV-FAC,and RV-LS was assessed.Results:Within and between observer comparisons of the parameters associated with major cardiac function revealed an intragroup correlation coefficient of>0.9,indicating high consistency,and a coefficient of variable of<1%,indicating low variability.Correlation analysis revealed no obvious correlation between gestational age and GSI,LV-FAC,LV-LS,RV-FAC,and RV-LS.A comparison of the fourchamber morphological structural parameters of the hearts in the two groups revealed that when compared with the control group,the 4CV end-diastolic long diameter was shortened in fetuses in the CoA group and the epicardial–contralateral epicardial transverse maximum diameter was wider,while the GSI was lower(P<0.05).A comparison of the LV and RV morphological structure parameters between the two groups revealed that when compared with the control group,the LV’s 24-segment EDD was smaller in the CoA group,the RV’s 24-segment EDD was greater in the control group,the SI of the LV’s segments 16–24 was greater than in the control group,and the SI of the RV’s segments 7–24 was less than in the control group(all P<0.05).When comparedwith fetuses in the control group,the LV’s segments16–24 were greater in the CoA group,whereas the RV’s segment 6–24 was smaller(P<0.05).When comparedwith the control group,LV-FAC,RV-FAC,and LS were lower in the CoA group(P<0.05).The FS of the LV segments 1–24 and the FS of the RV segments 1–16 were smaller in the CoA group than in the normal group(P<0.05).Conclusion:Fetal HQ,a new simple technique that offers rapid analysis and high repeatability,can quantitatively evaluate structural and systolic function changes in fetuses with CoA.展开更多
Objective:This study investigates the efficacy of analyzing fetal heart rate(FHR)signals based on Artificial Intelligence to obtain a baseline calculation and identify accelerations/decelerations in the FHR through el...Objective:This study investigates the efficacy of analyzing fetal heart rate(FHR)signals based on Artificial Intelligence to obtain a baseline calculation and identify accelerations/decelerations in the FHR through electronic fetal monitoring during labor.Methods:A total of 43,888 cardiotocograph(CTG)records of female patients in labor from January 2012 to December 2020 were collected from the NanFang Hospital of Southern Medical University.After filtering the data,2341 FHR records were used for the study.The ObVue fetal monitoring system,manufactured by Lian-Med Technology Co.Ltd.,was used to monitor the FHR signals for these pregnant women from the beginning of the first stage of labor to the end of delivery.Two obstetric experts together annotated the FHR signals in the system to determine the baseline as well as accelerations/decelerations of the FHR.Our cardiotocograph network(CTGNet)as well as traditional methods were then used to automatically analyze the baseline and acceleration/deceleration of the FHR signals.The results of calculations were compared with the annotations provided by the obstetric experts,and ten-fold cross-validation was applied to evaluate them.The root-mean-square difference(RMSD)between the baselines,acceleration F-measure(Acc.F-measure),deceleration F-measure(Dec.F-measure),coefficient of synthetic inconsistency(SI)and the morphological analysis discordance index(MADI)were used as evaluation metrics.The data were analyzed by using a pairedt-test.Results:The proposed CTGNet was superior to the best traditional method,proposed by Mantel,in terms of the RMSD.BL(1.7935±0.8099vs.2.0293±0.9267,t=-3.55,P=0.004),Acc.F-measure(86.8562±10.9422vs.72.2367±14.2096,t=12.43,P<0.001),Dec.F-measure(72.1038±33.2592vs.58.5040±38.0276,t=4.10,P<0.001),SI(34.8277±20.9595vs.54.8049±25.0265,t=-9.39,P<0.001),and MADI(3.1741±1.9901vs.3.7289±2.7253,t=-2.74,P=0.012).The proposed CTGNet thus had significant advantages over the best traditional method on all evaluation metrics.Conclusion:The proposed Artificial Intelligence-based method CTGNet delivers good performance in terms of the automatic analysis of FHR based on cardiotocograph data.It promises to be a key component of smart obstetrics systems of the future.展开更多
Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Meth...Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Methods Eighty-one pregnant women diagnosed as pre-eclampsia were prospectively enrolled and divided into severe pre-eclampsia(SPE)group(n=39)and mild pre-eclampsia(MPE)group(n=42),while 85 healthy pregnant women were taken as controls(control group).Fetal right heart function parameters,including right ventricular isovolumetric relaxation time(IRT),isovolumetric contraction time(ICT),ejection time(ET),total spent time(TST),Mod-MPI,tricuspid valve peak flow velocity ratio in early and late diastole(TV-E/A),as well as blood flow velocities in each waveform of DV spectrum(S,V,D,and A wave)were obtained,and the pulsatility index(PI)and the ratio of blood flow velocities in each waveform of the DV(S/V,S/D,S/A,V/D,V/A,D/A)were calculated.Intrauterine fetal distress,preterm delivery,neonatal asphyxia and newborn with low weight were considered as adverse pregnancy outcomes.The correlations of right heart Mod-MPI and TV-E/A with DV parameters in pre-eclampsia fetuses were assessed,and their predictive efficacies for adverse pregnancy outcomes were evaluated for right heart Mod-MPI and DV using the receiver operating characteristics(ROC)and the area under the curves(AUC).Results Compared with control group and MPE group,fetal right heart IRT,ICT and Mod-MPI increased and ET decreased in SPE group(all P<0.05).No significant differences of right heart TST and TV-E/A among 3 groups(both P>0.05).Fetal DV A-wave velocity and V/D values progressively decreased but PI progressively increased in control,MPE and SPE groups(all P<0.05).Fetal right heart Mod-MPI in pre-eclampsia was moderately positively correlated with DV PI(r=0.637,P=0.016),while TV-E/A was weakly negatively correlated with DV V/D(r=-0.355,P=0.043).Adverse pregnancy outcomes were noticed in 59 pre-eclampsia cases.The AUC of fetal right heart Mod-MPI and DV PI for predicting adverse pregnancy outcomes in pre-eclampsia cases was 0.897 and 0.848,respectively,without significant difference(Z=0.460,P=0.400).Conclusion Changes of right heart Mod-MPI and DV spectrum parameters in pre-eclampsia fetuses had high value for predicting adverse pregnancy outcomes.展开更多
BACKGROUND This study aimed to explore the possible etiology and treatment of severe fetal tachycardia in the absence of organic disease and provide a reference for clinical management of severe fetal tachycardia.CASE...BACKGROUND This study aimed to explore the possible etiology and treatment of severe fetal tachycardia in the absence of organic disease and provide a reference for clinical management of severe fetal tachycardia.CASE SUMMARY A 29-year-old pregnant woman,with a gravidity 1 parity 0,presented with a fetal heart rate(FHR)of 243 beats per minute during a routine antenatal examination at 31+2 wk of gestation.Before termination of pregnancy at 38 wk of gestation,the FHR repeatedly showed serious abnormalities,lasting more than 30 min.However,the pregnant woman and the fetus had no clinical symptoms,and repeated examination revealed no organic lesions.The mother and the baby were regularly followed up.CONCLUSION This was a case of severe fetal tachycardia with no organic lesions and management based on clinical experience.展开更多
Objective:This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty(FPV)in fetuses with pulmonary atresia with intact ventricular septum(PA/IVS).Methods:From August...Objective:This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty(FPV)in fetuses with pulmonary atresia with intact ventricular septum(PA/IVS).Methods:From August 31,2018,to May 31,2019,seven fetuses with PA/IVS and hypoplastic right heart were included in this study.All underwent echocardiography by the same specialist and were operated on by the same team.Intervention and echocardiography data were collected,and changes in the associated indices noted during follow-up were analyzed.Results:All seven fetuses successfully underwent FPV.The median gestational age at FPV was 27.54 weeks.The average FPV procedural time was 6 min.Persistent bradycardia requiring treatment occurred in 4/7 procedures.Finally,five pregnancies were successfully delivered,and the other two were aborted.Compared to data before fetal cardiac interventions(FCI),tricuspid valve annulus diameter/mitral valve annulus diameter(TV/MV)and right ventricle diameter/left ventricle diameter(RV/LV)of all fetuses had progressively improved.The maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/s.The average follow-up time was 30.40±2.05 months.During the follow-up period,the diameter of the tricuspid valve ring in five children continued to improve,and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth.However,the development of the right ventricle after birth was relatively slow.It was discovered that there were individual variations in the development of the right ventricle during follow-up.Conclusion:The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI.Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy.The right ventricle develops rapidly in utero,but the development of tricuspid valve is more apparent after birth than in utero.展开更多
Objective:To investigate the efficacy of in-phase and quadrature(IQ)demodulation in electronic fetal heart rate monitoring(EFM)to reduce false reports of fetal heart rate(FHR)doubling or halving.Methods:This is a pros...Objective:To investigate the efficacy of in-phase and quadrature(IQ)demodulation in electronic fetal heart rate monitoring(EFM)to reduce false reports of fetal heart rate(FHR)doubling or halving.Methods:This is a prospective cohort study.A total of 263 full-term pregnant women who delivered at Peking University Shenzhen Hospital between August 2019 and July 2020 were prospectively enrolled in the study.FHR monitoring began when the cervix was dilated to 2-3 cm and continued until delivery.Raw fetal Doppler audio signals and internal and external cardiotocography curves from internal electrode monitoring,EFM with conventional demodulation(external),and EFM with IQ demodulation(external)were acquired to compare FHR doubling and halving time.In cohort 1,FHR was compared between IQ demodulation and conventional demodulation.In cohort 2,FHR was compared between IQ demodulation,conventional demodulation,and internal FHR monitoring.Count data were statistically analyzed using the Chi-squared test,and measurement data were statistically analyzed usingt-test for correlation coefficients,and Bland-Altman analysis for concordance ranges.Results:To compare IQ demodulation and conventional demodulation,225 pregnant women were monitored for a total of 835,870 seconds.The beat-to-beat interval of FHRs in raw fetal Doppler audio signals was used as the reference.The results showed a doubling time of 3401 seconds(0.407%,3401/835,870)and a halving time of 2918 seconds(0.349%,2918/835,870)with conventional demodulation,compared to 241 seconds(0.029%,241/835,870)and 589 seconds(0.070%,589/835,870),respectively,with IQ demodulation.IQ demodulation reduced FHR doubling by approximately 93%(3160/3401)and FHR halving by approximately 80%(2329/2918)compared to conventional demodulation(P<0.01).Conclusion:EFM with IQ demodulation significantly reduces false FHR doubling and halving,with an efficacy similar to that of internal FHR monitoring.展开更多
<div style="text-align:justify;"> The morbidity and mortality of the fetus is related closely with the neonatal respiratory morbidity, which was caused by the immaturity of the fetal lung primarily. Th...<div style="text-align:justify;"> The morbidity and mortality of the fetus is related closely with the neonatal respiratory morbidity, which was caused by the immaturity of the fetal lung primarily. The amniocentesis has been used in clinics to evaluate the maturity of the fetal lung, which is invasive, expensive and time-consuming. Ultrasonography has been developed to examine the fetal lung quantitatively in the past decades as a non-invasive method. However, the contour of the fetal lung required by existing studies was delineated in manual. An automated segmentation approach could not only improve the objectiveness of those studies, but also offer a quantitative way to monitor the development of the fetal lung in terms of morphological parameters based on the segmentation. In view of this, we proposed a deep learning model for automated fetal lung segmentation and measurement. The model was constructed based on the U-Net. It was trained by 3500 data sets augmented from 250 ultrasound images with both the fetal lung and heart manually delineated, and then tested on 50 ultrasound data sets. With the proposed method, the fetal lung and cardiac area were automatically segmented with the accuracy, average IoU, sensitivity and precision being 0.98, 0.79, 0.881 and 0.886, respectively. </div>展开更多
文摘<strong>Introduction: </strong><span style="font-family:""><span style="font-family:Verdana;">Fetal heart rate monitoring during labor is used to study fetal well-being and predict neonatal acidosis of newborn. Fetal heart rate monitoring is analyzed by the obstetrical team and categorized according to the FIGO guidelines. An important limitation of this diagnostic tool is an inter- and intra-observer variability, leading to subjective cardiotocography interpretation and classification. Our objective was to study the association between the categories of fetal heart rate analysis (according to FIGO classification) and neonatal acidosis of full-term newborns. </span><b><span style="font-family:Verdana;">Study design:</span></b><span style="font-family:Verdana;"> This is a multicenter retrospective cohort study conducted between 2014 and 2018 in the Grand-Est region. We searched and included retrospectively children hospitalized in a pediatric intensive care unit in one of the participating hospitals with an ICD-10 coding type “P91.6” corresponding to “Hypoxic Ischemic Encephalopathy”. Maternal, pregnancy, delivery, and newborn characteristics were collected and compared by univariate logistic regression with multiple imputation. Odds Ratio and 95% confidence intervals (CI) were calculated using the model and presented. Multiple imputation with m = 100 imputations was tested, using Rubin rules to combine the results. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">55 patients were included in the study. Fetal heart rate tracings classified in Category 3 as “pathological” according to FIGO guidelines were significantly associated with an increased risk of severe neonatal acidosis. Late decelerations and bradycardia during labor were associated with severe neonatal acidosis. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Severe neonatal acidosis may be suspected by interpretation of fetal heart rate during labor. Fetal bradycardia and late decelerations are predictive of the severity of neonatal acidosis. This study emphasizes the need to screen severe neonatal acidosis and allows the identification of populations most at risk. Repeated team training and upgrading of fetal heart rate study would further reduce the incidence of neonatal acidosis.</span></span>
基金supported by Fujian Provincial Science and Technology Major Project(No.2020HZ02014)by the grants from National Natural Science Foundation of Fujian(2021J01133,2021J011404)by the Quanzhou Scientific and Technological Planning Projects(Nos.2018C113R,2019C028R,2019C029R,2019C076R and 2019C099R).
文摘Congenital heart defect,accounting for about 30%of congenital defects,is the most common one.Data shows that congenital heart defects have seriously affected the birth rate of healthy newborns.In Fetal andNeonatal Cardiology,medical imaging technology(2D ultrasonic,MRI)has been proved to be helpful to detect congenital defects of the fetal heart and assists sonographers in prenatal diagnosis.It is a highly complex task to recognize 2D fetal heart ultrasonic standard plane(FHUSP)manually.Compared withmanual identification,automatic identification through artificial intelligence can save a lot of time,ensure the efficiency of diagnosis,and improve the accuracy of diagnosis.In this study,a feature extraction method based on texture features(Local Binary Pattern LBP and Histogram of Oriented Gradient HOG)and combined with Bag of Words(BOW)model is carried out,and then feature fusion is performed.Finally,it adopts Support VectorMachine(SVM)to realize automatic recognition and classification of FHUSP.The data includes 788 standard plane data sets and 448 normal and abnormal plane data sets.Compared with some other methods and the single method model,the classification accuracy of our model has been obviously improved,with the highest accuracy reaching 87.35%.Similarly,we also verify the performance of the model in normal and abnormal planes,and the average accuracy in classifying abnormal and normal planes is 84.92%.The experimental results show that thismethod can effectively classify and predict different FHUSP and can provide certain assistance for sonographers to diagnose fetal congenital heart disease.
文摘This paper briefly introduces the collection and recognition of bio-medical sig nals, designs the method to collect FM signals. A detailed discussion on the sys tem hardware, structure and functions is also given. Under LabWindows/CVI,the ha rdware and the driver do compatible, the hardware equipment work properly active ly. The paper adopts multi threading technology for real-time analysis and make s use of latency time of CPU effectively, expedites program reflect speed, impro ve s the program to perform efficiency. One threading is collecting data; the other threading is analyzing data. Using the method, it is broaden to analyze the sig nal in real-time. Wavelet transform to remove the main interference in the FM a nd by adding time-window to recognize with BP network; Finally the results of c ollecting signals and BP networks are discussed.8 pregnant women’s signals of F M were collected successfully by using the sensor. The correct of BP network rec ognition is about 83.3% by using the above measure.
基金supported by the National Natural Science Foundation of China (81001228)National High Technology Research and Development Program of China (863 Program)(2007AA02Z442)
文摘Objective To evaluate the fetal cardiac function in gestational diabetes mellitus （GDM） pregnancies under different maternal glycemic controls. Methods Forty four GDM mothers received 78 fetal echocardiographic evaluations at three gestational periods （〈28, 28-34 and ≥34 weeks） and were divided into poorly-（DM1） and well-（DM2） controlled groups according to their glycemic control at examination. Seventy uncomplicated mothers were selected as controls. Parameters of fetal cardiac anatomy and function were measured and analyzed. Results GDM fetuses＇ cardiac ventricular walls were thicker than controls＇, and the differences between DM1 and DM2 were not significant except for end-diastolic left ventricular walls. In both GDM groups, the aortic flow velocities increased earlier than pulmonary artery and DM1 fetuses changed earlier than DM2 ones. GDM fetuses＇ left atrial shortening fraction was smaller than the controls＇ in the period of ≥34 weeks and negatively correlated with thicknesses of left ventricular walls and interventricular septum in DM1 fetuses （r=-0.438 and -0.506）. The right ventricular diastolic function in DM1 and DM2 fetuses decreased after the period of 28-34 weeks and in the period of ≥34 weeks respectively. Tel index of both left and right ventricles increased in DM1 group after the period of 〈28 weeks and in DM2 group only in the period of ≥ 34 weeks, with no significant differences between DM1 and DM2 groups in this period. Conclusion Fetuses of GDM mothers showed cardiac function impairments. Good maternal glycemic control may delay the impairments, but cannot reduce the degree. Some cardiac changes in GDM fetuses were similar to those in pregestational diabetic pregnancies except for several parameters and their changing time.
文摘Fetal heart rate (FHR) decelerations are the commonest aberrant feature on cardiotocograph (CTG) thus having a major influence on classification ofFHRpatterns into the three tier system. The unexplained paradox of early decelerations (head compression—an invariable phenomenon in labor) being extremely rare [1] should prompt a debate about scientific validity of current categorization. This paper demonstrates that there appear to be major fallacies in the pathophysiological hypothesis (cord compression—baroreceptor mechanism) underpinning of vast majority of (variable?) decelerations. Rapid decelerations during contractions with nadir matching peak of contractions are consistent with “pure” vagal reflex (head compression) rather than result of fetal blood pressure or oxygenation changes from cord compression. Hence, many American authors have reported that the abrupt FHR decelerations attributed to cord compression are actually due to head compression [2-6]. The paper debates if there are major fundamental fallacies in current categorization of FHR decelerations based concomitantly on rate of descent (reflecting putative aetiology?) and time relationship to contractions. Decelerations with consistently early timing (constituting majority) seem to get classed as “variable” because of rapid descent. A distorted unscientific categorization of FHR decelerations could lead to clinically unhelpful three tier classification system. Hence, the current unphysiological classification needs a fresh debate with consideration of alternative models and re-evaluation of clinical studies to test these. Open debate improves patient care and safety. The clue to benign reflex versus hypoxic nature of decelerations seems to be in the timing rather than the rate of descent. Although the likelihood of fetal hypxemia is related to depth and duration ofFHRdecelerations, the cut-offs are likely to be different for early/late/variable decelerations and it seems to be of paramount importance to get this discrimination right for useful visual or computerized system of CTG interpretation.
文摘Objective: To compare the diagnostic accuracy of Fetal Intelligent Navigation Echocardiography (FINE) method by Five-Dimensional Ultrasound in automated fetal heart examination to conventional fetal heart examination by Two-Dimensional ultrasound in second trimester pregnancy. Methods: 90 normal singleton pregnancies at the second trimester were enrolled in this prospective study. Fetal heart was examined by Two-Dimensional Ultrasound (2D US) and Five-Dimensional Ultrasound (FINE). Paired numerical data were compared using the paired samples t test. Inter-method agreement for the rating of the quality of cardiac views by 2D US or 5D US was assessed by calculation of the prevalence-adjusted and bias-adjusted kappa coefficient (PABAK). Results: There was no statistical significant difference between fetal heart echocardiography assessment using 2DUS or 5DUS(FINE) (p-value > 0.05). The overall inter-method agreement between 2D US and 5D US was 0.92. The difference in % of satisfactory views between 2D and 5D US was 1.73%, (95% CI - 0.5% to 3.33%) (P-value = 0.144). Conclusion: Our findings indicate the accuracy of 5DUS (FINE) echocardiography in evaluation of normal heart in the second trimester of pregnancy.
文摘Objective: To test the reproducibility of British experts’ (eFM, K2MS, Gibb and Arulkumaran) [1-3] illustrations of fetal heart rate (FHR) decelerations by trained British Obstetricians and midwives. To analyze reasons for any discrepancies by examining factors relating to the participants, British experts’ descriptions and NICE guidelines [4]. Design: Prospective observational study. Setting: National Health Service (NHS) Hospitals. Participants: 38 Obstetric Consultants, 49 registrars and 45 midwives. Methods: Printed questionnaire. Statistical Analysis: Fisher’s Exact test. Results: This largest study of its kind showed almost unbelievably high disconnect between CTG interpretation by experts and participants. 98% - 100% midwives, 80% - 100% Registrars and 74% - 100% Consultants categorized FHR decelerations differently from the five experts’ illustrations/interpretations (p < 0.0001). Remarkably, the three experts’ illustrations of early (supposedly most benign) decelerations were classed as atypical variable by 56% Consultants, 78% Registrars and 99% midwives and the CTGs as pathological by 85% of the participants. Conclusions: The high degree of disagreement with the experts’ illustrations (p < 0.0001) did not appear to be due to participant factors. The immediate reasons seemed to be the conflicting illustrations and heterogeneity of experts’ descriptions. But most importantly, these appeared to stem from non-standardized ambiguous definitions of FHR decelerations and many intrinsic systemic flaws in the current NICE guidelines [4]. The NICE concept of “true uniform” (identical) early and late decelerations seems biologically implausible (a myth) and no examples can be found. Another myth seems to be that early and late decelerations should be gradual. Only very shallow decelerations will look “gradual” on the British CTG. These systemic flaws lead to dysfunctional CTG interpretation increasing intervention as well as impairing diagnosis of fetal hypoxemia. This is because the vast majority of FHR decelerations fall in a single heterogeneous “variable” group with many further classed as “atypical” (pathological) based on disproven and discredited criteria [5-7]. There is increasing evidence in USA that a system with variable decelerations as the majority is clinically unhelpful because of loss of information [5-9]. In the interest of patient care and safety, open debate is necessary regarding a better way forward. Classification of FHR decelerations based primarily and solely on time relationship to contractions appears more scientific and clinically useful.
基金funded by the Ningxia Natural Science Foundation(grant ID.2022A1467).
文摘Objective:To use fetal heart quantification(fetal HQ)technology to compare the coarctation of the aorta(CoA)and normal fetal heart structure and systolic function and to assess whether there are abnormalities in the fetal heart structure and systolic function associated with CoA.Methods:This prospective cohort study was conducted from May 2020 to December 2022 and involved 18–40-week-old singleton pregnancies and 30 fetuses diagnosed with CoA using fetal echocardiography at the General Hospital of Ningxia Medical University and Peking University First Hospital Ningxia Women’s andChildren’s Hospital,China.The control group contained 60 normal fetuses.The following parameters were recorded and analyzed statistically:four-chamber view(4CV)end-diastolic long diameter,4CV epicardial–contralateral epicardial transverse maximum diameter,4CV global sphericity index(GSI),left ventricular(LV)and right ventricular(RV)24-segment end-diastolic diameter(EDD),24-segment sphericity index(SI),LV-fractional area change(LV-FAC),LV-longitudinal strain(LV-LS),RV-fractional area change(RV-FAC),RV-longitudinal strain(RV-LS),and LV and RV 24-segment transverse fractional shortening(FS).Measurement data were compared between the two groups using an independent sample t test,with P<0.05 indicating statistically significant differences.Moreover,the correlation between gestational age and GSI,LV-FAC,LV-LS,RV-FAC,and RV-LS was assessed.Results:Within and between observer comparisons of the parameters associated with major cardiac function revealed an intragroup correlation coefficient of>0.9,indicating high consistency,and a coefficient of variable of<1%,indicating low variability.Correlation analysis revealed no obvious correlation between gestational age and GSI,LV-FAC,LV-LS,RV-FAC,and RV-LS.A comparison of the fourchamber morphological structural parameters of the hearts in the two groups revealed that when compared with the control group,the 4CV end-diastolic long diameter was shortened in fetuses in the CoA group and the epicardial–contralateral epicardial transverse maximum diameter was wider,while the GSI was lower(P<0.05).A comparison of the LV and RV morphological structure parameters between the two groups revealed that when compared with the control group,the LV’s 24-segment EDD was smaller in the CoA group,the RV’s 24-segment EDD was greater in the control group,the SI of the LV’s segments 16–24 was greater than in the control group,and the SI of the RV’s segments 7–24 was less than in the control group(all P<0.05).When comparedwith fetuses in the control group,the LV’s segments16–24 were greater in the CoA group,whereas the RV’s segment 6–24 was smaller(P<0.05).When comparedwith the control group,LV-FAC,RV-FAC,and LS were lower in the CoA group(P<0.05).The FS of the LV segments 1–24 and the FS of the RV segments 1–16 were smaller in the CoA group than in the normal group(P<0.05).Conclusion:Fetal HQ,a new simple technique that offers rapid analysis and high repeatability,can quantitatively evaluate structural and systolic function changes in fetuses with CoA.
基金supported by National Key Research and Development Project(2019YFC0121907 and 2019YFC0120100)Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization(2021B1212040007)。
文摘Objective:This study investigates the efficacy of analyzing fetal heart rate(FHR)signals based on Artificial Intelligence to obtain a baseline calculation and identify accelerations/decelerations in the FHR through electronic fetal monitoring during labor.Methods:A total of 43,888 cardiotocograph(CTG)records of female patients in labor from January 2012 to December 2020 were collected from the NanFang Hospital of Southern Medical University.After filtering the data,2341 FHR records were used for the study.The ObVue fetal monitoring system,manufactured by Lian-Med Technology Co.Ltd.,was used to monitor the FHR signals for these pregnant women from the beginning of the first stage of labor to the end of delivery.Two obstetric experts together annotated the FHR signals in the system to determine the baseline as well as accelerations/decelerations of the FHR.Our cardiotocograph network(CTGNet)as well as traditional methods were then used to automatically analyze the baseline and acceleration/deceleration of the FHR signals.The results of calculations were compared with the annotations provided by the obstetric experts,and ten-fold cross-validation was applied to evaluate them.The root-mean-square difference(RMSD)between the baselines,acceleration F-measure(Acc.F-measure),deceleration F-measure(Dec.F-measure),coefficient of synthetic inconsistency(SI)and the morphological analysis discordance index(MADI)were used as evaluation metrics.The data were analyzed by using a pairedt-test.Results:The proposed CTGNet was superior to the best traditional method,proposed by Mantel,in terms of the RMSD.BL(1.7935±0.8099vs.2.0293±0.9267,t=-3.55,P=0.004),Acc.F-measure(86.8562±10.9422vs.72.2367±14.2096,t=12.43,P<0.001),Dec.F-measure(72.1038±33.2592vs.58.5040±38.0276,t=4.10,P<0.001),SI(34.8277±20.9595vs.54.8049±25.0265,t=-9.39,P<0.001),and MADI(3.1741±1.9901vs.3.7289±2.7253,t=-2.74,P=0.012).The proposed CTGNet thus had significant advantages over the best traditional method on all evaluation metrics.Conclusion:The proposed Artificial Intelligence-based method CTGNet delivers good performance in terms of the automatic analysis of FHR based on cardiotocograph data.It promises to be a key component of smart obstetrics systems of the future.
文摘Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Methods Eighty-one pregnant women diagnosed as pre-eclampsia were prospectively enrolled and divided into severe pre-eclampsia(SPE)group(n=39)and mild pre-eclampsia(MPE)group(n=42),while 85 healthy pregnant women were taken as controls(control group).Fetal right heart function parameters,including right ventricular isovolumetric relaxation time(IRT),isovolumetric contraction time(ICT),ejection time(ET),total spent time(TST),Mod-MPI,tricuspid valve peak flow velocity ratio in early and late diastole(TV-E/A),as well as blood flow velocities in each waveform of DV spectrum(S,V,D,and A wave)were obtained,and the pulsatility index(PI)and the ratio of blood flow velocities in each waveform of the DV(S/V,S/D,S/A,V/D,V/A,D/A)were calculated.Intrauterine fetal distress,preterm delivery,neonatal asphyxia and newborn with low weight were considered as adverse pregnancy outcomes.The correlations of right heart Mod-MPI and TV-E/A with DV parameters in pre-eclampsia fetuses were assessed,and their predictive efficacies for adverse pregnancy outcomes were evaluated for right heart Mod-MPI and DV using the receiver operating characteristics(ROC)and the area under the curves(AUC).Results Compared with control group and MPE group,fetal right heart IRT,ICT and Mod-MPI increased and ET decreased in SPE group(all P<0.05).No significant differences of right heart TST and TV-E/A among 3 groups(both P>0.05).Fetal DV A-wave velocity and V/D values progressively decreased but PI progressively increased in control,MPE and SPE groups(all P<0.05).Fetal right heart Mod-MPI in pre-eclampsia was moderately positively correlated with DV PI(r=0.637,P=0.016),while TV-E/A was weakly negatively correlated with DV V/D(r=-0.355,P=0.043).Adverse pregnancy outcomes were noticed in 59 pre-eclampsia cases.The AUC of fetal right heart Mod-MPI and DV PI for predicting adverse pregnancy outcomes in pre-eclampsia cases was 0.897 and 0.848,respectively,without significant difference(Z=0.460,P=0.400).Conclusion Changes of right heart Mod-MPI and DV spectrum parameters in pre-eclampsia fetuses had high value for predicting adverse pregnancy outcomes.
文摘BACKGROUND This study aimed to explore the possible etiology and treatment of severe fetal tachycardia in the absence of organic disease and provide a reference for clinical management of severe fetal tachycardia.CASE SUMMARY A 29-year-old pregnant woman,with a gravidity 1 parity 0,presented with a fetal heart rate(FHR)of 243 beats per minute during a routine antenatal examination at 31+2 wk of gestation.Before termination of pregnancy at 38 wk of gestation,the FHR repeatedly showed serious abnormalities,lasting more than 30 min.However,the pregnant woman and the fetus had no clinical symptoms,and repeated examination revealed no organic lesions.The mother and the baby were regularly followed up.CONCLUSION This was a case of severe fetal tachycardia with no organic lesions and management based on clinical experience.
文摘Objective:This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty(FPV)in fetuses with pulmonary atresia with intact ventricular septum(PA/IVS).Methods:From August 31,2018,to May 31,2019,seven fetuses with PA/IVS and hypoplastic right heart were included in this study.All underwent echocardiography by the same specialist and were operated on by the same team.Intervention and echocardiography data were collected,and changes in the associated indices noted during follow-up were analyzed.Results:All seven fetuses successfully underwent FPV.The median gestational age at FPV was 27.54 weeks.The average FPV procedural time was 6 min.Persistent bradycardia requiring treatment occurred in 4/7 procedures.Finally,five pregnancies were successfully delivered,and the other two were aborted.Compared to data before fetal cardiac interventions(FCI),tricuspid valve annulus diameter/mitral valve annulus diameter(TV/MV)and right ventricle diameter/left ventricle diameter(RV/LV)of all fetuses had progressively improved.The maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/s.The average follow-up time was 30.40±2.05 months.During the follow-up period,the diameter of the tricuspid valve ring in five children continued to improve,and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth.However,the development of the right ventricle after birth was relatively slow.It was discovered that there were individual variations in the development of the right ventricle during follow-up.Conclusion:The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI.Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy.The right ventricle develops rapidly in utero,but the development of tricuspid valve is more apparent after birth than in utero.
基金Shenzhen Science and Technology Innovation Commission(JCYJ20180228162311024)。
文摘Objective:To investigate the efficacy of in-phase and quadrature(IQ)demodulation in electronic fetal heart rate monitoring(EFM)to reduce false reports of fetal heart rate(FHR)doubling or halving.Methods:This is a prospective cohort study.A total of 263 full-term pregnant women who delivered at Peking University Shenzhen Hospital between August 2019 and July 2020 were prospectively enrolled in the study.FHR monitoring began when the cervix was dilated to 2-3 cm and continued until delivery.Raw fetal Doppler audio signals and internal and external cardiotocography curves from internal electrode monitoring,EFM with conventional demodulation(external),and EFM with IQ demodulation(external)were acquired to compare FHR doubling and halving time.In cohort 1,FHR was compared between IQ demodulation and conventional demodulation.In cohort 2,FHR was compared between IQ demodulation,conventional demodulation,and internal FHR monitoring.Count data were statistically analyzed using the Chi-squared test,and measurement data were statistically analyzed usingt-test for correlation coefficients,and Bland-Altman analysis for concordance ranges.Results:To compare IQ demodulation and conventional demodulation,225 pregnant women were monitored for a total of 835,870 seconds.The beat-to-beat interval of FHRs in raw fetal Doppler audio signals was used as the reference.The results showed a doubling time of 3401 seconds(0.407%,3401/835,870)and a halving time of 2918 seconds(0.349%,2918/835,870)with conventional demodulation,compared to 241 seconds(0.029%,241/835,870)and 589 seconds(0.070%,589/835,870),respectively,with IQ demodulation.IQ demodulation reduced FHR doubling by approximately 93%(3160/3401)and FHR halving by approximately 80%(2329/2918)compared to conventional demodulation(P<0.01).Conclusion:EFM with IQ demodulation significantly reduces false FHR doubling and halving,with an efficacy similar to that of internal FHR monitoring.
文摘<div style="text-align:justify;"> The morbidity and mortality of the fetus is related closely with the neonatal respiratory morbidity, which was caused by the immaturity of the fetal lung primarily. The amniocentesis has been used in clinics to evaluate the maturity of the fetal lung, which is invasive, expensive and time-consuming. Ultrasonography has been developed to examine the fetal lung quantitatively in the past decades as a non-invasive method. However, the contour of the fetal lung required by existing studies was delineated in manual. An automated segmentation approach could not only improve the objectiveness of those studies, but also offer a quantitative way to monitor the development of the fetal lung in terms of morphological parameters based on the segmentation. In view of this, we proposed a deep learning model for automated fetal lung segmentation and measurement. The model was constructed based on the U-Net. It was trained by 3500 data sets augmented from 250 ultrasound images with both the fetal lung and heart manually delineated, and then tested on 50 ultrasound data sets. With the proposed method, the fetal lung and cardiac area were automatically segmented with the accuracy, average IoU, sensitivity and precision being 0.98, 0.79, 0.881 and 0.886, respectively. </div>
