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Takeno MA, Nomura RMY. Fetal thymus in growth-restricted fetuses due to placental insufficiency. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:136-141. [PMID: 36629653 PMCID: PMC9937593 DOI: 10.1590/1806-9282.20220975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to assess fetal thymus size by ultrasound in growth-restricted fetuses due to placental insufficiency and compare to high-risk and low-risk pregnancy fetuses with normal placental function. METHODS This is a nested case-control study of pregnant women followed up at a university hospital (July 2012 to July 2013). In all, 30 pregnant women presenting small fetuses for gestational age (estimated fetal weight <p10) due to placental insufficiency (umbilical artery Doppler >p95) were compared to 30 high-risk and 30 low-risk pregnancies presenting normal Doppler indices. The thymus transverse diameter and perimeter were converted into zeta score according to the normal values for gestational age. Head circumference and femur length were used to calculate ratios. RESULTS Fetal thymus were significantly lower in pregnancies with placental insufficiency when compared to high-risk and low-risk pregnancies presenting, respectively, transverse diameter zeta score (-0.69±0.83 vs. 0.49±1.13 vs. 0.83±0.85, p<0.001) and P zeta score (-0.73±0.68 vs. 0.45±0.96 vs. 0.26±0.89, p<0.001). There was also a significant difference (p<0.05) in the ratios among the groups: pregnancies with placental insufficiency (TD/HC=0.10, P/FL=1.32, and P/HC=0.26), high-risk pregnancies (TD/HC=0.11, P/FL=1.40, and P/HC=0.30), and control group (DT/HC=0.11, P/FL=1.45, and P/HC=0.31). CONCLUSION Fetal thymus size is reduced in growth-restricted fetuses due to placental insufficiency, suggesting fetal response as a consequence of the adverse environment.
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Affiliation(s)
- Marisa Akemi Takeno
- Universidade de São Paulo, Faculty of Medicine, Department of Obstetrics and Gynecology – São Paulo (SP), Brazil
| | - Roseli Mieko Yamamoto Nomura
- Universidade de São Paulo, Faculty of Medicine, Department of Obstetrics and Gynecology – São Paulo (SP), Brazil.,Corresponding author:
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Gök K, Özden S. Finding the best method for screening for gestational diabetes mellitus: fetal thymic-thoracic ratio or fetal thymus transverse diameter. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:303-307. [PMID: 36790236 PMCID: PMC9983463 DOI: 10.1590/1806-9282.20221012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/04/2022] [Indexed: 02/12/2023]
Abstract
OBJECTIVE The aim of this study was to compare the efficiency of fetal thymic-thoracic ratio and fetal thymus transverse diameter measurements in gestational diabetes mellitus. METHODS Fetal thymic-thoracic ratio and fetal thymus transverse diameter were assessed in 360 pregnant women. Patients were examined in two groups: 180 gestational diabetes mellitus (study group) and 180 healthy pregnant women (control group). RESULTS There were no statistically significant differences between the cases with gestational diabetes mellitus and the control group in terms of fetal thymus transverse diameter; however, the fetal thymic-thoracic ratio was found to be significantly lower in cases with gestational diabetes mellitus compared to that in the control group (p<0.001). CONCLUSION The fetal thymic-thoracic ratio is superior to the fetal thymus transverse diameter in evaluating the fetal thymus size.
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Affiliation(s)
- Koray Gök
- Sakarya Üniversitesi, Faculty of Medicine, Department of Obstetrics and Gynecology - Sakarya, Turkey
| | - Selçuk Özden
- Sakarya Üniversitesi, Faculty of Medicine, Department of Obstetrics and Gynecology - Sakarya, Turkey
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Myers R, Hutter J, Matthew J, Zhang T, Uus A, Lloyd D, Egloff A, Deprez M, Nanda S, Rutherford M, Story L. Assessment of the fetal thymus gland: Comparing MRI-acquired thymus volumes with 2D ultrasound measurements. Eur J Obstet Gynecol Reprod Biol 2021; 264:1-7. [PMID: 34246829 DOI: 10.1016/j.ejogrb.2021.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The fetal thymus gland has been shown to involute in response to intrauterine infection, and therefore could be used as a non-invasive marker of fetal compartment infection. The objective of this study was to evaluate how accurately 2D ultrasound-derived measurements of the fetal thymus reflect the 3D volume of the gland derived from motion corrected MRI images. STUDY DESIGN A retrospective study was performed using paired ultrasound and MRI datasets from the iFIND project (http://www.ifindproject.com). To obtain 3D volumetry of the thymus gland, T2-weighted single shot turbo spin echo (ssTSE) sequences of the fetal thorax were acquired. Thymus volumes were manually segmented from deformable slice-to-volume reconstructed images. To obtain 2D ultrasound measurements, previously stored fetal cine loops were used and measurements obtained at the 3-vessel-view (3VV) and 3-vessel-trachea view (3VT): anterior-posterior diameter (APD), intrathoracic diameter (ITD), transverse diameter (TD), perimeter and 3-vessel-edge (3VE). Inter-observer and intra-observer reliability (ICC) was calculated for both MRI and ultrasound measurements. Pearson correlation coefficients (PCC) were used to compare 2D-parameters with acceptable ICC to TV. RESULTS 38 participants were identified. Adequate visualisation was possible on 37 MRI scans and 31 ultrasound scans. Of the 30 datasets where both MRI and ultrasound data were available, MRI had good interobserver reliability (ICC 0.964) and all ultrasound 3VV 2D-parameters and 3VT 3VE had acceptable ICC (>0.75). Four 2D parameters were reflective of the 3D thymus volume: 3VV TD r = 0.540 (P = 0.002); 3VV perimeter r = 0.446 (P = 0.013); 3VV APD r = 0.435 (P = 0.110) and 3VT TD r = 0.544 (P = 0.002). CONCLUSIONS MRI appeared superior to ultrasound for visualization of the thymus gland and reproducibility of measurements. Three 2D US parameters, 3VV TD, perimeter and 3VT APD, correlated well with TV. Therefore, these represent a more accurate reflection of the true size of the gland than other 2D measurements, where MRI is not available.
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Affiliation(s)
- Rebecca Myers
- King's College London School of Bioscience, St George's, University of London, UK
| | - Jana Hutter
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Jacqueline Matthew
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Tong Zhang
- Artificial Intelligence Research Center, Peng Cheng Laboratory, Shenzhen, China
| | - Alena Uus
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - David Lloyd
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Alexia Egloff
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Maria Deprez
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Surabhi Nanda
- Department of Fetal Medicine, St Thomas' Hospital London, UK
| | - Mary Rutherford
- Department of Perinatal Imaging, School of Biomedical Engineering, King's College London, UK
| | - Lisa Story
- Department of Fetal Medicine, St Thomas' Hospital London, UK; Department of Women and Children's Health King's College London, UK.
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Lian X, Xu Z, Zheng L, Zhu Z, Ejiwale T, Kumar A, Cai P, He S, Liu S, Zhang Y, Lyu G. Reference range of fetal thorax using two-dimensional and three-dimensional ultrasound VOCAL technique and application in fetal thoracic malformations. BMC Med Imaging 2021; 21:34. [PMID: 33618694 PMCID: PMC7898741 DOI: 10.1186/s12880-021-00548-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background To establish the normal reference range of fetal thorax by two-dimensional (2D) and three-dimensional (3D) ultrasound VOCAL technique and evaluate the application in diagnosing fetal thoracic malformations. Methods A prospective cross-sectional study was undertaken involving 1077 women who have a normal singleton pregnancy at 13–40 weeks gestational age (GA). 2D ultrasound and 3D ultrasound VOCAL technique were utilized to assess fetal thoracic transverse diameter, thoracic anteroposterior diameter, thoracic circumference, thoracic area, lung volume, thoracic volume and lung-to-thoracic volume ratio. The nomograms of 2D and 3D fetal thoracic measurements were created to GA. 50 cases were randomly selected to calculate intra- and inter-observer reliability and agreement. In addition, the case groups including congenital skeletal dysplasia (SD) (15), congenital diaphragmatic hernia (CDH) (30), pulmonary sequestration (PS) (25) and congenital cystic adenomatoid malformation (CCAM) (36) were assessed by the nomograms and followed up subsequently. Results Both 2D and 3D fetal thoracic parameters increased with GA using a quadratic regression equation. The intra- and inter-observer reliability and agreement of each thoracic parameter were excellent. 2D fetal thoracic parameters could initially evaluate the fetal thoracic development and diagnose the skeletal thoracic deformity, and lung volume, thoracic volume and lung-to-thorax volume ratio were practical to diagnose and differentiate CDH, PS and CCAM. Conclusion We have established the normal fetal thoracic reference range at 13–40 weeks, which has a high value in diagnosing congenital thoracic malformations.
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Affiliation(s)
- Xihua Lian
- Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, No. 2 Ji'an Road, Fengze District, Quanzhou, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Quanzhou, China.,Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Zhenhong Xu
- Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, No. 2 Ji'an Road, Fengze District, Quanzhou, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Quanzhou, China
| | - Liping Zheng
- Department of Ultrasound Medicine, Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Zhixing Zhu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Tofunmi Ejiwale
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Ayush Kumar
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Peiya Cai
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shaozheng He
- Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, No. 2 Ji'an Road, Fengze District, Quanzhou, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Quanzhou, China
| | - Shunlan Liu
- Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, No. 2 Ji'an Road, Fengze District, Quanzhou, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Quanzhou, China
| | - Ying Zhang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, No. 2 Ji'an Road, Fengze District, Quanzhou, China
| | - Guorong Lyu
- Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, No. 2 Ji'an Road, Fengze District, Quanzhou, China. .,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Quanzhou, China.
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Granadier D, Iovino L, Kinsella S, Dudakov JA. Dynamics of thymus function and T cell receptor repertoire breadth in health and disease. Semin Immunopathol 2021; 43:119-134. [PMID: 33608819 PMCID: PMC7894242 DOI: 10.1007/s00281-021-00840-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/12/2021] [Indexed: 12/26/2022]
Abstract
T cell recognition of unknown antigens relies on the tremendous diversity of the T cell receptor (TCR) repertoire; generation of which can only occur in the thymus. TCR repertoire breadth is thus critical for not only coordinating the adaptive response against pathogens but also for mounting a response against malignancies. However, thymic function is exquisitely sensitive to negative stimuli, which can come in the form of acute insult, such as that caused by stress, infection, or common cancer therapies; or chronic damage such as the progressive decline in thymic function with age. Whether it be prolonged T cell deficiency after hematopoietic cell transplantation (HCT) or constriction in the breadth of the peripheral TCR repertoire with age; these insults result in poor adaptive immune responses. In this review, we will discuss the importance of thymic function for generation of the TCR repertoire and how acute and chronic thymic damage influences immune health. We will also discuss methods that are used to measure thymic function in patients and strategies that have been developed to boost thymic function.
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Affiliation(s)
- David Granadier
- Program in Immunology, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Medical Scientist Training Program, University of Washington, Seattle, WA, USA
- Department of Molecular and Cellular Biology, University of Washington, Seattle, WA, USA
| | - Lorenzo Iovino
- Program in Immunology, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sinéad Kinsella
- Program in Immunology, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jarrod A Dudakov
- Program in Immunology, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
- Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
- Department of Immunology, University of Washington, Seattle, WA, USA.
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Orgul G, Soyer T, Yurdakok M, Beksac MS. Evaluation of pre- and postnatally diagnosed gastrointestinal tract obstructions. J Matern Fetal Neonatal Med 2018; 32:3215-3220. [PMID: 29606013 DOI: 10.1080/14767058.2018.1460350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: Signs of congenital obstruction of the gastrointestinal tract (GIT) organs may present on prenatal ultrasonography. Prenatal detection is influenced by several factors, including obstruction site, lesion degree (partial or complete), the occurrence of associated malformations, and gestational week at screening. Here, we aimed to evaluate the success of prenatal diagnosis of GIT obstructions in a tertiary center in Turkey. Materials and methods: The study included 34 prenatally and 22 postnatally diagnosed babies with different GIT malformations. GIT obstructions were divided into five groups according to the level of obstruction (A. esophagus, B. stomach and proximal duodenum, C. small intestine, D. large intestine, E. multiple obstructions). Results: The prenatal detection rate among all cases was 60.7%. The associated structural malformation and aneuploidy rates were 21.4 and 5.4%, respectively. Twelve neonates died within the first day after birth due to various reasons. The remaining 43 babies underwent surgery at different times according to their clinical conditions. The mean time between birth and surgery was 4.5 days (range, 1-56 days). There were 12 postoperative deaths due to various complications, and one case died at 2 years of age. Overall, 31 of the 56 (55.4%) babies were alive during the follow-up period. The successful prenatal diagnosis rates were 57.2, 85.8, 75, 25, and 80% in groups A, B, C, D, and E, respectively. The median birth weight increased significantly in groups A through D (p = .04). However, there were no intergroup differences in the Apgar scores, associated abnormality rates, time to surgery, and number of babies operated. Conclusions: These findings demonstrate the importance of prenatal ultrasonography and success of prenatal detection especially for upper GIT abnormalities. Although there are some prenatal signs of GIT obstructions, such as double bubble, polyhydramnios, enlarged bowel, and failure to visualize the stomach, early prenatal diagnosis is difficult and can be delayed, resulting in the detection of GIT obstruction after birth. When suspecting GIT obstruction, clinicians should evaluate the fetal anatomy carefully and be aware of associated chromosomal abnormalities.
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Affiliation(s)
- Gokcen Orgul
- a Department of Obstetrics and Gynecology, Division of Perinatalogy , Hacettepe University, Faculty of Medicine , Ankara , Turkey
| | - Tutku Soyer
- b Department of Pediatric Surgery , Hacettepe University, Faculty of Medicine , Ankara , Turkey
| | - Murat Yurdakok
- c Department of Child Health and Diseases , Neonatology Unit, Hacettepe University, Faculty of Medicine , Ankara , Turkey
| | - Mehmet Sinan Beksac
- a Department of Obstetrics and Gynecology, Division of Perinatalogy , Hacettepe University, Faculty of Medicine , Ankara , Turkey
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Neonatal Bowel Disorders: Practical Imaging Algorithm for Trainees and General Radiologists. AJR Am J Roentgenol 2018. [PMID: 29528714 DOI: 10.2214/ajr.17.19378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Neonatal bowel disorders require prompt and accurate diagnosis to avoid potential morbidity and mortality. Symptoms such as feeding intolerance, emesis, or failure to pass meconium may prompt a radiologic evaluation. CONCLUSION We discuss the most common neonatal bowel disorders and present a practical imaging algorithm for trainees and general radiologists.
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