<胎兒心律不整 - bradycardia>

才讀完台兒通訊上期的雙月刊，門診就來了一個意外發現有房室傳導阻斷寶寶。
在診間聽心跳的時候，聽半天覺得心跳怎麼這麼慢? 到處都再確定一下又跟媽媽的脈搏相比不同，所以應該也不是聽到媽媽的動脈血流聲，因此帶她去超音波室一照，發現果不其然胎兒的心跳量起來只有70-80下。
立馬安排了比較詳細的心臟超音波，還有抽血來做更進一步的檢查。

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寶寶的心跳正常來說是在110-160下/分鐘之間，超過160下是心搏過快，太低則是心搏過慢。
心律不整是一個大課題，今天先從 #心博過慢這個族群來講起。

完整內容請看部落格文章
https://drjessicakang.blogspot.com/2021/07/blog-post.html
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胎兒心搏過緩要考慮幾個鑑別診斷:
1. 竇性心搏過慢 Sinus bradycardia
(Transient, fetal distress, sinus node dysfunction, Long QT syndrome...)
2. 緩慢性的心律不整 Bradyarrhythmia -> 房室傳導阻斷 AV block

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1. #竇性心搏過慢

表示胎兒心跳是規則的慢，並不是心房心室的傳導出問題，一個A對一個V。

(1) 暫時性的/胎兒窘迫:
待產時候常見的因為胎頭壓迫所造成的心跳過慢，還有心跳一去不復返的胎兒窘迫。
要考慮的可能是超音波做太久探頭壓迫的影響，或是注意媽媽有沒有低體溫的症狀?
如果以上都沒有，但是心跳還是很慢，就要認真考慮是不是其他的問題了。

(2) 竇房結異常:
竇房結出現問題，就會影響到心律，有些結構上的問題可能會影響到竇房結的位置，像是heterotaxy(異位症)，interrupted IVC，或是單一心室的結構。

(3) Long QT syndrome:
如果心臟結構沒有問題，也排除了第二點的房室傳導阻斷，就要考慮是否為long QT syndrome (我對這個疾病的認識要遙想當年在中榮心臟內科當intern被電的時期阿)
但是Long QT這個疾病也通常只能在出生之後用心電圖來確認。

2. #房室傳導阻斷
大概1/15000-20000，大約40%合併心臟結構問題，其他60%若無心臟結構問題，要考慮跟免疫相關(特別是anti-Ro/SSA or anti-La/SSB抗體)

再來就是難到爆的分類 (沒錯就是跟以前CV學的Mobitz type 1漸行漸遠甚麼碗糕的)
基本上分類和大人一模一樣 (這樣是可以不用介紹的意思嗎??)
要量測PR interval還有對照A-V的比例 (認真覺得這期台兒通訊錄介紹的很淺顯易懂而且是中文版，有興趣的人可以去參考看看)

(#詳細說明請看部落格文章)
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***如果是懷疑AV block的胎兒，建議媽媽要抽anti-Ro/SSA, anti-La/SSB抗體，來確認免疫部分有沒有問題。

對於確定有anti-Ro/SSA或是anti-La/SSB抗體的媽媽，以前的印象總是要使用類固醇 (fluorinated corticosteroids)，像是betamethasone or dexamethasone來治療，但是最近有些文獻指出，使用類固醇治療與否對於胎兒預後或是新生兒的預後其實沒有顯著的差別。要加快胎兒心跳，也有人使用salbutamol, b-agonist來治療，但是都沒有定論；另外也有使用IVIG的例子。

對於大家最常使用的 #類固醇，文獻中主要提到有幾點需要注意:

1. #影響胎兒預後的因子: 發現時間點<20週，ventricular rate<50 bpm，胎兒水腫，左心室功能受影響 ->預後差
2. 使用類固醇，主要對於"#預防"胎兒變成最嚴重的3度房室傳導阻斷有用；但是對於已經是完全房室傳導阻斷的胎兒，效用就沒有那麼好
3. 如果出現胎兒水腫，使用類固醇有時候可以 #改善水腫嚴重程度
4. 長期使用類固醇，對於胎兒還是會有一些影響，如 #羊水過少，#胎兒生長遲滯等，因此要衡量一下利弊
5. anti-Ro/SSA, anti-La/SSB抗體陽性的個案，AVBII沒有辦法自發性地回復到正常，但是如果有使用類固醇，就有機會會回復

參考資料:
Michael et al. Eur J Obstet Gynecol Reprod Biol X. 2019 Jun 16;4:100072
Eliasson et al. Circulation 2011 Nov 1;124(18):1919-26

#胎兒異常
#胎兒心律不整
#產前診斷
#產前超音波

回想起 4 年前的今天，那篇獨具一格的新聞稿；還好大家沒跟著這樣做，我會崩潰！🤣

中文版：

你笑 ; 你哭，
你愛 ; 你輸，
你玩樂 ; 你奮鬥，
你工作，工作，工作..
你問Why ?

你想改變，
你有夢想，
你是大膽，
你不可擋。
你就是你。

我們聽見你，
我們看到你，
向你學習，
一切為你。
精彩的你。

HTC U Ultra：全是為你
HTC U Ultra 　為你的精彩而生
他照映你
以傾城絕美的全新液態表面設計與你匹配
銘記著你
惦記你生活的點滴細節，成為更貼心的夥伴
把你放上心中頂點
嶄新雙重顯示設計，型塑更加便利的生活
傾聽著你
為你的天生雙耳調出獨一無二的音頻
為你最動人的一刻而生
正反兩個UltraPixel相機，捕捉動人生命的一切光燦細節

照映著你
映射你的一切野心
全新3D曲面水漾玻璃，反射著你懾服眾人的一面
不只光澤豐潤，何止脫俗地對稱，流線鏡面如琉璃般，照映出最美的光線
揮散的晶礦色彩，層層鎖進精光外表的每一個角度
柔順地融進外型兩側，不著痕跡的躺在手掌之中

永遠向你學習
HTC Sense Companion2會學習您的生活習慣
在下雪的天氣裡，會建議你穿著更暖和，以及提早下班回家
或者是提醒您要將手機充電，以避免手機電量不夠持續到回到家
除此之外，還能在愉快的周末，推薦你最好的餐廳
它了解你-並且會隨著使用的時間，更透徹的了解你3

給你最真摯的回應
聲控辨識功能-最真實且自然的方式與你互動
HTC U Ultra 會辨認且回應你的聲音，甚至當手機處於睡眠狀態時
也能保持手機定位功能、接聽或是拒絕來電、暫停或是關閉鬧鐘等功能
只要你說出來，HTC U Ultra都能聽得到

永遠把你最重要的擺在第一
持續獲取更新資訊且不受干擾
全新雙螢幕設計，只要運用你的指尖滑動，即可提供給你所需的訊息
提供快速且方便的方式，讓你能夠快速地使用你常使用的功能
例如：你最喜愛的聯絡人、應用程式、提醒功能、事件通知等
因為，對於你最重要的，我們將永遠將它擺在第一

傾聽著你
每個人的內耳構造就跟指紋一樣獨特
HTC USonic4能以類聲納波分析你的內耳，並調配你專屬的音頻
就像手機裡有一個音效師
微麥克風傾聽你耳內反射的音波
左耳、右耳各一個
分析反射出的音頻將耳機調配出最適合你音響
保留所有聲音的細節
無論是在圖書館或是在派對中，都能將耳機調整到不受當下環境噪音影響的最佳程度

HTC BoomSoundTM立體聲喇叭帶來如脈動般的音響
採用如頂級音響的分離式聲音設計
高音喇叭在上，低音喇叭在下
4個全指向麥克風捕捉定位來源聲
能錄製360度全方位不失真的聲音
無論是在搖滾樂現場或是在音樂廳，隨時隨地隨心所欲

挑選最佳的U
隨心所欲拍攝最精彩的自拍
前置相機可任意在1,600萬畫素與UltraPixelTM之間切換
可視需求選擇UltraPixel的超感光–
特別適合在燭光晚餐時
或是1,600萬畫素的高解析度–
特別適合在拍大全景時保留所有的細節

拍攝你
所有的手機相機都標榜能拍出最棒的照片
而我們是業界評價最高的
12萬畫素的UltraPixel主相機
可在夜晚時拍出清晰、快速對焦的較佳影像
讓你絕不錯過捕捉任何一個好畫面

HTC U Ultra
完美對稱
絕美彩色3D立體雕琢鏡面
精巧細薄
搭載HTC Sense Companion、HTC USonic 3D立體音響及豪華雙鏡頭
打造呈現最極致的U– the #BrilliantU
詳情請參閱：htc.com。

HTC U Play：適合享樂的你
HTC U Play。展現喜愛享樂風格的你
他照映你
以傾城絕美的全新液態表面設計與你匹配
銘記著你
惦記你生活的點滴細節，成為更貼心的夥伴
傾聽著你
為你的天生雙耳調出獨一無二的音頻
為你最動人的一刻而生
正反兩只UltraPixel相機，捕捉動人生命的一切光燦細節

照映著你
映射你的一切野心
全新3D曲面水漾玻璃，反射著你懾服眾人的一面
不只光澤豐潤，何止脫俗地對稱，流線鏡面如琉璃般，照映出最美的光線
揮散的晶礦色彩，層層鎖進精光外表的每一個角度
柔順地融進外型兩側，不著痕跡的躺在手掌之中

銘記著你
HTC U Play 搭載HTC Sense Companion2
你的生活小助手，永遠知道你要什麼
內建聲控辨識，僅照你所說，依你所做
接聽或掛掉電話、延遲或取消鬧鐘、發送簡訊
只要透過簡單指令，不用雙手也能輕鬆操控你的手機
他不僅懂你，還能隨著時間學習，更了解你。3
It knows you – and it’s made to evolve and get to know you better over time.3

傾聽著你
每個人的內耳構造就跟指紋一樣獨特
HTC USonic4能以類聲納波分析你的內耳，並調配你專屬的音頻
就像手機裡有一個音效師
微麥克風傾聽你耳內反射的音波
左耳、右耳各一個
分析反射出的音頻將耳機調配出最適合你音響
保留所有聲音的細節
無論是在圖書館或是在派對中，都能將耳機調整到不受當下環境噪音影響的最佳程度

拍攝你
隨心所欲拍攝最精彩的自拍
前置相機可任意在1,600萬畫素與UltraPixelTM之間切換
可視需求選擇UltraPixel的超感光
或是1,600萬畫素的高解析度
1,600萬畫素的主相機可在夜晚時拍出清晰、快速對焦的較佳影像
讓你絕不錯過捕捉任何一個好畫面

HTC U Play
完美對稱
精巧細薄
搭載HTC Sense Companion、HTC USonic音響及3D立體雕琢的鏡面
打造呈現最極致的U– the #BrilliantU
詳情請參閱：htc.com。

英文版：

U laugh, U cry
U love, U lose
U play, U fight
U work, work, work…
U question why

U want change
U dream big
U are bold
U are unstoppable
U are U

We hear U
We see U
We learn from U
It’s all about U
To the brilliant U

HTC U Ultra: It’s all about U

Introducing HTC U Ultra. Made for the brilliant you
It reflects U
Beautiful with its sophisticated new liquid surface
It learns from U
Evolving as your companion, getting to know you better over time
It puts U on top
Convenient with a new Dual Display
It listens to U
Unique in adapting sound to your personal hearing
It captures the best U
Vivid light, color and detail with UltraPixel cameras front and back

Reflects U
Your ambitions – reflected
A new, beautifully 3D contoured, liquid surface that’s designed to reflect the best you
Lustrous, symmetrical, curved glass construction1 reflects light beautifully
Color from vapored minerals layered to add depth and brilliance from every angle
As the polished surface bends and blends seamlessly into the side of the phone
Allowing it to nestle perfectly in your hand.

Learns from U
Introducing HTC Sense Companion2
The personal companion who is always learning from you
Suggesting you dress warm and leave for work earlier on a snowy day
Or reminding you to charge if it figures you need more power to last until you get home
And even recommending the perfect restaurant when you’re away for the weekend
It knows you – and it’s made to evolve and get to know you better over time.3

Responds to U
Voice recognition – the most natural way to interact
HTC U Ultra can recognize your voice and respond, even if it’s asleep
Navigate your phone, take or reject calls, snooze or dismiss alarms, and more
Just say the word.

Puts U on top
Get updated, not interrupted
The new Dual Display gives you the information you need, at your fingertips
Perfect for fast, convenient access to the things you use the most
Like your favorite contacts, apps, reminders, event notifications and more
Because what’s important to you should always be right on top.

Listens to U
Every person’s inner ear is as unique as their fingerprint
HTC USonic4 analyzes your inner ears with a sonar-like pulse, and then adapts to you
Like having a sound engineer in your phone
Tiny microphones listen for the sonic reflection in your ears
One in the left ear, one in the right
Analyzing the reflected tone to optimize the headset just for you
Now you can hear the details you were missing.
Whether you’re in a library or at a party, you can adapt your headset to suit noise levels around you.

HTC BoomSoundTM Hi-Fi edition speakers deliver pulse-pounding audio
Featuring separated sound design like leading acoustic systems
Tweeter above, woofer below
While four omnidirectional mics capture positional sound
Recording 360-degree immersive audio that’s just like being there
At the rock show. In the concert hall. Anywhere you want.

Pick the best U
Take brilliant selfies anyway you like
Easily switch between 16MP and UltraPixelTM in the front camera5
So you can choose between unparalleled light sensitivity* of UltraPixel –
Perfect for candlelit dinners –
Or the high resolution of 16MP –
When you want the biggest shot with the most detail.

Captures U
Every phone camera claims to take great photos
Ours is rated the industry’s best
The 12MP UltraPixel main camera delivers less blur, faster focus, better photos at night
Because every photo is important to you, anytime, anywhere.

HTC U Ultra
Perfectly symmetric
Beautifully colored 3D curved glass
Exquisitely thin
Featuring HTC Sense Companion, HTC USonic with 3D Audio, and magnificent cameras
Built to reflect the best U – the #BrilliantU
For more information please check: htc.com.

HTC U Play: For the playful you

This is HTC U Play. The playful phone that fits perfectly in your hand
It reflects U
Beautiful with its sophisticated new liquid surface
It learns from U
Evolving as your companion, getting to know you better over time
It listens to U
Unique in adapting sound to your personal hearing
It captures the best U
Vivid light, color and detail with UltraPixel cameras front and back

Reflects U
Shine on with the 5.2” smartphone designed to reflect the best you
A new, beautifully 3D contoured, liquid surface
Lustrous, symmetrical, curved glass construction1 reflects light beautifully
Color from vapored minerals layered to add depth and brilliance from every angle
As the polished surface bends and blends seamlessly into the side of the phone
We’ve paid special attention to each detail.

Learns from U
HTC U Play comes with HTC Sense Companion2
The personal companion who is always learning from you
It even comes with voice recognition built-in
So it’s able to respond to your voice –
Just say the word to navigate your phone, take or reject incoming calls,
Snooze or dismiss an alarm, send messages and even begin hands-free navigation.
It knows you – and it’s made to evolve and get to know you better over time.3

Listens to U
Every person’s inner ear is as unique as their fingerprint
HTC USonic4 analyzes your inner ears with a sonar-like pulse, and then adapts to you
Like having a sound engineer in your phone
Tiny microphones listen for the sonic reflection in your ears
One in the left ear, one in the right
Analyzing the reflected tone to optimize the headset just for you
Now you can hear the details you were missing.
Whether you’re in a library or at a party, you can adapt your headset to suit noise levels around you.

Captures U
Take brilliant selfies anyway you like
Easily switch between 16MP and UltraPixelTM in the front camera5
So you can choose between unparalleled light sensitivity* of UltraPixel
Or the high resolution of 16MP for whatever meets your need
The 16MP main camera delivers less blur, faster focus, better photos at night
Because you never want to miss that perfect moment.

HTC U Play
Perfectly symmetric
Exquisitely thin
Featuring HTC Sense Companion, HTC USonic adaptive audio, and 3D curved glass
Built to reflect the best U – the #BrilliantU
For more information please check: htc.com.

最近這件事鬧的沸沸揚揚 也上了新聞 在留言上發現自己考試的影片有被po上去 增加一些曝光率這樣 哈XD

但對於此事件 我就不公開多表態什麼了 只希望一切能以理性與和平的方式去解決 我們大家都是文明人 都要努力讓這個世界變得更美好

謝謝大家關注這個議題，我剛剛把評審的照片拿掉了，原因是我希望大家不要將這位評審當成壞人，而也我們把焦點專注在這個事件上，而不是人身上，我們才能真正長期的改善這個問題．因為我不會中文，所以我會和我的夥伴們一起再產出一篇更詳盡完整的中文文章，屆時也煩請大家一同關注，讓台灣的藝術環境更好，最好也謝謝幫我翻譯以下文章的朋友，我非常訝異這篇造成的影響力，感謝你們！

I CAUSED A SCENE TODAY IN THE PUBLIC

Today I got very angry and upset for the first time in public in front of a crowd.

What started out as a nice day, I thought it would only get better by attending the street performance artist's exam in Taipei. Everything seemed nice when I saw the performers were all prepared in their provided locations around the Sun Yat Sen Memorial Hall. But after I saw the head of the judge panel treated the street performers while performing, I couldn't keep my mouth shut.

Let me explained: each performer had to pay to register for the license exam. They were given 3 minutes to present their work(s) hoping they'd get a lisence so they can earn some sort of living from their passion. This one particular judge (pictured) leading the group seems impatiently listen and watch the street performers. It barely hit the one minute mark, he aggressively cut into the song of a singer and told the performer "many singers sing in different languages like English etc, sing in another language!"(I paraphrased with my bad Chinese translation). Then the singer started singing in Taiwanese language. But barely two sentences, he talked to another judge barely paying attention to the performer this head judge basically just left and gestured to the rest of the group to follow him.

The singer sang barely a minute and a half (they were promised 3 mins and they kept being interrupted by this judge). Bare in mind, this judge is earning a wage while these hopeful performers were paying him to be there. He basically did the same thing over and over again disregarding the artist's intent and hard work. Not a single word of appreciation. He just acted as he was a big boss looking down on these petty performers. He chatted as he wished and walked away without saying a "thank you" or a gesture of acknowledgement. A percussionist kept being interrupted asking him to do something different. Then he just left after the third time. The rest of the judges just followed.

So, i approached him politely asking for his name and his business card. I told him I wanted to talk to him one on one in the future. Degradingly he asked me who I was. I could see in his eyes that he saw a young man who looked like a student to him. But I was not and am not. I am a 40 year old dance artist, filmmaker and educator that have taught around the globe and in many prestigious colleges and festivals.

He didn't want to give me his business card. He seemed annoyed and surprised that someone spoke up. So I said I can give him my contact info but we needed to talk on how the exam went.

The way Taipei city exams the performers today was both disrespectful and insulting to the arts community in general. I didn't want to say this all out. But he left me with no choice.

I told him, for one, the way he treated the performers was disrespectful. As an educator I could not be quiet when I see something like that. Second, the process of the exam is not doing the art community any justice. If he cannot see the artists as a human being first, then what does it say about his view on the Arts. I could see him pissed off. But again he left me with no choice. He was very degrading towards these performers. As an artist myself and an art advocate I had to do something.

The organizer apologized to me said the process needed to go on. I told him I wasn't trying to stop them. I merely want to know how I could get in touch with them to discuss this. If you know me well enough, you should know my temperament. I am a happy go lucky person. I almost never get angry in the public. But it was genuinely insulting and degrading to every artists based on what I saw today.

This arrogant judge didn't care of my opinion. I could see it in his eyes. He was basically the superior in his world and his way was the right way. That's how he had always done it. All the young staffers there were afraid of him. Today he was disrespectful, rude, and arrogant. I really want to know why he does what he does.

After the incident, a few people came up and thanked me for speaking up. They felt the same way but they didn't have the courage to say it to this judge or the organization that issues these licenses. One organizer from the New Taipei City said even she felt bad seeing how the performers being treated.

I don't understand why people don't stand up for each other. The Taipei City has failed their community and even more so to their arts community.

For an organization that is supposed to advocate for the arts, culture and authenticity, they did miserably today. It is like giving an exam to a dog, a cat, a bird and a monkey then telling them that their exam is climbing a tree. It's absolutely ridiculous.

I left them my contact information. They said they will contact me. If they don't, this could be an interesting subject for my next film project. A documentary on how these hopeful, aspiring performers being treated.

I am mad and I am angry. I really hope they will change their shallow way of seeing Arts.

P.S. Share or repost in Chinese. They need to change. Thanks.

台北國際藝術村－寶藏巖 Taipei Artist Village－Treasure Hill
Taipei National University of the Arts
臺北表演藝術中心 Taipei Performing Arts Center
National Theater and Concert Hall, Taipei
中正紀念堂 Chiang Kai-shek Memorial Hall
National Taiwan University of Arts