Velamentous Cord Insertion: Interest of Antenatal Diagnosis and Review of the Literature

Velamentous insertion of the umbilical cord corresponds to the insertion of the cord directly on amniotic membranes. It is a rare situation whose frequency varies from 0.5% to 1.69% of single pregnancies. It must be diagnosed during the morphological ultrasound of the 2nd trimester, actively looking for the association with a vasa previa, due to the risk of fetal haemorrhagic threat. We report an antenatal diagnosis of velamentous cord insertion and its management with literature review.

Ultrasonic diagnosis of biliary atresia: A retrospective analysis of 20 patients

AIM: To investigate the clinical value of ultrasono-graphic diagnosis of biliary atresia (BA), a retrospective analysis of the sonogram of 20 children with BA was undertaken. METHODS: Ultrasonography (US) was performed in 20 neonates and infants with BA, which was confirmed with cholangiography by operation or abdominoscopy. The presence of triangular cord, the size and echo of liver, the changes in empty stomach gallbladder and postprandial gallbladder were observed and recorded. RESULTS: The triangular cord could be observed at the porta hepatis (thickness: 0.3-0.6 cm) in 10 cases. Smaller triangular cord (0.2-0.26 cm) can be observed in 3 cases. The gallbladder was not observed in 2 cases, and 1 case showed a streak gallbladder without capsular space. The gallbladders of 15 cases were flat and small. The gallbladders of 2 cases were of normal size and appearance, however, there was no postprandial contraction. The livers of all cases showed hepatomegaly and hetreogeneous echogenicity. Statistical analysis was performed to compare the hepatomegaly and hetreogeneous echogenicity and the stage of hepatic fibrosis. CONCLUSION: The presence of the triangular cord atthe porta hepatis is specific. However, it is not the only diagnostic criterion, since flat and small gallbladder and poor contraction are also of important diagnostic and differential diagnostic significance. The degree of hepatomegaly and hetreogeneous echogenicity is proportional with liver fibrosis, and able to indicate the duration of course and prognosis.

Ultrasonic diagnosis of patients with clonorchiasis and preliminary study of pathogenic mechanism

Objective:To discuss the liver function damage mechanism of patients with clonorchiasis by analyzing the ultrasound characteristics,liver function,change of the serum inflammatory factors and cell apoptosis factors.Methods:Color Doppler ultrasound technique was adopted to detect the portal vein and blood flow change of patients with clonorchiasis;ELISA was used to determine the level of different serum inflammatory factors.The levels of serum total bilirubin,serum albumin and glutamic-pyruvic transaminase were detected by automatic biochemical analyzer.Western blot was used to determine the expression of proteins relevant to apoptosis.Results:Compared with the health control group,the trunk diameter of portal vein and the thickness of spleen,as well as the hepatic artery pulsation index of clonorchiasis patients increased obviously,the mean blood flow velocity of portal vein(P<0.05 or P<0.01) decreased.The content of total bilirubin and transaminase in plasma increased significantly,but albumin decreased(P<0.05).Levels of TNF-α,IL-6 and IFN-γ increased remarkably,and the level of every factor was significantly different among patients with Child-Pugh Ⅰ,Child-Pugh Ⅱ and Child-Pugh Ⅲ classification of liver function(P<0.05 or P<0.01).With the exacerbation of liver dysfunction,levels of TNF-α,IL-6 and IFN-γ gradually increased(P<0.05).Compared with the healthy control group,the expression quantity of apoptosis protein Fas,FasL,Bax and Caspase-3 increased significantly(P<0.05 or P<0.01),but Bcl-2 decreased(P<0.05).Conclusions:Changes of ultrasonic characteristics and liver dysfunction,caused by liver fluke infection,may be related to that both inflammatory response and apoptosis response have participated in the pathogenic process and liver damage course of clonorchiasis.

Antenatal Diagnosis and Outcome of 12 Congenital Cystic Adenomatoid Malformation of Lung

Objective To investigate the ultrasonic detection probability, type, prenatal diagnosis, and outcome of congenital cystic adenomatoid malformation of lung （CCAM）. Methods In this retrospective study, all 12 cases which were diagnosed with suspected prenatal CC,4M over the period in the hospital were analyzed. Information on diagnosis time, types and progression of the lesions during pregnancy, the additional abnormalities, and the outcome of pregnancies were recorded.Results The positive rate of ultrasonic detection of CCAM was about 1.01‰ （1/11 124） before 28 gestation weeks. There were 1 case of type Ⅰ （8%）, 2 cases of type Ⅱ （17%） and 9 cases of type Ⅲ （75%）. Nine pregnancies were terminated and 2 cases were confirmed by pathology. Three neonates were alive and without any symptom now. Conclusions Type Ⅲ is the major type. Ultrasound examination during 20-28 weeks and following up, prenatal consultation, chromosome examination offetus, delivery with a pediatrician standing by, and all suspected neonates being investigated are recommended.

ANTENATAL DIAGNOSIS AND MANAGEMENT OF DANDY-WALKER SYNDROME

The Dandy-Walker syndrome (DWS) can be accurately diagnosed in utero by sonographic demonstration of characteristic morphologic changes of the fetus, which includes hydrocephalus, incomplete cerebellar vermis and a posterior fossa cyst. We present a case of Dandy-Walker syndrome diagnosed antenatally. The assoiacted anomalies are reviewed, and the value of antenatal diagnosis is discussed.

Antenatal Diagnosis of Uterine Incarceration: Surgical Role of MRI and Intraoperative Transmyometrium Ultrasound

Uterine incarceration is a rare condition thought to result from incarceration of a retroverted uterus in the small pelvis. The present case report describes a case of uterine incarceration caused by extensive pelvic adhesions after appendectomy for perforated appendicitis. A 39-year-old primigravida woman was referred to our obstetric unit for follow-up after successful in vitro fertilization. The symptoms related to uterine incarceration included anuria at 15 weeks of gestation and uterine contractions starting at 28 weeks of gestation. The absence of a cervical canal on ultrasonography is a key finding required to diagnose this rare condition. In the present case, the incision for uterotomy was determined by prenatal magnetic resonance imaging and transmyometrium ultrasonography during cesarean section. Both MRI and ultrasound images clearly showed anatomical relationships between the bladder, cervical canal and uterine wall. Clinicians need to know how the incision for uterotomy should be made and to avoid serious complications during cesarean section.

Antenatal Diagnosis of Isolated Total Arhinia in the Second Trimester of Pregnancy

Congenital arhinia is a very rare condition especially when it is isolated. Most of arhinia are identified after birth and only five prenatal cases are described in the literature. Generally, arhinia is associated with other malformations mainly craniofacial anomalies. Genetics aberrations are uncommon. Our case was diagnosed in the second trimester of pregnancy and we found no associated anomaly except for a single umbilical artery. Autopsy confirmed the diagnosis and neuropathology analysis revealed the absence of olfactory bulbs and tracts.

An Unusual Case of BSND Gene–Related (Type IV) Bartter Syndrome Presenting as Antenatal Bartter Syndrome:A Case Report and Review of Literature

Bartter syndrome is a group of autosomal recessive renal tubular disorders;it has two types of presentation:antenatal and classic.The antenatal type presents as severe unexplained polyhydramnios in the second trimester.This is due to fetal urinary losses of sodium,chloride,and potassium,leading to fetal polyuria.The classic type presents in the late neonatal or infancy stage,with dehydration,dyselectrolytemia,failure to thrive,and nephrocalcinosis.Antenatal scans are normal in such cases.Type I and II Bartter syndrome presents in the antenatal period,whereas type IV has a classic presentation.We describe an unusual case of type IVa Bartter syndrome presenting in the antenatal period,with severe polyhydramnios.The initial diagnosis was made based on amniotic fluid chloride levels and later confirmed by performing a genetic test.Genetic testing is important for confirming diagnosis and prognostication regarding the condition.

超声瞬时弹性成像检测受控衰减参数评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究

目的分析应用超声瞬时弹性成像检测的受控衰减参数(CAP)评估非酒精性脂肪性肝病(NAFLD)患者肝脂肪变程度的价值。方法2020年5月~2022年5月我院诊治的NAFLD患者78例,均接受肝脏超声检查和超声瞬时弹性成像检查,绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估CAP诊断NAFLD患者肝脂肪变程度的效能。结果肝脏超声检查结果显示,78例NAFLD患者中包括轻度肝脂肪变41例、中度肝脂肪变23例和重度肝脂肪变14例;重度肝脂肪变患者血清ALT和AST水平分别为(77.2±14.9)U/L和(59.1±11.7)U/L,显著高于中度肝脂肪变患者【分别为(40.1±8.3)U/L和(35.9±6.2)U/L,P<0.05】或轻度肝脂肪变患者【分别为(26.7±5.5)U/L和(23.3±4.8)U/L,P<0.05】;重度肝脂肪变患者血清TG水平和CAP分别为(3.5±0.7)mmol/L和(317.7±27.6)dB/m,显著高于轻度肝脂肪变患者【分别为(1.6±0.6)mmol/L和(259.9±27.5)dB/m,P<0.05】或中度肝脂肪变患者【分别为(2.7±0.6)mmol/L和(292.1±30.7)dB/m,P<0.05】,而血清HDL-C水平为(0.8±0.4)mmol/L,显著低于轻度肝脂肪变患者【(1.3±0.3)mmol/L,P<0.05】或中度肝脂肪变患者【(1.1±0.3)mmol/L,P<0.05】;以CAP>285.4dB/m为截断点,诊断NAFLD患者中度肝脂肪变,以CAP>309.1dB/m为截断点,诊断NAFLD患者重度肝脂肪变,结果发现轻度肝脂肪变39例,中度肝脂肪变22例,重度肝脂肪变17例,其AUC、敏感度和特异度分别为0.783(95%CI:0.669~0.896)、78.3%和75.6%,和0.696(95%CI:0.515~0.876)、78.6%和69.6%(P<0.05)。结论应用CAP诊断NAFLD患者肝脂肪变程度可能比超声检查更准确,有很大的临床应用价值。

超声征象联合诊断在儿童急性阑尾炎中的临床意义

目的探讨在急性阑尾炎患儿诊断中,超声征象的特点及诊断意义。方法以81例急性阑尾炎患儿为研究对象,将81例急性阑尾炎患儿依病理检测结果分为2组:进展性阑尾炎患儿34例(41.98%),单纯性阑尾炎患儿47例(58.02%)。通过超声检测的间接征象、直接征象,以及病理检查资料,并借助ROC曲线分析超声征象联合应用的曲线下面积(area under curve,AUC),进行综合分析,对患儿超声检查结果进行评分。结果进展组患儿超声检测的管壁连续性中断/层次清晰度不高、管腔积液、阑尾周围或腹腔积液、阑尾周围高回声、盲肠、回肠壁增厚检出率均高于单纯组(P<0.05);进展组超声间接征象、直接征象、联合征象评分均高于单纯组(P<0.05);ROC(receiver oprating characteristic)曲线下,联合征象诊断灵敏度、特异度、阳性预测值和阴性预测值分别为98.77%、97.53%、98.77%、96.30%均高于间接征象、直接征象,AUC为0.902高于间接征象、直接征象(P<0.05)。结论超声检测征象联合诊断,能够为急性阑尾炎患儿的早期诊断提供客观证据,且还可实现对疾病动态监测,从而有利于临床治疗方案的制定。

柔性超声换能器在生物医学中的研究进展

传统超声换能器存在体积大、表面刚性的缺点,无法用于人体复杂皮肤表面和可穿戴器件的设计。为使换能器具有灵活、体积小,满足可穿戴的特点,将其压电元件、电极和封装等各组成部分重组为柔性换能器。相比于传统换能器,它有两个优点:首先,不需要专业人员操作,可实现持续性的超声监控或治疗。其次,通过更全面的皮肤表面覆盖,扩大声场范围。在超声诊断方面,改善声信号采集,获得更全面的检测信息;在超声治疗方面,增加声能量沉积,提高疗效。柔性换能器使超声医疗应用场景多元化,可实现连续超声诊断或超声治疗。该文首先概述了其在设计和加工方面的最新进展,然后重点介绍了其在诊断和治疗方面的应用,最后讨论了这一领域所面临的挑战并对发展前景进行展望。

儿童卵黄囊瘤的超声诊断价值及漏误诊病例分析

目的探讨儿童卵黄囊瘤(YST)的超声特征表现及诊断价值,提高术前超声诊断YST准确率。方法回顾性分析经病理确诊的29例YST患儿的临床表现、实验室检查结果及超声声像图特征,总结分析漏诊、误诊原因。结果29例患儿中,超声正确诊断25例,漏诊1例,误诊3例,准确率为86.21%。所有患儿初次就诊时的血清甲胎蛋白(AFP)水平检测结果均明显升高,均>1000 ng·mL^(-1)。结论超声检查对儿童YST的诊断具有重要的临床应用价值,结合AFP水平检测结果显著升高可提高术前超声诊断准确率,有助于早期识别和确诊YST。

超声人工智能医疗器械的测试方法与研究

当前,人工智能技术快速发展,人工智能在很多领域都有广泛应用,在医疗器械和医疗诊断上,也有一定程度的应用,这对于推动医疗健康服务自动化和智能化都具有重要意义,能够提升医疗诊断工作效率和质量。而在相关超声诊断类人工智能医疗器械的使用中,确保人工智能算法的安全性和准确性是人工智能类超声诊断医疗仪器发展中面临的主要挑战。现阶段,我国对于人工智能应用的检测标准化流程以及评价标准还没有建立起来,因此,本文就超声诊断类人工智能医疗器械测试的方法进行分析,探究超声诊断类人工智能医疗器械的主要应用测试路径。

粤北地区大肠黏膜下肿物超声内镜诊断与内镜黏膜下剥离术后病理结果的对比研究

目的:探讨粤北地区大肠黏膜下肿物超声内镜诊断结果与内镜黏膜下剥离术(ESD)后病理结果的差异,为大肠黏膜下肿物的早期诊断与手术方案设计提供帮助。方法:回顾性分析2017年11月—2023年9月于粤北人民医院行超声内镜检查及ESD治疗的91例大肠黏膜下肿物患者的临床资料。评估记录病变大小、病变起源、病变类型,根据术中观察和ESD后病理结果,评价术前超声内镜检查的准确率,并进行一致性分析。结果:91例患者,术前超声内镜检查诊断病变类型的准确率为90.11%(82/91),超声内镜诊断与病理诊断的Kappa值为0.514,一致性好;术前超声内镜检查诊断病变大小的准确率为93.41%(85/91),超声内镜诊断与ESD诊断的Kappa值为0.771,一致性极好;术前超声内镜诊断病变起源的准确率为93.41%(85/91),超声内镜诊断与病理诊断的Kappa值为0.781,一致性极好。结论:粤北地区超声内镜诊断大肠黏膜下肿物的准确率较高,可为内镜下治疗提供较为准确的依据。

飞行器结构健康监测技术研究进展

结构健康监测技术有望在飞行器设计、服役和维护中发挥关键作用,提高飞行器结构效率,确保飞行器结构的安全性和可靠性。本文首先概述结构健康监测的基本概念及其适用范围,强调其在航空航天领域中的重要性。随后,针对结构健康监测技术在飞行器典型结构中的研究工作情况,重点围绕冲击监测、超声导波损伤监测以及光纤传感器应变监测等先进技术进行详细讨论,总结国内外研究现状、技术能力以及典型应用。最后,指出飞行器结构健康监测面临的挑战性问题,展望该技术在航空航天领域的应用前景。

天然气超声流量计健康状态评价方法初探

目的天然气计量用超声流量计性能诊断主要采用设定参数阈值的诊断方法,为降低误报、漏报等情况,建立了基于生成对抗神经网络(generated adjoint neural network,GAN)和高维非线性无监督学习的超声流量计健康状态系统诊断方法。方法采用GAN对原始数据进行学习、生成和扩充,保障超声流量计健康状态诊断建模的数据基础,提取超声流量计在运行过程中的健康状态参数并对其进行时序分析,采用高维非线性无监督聚类学习方法,结合超声流量计失效模式分析,对超声流量计设备进行在线的健康状态诊断。结果结合超声流量计工作原理和现场实际采集数据,对生成的故障数据集进行了验证。结论能够准确识别超声流量计当前状态,显著解决传统阈值法误报率、漏报率高的问题,为超声流量计健康诊断的统一管理与开发给予支撑。

新生儿脐带绕颈4周及以上的临床分析

目的:探讨新生儿脐带绕颈≥4周的高危因素、超声检查诊断符合率及妊娠结局。方法:选取2011年1月至2024年2月于华中科技大学同济医学院附属同济医院分娩的新生儿脐带绕颈≥4周的64例孕妇(脐带绕颈≥4周组)的临床资料进行回顾性分析,同时随机选取同一时期分娩的新生儿脐带绕颈1~2周的80例孕妇(脐带绕颈1~2周组)作为对照。收集两组一般资料、临床表现、超声诊断等资料,采用单因素及多因素Logistic回归分析脐带绕颈≥4周的高危因素、超声检查诊断符合率,并比较两组胎儿结局的差异。结果:①脐带绕颈≥4周组孕次、人工流产次数、产次、剖宫产史次数比脐带绕颈1~2周组低,自觉胎动异常、脐动脉收缩末期峰值与舒张末期峰值比(S/D)异常、胎心监护(NST)异常、胎儿窘迫的发生率比脐带绕颈1~2周组高,差异均有统计学意义(P<0.05)。②多因素Logistic回归分析示:羊水过多及脐带过长是脐带绕颈≥4周的独立危险因素(OR>1,P<0.05)。③超声检查诊断脐带绕颈≥4周在距剖宫产术前时间≤2 d时,超声诊断的符合率最高,与>3 d的符合率差异有统计学意义(46.2%vs.6.3%,P<0.05);与脐带绕颈≤3周比较,超声诊断脐带绕颈4周和5周的超声诊断符合率更高,差异有统计学意义(P<0.05)。④脐带绕颈≥4周组早产、新生儿窒息、入住新生儿科的发生率高于脐带绕颈1~2周组,差异有统计学意义(P<0.05);胎儿分娩孕周及新生儿出生体质量小于脐带绕颈1~2周组,差异有统计学意义(P<0.05)。结论:羊水过多及脐带过长是脐带绕颈≥4周的高危因素。超声诊断距剖宫产术前时间越近以及脐带绕颈周数越多,诊断符合率越高。脐带绕颈≥4周的新生儿结局更差。

CMA技术联合染色体核型分析产前诊断唐氏综合征价值

目的:探究染色体微阵列分析(CMA)联合染色体核型分析在唐氏综合征诊断中的应用价值。方法:回顾性收集2022年12月-2023年12月在本院行羊水穿刺的产前检查高风险孕妇122例临床资料,以胎儿游离DNA检测技术为金标准,对比染色体核型分析、CMA及CMA联合染色体核型分析检出唐氏综合征的准确率,绘制受试者工作特征(ROC)曲线分析染色体核型分析、CMA及CMA联合染色体核型分析诊断唐氏综合征效能,对比不同产前诊断高风险指征孕妇的染色体核型分析、CMA检测结果,观察染色体异常核型检测结果。结果:122例行羊水穿刺的产前检查高风险孕妇中共检出胎儿唐氏综合征14例,总检出率为11.5%;核型分析检测准确率92.6%(113/122),曲线下面积(AUC)为0.808,诊断敏感度64.3%、特异度96.3%;CMA准确率94.3%(115/122),AUC为0.843,诊断敏感度71.4%、特异度97.2%;两项联合检测准确率99.2%(121/122),AUC为0.964,诊断敏感度92.9%、特异度100.0%。核型分析与CMA联合检测的诊断准确率与AUC均高于核型分析、CMA单一检测(P<0.05)。核型分析、CMA及两项联合检测在超声胎儿颈项透明层(NT)增厚孕妇中分别检出2例、1例、2例胎儿唐氏综合征,在高龄(>35岁)孕妇中分别检出0例、1例、2例胎儿唐氏综合征,在无创产前检测(NIPT)异常孕妇中分别检出5例、5例、6例胎儿唐氏综合征,在唐氏综合征高风险孕妇中分别检出2例、2例、3例胎儿唐氏综合征;染色体核型检测异常包括数目异常7例、结构异常2例。结论:CMA联合核型分析诊断唐氏综合征准确性、敏感性最佳,对于临床产前诊断唐氏综合征具有重要参考价值。

基于ResNet与分离注意力机制的肺部超声图像分类系统设计

目的为解决传统的深度学习模型在处理具有多样性图像质量和微妙病变区域差异的肺部超声图像方面性能不佳的问题,设计一种基于残差网络(Residual Network,ResNet)与分离注意力机制的肺部超声图像分类系统。方法采用ResNet152作为基础模型,结合分离注意力机制,通过对肺部超声图像进行预处理、数据增强和标准化处理,以提高模型的特征提取和分类能力。模型首先通过ResNet152进行深度特征提取,随后在各层引入分离注意力机制,增强模型对重要图像特征的关注,从而提高分类性能。结果实验结果表明,优化后模型与原始模型相比,分类准确度在A线、B线、胸腔积液和肺实变上分别提升了0.51%、0.95%、14.17%和6.29%。通过消融实验,当同时使用Mish函数和分离注意力机制时,混合模型达到了97.92%的准确度。结论本文提出的融合ResNet与分离注意力机制的肺部超声图像分类系统模型可为临床超声诊断提供较高的参考价值。

超声声衰减系数与受控衰减参数联合肝脏硬度检测诊断NAFLD患者NASH发生效能研究

目的探讨超声声衰减系数(UAC)与受控衰减参数(CAP)联合肝脏硬度检测(LSM)诊断非酒精性脂肪性肝炎(NASH)的效能。方法2020年6月~2023年6月我科诊治的87例非酒精性脂肪性肝病(NAFLD)患者,均接受彩色多普勒超声诊断仪检测UAC,使用FibroTouch检测CAP和LSM,所有患者接受肝活检,经脂肪性肝病活动评分(NAS)诊断NASH。应用受试者工作特征曲线(ROC)分析指标诊断NASH的效能。结果经组织病理学检查,本组诊断SFL者61例,NASH者26例;NASH组UAC、CAP和LSM分别为(0.9±0.1)dB/cm·MHz、(327.4±30.6)dB/m和(11.6±1.6)kPa,均显著高于SFL组【分别为(0.6±0.1)dB/cm·MHz、(266.3±21.5)dB/m和(6.7±0.4)kPa,P<0.05】;分别以CAP为315.2 dB/m和LSM为10.3 kPa或UAC为0.9 dB/cm·MHz为截断点,前者诊断NASH的曲线下面积为0.9,其敏感性为84.0%,特异性为87.6%,显著优于UAC诊断(分别为0.8、80.0%和72.4%,P<0.05)。结论应用CAP联合LSM诊断NAFLD患者NASH发生具有很高的效能,可帮助临床进行初步筛查。