Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopicassisted radical gastrectomy

BACKGROUND Laparoscopic-assisted radical gastrectomy(LARG)is the standard treatment for early-stage gastric carcinoma(GC).However,the negative impact of this proce-dure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation.AIM To investigate the influence of pressure-controlled ventilation volume-guaranteed(PCV-VG)and volume-controlled ventilation(VCV)on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score(LUS).METHODS The study included 103 patients with GC undergoing LARG from May 2020 to May 2023,with 52 cases undergoing PCV-VG(research group)and 51 cases undergoing VCV(control group).LUS were recorded at the time of entering the operating room(T0),20 minutes after anesthesia with endotracheal intubation(T1),30 minutes after artificial pneumoperitoneum(PP)establishment(T2),and 15 minutes after endotracheal tube removal(T5).For blood gas analysis,arterial partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were observed.Peak airway pressure(P_(peak)),plateau pressure(Pplat),mean airway pressure(P_(mean)),and dynamic pulmonary compliance(C_(dyn))were recorded at T1 and T2,1 hour after PP establishment(T3),and at the end of the operation(T4).Postoperative pulmonary complications(PPCs)were recorded.Pre-and postoperative serum interleukin(IL)-1β,IL-6,and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay.RESULTS Compared with those at T0,the whole,anterior,lateral,posterior,upper,lower,left,and right lung LUS of the research group were significantly reduced at T1,T2,and T5;in the control group,the LUS of the whole and partial lung regions(posterior,lower,and right lung)decreased significantly at T2,while at T5,the LUS of the whole and some regions(lateral,lower,and left lung)increased significantly.In comparison with the control group,the whole and regional LUS of the research group were reduced at T1,T2,and T5,with an increase in PaO_(2),decrease in PaCO_(2),reduction in P_(peak) at T1 to T4,increase in P_(mean) and C_(dyn),and decrease in Pplat at T4,all significant.The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively.Postoperative IL-1β,IL-6,and TNF-αsignificantly increased in both groups,with even higher levels in the control group.CONCLUSION LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV.Under the lung protective ventilation strategy,the PCV-VG mode more significantly improved intraop-erative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production,thereby alleviating lung injury.

Predictive Score for Pulmonary Ultrasound and Factors Associated to Mortality and Hospitalization during the Covid-19 Pandemic

Pulmonary ultrasound is a non-invasive bedside resource that has showed to be useful for the assessment of patients presenting with respiratory insufficiency as well as the diagnosis of several pleural and other pulmonary pathologies. The pulmonary ultrasound score (LUS) is a semi quantitative scale that measures the loss of pulmonary aeration cause by many pathologic conditions. Our primary objective was to describe factors associated to death and hospitalization in patients aged 16 or older that were admitted to the emergency department (ED) with signs or symptoms of COVID-19 infection through the diagnosis of viral pneumonia with pulmonary ultrasound (PU). It was a cohort retrospective study through a one-year period. Emergency physicians performed lung ultrasounds and calculated LUS. Results: 672 patients suspected of COVID-19 infection with a PU finding of viral pneumonia were included. 495 patients had a positive COVID-19 PCR test, 73.6% of the population. 258 patients presented with high probability of COVID-19 pneumonia following the patterns in PU. 55% were male with a median age of 45 years old. The average LUS score at admission was 8. Global hospitalization rate was 51.5%, 7.5% were admitted to the ICU. Patients with a LUS > 10 had a mortality of 6%, and patients admitted to the ICU had a 50% mortality rate. They presented with an average LUS score at admission of 15.2. Conclusions: LUS was a good predictor of death, hospitalization to general ward or ICU of patients with COVID-19 admitted from the emergency department.

Comparison of Bishop score and cervical length measurement through transvaginal ultrasound as prediction against labor induction

Objective:To compare the Bishop score and cervical length measured by transvaginal ultrasound concerned with prediction over the success of labor induction.Methods:This cross-sectional observational analytical study was conducted from May 2017 to October 2017 at several teaching hospitals of Obstetrics and Gynecology Department, Faculty of Medicine Hasanuddin University of Makassar, India. There were 110 samples of pregnant women undergoing labor induction process including 79 samples of successful induction and 31 samples of induction failure. The data analysis used Pearson Chi-square test and multivariate logistic regression to see the effect of Bishop score and measurement of cervical length with successful induction of labor.Results: Number of samples with successful labor induction with Bishop score <3 was 25 (31.6%) and Bishop score≥3 was 54 (68.4%), with rate ratio=3.714 andP=0.000. With measurement of cervical length (cut-off point 2.98 cm), number of samples with successful labor induction with cervical length≤2.98 cm was 12 (15.2%) and cervical length >2.98 cm was 67 (84.8%), with rate ratio=3.124 andP=0.000. Multivahate analysis of logistic regression was found to be more influential in the predicted success of labor induction (P=0.014 with Bishop score <3, odds ratio=1.000 and Bishop score≥3, odds ratio=3.779. Conclusions: Bishop score is better in predicting the success of labor induction compared to the measurement of cervical length through transvaginal ultrasound.

Assessing gestational age of babies: Performance of obstetric ultrasound scan compared to that from the combination of Naegle’s rule and Dubowitz score in the 21st century

Background: Some researchers have suggested that when Naegle’s rule (NR) and Dubowitz score (DS) are combined, it could out-perform obstetric ultrasound scan (USS). Others still believe that obstetric USS alone is still effective relative to the combination of NR rule and DS in assessing the gestational age (GA) of babies. Objectives: To determine and compare the GA of babies using obstetric USS, NR and DS;and to provide relevant public health information on obstetric USS in the 21st century. Methods: Subjects were selected using systematic random sampling and the GA of babies was determined using obstetric USS, NR, and DS. Statistical package for social science (SPSS) statistical software version 16, Illinois, Chicago USA was used for all data analysis. Results: Eightyfive mother-baby pairs were studied. Forty-four babies (52%) were males and 41 (48%) females. Sixty four (75%) were term with a mean (SD) BW of 3.02 (0.59) at 95%CI (2.89 -?3.14) kg. The overall mean GA of the babies was 38.49 (2.89) at 95%CI (38.14 -?38.85) weeks. The mean GA using obstetric USS, NR and DS were 38.52 (1.98) at 95%CI (38.14 -?38.99), 38.09 (4.13) at 95%CI (37.20-?38.99) and 38.82 (2.02) at 95%CI (38.39 -?39.26), but comparison of these means was not significant (p = 0.256). Combined mean GA by NR and DS was 38.46 (3.26) at 95%CI (37.96 -?38.95). Comparing this mean with mean GA obtained by obstetric USS was also not significant (p = 0.885). Conclusion: The GA assessments by Obstetric USS, NR and DS were all reliable, and Obstetric USS performed effectively relative to combined NR and DS.

Ultrasound unveiling:Decoding venous congestion in heart failure for precision management of fluid status

This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome(CRS),despite its high prevalence and the substantial worsening of both kidney function and heart failure.While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure,integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions.In particular,with the assessment of Doppler patterns across multiple venous districts,the Venous Excess Ultrasound(VExUS)score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions.Integrating specific echocardiographic parameters,particularly those concerning the right heart,may thus improve the VExUS score sensitivity,offering perspective into the nuanced comprehension of cardio-renal dynamics.A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.

Transabdominal intestinal ultrasound and its parameters used in the assessment of pediatric inflammatory bowel disease

This article extends on the use of transabdominal intestinal ultrasound in diagnosing pediatric inflammatory bowel disease.Some of the more essential features used in assessing bowel inflammation,such as hyperemia and wall thickness on ultrasound,are expanded upon from the publication on imaging and endoscopic tools in pediatric inflammatory bowel disease.

子宫卵巢超声结合Z-score方法对女性性早熟的诊断价值

目的分析子宫卵巢超声结合Z-score方法在女性性早熟中的诊断价值。方法选取2017年2月—2020年2月广东省东莞市第八人民医院(以下简称“我院”)收治的207例3~8岁女性性早熟患儿为实验组,另选取同期在我院咨询身高或体检的3~8岁健康儿童112名为对照组。根据性早熟部位分为单纯乳房过早发育(PT)及阴毛早生(PP)亚组50例、外周性性早熟(PPP)亚组61例、中枢性性早熟(CPP)亚组96例。两组均接受子宫、卵巢超声检测以获取子宫体、双侧卵巢径线,并计算体积;建立Z-score模型,计算Z值;受试者工作特征曲线(ROC)用于女性性早熟的诊断效能。结果年龄与卵巢体积、子宫体长径相关性最大(r=0.82、0.95,P<0.05)。PPP患儿子宫体长径平均Z值为2.59±2.29(-2.70,6.00),曲线下面积为0.909,最佳诊断临界值为1.05,敏感度为97.99%,特异性为81.90%。CPP患儿巢体积平均Z值为7.49±7.49(-0.48,36.99),曲线下面积为0.939,最佳诊断临界值为2.15,敏感度为100.00%,特异性为80.90%;宫体长径平均Z值为4.59±4.19(-1.15,22.79),曲线下面积为0.839,最佳诊断临界值为1.13,敏感度为90.80%,特异性为85.10%。结论子宫卵巢超声结合Z-score方法能有效诊断PPP、CPP,对儿童至青春期女性性早熟的诊断有重要作用,值得临床推广。

Application of Real-time Ultrasound Elastography in Diagnosing Benign and Malignant Thyroid Solid Nodules

Objective Real-time ultrasound elastography(US-E) is a helpful tool in diagnosing thyroid nodules.This study aims to evaluate thyroid solid nodules,to establish the accuracy of US-E in providing information on the nature of these nodules,and to assess the clinical value of elasticity scores(ES) and strain ratio(SR) in differentiating thyroid solid nodules and to explore its distribution characteristics using pathological analysis as reference. Methods Traditional ultrasonography and US-E were performed on 131 thyroid solid nodules(99 benign ones and 32 malignant ones) in 120 patients(78 females and 41 males).Three radiologists evaluated the nodules based on a four-degree elasticity scoring system.The nodules were classified according to the ES as soft(ES 1-2) or hard(ES 3-4).The SR was calculated online. Results The sensitivity and specificity of the ES for thyroid cancer diagnosis were 78%and 80%,respectively.SR values > 2.9 used as a standard to distinguish benign from malignant nodules had a sensitivity of 87%and a specificity of 92%.The SR of the benign lesions was 1.64±1.37,which was significantly different from that of malignant lesions,which was 4.96±2.13(P<0.01). Conclusions Both the ES and SR were higher in malignant nodules than those in benign ones.Real-time US-E was a useful index in the differential diagnosis of thyroid solid nodules.It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence.

Ultrasound Guidance and Nerve Stimulation Combined Versus Nerve Stimulation alone for Lumbar Plexus Block:A Randomized Controlled Trial

A nerve stimulation-guided lumbar plexus block is a well-established technique.It is not clear whether ultrasound guidance has additional value for this deep block technique.This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space(PMTS-ITS)approach in combination with nerve stimulation reduces the onset time of a complete sensory block.Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score(UVS)of≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group(group U-N)or nerve stimulation group(group N)in this prospective,randomized,parallel-group,active-controlled study.The primary outcome was the onset time of a complete sensory block.The results showed that the onset time of a complete sensory block to pinprick and cold was 10(10–40)min and 10(10–40)min in group U-N,respectively,and 30(10–40)min and 20(10–40)min in group N(P=0.005,P=0.004),respectively.The performance time was 658±87 s in group U-N and 528±97 s in group N(P<0.001).There was no(0%)patient who required 5 or more needle passes in group U-N and 6(27.3%)in group N(P=0.028).The block failure rate was 9.1%in group U-N and 31.8%in group N(P>0.05).In conclusion,ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS≥10.Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.

Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study

AIM To explore the risk factors of developing chronic pan-creatitis （CP） in patients with acute pancreatitis （AP） and develop a prediction score for CP.METHODS Using the National Health Insurance Research Database in Taiwan, we obtained large, population-based data of 5971 eligible patients diagnosed with AP from 2000 to 2013. After excluding patients with obstructive pancreatitis and biliary pancreatitis and those with a follow-up period of less than 1 year, we conducted a multivariate analysis using the data of 3739 patients to identify the risk factors of CP and subsequently develop a scoring system that could predict the development of CP in patients with AP. In addition, we validated the scoring system using a validation cohort.RESULTS Among the study subjects, 142 patients （12.98%） developed CP among patients with RAP. On the other hand, only 32 patients （1.21%） developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP （RAP）, alcoho-lism, smoking habit, and age of onset of 〈 55 years were the four important risk factors for CP. We developed a scoring system （risk score 1 and risk score 2） from the derivation cohort by classifying the patients into low-risk, moderate-risk, and high-risk categories based on similar magnitudes of hazard and validated the performance using another validation cohort. Using the prediction score model, the area under the curve （AUC） [95% confdence interval （CI）] in predicting the 5-year CP incidence in risk score 1 （without the number of AP episodes） was 0.83 （0.79, 0.87）, whereas the AUC （95%CI） in risk score 2 （including the number of AP episodes） was 0.84 （0.80, 0.88）. This result demonstrated that the risk score 2 has somewhat better prediction performance than risk score 1. However, both of them had similar performance between the derivation and validation cohorts.CONCLUSIONIn the study,we identifed the risk factors of CP and devel-oped a prediction score model for CP.

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics.As a part of cardiorenal syndrome,the diagnosis is usually made based on history and physical examination,with findings such as jugular venous distension,a third heart sound,and vital signs as supporting findings.More recently,however,these once though objective measures have come under scrutiny for their accuracy.At the same time,bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion.In this mini-review,we will discuss some of the traditional methods used to measure venous congestion,describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation,and offer a description of venous excess ultrasound score,a relatively novel scoring technique used to objectively quantify congestion.While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements,more study is underway to solidify the role of this objective measure in daily clinical practice.

Role of Lung Ultrasound in the Assessment of Hydration Status of Chronic Haemodialysis Patients

Background: Fluid overload is frequent in Haemodialysis (HD) and is one of the major factors of cardiovascular morbidity and mortality for chronic HD patients. The main challenge with chronic haemodialysis patients is indeed the maintenance of a normal extracellular volume through dry weight determination. Our study aimed at assessing the role of lung ultrasound in the detection of B-lines for the determination of hydration status in chronic HD patients. Methods: We conducted a cross-sectional study including 31 patients undergoing chronic HD treatment for at least 3 months, in the Yaounde University Teaching Hospital dialysis unit. Lung ultrasonography and clinical examinations were performed immediately before dialysis, and 30 minutes after dialysis. Differences between clinical and ultrasound variables before and after dialysis were measured to assess the effects of dialysis. Association between categorical variables was assessed with the Chi-squared test or Fischer test, and Rho’s Spearman coefficient for quantitative variables. Results: There was a reduction in the median of B-lines score after dialysis [12 (7 - 26) versus 8 (5 - 13)], clinical score [2 (1 - 3) versus 0 (-1 - 2)], mean of systolic blood pressure (164.74 ± 26.50 versus 158.48 ± 27.89), frequency of dyspnoea in patients (32.3% versus 6.5%);and raising of the frequency of cramps in patients (0% versus 19.4%) and all statistically significant (p ≤ 0.031). B-lines score before and after dialysis was associated with dyspnoea and raised jugular venous pressure (p Conclusion: Lung ultrasound for the detection of B-lines reflects the variation of extracellular volume during dialysis and can even capture pulmonary oedema at a pre-clinical stage. It is then a reliable and sensible method for assessing extravascular lung water and thus hydration status of haemodialysis patients. It could constitute a better alternative for an objective and accurate definition of dry weight, specifically in the African and Cameroonian context, with its assets being low cost, availability, and easiness to perform in a large population of HD patients. We, therefore, recommend further multicentric studies in order to design a standardized protocol of ultrasound follow-up for all chronic HD patients’ hydration status assessments.

Combined Median Score Increasing Sensitivity of Carpal Tunnel Syndrome Diagnosis

Carpal tunnel syndrome (CTS) is the most common of all focal neuropathies. Electrodiagnostic (EXD) of CTS has advanced to include Combined Sensory Indexes (CSI) improving the specificity and sensitivity of EXD by employing intra-hand comparative data. Ultrasound (US) is a popular tool for the assessment of CTS. Cross Sectional Area (CSA) is the most consistent US parameter, but as a single test, it has a similar false negative profile to EXD. This study describes a dual method of CTS interrogation by EXD and US with the results applied to a single numerical score;the Combined Median Score (CMS). This is the product of CSA of median nerve at Carpal Tunnel inlet and CSI. In a series of 100 suspected cases, standard EDX identified 89 positive cases, CSI identified 92 positives, CMS identified 95 positives. This new method further reduced the false negative rate in CTS.

The Observation on Risk of Ventilator Failure Weaning by Ultrasound bedside Monitoring of Inferior Vena Cava and Lung B Line

Objective: This study was designed to investigate risk of ventilator weaning by ultrasound bedside monitoring of the width of inferior vena cava (IVC) and the number of lung B-lines (B-lines). Methods: This study was conducted on 106 patients from January 2019 to January 2020 who had mechanical ventilation for more than 48 hours in an emergency care unit. They were clinically stable and had the criteria for weaning from the ventilator. Before Spontaneous Breathing Test (SBT) and 30 min or 120 min after SBT, the width of IVC and the number of B-lines in patients were monitored via bedside ultrasound. There were 87 cases of successful weaning as a control group and 19 cases of ventilator failure weaning as a study group. Changes of the width of IVC and the number of B-lines were compared in the different stages of SBT. Results: A total of 106 patients were included in this study. There were 87 cases of ventilator successful weaning and 19 cases failure weaning. The weaning success rate was 82.08%. The width of IVC and the number of B-lines in the study group were higher than those in the control group in same stage of SBT, the difference was statistically significant (P < 0.05), and which increased significantly with time. There was no significant difference in the width of IVC and the number of B-lines on the different stage of SBT in the control group (P > 0.05), and significant difference in the study group. Conclusion: The width of IVC and the number of B-lines monitored by bedside ultrasound can assess the risk of ventilator weaning, it may be caused by cardiopulmonary interaction.

Study the Role of Lung Ultrasound in Assessment of Subclinical Fluid Overload in Maintenance Hemodialysis Patients with Intra-Dialytic Hypertension

Objectives: To elucidate the role of lung ultrasound in assessment of subclinical fluid overload in hemodialysis (HD) patients. Background: Volume overload has a significant role in HD patients with difficult blood pressure control. The clinical evaluation of fluid status is challenging and has poor diagnostic accuracy. Extravascular lung water (ELW) represents an important element of body fluid volume. Lung ultrasound (LUS) is increasingly used for ELW assessment through the analysis of B-lines artifacts. Methods: Eighty-eight HD patients were followed up prospectively. Patients were divided into 3 groups according to the changes of systolic blood pressure (SBP) during HD sessions. Group (1): patients with intra-dialytic hypertension (n = 12), group (2): patients with intra-dialytic hypotension (n = 28) and group (3): patients with no significant blood pressure variabilities (n = 48). Numbers of B-lines were measured by LUS and IVC diameters were measured pre and post-dialysis. In addition, Endothelin-1 (ET-1) and other routine laboratory tests were done. Results: There were significant increases in the number of B-lines and IVC diameter pre and post-dialysis in group (1) compared to the other two groups. There was significant decrease in post dialysis IVC diameter but not the number of B-lines in group (2) compared with the other two groups. ET-1 level was significantly increased in group 1 compared to the other two groups. There was a statistically significant positive correlation between the pre-dialysis number of B-lines and ET-1. Conclusion: Lung ultrasound can be considered a sensitive and specific modality for volume assessment in HD patients especially with intra-dialytic hypertension. We recommend serial LUS as a part of management in this group of patients.

Comparison of Transrectal Prostate Digital and Ultrasound-Guided Core Biopsies in 400 Men in a Low-and-Middle Income Country

Background: The diagnosis of prostate cancer (PCa) relies on clinical assessment with digital rectal examination, serum PSA and histological examination. Limitations in our technical facilities, high financial cost of ultrasound-guided biopsy often prevent us from implementing the guidelines on the practice of prostate biopsy. Methods: We conducted a retrospective and cross-sectional descriptive study comparing digital-guided and ultrasound-guided transrectal prostate biopsy of 400 patients over a period of 12 years in the Yaounde Central Hospital. We reviewed files of patients who underwent digital and ultrasound guided biopsy procedures. Data was analyzed using EPI info 7.0. Parametric variables were reported as means and standard deviations and percentages and counts were used to report categorical variables. Results: Out of the 400 patients, 292 digital-guided transrectal biopsies (73%) and 108 ultrasound-guided transrectal biopsies (27%) were performed in patients who were suspected of having prostate cancer (PCa). Patients were aged between 39 to 90 years. Both procedures were effective in identifying prostate cancer. Gleason score between 2 to 10 detected prostate adenocarcinoma for 301 patients (75.2%). The complications included anal pain, rectal bleeding, hematuria and urinary tract infections, with an occurrence rate similar for both ultrasound-guided (2.25%) and digitally-guided techniques (2.5%). Seven patients (1.75%) required hospitalization for management of complications. The mortality rate was null. Conclusion: Both techniques are effective in detecting PCa with the similar complication rates. Digital-guided trans-rectal prostate biopsy still has its place in a resource-limited setting like ours.

床旁超声联合镇静躁动评分对ICU机械通气患者撤机的指导作用

目的:分析床旁超声联合镇静躁动评分对ICU机械通气患者撤机的指导作用。方法:选取2022年4月—2023年3月东莞市黄江医院收治的52例ICU机械通气患者。随机将其分为对照组和观察组,各26例。对照组根据常规方式进行撤机,观察组根据床旁超声联合镇静躁动评分进行撤机。比较两组撤机成功率,临床指标,不良事件。结果:观察组撤机成功率高于对照组,差异有统计学意义(P<0.05)。观察组机械通气时间、ICU住院时间均短于对照组,死亡率低于对照组,差异有统计学意义(P<0.05)。观察组不良事件发生率低于对照组,差异有统计学意义(P<0.05)。结论:床旁超声联合镇静躁动评分在ICU机械通气患者撤机中的指导作用突出,能够保证撤机成功率,降低死亡率,缩短机械通气时间和ICU住院时间,降低不良事件发生率。

宫颈成熟度评估及促宫颈成熟方法的研究进展

随着社会发展和我国生育政策的改变,高危妊娠的比例逐渐增加,这也导致医学原因所致的引产增多,而宫颈成熟是引产成功的关键。因此,准确评估并有效促进宫颈成熟已成为临床研究的焦点。目前关于宫颈成熟度的评估主要采用宫颈评分和超声测量,宫颈Bishop′s评分具有一定主观性,联合超声测量可增加评估的客观性,但仍应完善超声敏感指标,提高超声测量技术。促宫颈成熟的方法主要包括药物法和机械法,两者成功率均不高,且药物法存在子宫过度刺激的风险,机械法则具有母胎感染的风险。因此,未来进一步完善宫颈成熟度评估及促宫颈成熟的方法,可以为疾病的治疗提供新思路。

正常胎儿脐静脉血流量Z评分模型的构建及其对小于胎龄儿围生期不良结局的预测价值

目的构建正常胎儿脐静脉血流量(Quv)Z评分模型,并探讨该模型对小于胎龄儿(SGA)围生期不良结局的预测价值。方法(1)纳入862例18~40周正常胎儿建立模型。以腹部超声测量的腹内段Quv作为因变量,孕周为自变量,采用回归分析获得Quv均数及标准差的最佳拟合方程后,根据公式[Z评分=(实际Quv测值-拟合Quv均值)/拟合Quv标准差]建立正常胎儿Quv Z评分模型。(2)另纳入53例正常胎儿(正常组)和109例SGA,并根据围生期有无不良结局将SGA分为不良结局组(n=50)、无不良结局组(n=59)。利用所建立的模型获得3组的胎儿Quv Z评分。通过绘制受试者工作特征曲线分析正常胎儿Quv Z评分预测SGA围生期不良结局的效能。结果(1)正常胎儿的Quv与孕周呈正相关(P<0.05),Quv的均数及标准差相对孕周的最佳拟合方程均为线性方程。根据公式获得正常胎儿Quv Z评分模型:Z评分=(Quv+346.069-20.754×孕周)(/-51.320+4.075×孕周)。正常组胎儿Quv的Z评分呈正态分布,且不随孕周而改变。(2)不良结局组、无不良结局组、正常组的胎儿Quv Z评分依次增加(P<0.05)。(3)正常胎儿Quv Z评分预测SGA围生期不良结局的曲线下面积为0.843,基于最佳截断值-2.06的预测敏感度、特异度、阳性预测值、阴性预测值分别为74.0%、86.4%、82.2%、76.4%。结论所建立的正常胎儿Quv Z评分模型可消除孕周的影响,具有较好的临床适用性。正常胎儿Quv Z评分是预测SGA围生期不良结局较敏感的指标。

超声弹性评分联合血清甲状腺球蛋白水平对老年甲状腺癌患者治疗预后的预测价值

目的分析超声弹性评分与血清甲状腺球蛋白(Tg)水平联合预测老年甲状腺癌(TC)患者治疗预后的效用。方法选取76例老年TC患者,术前均行超声检查,并行超声弹性评分。于术后1年测定患者血清的Tg水平,分析不同临床病理特征的超声弹性评分与血清Tg水平;同时绘制受试者工作曲线(ROC),分析超声弹性评分、血清Tg水平单独与联合预测老年TC患者术后淋巴结转移的效能;另对比不同超声弹性评分与血清Tg水平患者无进展生存期。结果术后发生淋巴结转移患者术前超声弹性评分高于无淋巴结转移者,术后发生淋巴结转移患者术后1年的血清Tg水平高于无淋巴结转移者,有统计学差异(P<0.05)。ROC结果显示:超声弹性评分、血清Tg水平联合检测预测老年TC患者术后淋巴结转移的曲线下面积(AUC),高于两种方法单独检测。超声弹性评分<3.5分与血清Tg水平<24.995μg老年TC患者的无进展生存期高于超声弹性评分≥3.5分与血清Tg水平≥24.995μg的患者,有统计学差异(P<0.05)。结论超声弹性评分联合血清Tg水平可预测老年TC患者治疗预后。