Objective: To investigate the effects of electrical dry needling (DN) plus corticosteroid injection (CSI) on pain, physical function, and global change in patients with osteoarthritis of the knee (KOA). Design: A prospective, single-blinded, randomized controlled trial. Setting: Pain treatment clinic. Participants: Sixty patients with KOA were randomly assigned to the electrical dry needling plus corticosteroid injection (electrical-DN+CSI) group or CSI group. Interventions: The CSI group received glucocorticoid injection only once during the trial, and the electrical-DN+CSI group received glucocorticoid injection combined with 4 sessions of electrical-DN. Main Outcomes Measures: The primary outcome was the numerical rating scale at 3 months. The secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index, the time to complete the Timed Up and Go test, and the score of the global rating of change scale at 3 months. A generalized linear mixed-effects model was used to analyze the repeated measurement data. Results: Baseline characteristics and measurements were similar in the 2 groups. The group by time interaction effect was significant for all variables (P<.05). The electrical-DN+CSI group obtained a more significant reduction in pain intensity and more significant improvement in dysfunction than the CSI group at 3 months (P<.05). The median global rating of change score for the CSI group was +3 (somewhat better), and that for the electrical-DN+CSI group was +4 (moderately better). Conclusion: Electrical-DN therapy at myofascial trigger points combined with CSI is more effective at alleviating pain, improving dysfunction, and creating global change than CSI alone for patients with KOA. Electrical-DN may be an essential part of treatment for KOA rehabilitation. (C) 2022 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

BACKGROUND:To date, the literature directly comparing early carotid endarterectomy (CEA) and delayed CEA in patients with symptomatic carotid stenosis (CS) is limited. We aimed to evaluate the efficacy and safety of early CEA and delayed CEA in patients with symptomatic CS by performing a meta-analysis. MATERIAL AND METHOD:The PubMed, Cochrane Library (last searched in May 2020) and relevant websites such as Web of Science and EMBASE (1990 to May 2020) were searched. All meta-analyses of eligible results were conducted using the STATA version 12.0 (Stata Corporation, College Station, Texas, USA). RESULTS:A total of 7 articles were included in the study hailing from the New Scotland, Chicago, Sweden, UK, Italy, and France. In this study, the early CEA meant that the procedure was performed within the first 14 days or first 30 days. And the delayed CEA meant the procedure was performed more than 14 days or 30 days after the symptom occurrence. Referring to the latter early CEA group and delayed CEA group, there were three publications. The results illustrated that the early CEA group was not associated with a higher incidence of stroke (OR = 0.77, 95 % CI: 0.273-2.170; P = 0.620). And no statistic difference was found on the incidence of postoperative 30-day mortality and stroke or mortality. Meanwhile, referring to the former early CEA group and delayed CEA group, there were six articles. The results demonstrated that the early CEA group was associated with a higher rate of postoperative 30-day mortality (RD = 0.010, 95 % CI: 0.002 to 0.019; P = 0.022). CONCLUSION:The meta-analysis of these related studies suggests that, compared to the delayed CEA group, the early CEA performed in patients with the acute post stroke phase resulted in a higher risk of postoperative mortality. Therefore, the delayed CEA was safer than early CEA for patients with symptomatic CS.

BACKGROUND: To systematically assess the efficacy and safety between flow diversion and coiling for patients with unruptured intracranial aneurysms. METHODS: Potential academic articles were identified from Cochrane Library, Medline, PubMed, EMBASE, ScienceDirect, and other databases. The time range we retrieved from was the inception of electronic databases to February 2019. Gray studies were identified from the references of included literature reports. STATA version 11.0 was used to analyze the pooled data. RESULTS: A total of 11 articles (10 retrospective studies and 1 prospective study) were involved in our study. The overall participants of the coiling group were 611, whereas 576 were in the flow diversion group. Our meta-analysis showed that flow diversion was preferable for unruptured intracranial aneurysms as its lower value of total cost per case (weighted mean difference, 5705.906; 95% confidence interval [CI], [4938.536, 6473236]; P < 0.001), fluoroscopy time per case (weighted mean difference, 25.786; 95% CI, 17.169-34.377; P < 0.001), and retreatment rates (odds ratio [OR], 7.127; 95% CI, [3.525, 14.410]; P < 0.001), at the same time, a higher rate of immediate completed occlusion (OR, 0.390; 95% CI, [0.224, 0.680]; P = 0.001) and follow-up completed occlusion (OR, 0.173; 95% CI, [0.080, 0.375]; P < 0.001) was demonstrated in the flow diversion group. There was no difference on intraoperative complication rates (P = 0.070), procedure-related mortality (P = 0.609) and rupture rates (P = 0.408), modified Rankin Scale (mRS) 0-2 at discharge (P = 0.077), and mRS 0-2 at follow-up (P = 0.484). CONCLUSIONS: The use of flow diversion for the treatment of unruptured intracranial aneurysms may reduce total cost per case, fluoroscopy time per case, retreatment rates, and increases immediate completed occlusion and follow-up completed occlusion rates without affecting the results of mRS and intraoperative complication.

Objective: To investigate the clinical effect of intra-articular pulsed radiofrequency on the pain caused by refractory knee osteoarthritis. Methods: 42 cases of patients (totally 67 knees) suffering the pain caused by severe knee osteoarthritis were randomly divided into two groups: group C and group R. Group C was treated with intraarticular injection of compound betamethasone; Group R was treated with intra-articular pulsed RF. Visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC index), clinical effect and recurrence rate during follow-up, adverse reactions as well as the changes of tumor necrosis factor (TNF-a), matrix metalloproteinase-3 (MMP-3) and interleukin-1 (IL-1) in synovial fluid of both groups were recorded at pre-treatment and 1, 4, 8, 12, 24 weeks after treatment respectively. All collected data were analyzed by SPSS 11.5 software. Results: Comparing with pre-treatment scores, the VAS and WOMAC scores at 1, 4, 8, 12 and 24 weeks after treatment were decreased significantly in both groups with group C significantly higher than group R; The total effective rate was 95.5% in group R comparing with 85.5% in group C, and there was significant difference between the two groups. After treatment, the recurrence rate of group C was significantly higher than that of group R, with statistical difference. No obvious adverse reactions occurred in all patients. After treatment, the content of TNF-alpha, MMP-3 and IL-1 in the synovial was significantly reduced in the patients of group R, and the reduced volume was significantly higher than that of group C, with significant difference. Conclusion: the effect of intra-articular pulsed RF treatment is obviously superior to the traditional compound betamethasone injection group in the treatment for refractory knee osteoarthritis; pulsed RF could obviously alleviate the clinical symptoms and decrease the content of TNF-alpha, MMP-3 and IL-1 in the synovial, in addition, it is safe and reliable, all of these make it an effective method for senile refractory knee osteoarthritis.

Objective To explore the relative contribution of refractive status and stereopsis in a school population and to determine the associations between refractive status and stereoacuity,age,and axial length.Methods Subject data were sampled from the materials of a population-based cluster sampling of children in 8 primary schools in Shanghai in this cross-sectional investigation.According to the standards established for this study,a table was created based on a questionnaire and the examination of vision,stereopsis and axial length of the subjects.SPSS 20 software was used to analyze the data for the different ages (6,7,8,9 and 10 years of age) and refractive status (emmtropia,mild myopia,severe myopia,mild hyperopia and severe hyperopia).A x2 test was used to compare groups.An ANOVA was used to compare the normal distribution measurement data among groups.For non-normal distributions data,nonparametric tests were used throughout.Results ①The trend for the incidence of myopia increased and for the incidence of hyperopia decreased with an increase in age.There was a positive correlation between the prevalence of myopia and increased age (r=0.427,P＜0.01),and a negative correlation between the prevalence of hyperopia and increased age (r=0.269,P＜0.01).There was a significant difference in stereopsis with normal uncorrected vision (Kruskal Wallis,x2=88.867,P＜0.01).There was a statistically significant difference in stereopsis between ages 6 and 7 (Kolmogorov-Smirnov,Z=2.584,P＜0.01),but no difference between ages 7 and 8,8 and 9,and 9 and 10 (P＞0.05).The difference in the detection rate of anomalous stereopsis was statistically significant for different refractive states (x2=57.294,P＜0.01).Stereoacuity also differed significantly among different refractive groups (Kruskal Wallis,x2=67.428,P＜0.01).The differences were statistically significant between severe hyperopia (Z=2.584,P＜0.01),severe myopia (Z=2.138,P＜0.01),and mild hyperopia (Z=1.819,P＜0.01) and normal groups respectively.The mean value of axial length gradually increased with an increase in age and the differences were significant among age groups (F=115.248,P＜0.01).The differences were significant when all age groups were compared to each other (P＜0.01).Conclusion ①The results suggest that the prevalence of myopia increases with age,but the prevalence of hyperopia decreases with age in school-aged children.The eye in school-aged children goes from farsightedness to myopia.②Stereopsis reaches maturity at 7 to 8 years of age.③Mild and severe hypermetropia obviously influenced the development and establishment of stereopsis.④The mean axial length of the eye gradually increased with age.

OBJECTIVE:To estimate cesarean delivery rates and indications by region in mainland China.METHODS:A cross sectional survey of all deliveries in 39 hospitals in 14 provinces of mainland China from January 1 to December 31, 2011 was evaluated for mode of delivery, cesarean delivery rates and indications for delivery.RESULTS:(1) A survey of a total of 112 138 women at delivery with gestations greater than 24 weeks was analyzed. 79 631 and 32 507 deliveries were obtained from the tertiary and secondary hospitals respectively. 90 971 were primipara, 21 167 were multipara. Of these pregnancies, 61 084, 49 734 and 1 320 cases resulted in cesarean delivery, vaginal delivery and operative vaginal delivery respectively, the cesarean delivery rate was 54.472% (61 084/112 138). Among 61 084 women who had cesarean delivery, 14 998 cases of the cesarean deliveries were performed without medical indications, 46 086 cases of the cesarean deliveries had medical indications. The cesarean delivery rate of the tertiary hospitals was 55.927% (44 535/79 631), and was significant higher than that in the secondary hospitals (50.909%, 16 549/32 507; P < 0.01). (2) Overall 24.553 % (14 998/61 084) of cesarean deliveries were performed without medical indications. 19.744% (8 793/44 535) of the cesarean deliveries without medical indications were performed in the tertiary hospitals, and was significant lower than in the secondary hospitals (37.495%, 6 205/16 549;P < 0.01). (3) Maternal request was the most common indication (24.553% of all cesarean deliveries), followed by fetal distress (12.507% , 7 640/61 084), cephalopelvic disproportion (11.787%, 7 200/61 084), previous uterine surgery (10.374%, 6 337/61 084), malpresentation (5.815%, 3 552/61 084), failure to progress (5.710%, 3 488/61 084) and suspected macrosomia (5.594%, 3 417/61 084).CONCLUSIONS:The increasing caesarean section rate in mainland China is explained mainly by the high non-indicated caesarean section rate. The main medical indications of the cesarean deliveries included fetal distress, cephalopelvic disproportion, previous uterine surgery, malpresentation and failure to progress.

Objective To establish normative data for placenta volume (PV) at 11-13+6 weeks of gestation age using three-dimensional ultrasound (3DUS).Methods From June 2011 to July 2012,placental volume was prospectively measured by vitual organ computer-aided analysis(VOCAL) method in 169normal pregnancies and correlated with gestational age and crown-rump length (CRL).The maximum placental diameter(MPD) and the maximum placenta thickness(MPT) were calculated in the same maximal plane.Then,regression analysis was used to deduce the formula for the expected placenta volume.Results 1) The placenta volume ranged from 33.2 cm3 at 11 weeks to 171.3cm3 at 14 weeks with a mean of (84.9 ± 26.5 cm3),the gestational age ranged from 79 days and 100 days with a mean of (87.6 ± 3.9)day,the CRL ranged from 4.6 cm to 8.3 cm with a mean of (6.2 ± 0.8) cm.2) Linear regression yielded the following formula for the placental volumes (PV) according to gestational age(GA):PV =-190.6 + 21.8 ×GA (r =0.511,P ＜0.001) and according to CRL:PV =-17.5 + 16.5 × CRL (r =0.513,P ＜0.001).3) The placenta volume could be estimated by the formula according to MPD and MPT:PV=-30.7 + 12.6 ×MPD + 11.7 × MPT (r =0.622,P ＜ 0.01).Conclusions Placental volume of the first trimester has positive relationship with gestational age and crown-rump length during the first trimester.Placenta volume can be estimated simply by maximal placenta length and thickness through two dimensional ultrasound.

Objective To investigate the distribution of fetal discrepancy in twins during the first trimester,and its influencing factor.Methods This was a prospective analysis of twin pregnancies that underwent 11 +0-13 +6 week scan at a tertiary hospital from Sep 2008 to May 2012.Differences in crownrump length (CRL),nuchal translucency (NT) were calculated for each twin pair and their distribution was analyzed according to chorionicity,gestational age,mode of conception,and the gender.Results A total of 86 twin pregnancies were included,20(23.3％) were monochorionic and 66 (76.7％) were dichorionic twins.The average discrepancy in CRLs and NTs was (3.03 ± 2.70) mm and (0.27 ± 0.20) mm respectively.There was no significant different in the CRL and NT discrepancy between monochorionic and dichorionic twin pairs.The overall CRL and NT discrepancy were not change significantly with gestational age,mode of reception or gender.Conclusions Discrepancy of CRL,NT from 11+0 to 13+6 weeks of gestation are not significantly correlated with chorionicity,gestational age,mode of conception and fetal gender.

Objective To investigate the incidence and distribution of fetal discrepancy during the first trimester in dichorionic twins.Methods This was a prospective analysis of dichorionic twin pregnancies that underwent 11+0～ 13+6 week scan at a tertiary hospital from Sep 2008 to Oct 2010.Differences in crown-rump length (CRL),nuchal translucency ( NT),heart rate ( HR).deepest vertical pockets of amniotic fluid (DVP) for every pair of twin fetuses were calculated and expressed as absolute value and percentage of discordance.Results A total of 66 dichorionic twin pregnancies were included.The average CRL was significantly different between the larger fetus and the smaller one,which were (65.28 ±8.54)mm and (62.34 ± 8.49) mm respectively ( P ＜ 0.001).The average NT was significantly different between two fetuses,which were ( 1.56 ± 0.35) mm and (1.28 ± 0.30) mm respectively. HR and DVP were also statistically different between two fetuses ( P ＜0.001).Conclusions The growth of two fetuses in normal dichorionic twins is not uniform during the first trimester.

OBJECTIVES:The purpose of this study was to investigate the influence of atherosclerosis and age on 4 representative Doppler parameters in the diagnosis of renal artery stenosis.METHODS:The 4 parameters, renal peak systolic velocity (PSV), renal-aortic ratio, renal-interlobar ratio, and acceleration time, were measured in 208 patients before angiography. The 208 patients were divided into groups according to age and atherosclerosis stratification. The Student t test, 1-way analysis of variance, and the χ(2) test were used to compare all 4 parameters and clinical characteristics. The optimal cutoff values were determined by receiver operating characteristic curves. The diagnostic concordance between atherosclerosis and age strata was evaluated by the Cohen κ coefficient.RESULTS:Of the 416 renal arteries shown on Doppler sonography, 204 had a diagnosis of renal artery stenosis and 19 as occlusion on angiography. The optimal cutoff values for the renal-aortic ratio and renal-interlobar ratio in the groups aged 46 years or older and younger than 46 years were much different (2.3 versus 1.4 and 5.1 versus 6.5, respectively), whereas those for the renal PSV and acceleration time were close to each other or the same (170 versus 180 cm/s and 51 versus 51 milliseconds). The κ coefficients for the renal PSV, renal-interlobar ratio, acceleration time, and renal-aortic ratio between the atherosclerosis and age strata were 0.93, 0.99, 1.00, and 0.71.CONCLUSIONS:Atherosclerosis and age show comparable influences on Doppler parameters in the diagnosis of renal artery stenosis. For clinical convenience, cutoff values may be separately established on the basis of a 46-year-old borderline for the renal-aortic ratio and renal-interlobar ratio, although this process is not necessary for the renal PSV and acceleration time.

Objective: To investigate the diagnostic value of ultrasound in twin pregnancy with fetal abnormalities. Methods: The ultrasonic features and clinical data of 14 twin pregnancies with fetal abnormalities found by prenatal ultrasound were analyzed retrospectively. Results: Among 14 twin pregnancies, there were 5 twins with structurally anomalous in 1 fetus, 1 with structurally anomalous in both fetuses, 1 with twin-to-twin transfusion syndrome, 2 with selective intrauterine growth restriction, 1 with co-twin neurological abnormality following the death of 1 twin, 2 with conjoined twins, 2 with twin reverse arterial perfusion sequence. Conclusion: Ultrasound can diagnose structural complications and abnormalities of twin pregnancy, and plays an important role in clinical treatment. Copyright © 2012 by the Press of Chinese Journal of Medical Imaging Technology.

Objective: To discuss the ultrasound screening method and sonographic features of fetal pelvic kidney. Methods: Prenatal sonographic characteristics of 8 fetal pelvic kidneys detected with prenatal ultrasound were retrospectively analyzed according to the autopsy after induction of labor or postnatal follow-up. Results: Pelvic kidneys were detected in 8 fetuses with gestation of 22-36 weeks, 4 in left, 3 in right, while 1 was crossed fused kidney. Two fetuses had normal sized, shaped and structural pelvic kidneys, 1 had normal structural but crossed fused right pelvic kidney, 2 had severe hydronephrosis with pelvic kidneys, 3 had multicystic kidney dysplasia, 2 in the ipsilateral pelvic kidney and 1 in bilateral kidneys with other multiple abnormalities. Induction of labor was performed for 3 fetuses, and pelvic kidney was confirmed in 2 with histopathological examination. After birth, pelvic kidney was confirmed with follow-up in 3 of 4 newborns. One fetus was still in pregnancy. Conclusion: In fetuses with unilateral empty renal fossa, attention should be paid to find the pelvic kidney. Color Doppler ultrasonic depiction of renal artery is important for the diagnosis of fetal pelvic kidney.

Objective To evaluate the diagnostic capability of prenatal ultrasound in diagnosis of fetal akinesia deformation sequence (FADS).Methods The prenatal sonographic characteristics of 5 fetuses with FADS were analyzed retrospectively.Results Both multiple joint contractures and central nervous system (CNS) anomalies,which include 5 small head circumferences,2 short cerebellar diameters,and 1 flat forehead,were found by prenatal ultrasound in all 5 FADS fetuses.Additional fetal abnormalities such as micrognathia,polyhydramnios,short umbilical cord and intrauterine growth retardation were also observed.The results of fetal chromosome analysis were available in 2 cases indicating normal karyotype.Conclusions Prenatal identification and diagnosis of FADS is possible based on the findings of sonographic examination.

Objective To investigate the clinical value and method of fetal tricuspid regurgitation in the first trimester.Methods Fetuses were performed ultrasonography at 11 to 14 gestational weeks,measuring crown rump length,nuchal translucency and acquiring tricuspid waveform.All the fetuses were followed up until 6 months after birth,including prenatal ultrasound examination,maternal serum biochemistry and karyotype test.Results A total of 262 fetuses were performed ultrasonography in the first trimester,the tricuspid waveform were acquired successfully in 249 (95%).Nine cases with tricuspid regurgitation were detected,including 3 cases of trisomy 21,3 cases with complex heart defects,one case with omphalocele,two resulted in intrauterine death and one case of normal chromosome and phenotype.Conclusions Tricuspid waveform is relatively easier to examine and assessment.Tricuspid regurgitation is a useful first-trimester ultrasound marker for the detection of chromosomal abnormalities,cardiac defects,and adverse pregnancy outcome.

Objective To investigate the diagnostic value of prenatal ultrasonography in the fetal hemivertebra. Methods The ultrasonographic findings of three fetuses with hemivertebra diagnosed in our hospital were reviewed and compared with those of postnatal ultrasonography,other image modalities,and autopsy. Results In all fetuses,a distortion of the spine was observed where only one half of the vertebra could be identified. The parents opted for termination of the pregnancy in one case and the deformity was confirmed by autopsy. The other two fetuses were delivered and in one fetus the diagnosis was confirmed by radiological assessment. Conclusions Hemivertebra can be diagnosed accurately by second-trimester ultrasonography. The prognosis is mostly favorable when no other anomalies are associated. Meticulous examination may disclose the lesion and help decide the fate of pregnancy.

Objective To investigate the diagnositic value of ultrasonography in fetuses with cystic biliary malformation. Methods Three cases of cystic biliary malformation diagnosed in our hospital by prenatal ultrasound were followed up until surgery after birth. Results In all three cases.an anechoic cystic lesion was detected in the right upper abdomen at 16,26,34 weeks' gestation respectively, which were diagnosed as biliary cystic malformation by prenatal ultrasound. Two cases were confirmed as choledochal cyst by surgery, one case as biliary atresia. The maximum diameter during pregnancy of choledochal cyst were 3. 9 cm and 4.2 cm respectively, which increased steadily as gestational age advanced, with normal gallbladder in continuity with the choledochal cyst. But the largest diameter of the cyst in congenital biliary atresia was 1.7 cm and remained unchanged throughout the remaining pregnancy, the gallbladder could not be detected or an irregular small gallbladder was shown. Excision of the cyst and Roux-en-Y hepaticojejunostomy were successfully performed in all three cases. Postoperative course were uneventful. Conclusions Cyst diameter, change in size, gallbladder ultrasound pattern may allow to make a prenatal differential diagnosis of biliary tree cystic malformation. Small and stable cyst with an undetected gallbladder or small gallbladder is more suggestive of biliary atresia than choledochal cyst. Precise imaging may facilitate prenatal counseling and perinatal management. The outcomes had improved with earlier operations.

Objective To analyze the clinical and ultrasonographic features of intraductal papillary mucinous neoplasm (IPMN) of the pancreas and to assess the usefulness of transabdominal ultrasonography. Methods Twelve patients with IPMN underwent surgery, including 4 (33.3%)with adenoma and 8(66.7%) with adenocarcinoma. IPMN was classified into 3 categaries by the site of main duct,branch duct and combined type based on the ultrasonographic findings preoperatively. All the clinical presentations and the ultrasonographic imaging findings were analyzed and compared with the histologic diagnosis. Results Of malignant IPMNs,diabetes was presented in 5 cases,elevated CA19-9 was presented in 4 cases and steatorrhea was presented in 2 cases. But these was not presented in benigns. Transabdominal ultrasonography revealed all the cystic or cystic-solid lesions in this study. The mean diameter of the lesions with adenoma was (1.4 ± 0.8)cm (range,0.5 - 2.0 cm) and that with adenocarcinoma was (6.3 ± 6.0)cm (range, 2.0 - 20 cm). The mean diameters of the main duct for the cases with adenomas and adenocarcinomas were (1.0 ± 0.8) cm and ( 1.6 ± 1.0) cm, respectively. Among the adenomas, 3 cases were calssified as branch type and 2 were demonstrated with mural nodules and no colour signals was detected within them. Five of the malignancies were considered as main duct type and 3 were combined type. Seven cases were detected mural nodules and showed abundant colour flow signals within them. Conclusions Transabdominal ultrasonography revealed the pancreatic cystic lesions and dilated ducts of IPMN. Some characteristics should be considered for malignancy: clinical symptoms, tumor size and mural nodules with colour flow signals,which may be helpful for the diagnosis and management of IPMN.

OBJECTIVE:To analyze the clinical and ultrasonographic imaging features of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.METHODS:Twelve patients with IPMN underwent surgery between May 2005 and December 2008, including 4 (33.3%) with adenoma and 8 (66.7%) with adenocarcinoma. IPMN was classified preoperatively into 3 types based on sonographic findings of different sites: main duct, branch duct, and combined type. All clinical presentations and ultrasonographic findings of those patients were reviewed and the correlation between ultrasonographic findings and histopathological results was analyzed.RESULTS:There were 9 men and 3 women with a mean age of 60.1 +/- 9.6 years (range, 32-73). Of all the 12 patients with IPMN, 9 (75.0%) had experienced some symptoms of epigastric discomfort and/or pain as well as backache; 7 cases were with medical history of acute pancreatitis, 5 cases with diabetes, 4 cases with elevated CA19-9, and 2 cases with steatorrhea. All lesions of IPMN have been revealed by transabdominal ultrasonography. The mean diameters of the lesions were 1.4 +/- 0.8 cm (range, 0.5-2.0) and 6.3 +/- 6.0 cm (range, 2.0-20.0) in adenomas and adenocarcinomas, respectively. And the mean diameters of the main duct in adenomas and adenocarcinomas were 1.0 +/- 0.8 cm and 1.6 +/- 1.0 cm, respectively. Among the 4 adnomas, 3 (75.0%) cases were classified as branch type based on sonographic findings, and 2 were demonstrated as mural nodules in which no color signals was detected. Among the 8 adenocarcinomas, 5 (62.5%) cases were classified as main duct type, and 3 (37.5%) as combined type. In 7 of the 8 adenocarcinomas, mural nodules were detected within the dilated ducts or cysts of the lesions in which color flow signals were detected.CONCLUSIONS:Transabdominal ultrasonography can reveal the pancreatic cystic lesions of IPMN as well as dilated pancreatic ducts. Some characteristics should be noticed as suggesting the possibility of malignancy: clinical symptoms of pancreatic insufficiency, large tumor size, and mural nodules with color Doppler flow signals. Transabdominal ultrasonography could be a useful tool to help diagnose and make appropriate management of IPMN.

目的探讨超声在剖宫产瘢痕妊娠诊断与治疗中的价值。方法回顾性分析83例经手术及病理证实的剖宫产瘢痕妊娠病例,总结其主要临床表现、超声特点及超声辅助的治疗方法。结果在83例剖宫产瘢痕妊娠病例中,根据其超声图像特点分为三型:瘢痕处肌层内孕囊型(35例)、瘢痕处及宫腔内孕囊型(13例)、包块型(35例)。前两型的主要临床表现为停经后不规则阴道出血(分别为60.0%和61.5%),包块型的主要临床表现为清宫术或药物治疗后持续性阴道出血或血β-HCG水平异常(82.9%)。83例中通过超声检查正确诊断为剖宫产瘢痕妊娠者71例,诊断符合率为85.5%。13例瘢痕处肌层内孕囊型、11例瘢痕处及宫腔内孕囊型和2例包块型的患者采用经腹超声监测下清宫术治疗;2例瘢痕处肌层内孕囊型、1例瘢痕处及宫腔内孕囊型和5例包块型的患者采用经腹超声引导下病灶局部注射甲氨蝶呤治疗。结论超声对剖宫产瘢痕妊娠的诊断具有重要临床意义,在选择治疗方案、指导治疗及治疗后随诊方面起到重要作用。

Objective To evaluate the differences among five representative and useful Doppler parameters in the diagnosis of the three common types of renal artery stenosis (RAS). Methods Five Doppler parameters including renal peak systolic velocity (RPSV), renal-aortic ratio (RAR), renal-interlobar ratio (RIR),acceleration time (AT),and resistant index (RI) were measured in 221 patients before renal arteriography. Differences between the groups of patients with various clinical causes of RAS were analyzed by Chi-Squared test. One-way ANOVA or t test were used to compare the means between different groups.The optimal cutoff value was determined with the maximum sum of sensitivity and specificity. Results Of the 442 renal arteries (main and accessory renal arteries) demonstrated at arteriography,214 were normal or stenosed less than 50 %, 204 stenoses 50% - 99 %, and 24 occlusions. RIR, RAR and RI were significantly different between the atherosclerotic and non-atherosclerotic RAS groups (P ＜0.05), while RPSV and AT were not. The optimal cutoff values of RAR,RIR and RI for detecting RAS between the atherosclerotic and non-atherosclerotic groups were much different (2.5 versus 1.9, 5. 1 versus 6.5, 0.57 versus 0.50,respectively) ,but those of RPSV and AT were similar or the same (170 cm/s versus 200 cm/s,51 ms versus 51 ms,respectively). Conclusions In the case of RAS (diameter reduction≥50%),it is advised to establish separate cutoff values of RAR, RIR and RI according to atherosclerotic and non-atherosclerotic RAS, but the same cutoff value of RPSV and AT can be applied. RIR is a good Doppler parameter in the diagnosis of RAS,especially atherosclerotic and fibromuscular dysplasia RAS.