目的:分析首次和复发剖宫产瘢痕部位妊娠(CSP)患者两次行介入联合清宫术治疗的临床效果.方法:收集宁波市妇女儿童医院首次和复发CSP两次均行介入联合清宫术治疗的患者36例.比较患者两次介入治疗术后清宫情况、异位栓塞发生率、住院时间及血清人绒毛膜促性腺激素(β-hCG)水平恢复正常时间.结果:患者复发CSP与首次CSP时行介入联合清宫术治疗比较,清宫出血量增加(88.61±85.16 ml vs.7.22±4.88 ml,P＜0.01)、清宫过程中大出血发生率增加(22.22％vs.0,P＜0.01)、清宫成功率降低(80.56％vs.100.00％,P＜0.05)、宫腔妊娠组织残留发生率增高(30.56％vs.8.33％,P＜0.05)、异位栓塞发生率增高(22.22％vs.0,P＜0.01)、住院时间延长(6.17±1.11 天 vs.5.33±0.53 天,P＜0.01)、血 p-hCG 水平恢复正常时间延长(43.72±8.93天vs.29.29±4.21天,P＜0.01).结论:首次CSP行介入联合清宫术治疗效果较好,但复发CSP行第2次介入术后清宫过程中出血风险较大,术后恢复较慢,术前需做好充分准备.

目的 探讨剖宫产术后子宫切口严重感染的MRI影像表现及其诊断价值.方法 回顾性收集2015年2月至2021年10月宁波市妇女儿童医院产科收治的子宫切口严重感染的12例患者,均行盆腔MRI平扫、DWI及增强检查,总结子宫切口严重感染及其合并宫内外感染的MRI影像表现及愈合过程.结果 12例患者子宫切口处肌层不连续,内见团状异常信号突向膀胱,T1WI呈等信号、T2WI呈稍高信号,部分可见气液平,切口边缘DWI序列见斑片状高信号,增强后切口处见未强化区,浆膜层连续或不连续,并且出现不同程度的宫内外感染.12例患者治疗后随访观察到子宫切口感染由控制、好转到愈合的过程.结论 MRI能够直观显示子宫切口严重感染情况及其合并宫内外感染程度及范围,动态观察子宫切口愈合情况,并了解临床治疗效果.

With the increase of various risk factors such as cesarean section and abortion, placenta accrete spectrum (PAS) disorder is happening more frequently year by year. Therefore, prenatal prediction of PAS is of crucial practical significance. Magnetic resonance imaging (MRI) quality will not be affected by fetal position, maternal size, amniotic fluid volume, etc., which has gradually become an important means for prenatal diagnosis of PAS. In clinical practice, T2-weighted imaging (T2WI) magnetic resonance (MR) images are used to reflect the placental signal and T1-weighted imaging (T1WI) MR images are used to reflect bleeding, both plays a key role in the diagnosis of PAS. However, it is difficult for traditional MR image analysis methods to extract multi-sequence MR image features simultaneously and assign corresponding weights to predict PAS according to their importance. To address this problem, we propose a dual-path neural network fused with a multi-head attention module to detect PAS. The model first uses a dual-path neural network to extract T2WI and T1WI MR image features separately, and then combines these features. The multi-head attention module learns multiple different attention weights to focus on different aspects of the placental image to generate highly discriminative final features. The experimental results on the dataset we constructed demonstrate a superior performance of the proposed method over state-of-the-art techniques in prenatal diagnosis of PAS. Specifically, the model we trained achieves 88.6% accuracy and 89.9% F1-score on the independent validation set, which shows a clear advantage over methods that only use a single sequence of MR images.

OBJECTIVES:To evaluate AI biases and errors in estimating bone age (BA) by comparing AI and radiologists' clinical determinations of BA.METHODS:We established three deep learning models from a Chinese private dataset (CHNm), an American public dataset (USAm), and a joint dataset combining the above two datasets (JOIm). The test data CHNt (n = 1246) were labeled by ten senior pediatric radiologists. The effects of data site differences, interpretation bias, and interobserver variability on BA assessment were evaluated. The differences between the AI models' and radiologists' clinical determinations of BA (normal, advanced, and delayed BA groups by using the Brush data) were evaluated by the chi-square test and Kappa values. The heatmaps of CHNm-CHNt were generated by using Grad-CAM.RESULTS:We obtained an MAD value of 0.42 years on CHNm-CHNt; this result indicated an appropriate accuracy for the whole group but did not indicate an accurate estimation of individual BA because with a kappa value of 0.714, the agreement between AI and human clinical determinations of BA was significantly different. The features of the heatmaps were not fully consistent with the human vision on the X-ray films. Variable performance in BA estimation by different AI models and the disagreement between AI and radiologists' clinical determinations of BA may be caused by data biases, including patients' sex and age, institutions, and radiologists.CONCLUSIONS:The deep learning models outperform external validation in predicting BA on both internal and joint datasets. However, the biases and errors in the models' clinical determinations of child development should be carefully considered.KEY POINTS:• With a kappa value of 0.714, clinical determinations of bone age by using AI did not accord well with clinical determinations by radiologists. • Several biases, including patients' sex and age, institutions, and radiologists, may cause variable performance by AI bone age models and disagreement between AI and radiologists' clinical determinations of bone age. • AI heatmaps of bone age were not fully consistent with human vision on X-ray films.

目的 探讨锥形鞘管行子宫输卵管造影的临床价值.方法 选取宁波市妇女儿童医院2021年4-9月因不孕症行子宫输卵管造影的950例患者,根据造影导管类型分为双腔球囊导管组(450例)和锥形鞘管组(500例).比较两组插管情况、宫腔显影情况、对比剂逆流情况及疼痛副反应情况.结果 锥形鞘管组插管成功率及宫腔显影完整率均高于双腔球囊导管组,对比剂逆流比率及中重度疼痛副反应比率均低于双腔球囊导管组(均P＜0.05);对比剂逆流表现为宫腔周围可见云雾状、放射状或树枝状影.结论 应用锥形鞘管行子宫输卵管造影操作简单,可提高插管成功率,降低子宫畸形的误诊率,降低对比剂逆流及疼痛副反应,值得临床推广使用.

Acid phosphatase (EC. 3.1.3.2) has been separated by molecular sieving into two fractions and these fractions were purified by Sephadex ion-exchange chromatography. One of the purified enzymes (fraction II) was purified 830 fold and had a specific activity of 34 international units per mg protein at 37 degrees C and at a pH of 4.9. The Km value with p-nitrophenylphosphate as substrate was 9.10(-4) M and the kinetic studies showed no possibilities of control by allosteric transitions, and no effect of metabolites (amino acids) on the reaction velocity.

目的 探讨介入治疗联合清宫术与宫腔镜手术治疗剖宫产瘢痕妊娠(CSP)出血情况,评价介入治疗对首次和再次CSP的效果.方法 收集宁波市妇女儿童医院2014年1月至2019年12月收治的88例CSP患者临床资料.其中33例患者2次CSP接受2次介入治疗联合清宫术(A组),55例患者首次CSP未介入治疗直接接受宫腔镜手术(B组).观察指标:两组手术出血量,A组再次CSP二次介入治疗与首次CSP介入治疗手术情况(子宫供血血管、栓塞血管、血管破裂、曝光时间、手术时间),术后清宫出血量、清宫成功率.结果 A组、B组术中出血量分别为(40.38±87.30) mL、(69.27±68.63) mL,A组出血量较少(P=0.048).再次CSP二次介入治疗与首次CSP介入治疗相比,双侧子宫动脉供血比率(48.5％对100％,P＜0.01)、双侧子宫动脉栓塞比率(42.4％对97％,P＜0.01)均显著较低,超选择插管和栓塞过程中血管易破裂(15％对0％,P=0.02)、曝光时间[(5.26±1.67) min对(2.72±1.02) min,P＜0.001]、手术时间[(61.94±15.85) min对(40.45±9.49) min,P＜0.01]均明显延长;介入术后清宫过程中出血量[(74.70±114.23) mL对(6.06±2.08) mL,P=0.01]明显增多,清宫成功率(87.9％对100％,P=0.04)较低.结论 清宫术前介入栓塞可有效减少CSP治疗中出血,但再次CSP行二次介入治疗手术难度较大,术后清宫过程中出血风险仍较高,清宫术前需做好充分准备.

Objective:To evaluate the effect of resveratrol combined with γ-ray irradiation on the biological behavior of cervical cancer cells, and to explore its possible mechanism.Methods:The proliferation of cell populations after different concentrations of resveratrol solution±γ-ray irradiation was detected by CCK-8 assay. Scratch test and Transwell chamber test were used to detect cell migration and invasion. Flow cytometry and Annexin V-FITC/PI double staining were employed to assess cell apoptosis. Western blot was performed to measure the expression levels of PI3K, Akt, p-Akt, mTOR and p-mTOR proteins.Results:Compared with the normal control (NC) group, the resveratrol group±γ-ray irradiation could inhibit the proliferation, migration, and invasion and promote cell apoptosis of human cervical cancer Hela cells, and the combined effect was more obvious. Compared with the NC group, resveratrol and γ-ray irradiation could significantly down-regulate the expression levels of Bcl-2, PI3K, p-Akt and p-mTOR proteins, up-regulate the expression level of Bax protein, but did not significantly alter the expression levels of Akt and mTOR proteins in human cervic1 255al cancer Hela cells.Conclusions:Resveratrol combined with γ-ray irradiation can dramatically inhibit the proliferation, migration, invasion, and promote the apoptosis of cervical cancer Hela cells. The mechanism may be related to the inhibition of the PI3K/Akt/mTOR signaling pathway and down-regulating the expression levels of downstream related proteins.

BACKGROUND:Architectural distortion is a common mammographic sign that can be benign or malignant. This study investigated the diagnostic value of magnetic resonance imaging (MRI) for architectural distortions that were category 3-4 under the breast imaging reporting and data system (BI-RADS) by mammography.METHODS:We retrospectively analyzed 219 pathologically confirmed lesions in 208 patients who had BI-RADS category 3-4 architectural distortion in mammography images. Two radiologists described and categorized the architectural distortion and assigned the BI-RADS categories to the corresponding lesions on MRI images. Using the postoperative pathological diagnosis as the gold standard, we performed receiver operating characteristic (ROC) analysis for the efficacy of mammography and MRI in differentiating patients with benign or malignant lesions.RESULTS:Totally 151 benign lesions and 68 malignant lesions were confirmed. According to the full-field digital mammography (FFDM), 82 lesions were in BI-RADS category 3, 104 lesions in 4A, 29 lesions in 4B, and 4 lesions in 4C. The positive predictive values of FFDM for BI-RADS categories 3, 4A, 4B, and 4C were 13.4% (11/82), 27.9% (29/104), 82.8% (24/29), and 100.0% (4/4), respectively. According to MRI, 59 lesions were in BI-RADS categories 1-2, 87 lesions in 3, 39 lesions in 4, and 34 lesions in 5, with their positive predictive values being 0.0% (0/58), 2.3% (2/87), 89.7% (35/39), and 100.0% (34/34), respectively. The area under the ROC curve (AUC) of breast benign and malignant lesions differentiated by FFDM was 0.647, and the diagnostic sensitivity, specificity, and Youden index were 86.3%, 41.7%, and 0.280, respectively. The AUC of FFDM combined with dynamic contrast-enhanced MRI (DCE-MRI) in differentiating breast benign vs. malignant lesions was 0.851, and the diagnostic sensitivity, specificity, and Youden index were 89.2%, 80.7%, and 0.699, respectively. The AUC of FFDM combined with DCE-MRI and the apparent diffusion coefficient (ADC) in differentiating benign vs. malignant lesions was 0.983, and the diagnostic sensitivity, specificity, and Youden index were 98.1%, 97.5%, and 0.956, respectively.CONCLUSIONS:MRI can improve the diagnostic efficiency of mammography in diagnosing BI-RADS category 3-4 architectural distortions and can help in the qualitative diagnosis of architectural distortion lesions.

目的 探讨卵巢透明细胞癌(OCCC)的影像学表现和病理特点,以提高对该病的诊断水平.方法 回顾性分析经病理学证实的11例OCCC的MRI、CT影像资料和临床资料,8例患者行MRI平扫及增强检查;3例患者行CT平扫及增强检查,对病灶内部结构、信号特征及增强表现进行分析.结果 1例患者为双侧发病,10例为单侧发病,共12个病灶.病灶最大径40～115 mm,平均79.5 mm;1个病灶呈实性,11个病灶呈囊实性(其中6个病灶呈单房囊性为主的囊实性肿块,可见沿囊壁突向囊内的多发、不规则壁结节;5个病灶呈以实性为主的囊实性肿块);2个病灶边缘不整,10个病灶形态规整,呈椭圆形或圆形,包膜完整;12个病灶实性成份DWI均呈明显高信号,增强扫描后呈不均匀明显强化.结论 OCCC患者的影像学检查有一定特征性,但缺乏明显的特异性,结合临床病史和实验室检查资料,可以提高术前诊断准确性.

目的:分析价加味麻杏石甘汤治疗小儿支原体肺炎效果的应用价值.方法:选取(2016年2月-2018年2月)小儿支原体肺炎患儿84例,根据治疗方法不同分为对照组和观察组.对照组患儿采用阿奇霉素序贯治疗,观察组患儿采用阿奇霉素序贯治疗+加味麻杏石甘汤治疗,采用X线及实验室检验评价患儿治疗后疗效.结果:治疗前,两组患儿中医症候主症、次症及总积分比较,差异无统计学意义(P＞0.05).治疗后,观察组患儿中医症候主症、次症及总积分低于对照组,差异有统计学意义(P＜0.05).观察组患者治愈率+显效率为76.19％,对照组为54.76％,观察组患者治愈率+显效率高于对照组,差异有统计学意义(P＜0.05).治疗前,两组患儿炎症因子、G-CSF、D-D、CysLTs、MPO、GSH-Px水平比较,差异无统计学意义(P＞0.05).治疗后,观察组患儿炎症因子、G-CSF、D-D、CysLTs水平低于对照组,MPO、GSH-Px水平高于对照组,差异有统计学意义(P＜0.05).结论:加味麻杏石甘汤治疗小儿支原体肺炎疗效显著,可减轻炎症反应,抑制氧化应激反应,改善患儿临床症状.

Objective To study the clinical manifestations and magnetic resonance imaging(MRI) features of superficial sid-erosis of central nervous system (SSCNS) in children so as to improve the level for the diagnostic s of this disorder. Methods A retrospective analysis of 5 pediatric SSCNS patients, who were confirmed by clinical and MRI imaging examination in Ningbo woman & children's hospital from February 2014 to October 2016, was conducted in this work. All those 5 patients underwent routine MRI scanning, T2?-weighted gradient echo sequence (GRE-T2?WI), and susceptibility weighted imaging (SWI) se-quence scanning. Then, the clinical manifestations and MRI signal characteristics were analyzed. Results In those five chil-dren,two children presented with unilateral hearing loss,one with Barbinski positive sign,3 with headache or dizziness history, one with unilateral vision loss,and one with a history of epilepsy. The MRI images of T2WI,GRE-T2?WI and SWI exhibited the low signal shadow in the left frontal cortex of temporal lobe cortex,right inferior surface covering the surface of the frontal cortex surface,right temporal lobe and local cortical surface of left parietal lobe cortex surface and the right lateral fissure,respectively. The lesions showed slightly low signal in the sequence of T1WI,with no obvious manifestation. Conclusion The clinical mani-festations of SSCNS in children are different from those in adults. MRI is the preferred method for the examination of SSCNS in children. GRE-T2?WI sequence is more intuitive and has the highest sensitivity in showing SSCNS in children.

OBJECTIVE:To investigate diagnostic value of MRI, X ray and CT for bone infarction in children with systemic lupus erythematosus.METHODS:Eleven systemic lupus erythematosus children with bone infarction were retrospectively analyzed from January 2015 to January 2017 , and tested by MRI, X-ray and CT. Among them, including 1 male and 10 females aged from 6 to 16 years old with an average of 13 years old. All patients were detected by MRI, 9 patients were detected by X-ray and 3 patients were detected by CT, imaging findings were analyzed.RESULTS:The location of bone infarction involved 60 sits, 30 sites located on metaphyseal-diaphyseal region, 8 located on patella, 21 located on epiphysis, and 1 located on talus. Focus of 11 patients were detected by MRI, the main manifestation showed geographic change, long T1 and T2 signal could seen around focus, and showed double ring sign and three ring sign; 5 of 9 patients by X-ray examination detected focus;2 of 3 patients by CT examination detected focus. No abnormity seen at early stage by X-ray and CT examination, and low density focus around harden edge at chronic stage.CONCLUSIONS:MRI could display bone fracture at early stage, X-ray and CT could only display lesion at chronic stage, MRI is the most effective method in diagnosing bone infarction.

目的:研讨乳腺癌患者早期使用钼靶X线摄片联合螺旋CT技术诊断的临床价值.方法:以我院2015年1月-2017年10月收治的50例乳腺癌患者为观察对象,对其实施钼靶X线摄片、螺旋CT技术检查,同时与其手术病理资料相结合,评估两种技术联合诊断的准确情况.结果:钼靶X线、螺旋CT的检出率分别为78.0％和80.0％,相比手术病理结果均较低,比较差异显著(P＜0.05);而钼靶X线+螺旋CT的检出率为92.0％,与手术病理结果相比,差异不显著(P＞0.05).手术病理对腋窝淋巴结转移的检出率显著高于钼靶X线与螺旋CT,比较差异显著(P＜0.05).对钙化病灶的检查,钼靶X线、螺旋CT比较差异不显著(P＞ 0.05).结论:对乳腺癌患者联合使用钼靶X线及螺旋CT技术检查,早期诊断准确性较高,能够为临床提供更具有价值的诊治依据,值得推荐.

Objective To investigate the X-ray findings of the internal anal sphincter achalasia (IASA) and to improve the di-agnostic accuracy of the disease .Methods 27 patients with a clinical diagnosis of IASA with barium enema X-ray image data were collected from ningbo woman&children ' s hospital from January 2009 to March 2015 .We analyzed of the rectum and sig-moid colon morphology , expansion degree , tube wall edge smoothness .Results 27 cases were in barium enema despite the strong crying but couldn ' t saw like children of the same age the rapid discharge diluted barium liquid;25 cases of children with a-nal tube above rectum and sigmoid colon expaned;22 cases of children with rectal tube wall sometimes appeared single or multiple limitations of diverticular bulge shadow , sometimes projected shadow lost and pipe wall flatted , which had four children along the anal tube on both sides of the convex downwards .Conclusion X-ray examination is of great value for diagnosis of internal anal sphincter achalasia in children , and it is the first choice of examination .

目的 探讨卵巢浆液性囊性腺纤维瘤的磁共振(MRI)特征表现及病理学基础,提高对该病的诊断水平.方法 回顾性分析经病理证实的21例卵巢浆液性囊性腺纤维瘤患者的MRI影像资料,所有患者术前均行MR平扫及增强扫描,对病灶内部结构、信号特征及增强表现进行分析.结果 2例患者为双侧发病,19例为单侧发病,共23个病灶.病灶最大经为33 ～ 159mm,平均82.7mm;7个为囊实性,16个为囊性,其中单囊4个,多囊12个,有6个含有壁结节.所有病灶囊壁、分隔及实性成份在MRI-T2WI呈低信号,5个囊内壁局部增厚,呈“地毯征”;4个囊实性病灶中实性成份见小囊样高信号影,形成“黑色海绵征”.增强扫描17个病灶实性成份及囊壁呈轻中度强化,6例未见强化.结论 卵巢浆液性囊性腺纤维瘤中囊壁及实性成份T2WI呈低信号,增强扫描大部分呈轻中度强化;“地毯征”及“黑色海绵征”是其特征表现.

目的 探讨数字钼靶X线检查钙化灶对良恶性乳腺病变的诊断价值.方法 回顾性分析206例患者的乳腺钼靶X线影像资料,参照乳腺影像报告和数据系统(BI-RADS)评估分类,分析良恶性病变钙化灶的形态、分布特点及其他阳性征象的差异.结果 钙化灶形态方面,斑点样、无定形或模糊、粗糙不均质、细小多形性、细线或细线分支状钙化的恶性率分别为10.96％(8/73)、39.66％(23/58)、69.23％(9/13)、78.79％(26/33)、96.56％(28/29).钙化灶分布方面,弥漫/散在、区域性、簇状、段样钙化的恶性率分别为0、18.19％(4/22)、49.50％(50/101)、72.73％(40/55).206例中,124例无其他阳性征象,82例伴有其他阳性征象.有无其他阳性征象患者钙化灶形态、分布方面良恶性差异均有统计学意义(P均＜0.05).结论 乳腺钙化的形态、分布特点有助于评估乳腺病变的恶性度,当伴随其他阳性征象时,恶性度明显提高.

Objective: To analyze the MR and ultrasound (US) features of struma ovarii (SO).Methods:MR and US images of 8 patients with pathologically proved SO were retrospectively analyzed. Imaging features were compared with pathological results.Results: All tumors were unilateral, well-deifned, mixed solid and cys-tic. The maximum sizes of the tumors ranged from 5.1 cm to 19.3 cm. MR appearances: The solid components were intermediate intensities on T2-weighted images and high intensities on diffusion-weighted images. The signal intensities of the cystic components were various. The areas of prominent low intensity on T2-weighted images were recognized in all cases, which were low intensities on diffusion-weighted images. Cyst walls, septa and solid components were well enhanced. Ultrasonographic appearances: The solid portion of tumors showed parenchymal echogenicity with “struma pearls” in 7 cases.Conclusion: Struma ovarii appeared as a smooth mar-ginated mass with the areas of prominent low intensity on T2-weighted images on MR, and “struma pearls” on US images. The MR and US characteristic appearances of SO may be of great value for the diagnosis.

In recent years,with the increase of cesarean section rate,the incidence of placenta implantation and the incidence of its complications are also increasing. In previous treatment,the removal of the uterus was always conducted to save patients'life,and in such case many young patients lost reproductive organ. Complete placenta implanation is clinically rare, while there is a lack of uniform treatment guideline. The study reported the process of the successful conservation treatment of three cases of complete placenta implanation. Complete placenta implanation was found in the three patients by B ultrasound,MRI and cesarean section. Placenta was remained in uterine cavity,ultra-selective uterine artery was administrated with selective uterine artery infusion of 50 mg methotrexate combined with uterine arterial embolization,an adjuvant therapy of oral administration of mifepristone was given to the patients,and intravenous drip of wide -spectrum antibiotics were also administrated to prevent infection. The therapy brought favorable effects for the three patients.

目的 分析先天性肺结核患儿的临床及影像学表现,提高对该病的认识水平.方法 回顾性分析18例先天性肺结核患儿的临床及影像学资料,其中男性10例,女性8例,年龄17～180天,平均年龄85.5天,18例患儿行X线胸片检查,16例行胸部CT检查,6例行头颅MRI检查.结果 临床症状主要为发热咳嗽(18例),实验室检查白细胞增高2例,胃痰液和脑脊液中抗酸杆菌阳性率较低(2/18 vs 0/9),PPD阳性率低(2/18),T-SPOT阳性率较高(3/3).X线表现为弥漫粟粒结节10例,广泛分布结节-斑片影6例,且分布右肺多于左肺,上肺多于下肺,多伴肺实变(10例),肺门增大(11例).CT表现中,弥漫粟粒结节9例,结节密度较低,6例伴结节融合,融合结节密度高,边界清；广泛分布结节-斑片影5例,多为类圆形,密度较高,边界可清或伴淡薄样渗出；7例纵隔及肺门淋巴结肿大且伴蛋壳样或沙粒状钙化.6例头颅MRI中,4例有脑皮质或实质病变.结论 先天性肺结核的临床表现及结核生化指标检测均缺乏特异性,而影像学表现虽复杂多样,却有一定的规律和特征,能为临床早期诊断及治疗提供帮助.