Accurate preoperative differentiation between benign and malignant ovarian tumors is critical for optimal patient management. The Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound risk stratification and serum biomarkers like CA125 and HE4 are key diagnostic tools, but their comparative and combined efficacy, especially when stratified by menopausal status, warrants further investigation. This study aimed to evaluate and compare the individual diagnostic performance of O-RADS US, CA125, HE4, and the ROMA index, and to assess the added value of combining O-RADS US with serum biomarkers for preoperative ovarian tumor diagnosis. A retrospective analysis was conducted on 367 patients with pathologically confirmed ovarian tumors. All patients underwent preoperative transvaginal ultrasound for O-RADS classification and serum testing for CA125 and HE4. The ROMA score was calculated. Multivariable logistic regression analysis was performed to identify independent predictors of ovarian malignancy. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit of the models across a range of threshold probabilities. Patients were stratified into premenopausal (n = 228) and postmenopausal (n = 139) subgroups for comparative analysis. Malignant tumors (n = 163) were associated with significantly older age, larger lesion diameter, higher O-RADS categories, and elevated levels of CA125, HE4, and ROMA compared to benign tumors (n = 204) (all p < 0.001). O-RADS classification showed a strong correlation with malignancy (χ²=278.335, p < 0.001). Multivariable logistic regression identified O-RADS score and HE4 as independent predictors of ovarian malignancy. In stratified analysis, age was not a significant discriminator in postmenopausal women (p = 0.743), unlike in premenopausal women. ROC analysis revealed that in premenopausal women, O-RADS had superior diagnostic accuracy (AUC = 0.971) compared to CA125 (AUC = 0.798), HE4 (AUC = 0.838), and ROMA (AUC = 0.843). Conversely, in postmenopausal women, HE4 demonstrated the highest accuracy among serum biomarkers (AUC = 0.971), comparable to O-RADS (AUC = 0.939). Critically, the combination of O-RADS and HE4 yielded the most balanced and robust diagnostic performance overall (AUC = 0.959, Sensitivity = 94.95

PurposeThis study aimed to investigate the diagnostic values of automated follicle measurement and superb microvascular imaging using transvaginal three-dimensional (3D) ultrasound for diminished ovarian reserve (DOR) in women of reproductive age.MethodsThis retrospective study included women who underwent ovarian reserve function assessment at the Affiliated Obstetrics and Gynecology Hospital of Tongji University between November 2022 and June 2023. The participants were categorized into the DOR and normal groups based on the anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels.ResultsThis study included 109 participants: 36 with diminished ovarian reserve (DOR) and 73 with normal ovarian function. Significant differences emerged between the groups in age, body mass index, AMH, FSH, the FSH/LH ratio, and estradiol (all p < 0.05). Transvaginal 3D ultrasound parameters also differed significantly, including antral follicle count (AFC), total ovarian volume (OV), the stroma-to-antrum ratio (S/A), vascularization index (VI), flow index (FI), vascularization-flow index (VFI), and ovarian interstitial artery peak and end-diastolic velocities (PSV, EDV) (all p < 0.05). The efficacy of the ultrasound–serum combined index in diagnosing DOR (AUC = 0.995, 95% CI: 0.949–1.000) is superior to that of the multi-parameter ultrasound index (AUC = 0.973, 95% CI: 0.914–0.996), AFC (AUC = 0.965, 95% CI: 0.902–0.993), and AMH (AUC = 0.974, 95% CI: 0.916–0.996). According to the ROC curve analysis, when selecting the cutoff value based on the highest sensitivity, the optimal cutoff for AFC was 6.5. After including the age variable, least absolute shrinkage and selection operator (LASSO) regression identified AFC, stromal OV, total VI, total FI, and EDV as optimal variables. Among them, AFC had the highest weight coefficient. The OR values of AFC (OR = 0.596, 95% CI: 0.442–0.804, p < 0.001) and total FI (OR = 0.853, 95% CI: 0.737–0.988, p = 0.033) in the multivariate analysis are statistically significant. Decision curve analysis (DCA) demonstrated that the PRE_LASSO model consistently outperformed the PRE_AFC model in net benefit across most threshold ranges. The scatter plot of net reclassification improvement (NRI) showed that most case patients had increased risk, while control patients had reduced risk, indicating that the PRE_LASSO model exhibits superior clinical application value and risk stratification capability.ConclusionThis study identified AFC as the key predictor factor for DOR, with an AUC of 0.965 (95% CI: 0.902–0.993), demonstrating high diagnostic value. These results underscore the promising potential of transvaginal 3D ultrasound techniques to enhance the precision of ovarian reserve assessments.

Cardiac fibrosis is a critical pathological feature in nearly all forms of heart disease and contributes to heart failure. However, existing diagnostic and therapeutic approaches are insufficient for detecting fibrosis or targeting conventional pathways. Further molecular investigations are urgently needed to develop effective treatments. Circular RNAs (circRNAs), distinguished by their stability and regulatory roles, show significant potential. CircRNA_006640 was substantially upregulated in left ventricular tissues of male mice subjected to transverse aortic constriction, as well as in blood samples. Gain- and loss-of-function studies confirmed that circRNA_006640 promoted proliferation and phenotypic transformation in mouse cardiac fibroblasts. Real-time quantitative reverse transcription polymerase chain reaction and Western blotting demonstrated that circRNA_006640 suppressed miR-7648-3p and miR-185-3p, which in turn inhibited connective tissue growth factor (CTGF). Furthermore, there was a synergistic effect between miR-7648-3p and miR-185-3p to enhance the suppression of CTGF. In vivo, circRNA_006640 markedly exacerbated cardiac fibrosis. Knockdown of circRNA_006640 using small interfering RNA effectively mitigated cardiac fibrosis and preserved cardiac function, indicating therapeutic potential for antifibrotic strategies. CircRNA_006640 acts as a novel upstream regulator of CTGF, exacerbating cardiac fibrosis by sponging miR-7648-3p and miR-185-3p. The synergistic interaction between miR-7648-3p and miR-185-3p strengthens the profibrotic effect. Targeting CircRNA_006640 may hold promising therapeutic potential for cardiac fibrosis.

Heart failure caused by pressure-overloaded left-heart (poLV) diseases is especially difficult to manage in children. Long-term surveillance and early recognition of poLV remodeling are crucial, while current biomarkers remain inadequate for predicting remodeling in the pediatric population. This study aimed to investigate whether gut dysbiosis is associated with alterations in circulatory extracellular vesicles and their miRNA cargo, and to identify an exploratory combined microbial/miRNA signature associated with pediatric cardiac remodeling. For the animal experiments, a fecal microbiota transplantation strategy using germ-free (GF) mice was adopted. Circulatory extracellular vesicles (cEVs) were isolated and studied in primary mouse cardiomyocytes in vitro and in neonatal ascending aorta constriction (nAAC) mice in vivo. Metagenomics and miRNA sequencing were adopted to identify the characterized gut microbes in fecal samples and cEVs-miRNAs in mice. Next, we performed a clinical cohort study (poLV n = 52 vs. healthy controls n = 60). Fecal microbiota species and cEVs-miRNAs were further validated. Least absolute shrinkage and selection operator (LASSO) regression analysis was used to derive an exploratory combined panel in the clinical cohort. For experimental studies in vivo and in vitro, cEVs isolated from GF mice after transplantation of nAAC fecal microbiota (nAAC FMT-cEVs) significantly increased the cell surface area of primary mouse cardiomyocytes, compared with sham FMT-cEVs treatment. Supplementing nAAC FMT-cEVs to nAAC mice aggravated hypertrophy and fibrosis with worsened cardiac function. Metagenomic sequencing identified gut microbes that characterized nAAC and sham mice. miRNA sequencing identified the top differential miRNAs in FMT-cEVs. In the clinical cohort, four miRNAs and six gut microbes were validated as significant. LASSO analysis derived a four-feature exploratory combined panel including two cEV-miRNAs and two gut microbes, which showed good discriminative performance in the derivation cohort (AUC = 0.898). The panel value showed significant correlation to cardiac remodeling parameters and systolic function measured by echocardiography and computed tomography (CT). Gut dysbiosis was associated with altered cEV-associated miRNA composition and with functional effects on poLV remodeling in vitro and in vivo, offering an additional perspective on gut microbiota–cardiovascular interactions. In the clinical cohort, an exploratory combined panel integrating specific gut microbes and cEV-associated miRNAs showed good discriminative performance in the derivation cohort and was associated with cardiac remodeling parameters. These human findings should be interpreted as exploratory and require validation in independent pediatric cohorts.

OBJECTIVES:This study aimed to compare changes in ultrasonic Doppler parameters, particularly the peak ratio (PR) of the ophthalmic artery (OA) and optic nerve sheath diameter (ONSD), in pregnancies complicated by fetal growth restriction (FGR). Furthermore, it sought to evaluate differences in these parameters across various subgroups and analyze the cut-off value of PR for predicting delivery within 1 week in pregnancies complicated by FGR. METHODS:A total of 62 pregnant women in the mid-to-late stages of gestation were enrolled, comprising 31 participants in the FGR group and 31 in the control group. The general conditions, pregnancy outcomes, Doppler parameters of the OA, and ONSD were compared between the two groups. Comparative analysis was performed to investigate differences in OA Doppler parameters and ONSD across FGR subgroups. The predictive value of PR for delivery within 1 week was assessed using the area under the receiver operating characteristic curve. RESULTS:The PR of the OA was significantly elevated in the FGR group compared to the control group, demonstrating a statistically significant difference. The threshold PR value for predicting delivery within 1 week was 0.565, with a sensitivity of 0.88 and a specificity of 0.58. CONCLUSIONS:The PR value of the OA in pregnant women with FGR is significantly increased and may serve as a reliable predictor for pregnancies complicated by FGR.

Fetal growth restriction (FGR) contributes to over 30

BACKGROUND:Current ultrasound-based screening for endometrial cancer (EC) primarily relies on endometrial thickness (ET) and morphological evaluation, which suffer from low specificity and high interobserver variability. This study aimed to develop and validate an artificial intelligence (AI)-driven diagnostic model to improve diagnostic accuracy and reduce variability. METHODS:A total of 1,861 consecutive postmenopausal women were enrolled from two centers between April 2021 and April 2024. Super-resolution (SR) technique was applied to enhance image quality before feature extraction. Radiomics features were extracted using Pyradiomics, and deep learning features were derived from convolutional neural network (CNN). Three models were developed: (1) R model: radiomics-based machine learning (ML) algorithms; (2) CNN model: image-based CNN algorithms; (3) DLR model: a hybrid model combining radiomics and deep learning features with ML algorithms. RESULTS:Using endometrium-level regions of interest (ROI), the DLR model achieved the best diagnostic performance, with an area under the receiver operating characteristic curve (AUROC) of 0.893 (95% CI: 0.847-0.932), sensitivity of 0.847 (95% CI: 0.692-0.944), and specificity of 0.810 (95% CI: 0.717-0.910) in the internal testing dataset. Consistent performance was observed in the external testing dataset (AUROC 0.871, sensitivity 0.792, specificity 0.829). The DLR model consistently outperformed both the R and CNN models. Moreover, endometrium-level ROIs yielded better results than uterine-corpus-level ROIs. CONCLUSIONS:This study demonstrates the feasibility and clinical value of AI-enhanced ultrasound analysis for EC detection. By integrating radiomics and deep learning features with SR-based image preprocessing, our model improves diagnostic specificity, reduces false positives, and mitigates operator-dependent variability. This non-invasive approach offers a more accurate and reliable tool for EC screening in postmenopausal women. CLINICAL TRIAL NUMBER:Not applicable.

OBJECTIVES:Cesarean scar disorder (CSD) is a recently defined condition resulting from cesarean delivery (CD) surgery, and transvaginal uterine diverticulum repair (TVUDR) is generally chosen for treatment of CSD. This study constructed a prediction model for CSD disappearance after TVUDR using imaging data for CSD measured by transvaginal ultrasound (TVU), MRI, and contrast-enhanced MRI. METHODS:The data of 283 women with previous CD treated with TVUDR were retrospectively collected between January 2014 and February 2016. The imaging data for the CSD parameters were measured, including length, width (W), depth (D), residual myometrium thickness (RMT), RMT/depth (RMT/D), and RMT/(RMT + depth) [RMT/(RMT+D)]. RESULTS:Of the patients included, 129 women presented with disappearance of CSD. We noted potential differences between CSD disappearance and existence after TVUDR for W, RMT, RMT/D, and RMT/(RMT+D) measured by MRI, and D, RMT/D, and RMT/(RMT+D) measured by contrast-enhanced MRI. After adjusting for potential confounding factors, W measured using MRI was found to be associated with the disappearance of CSD (OR 1.134; 95% CI 1.050-1.224, P = 0.001). Subsequently, the W measured by MRI was selected in the prediction model, for which the C-index was 0.624. The area under the receiver operating characteristic curve in the least absolute shrinkage and selection model was 62.40% (95% CI 54.96-69.83%). CONCLUSIONS:MRI and contrast-enhanced MRI were found to be relatively accurate methods for detecting CSD. Moreover, W measured using MRI was significantly associated with the disappearance of CSD after TVUDR.

Fetal growth restriction (FGR) is associated with various perinatal complications. Limited research has focused on the fetal heart in the context of FGR. This study aimed to investigate the application value of fetal heart quantification (HQ) technology in evaluating the size, morphology, and function of the heart in FGR. A total of 31 fetuses diagnosed with FGR in our hospital from April 2022 to May 2024 were included, alongside another 31 normal fetuses matched for gestational age as the control group. Ultrasound Doppler parameters of the middle cerebral artery (MCA), umbilical artery (UA), venous catheter, and fetal HQ parameters were collected for comparative analysis, and perinatal data were followed up. Fetuses with FGR exhibited significant differences in various parameters of the MCA and UA compared to the control group (P < 0.05). The four-chamber view end-diastolic transverse width, end-diastolic area, left ventricular (LV) end-diastolic area, end-systolic area, end-systolic length, end-diastolic volume, end-systolic volume, and right ventricular (RV) end-systolic area in the FGR group were significantly lower than those in the control group (P < 0.05). In the 24-segment analysis, the LV fractional shortening in the FGR group was greater than in the control group at segments 12 to 14, while the end-diastolic diameter (ED) at segments 5 to 13 of the LV and segments 1 to 14 of the RV were smaller than those in the control group, with statistical significance (P < 0.05). Analysis of each subgroup indicated that fractional shortening (FS) in the early-onset group was significantly greater than in the late-onset group at RV segments 2 to 8. LV-ED at segments 1 to 15 and RV-ED at segments 1 to 16 were significantly smaller in the early-onset group than in the control group, and LV ED segments 20 to 21 were significantly smaller in the early-onset group compared to the late-onset group (P < 0.05). FS in the mild group was significantly larger than in the normal group at LV segments 10 to 16. The severe group exhibited significantly smaller LV segment 2 to 11 ED and the mild group showed smaller RV segments 1 to 13 compared to the control group (P < 0.05). Fetal HQ is a promising technique for evaluating the cardiac function, size, and morphology in cases of FGR.

PurposeCongenital right aortic arch (RAA) and double aortic arch (DAA) were difficult to be diagnosed by traditional fetal echography. However, these two diseases have distinct clinical therapies and long-term outcomes which makes the differential diagnosis of great importance. While fetal screening by traditional fetal echography provides limited information about the branches of the aortic arch. This study aimed to discover and evaluate a novel combination of different echocardiography views in the diagnosis and differentiation of RAA and DAA.MethodsFrom January 2014 to December 2022, a total of 414,686 pregnant women underwent routine ultrasound examinations of the fetus during the second trimester. The scan of the fetal heart included a fetal four-chamber view, The left ventricular outflow tract (LVOT) view, a right ventricular outflow tract (RVOT) view, a three-vessel (3 V) view, and three vessels and trachea (3VT) view. Then the cases diagnosed as RAA or DAA by initial ultrasound screening from two hospitals were divided into the RAA group and the DAA group. Then enter the prenatal diagnosis consultation. All the pregnant women were offered invasive prenatal diagnosis. Genetic tests were fully discussed and decided after genetic counseling. Further ultrasound examination by two more experienced sonographers, in addition to the fetal echocardiogram views, includes further multi-angle scanning of the aortic arch branches with color Doppler flow imaging (CDFI) or high definition flow imaging (HDFI) for further diagnosis, and the reasons for misdiagnosis were analyzed and summarized.ResultsA total of 332 cases were diagnosed with RAA or DAA by initial ultrasound, including RAA group 244 cases and DAA group 88 cases. In the RAA group, the mirror RAA (MRAA) could not be completely diagnosed by 3VT view alone in traditional echocardiography, with accuracy and sensitivity of 88.9% and 72.6%, respectively. In the DAA group, 36 cases were misdiagnosed only by 3VT view alone in traditional echocardiography, with the accuracy and specificity of 88.9% and 86.8%, respectively. However, the accuracy for MRAA or DAA could reach 100% when combined with 3VT and multi-angle scanning of the aortic arch branches. The abnormal detection rate of genetic tests was 10.5% (20/190), excluding the cases who refused the invasive prenatal diagnosis.ConclusionCombining 3VT and multi-angle scanning of the aortic arch branches With CDFI or HDFI could effectively distinguish RAA variants from DAA. The invasive prenatal diagnosis should be recommended for patients with RAA or DAA, and the accurate prenatal diagnosis was highly valuable in providing appropriate perinatal counseling and prognostic evaluation.

ObjectivesA classification system of ovarian ectopic pregnancies (OEP) could aid in their management. This study aimed to investigate the ultrasound classification and preoperative ultrasound diagnosis of OEP.MethodsThis retrospective case series study analyzed the clinical and ultrasound imaging data of 68 pregnant women diagnosed and confirmed with OEP at the Obstetrics and Gynecology Hospital affiliated with Tongji University between January 2015 and March 2023. The study focused on examining the ultrasound characteristics of different types of ovarian pregnancies and the accuracy of preoperative ultrasound diagnoses.ResultsThe study included 68 patients with a median age of 30 (22‐47) years. There were 43 cases (63.2%) of ruptured OEP and 25 (36.8%) of unruptured OEP. The unruptured cases were subclassified as embryonic sac type (n = 16) and heterogeneous mass type (n = 9). Preoperative ultrasound accurately diagnosed 19 cases (27.9%) of OEP, including 10 (62.50%) of the embryonic sac type, 4 (44.44%) of the heterogeneous mass type, and 5 (11.63%) of the ruptured type. Preoperative ultrasonography showed that embryonic sac type OEP was characterized by an intra‐ovarian cystic structure with a distinctive hyperechoic ring and, in some cases (8 out of 16), the presence of embryonic buds and/or yolk sacs. Ruptured OEP was characterized by mixed masses in the pelvic cavity with minimal or significant free pelvic fluid, an unclear boundary between the mass and the ovary, and limited or no vascularity.ConclusionsUltrasound may be used to determine the type of OEP preoperatively, with a higher diagnostic yield for the embryonic sac subtype. Preoperative ultrasonographic classification may enhance the preoperative diagnosis of OEP.

Background To investigate myocardial viability and MI model types using multilayer strain and stress echocardiography and evaluate the sensitive STI indicators of myocardial contractile function and viability. Methods Fifty-four rabbits were randomly divided into the 60-min, 90-min, and 120-min coronary artery occlusion groups. Blood collections and speckle tracking echocardiography (STE) were performed at baseline, after ligation, and after low-dose dobutamine stress echocardiography (LDDSE). The ratio of infarcted myocardium to viable myocardium was calculated using Evans Blue-TTC. Results After ligation, the ventricular global endocardial longitudinal strain (GSLsys-endo), global myocardial longitudinal strain (GSLsys-mid), and global epicardial longitudinal strain (GSLsys-epi) decreased in the three groups (P < 0.05); longitudinal strain of endocardium (SLsys-endo), longitudinal strain of myocardium (SLsys-mid), and longitudinal strain of epicardium (SLsys-epi) decreased in the affected segments (P < 0.05). After LDDSE, the absolute values of the above indicators in the 60-min and 90-min groups and GSLsys-endo, GSLsys-mid, GSLsys-epi in the 120-min group were significantly increased (P < 0.05). The absolute values of SLsys-endo, SLsys-mid and SLsys-epi in the ischemic segments increased (P < 0.05) in all groups. In the infarcted segments, the absolute values of SLsys-mid and SLsys-epi in 60-min group, SLsys-epi in 90-min group and none in 120-min group increased (P < 0.05). After coronary artery occlusion, malondialdehyde and tumor necrosis factor-α levels were increased, and superoxide dismutase was decreased (P < 0.05). The myocardial infarction area percentage was higher in the 120-min group (40.5%±2.8%), followed by the 90-min (29.3%±3.6%) and 60-min (16.8%±3.2%) groups (P < 0.05). The mortality of the 120-min group was higher than in the two other groups (22.2% vs. 5.6% and 11.1%, P < 0.05). Conclusions Multilayer strain and stress echocardiography can evaluate myocardial viability and MI model types in rabbits after different ischemic durations and provide insights into the selection of an appropriate STI indicators and animal model for future reperfusion experiments.

OBJECTIVE:Our study aimed to investigate the association between maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and impaired pelvic floor muscle (PFM) morphology and function during the early postpartum period. METHODS:This retrospective cohort study was conducted at Shanghai First Maternity and Infant Hospital from December 2020 to December 2022. A total of 1118 primiparous women with singleton pregnancies who underwent vaginal deliveries and participated in postpartum PFM assessments were included. Maternal pre-pregnancy BMI and GWG were considered as exposures. PFM morphology and function impairment were the primary outcomes. PFM morphology impairment, defined as levator ani muscle avulsion, was assessed using transperineal ultrasound. PFM function impairment, manifested as diminished PFM fiber strength, was assessed through vaginal manometry. Multivariable logistic regression analysis was employed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Restricted cubic spline models were used to validate and visualize the relationship. RESULTS:Women with lower pre-pregnancy BMI were at an increased risk of levator ani muscle avulsion (aOR = 1.73, 95% CI: 1.10-2.70, P = 0.017), particularly when combined with excessive GWG during pregnancy (aOR = 3.20, 95% CI: 1.15-8.97, P = 0.027). Lower pre-pregnancy BMI was also identified as an independent predictor of PFM weakness (aOR = 1.53, 95% CI: 1.08-2.16, P = 0.017 for type I fiber injuries). Notably, regardless of the avulsion status, both underweight and overweight/obese women faced an elevated risk of reduced PFM strength (aOR = 1.74, 95% CI: 1.17-2.59, P = 0.006 for underweight women with type I fiber injuries; aOR = 1.67, 95% CI: 1.06-2.64, P = 0.027; and aOR = 1.73, 95% CI: 1.09-2.76, P = 0.021 for overweight/obese women with type I and type II fibers injuries, respectively). CONCLUSIONS:Both lower and higher pre-pregnancy BMI, as well as excessive GWG, were strongly associated with PFM impairments. These findings highlighted the critical importance of comprehensive weight management throughout pregnancy to effectively promote women's pelvic health.

目的 应用超声及X线检查对新生儿肺源性呼吸窘迫进行评估和评分,与临床呼吸窘迫分级评分进行比较,探讨肺超声对新生儿肺源性呼吸窘迫的诊断价值,指导临床治疗.方法 收集2021年4月—2022年11月同济大学附属第一妇婴保健院新生儿加强监护病房收治的疑似肺源性呼吸窘迫的患儿210例,均行肺部超声及X线检查,以临床最后诊断为依据,比较分析肺超声及X线检查诊断肺源性呼吸窘迫的价值,并与临床呼吸窘迫分级评分进行相关性分析.结果 新生儿加强监护病房疑似肺源性呼吸窘迫的新生儿210例,临床最终确诊164例,肺部超声和X线检查对以上疑似病例的阳性检出率分别为71.42％、64.28％,阳性预测值分别为96.77％、94.40％,阴性预测值分别为63.63％、53.33％,差异均无统计学意义(P＞0.05).肺超声诊断新生儿呼吸窘迫的灵敏度、准确率均高于X线,差异有统计学意义(P＜0.05),两者间特异度差异无统计学意义(P＞0.05).临床各级呼吸窘迫的肺超声评分(lung ultrasound score,LUS)比较差异均具有统计学意义(P＜0.05).肺超声评分与临床呼吸窘迫程度呈高度正相关性,双侧肺超声总评分、右侧肺超声评分、左侧肺超声评分与呼吸窘迫临床评分呈显著线性正相关,相关系数分别为0.953、0.867和0.924.结论 肺部超声在诊断肺源性呼吸窘迫中具有一定的应用价值,且LUS越高,呼吸窘迫程度越重,可辅助临床采用合理的呼吸支持方式,避免不当用氧影响患儿肺部发育.

Objective To investigate the effect of uterine adenomyosis on pregnancy complications and pregnancy outcomes. Methods The medical records of 3 300 singleton pregnant women in Shanghai First Maternity and Infant Hospital were retrospectively reviewed, there were 241 cases of adenomyosis（adenomyosis group）, and 3 059 cases without adenomyosis（normal control group）. The association of adenomyosis and pregnancy complications and pregnancy outcomes was analyzed. Results The incidence of pregnancy complications in adenomyosis group was significantly higher than that in normal control group, including preeclampsia（7.0% vs 2.5%,P＜0.001）, gestational diabetes mellitus（14.5% vs 10.4%, P＜0.05）, cervical incompetence（4.9% vs 0.8%, P＜0.001）, placenta previa（2.9% vs 0.5%, P＜0.001）, abortion（14.5% vs 1.8%, P＜0.001）, premature delivery（＜37 w）（12.0% vs 5.0%, P＜0.001）, and low-birth weight（7.9% vs 3.6%,P＜0.001）. The incidence of premature rupture of membranes（PROM） in normal control group was significantly higher than that in adenomyosis group（20.5% vs 12.8%, P＜0.05）. In patients with adenomyosis, the incidence of premature rupture of membranes of natural conception subgroup was higher than that in the ART（assisted reproductive technology） group, while there was no significant difference in the incidence of abortion, premature delivery and the other pregnancy complications between these two subgroups. Conclusion Adenomyosis would increase the incidence of abortion, premature delivery and the incidence of pregnancy complications in pregnant women, while which are not affected by the in the method of conception in those with adenomyosis.

Abstract Purpose Patients with fetal right aortic arch (RAA) and double aortic arch (DAA) have different clinical outcomes, while fetal screening by traditional echocardiography provides limited information. This study aimed to discover and evaluate a novel combination of different echocardiography views in the diagnosis and differentiation of RAA and DAA. Methods From January 2014 to December 2022, the cases diagnosed as RAA or DAA by initial ultrasound screening from two hospitals were divided into the RAA group and DAA group. All the pregnant women were routinely offered karyotyping if confirmed diagnosis. Three-vessel-trachea (3VT) and descending aortic arch (DAO) coronal views were combined for further diagnosis, and the reasons for misdiagnosis were analyzed and summarized. Results A total of 332 cases were diagnosed with RAA or DAA by initial ultrasound, including RAA group 244 cases and DAA group 88 cases. In the RAA group, the mirror RAA (MRAA) could not be completely diagnosed by 3VT view alone, with the accuracy and sensitivity of 88.9% and 72.6%, respectively. In the DAA group, 36 cases were misdiagnosed only by 3VT view alone, with the accuracy and specificity of 88.9% and 86.8%, respectively. However, the accuracy for MRAA or DAA could reach to 100% when combining with 3VT and DAO coronal views. The abnormal detection rate of karyotyping was 10.5% (20/190), excluding the cases who refused the karyotyping. Conclusion Combining 3VT and DAO coronal view could effectively distinguish RAA variants from DAA. The karyotyping should be recommended for the patients with RAA or DAA, and the accurate prenatal diagnosis was highly valuable to provide appropriate perinatal counseling and prognostic evaluation.

目的 对Mainz超声评分系统进行补充改良,探讨其鉴别盆腔肿瘤良恶性的临床应用价值.方法 随机选取255例患者,共275个盆腔肿块,肿块根据病理学分为良性组(198例)和恶性组(77例),其中恶性组包括交界性肿瘤12例.两位具有5年以上工作经验的超声医师在双盲的情况下对患者行常规二维超声及三维能量多普勒(3D power doppler ultrasound,3D-PDU)检查,其中一位医师应用改良版Mainz超声评分系统对肿瘤进行评分,绘制ROC曲线;另一医师则根据肿瘤的超声特征结合三维能量多普勒对肿瘤进行良恶性的鉴别.再选一名年轻医师应用改良Mainz超声评分系统鉴别盆腔肿块良恶性.结果 255例患者中,术前超声检查出盆腔肿块275个,其中良性组184例患者198个肿块,双侧14例,单侧170例;恶性组71例患者77个肿块,双侧6例,单侧65例.两组患者的年龄、绝经状态、体重差异均无统计学意义(P＞0.05).当截断值为13分时,改良版Mainz超声评分系统鉴别盆腔肿块良恶性的灵敏度、特异度、阳性预测值、阴性预测值分别为81％、85％、73％、90％,而应用二维超声结合3D-PDU检查鉴别盆腔肿块良恶性的灵敏度、特异度、阳性预测值、阴性预测值分别为70％、71％、63％、75％.年轻医师应用改良版Mainz超声评分系统鉴别盆腔肿块良恶性的灵敏度、特异度、阳性预测值、阴性预测值分别为81％、79％、83％、76％,与高年资医师比较的Kappa指数为0.77.结论 改良版Mainz超声评分系统对盆腔肿瘤良恶性的鉴别诊断具有重要意义且应用性较好.

目的:探讨经阴道超声评估宫腔粘连(IUA)患者子宫内膜分型以及与妊娠结局的关系.方法:选取医院收治的158例IUA且术前和术后均行经阴道超声检查的已婚患者,根据是否妊娠将其分为妊娠组(109例)和非妊娠组(49例),比较两组患者术前、术后子宫内膜分型情况.结果:两组患者在年龄、不孕时限比较差异均有统计学意义(t=2.405,t=2.929;P<0.05),术后月经量增加、宫腔粘连程度、术前内膜分型以及术后内膜分型比较,差异均有统计学意义(x2=22.769,x2=10.97,x2=6.605,x2=73.534;P<0.05).两组患者在体重指数、宫腔操作次数、流产次数的差异均无统计学意义.宫腔镜术前与术后子宫内膜分型的比较,妊娠组中A型内膜的数量由阴道超声下诊断为38例增长为术后阴道超声下的58例,B型内膜的数量由术前阴道超声下的53例减少为术后阴道超声下的40例,C型内膜由术前阴道超声下的18例减少为术后阴道超声下的11例,妊娠组中术前与术后子宫内膜分型比较差异有统计学意义(x2=39.422,P<0.05).非妊娠组中A型由术前阴道超声下的15例增长为术后阴道超声下的18例,B型由术前阴道超声下的18例增长为术后阴道超声下的21例,C型由术前阴道超声下的16例减少为阴道超声下的10例,非妊娠组中术前与术后比较差异无统计学意义.宫腔镜手术治疗后,A型、B型内膜的妊娠率高于C型,A型与C型比较差异有统计学意义(x2=43.096,P<0.05).结论:超声下观察子宫内膜的分型可以评估子宫内膜的容受性,有助于预测IUA患者的妊娠状况.超声检查对子宫内膜分型的观察,能较好的反应治疗前后内膜容受性的改变.

Objective:To explore the application of speckle tracking imaging (STI) stratification strain technique in the assessment of circumferential myocardial function and the myocardial protection of ATP-postconditioning (ATP-PostC) in a rabbit model of acute myocardial infarction.Methods:A total of 40 rabbits were randomly divided into 2 groups: pure ischemia reperfusion group (IR group)and ATP-PostC group. STI images were recorded before and 45 min after occlusion of coronary artery, post low-dose dobutamine stress echocardiography, 60 and 120 min after reperfusion, respectively. The following parameters were obtained: left ventricular ejection fraction(LVEF), heart rate (HR), endocardial circumferential systolic strain (CSsys-endo), mid-myocardial circumferential systolic strain (CSsys-mid) and epicardial circumferential systolic strain (CSsys-epi) at left ventricular short-axis level. At different time points after occlusion and reperfusion, 5 experimental rabbits were killed in each group for pathological examination.Results:①Forty-five min after coronary artery occlusion in both groups, the values of LVEF and HR were decreased( P<0.05), and the absolute values of CSsys-endo, CSsys-mid and CSsys-epi were significantly reduced( P<0.01). After LDDSE, the absolute values of CSsys-endo, CSsys-mid and CSsys-epi were increased, which were different from those after blockade( P<0.05). ②After reperfusion, the circumferential strains were not significantly different from those after blockade in IR group ( P>0.05). After blockade, the absolute values of circumferential strains were increased significantly in the ATP-PostC group compared with IR group( P<0.05). In the ATP-PostC group, the absolute values of CSsys-endo at different time points after reperfusion increased significantly compared with that after blockade ( P<0.05). The absolute values of CSsys-endo and CSsys-mid 120 min after reperfusion continued to increase significantly compared with those 60 min after reperfusion( P<0.05). ③Pathological examination: After 60 min of blockade, there was no significant difference in myocardial infarction area between the IR group and the ATP-PostC group( P>0.05). The percentage of infarct areas at each time point of reperfusion in the ATP-PostC group was decreased compared with that after blockade( P<0.05). Compared with the IR group, the percentage of infarct area in the ATP-PostC group was smaller after 120 minutes of reperfusion and the difference was statistically significant ( P<0.05). Conclusions:The applications of STI stratification strain technique and LDDSE can assess left ventricular circumferential strains at each of myocardial layers before and after reperfusion in rabbit myocardial ischemia ATP-PostC model, identify and evaluate the function of viable myocardium, and exhibit the significant protective effects of ATP-PostC on myocardial reperfusion injury.

Objective:To assess the clinical value of uterine curettage ultrasound in the evaluation of cesarean section scar pregnancy (CSP) after uterine arterial chemoembolization (UAE).Methods:Retrospective analysis were performed in 42 patients who took uterine curettage within 24-48 hours after UAE treatment in the Second Affiliated Hospital of Harbin Medical University from January 2015 to June 2018. The ultrasonic manifestations were graded and classified before UAE. The intraoperative and postoperative complications, time of β-human chorionic gonadotrophin declined to normal limits were evaluated, and the formation of hematoma and hematoma absorption time were followed up by ultrasound.Results:UAE was performed successfully in all patients. The ultrasound-guided scar pregnancy was successfully completed. The uterus was successfully retained in all patients.Among the 42 patients, 18 cases were 3 scores group, and 24 cases were 4 scores group according to the ultrasonic scoring system. Two cases were type Ⅰgroup, 25 cases were type Ⅱ group, and 15 cases were type Ⅲ group according to the ultrasonic classification. The amount of intraoperative complications, postoperative mass formation and absorption time were significantly different between 3 scores group and 4 scores group ( P<0.05). No significant differences were found in intraoperative complications, postoperative complications, postoperative mass formation and β-human chorionic gonadotropin (β-hCG) value among different ultrasonic classification groups ( P>0.05). Conclusions:Ultrasonography has clinical application value in evaluating the prognosis of CSP treated with UAE. Ultrasonic scoring system can evaluate the efficacy and is helpful for predicting clinical outcome of CSP.