球瓣比和球囊长度与儿童经皮球囊肺动脉瓣成形术疗效的关系

目的通过分析不同的球瓣比和球囊长度对儿童经皮球囊肺动脉瓣成形术(PBPV)近期及中远期疗效的影响，探讨最适宜的球瓣比和球囊长度。 方法1987~2005年山东省立医院儿科诊治119例肺动脉瓣狭窄患儿，使用不同球瓣比和长度的扩张球囊行PBPV术，扩张前后测量右室与肺动脉间的峰值压力阶差，并行左侧位右室造影，测量瓣环大小并观察有无右室流出道激惹。术前、术后定期行经胸超声心动图检查，估测最大跨肺动脉瓣压力阶差，并观察肺动脉瓣形态及其反流情况。 结果超大球囊法行PBPV术后，患儿的近期及中远期跨肺动脉瓣压差持续下降，且压差下降率不随球瓣比的增加而增大；术后未发现有肺动脉瓣再狭窄者，所有患儿均有不同程度的肺动脉瓣反流，且反流的程度随时间的延长而加重，并与球瓣比成正相关。对于年龄较小(≤6岁)的儿童，球瓣比大且长度≥40mm的球囊较易引起右室流出道痉挛及三尖瓣反流。中远期三尖瓣反流的发生可能间接继发于肺动脉瓣反流所引起的右室容量负荷过重。 结论PBPV治疗肺动脉瓣狭窄，最佳的球瓣比为1.0~1.2，疗效满意且并发症少；6岁以下儿童宜使用长度<40mm的球囊，可减少右室流出道痉挛及近期三尖瓣反流的发生。     

干细胞因子和白血病抑制因子对冻融后人原始卵泡体外生长发育的研究

目的:探讨干细胞因子(stem cell factor,SCF,又称KIT配体)和白血病抑制因子(leukaemiainhibitory factor,LIF)对冻融后人原始卵泡体外培养生长发育的影响。方法:收集18例卵巢良性肿瘤手术患者的正常卵巢皮质,采用直接覆盖玻璃化冷冻法保存卵巢组织,冻融后分离卵泡,随机分成5组:对照组(A组)、10 ng/ml SCF组(B组)、10 ng/ml LIF组(C组)、10 ng/ml SCF+10 ng/ml LIF组(D组)和100 ng/ml SCF+10 ng/ml LIF组(E组),行体外培养,比较SCF和/或LIF对人原始卵泡生长发育的影响。结果:①随培养天数的增加,对照组卵泡直径增长缓慢,明显小于各实验组(P<0.05);D、E组中卵泡直径增长迅速,较B、C组差异有统计学意义(P<0.05)。②随着培养天数的增加,各组卵泡均能分泌激素。4 d后对照组卵泡激素水平增长缓慢,明显低于各实验组(P<0.05),而D、E组中卵泡激素分泌增长迅速,较B、C组差异有统计学意义(P<0.05),D、E组中卵泡激素增长速度相差不大,但在第4日差异有统计学意义(P<0.05)。结论:在体外培养液中添加SCF或LIF以及两者联合添加有利于促进卵泡的生长发育,提高E2分泌功能,且SCF和LIF联合其作用更加明显。     

An analysis of ovarian tumor diameter and survival

Abstract. Stratton JF, Pharoah P, Tidy JA, Paterson MEL. An analysis of ovarian tumor diameter and survival.
Residual disease following primary debulking surgery is a recognized prognostic factor in ovarian cancer. Few studies have looked at the effect of initial ovarian tumor diameter on survival. As larger tumors are more likely to be detected by ultrasound, this information may be important in determining a survival benefit in screen-detected cancers. We reviewed the case notes and pathology of 168 consecutive cases of primary debulking surgery in epithelial ovarian cancer. We examined the influence of ovarian tumor diameter on survival and its relationship to CA125 levels and stage. For the purposes of analyses, we divided subjects into two groups: those with tumors < 6 cm and those with tumors > 6 cm.
There were significant differences between the groups, with smaller tumors having more advanced stage disease compared to larger tumors (χ²₃ = 15.7, P = 0.0013) The median survival for tumors less than or equal to 6 cm was 17months (95% confidence interval [95% CI], 12 to 22), while for tumors greater than 6cm, the median survival was 36 months (95% CI, 13 to 59; logrank test = 8.61, P = 0.003). However, stage is also an important predictor of survival, and in a multivariate analysis, tumor size was not found to be an independent prognostic factor. There was no significant difference between the groups for CA125 levels. As larger diameter ovaries are more likely to be detected by ultrasound, it may be that screen-detected ovarian cancers will show a survival benefit simply because they detect a subset of ovarian cancers that are associated with a better prognosis.     

The fetal biparietal diameter

Ultrasonographic measurement of the fetal biparietal diameter (989 measurements in 669 women) was used to investigate the relationship between the pattern of these measurements and the duration of pregnancy. An exponential function was tested with a computer, and equations were calculated for both combined series and single measurements. The linearity of the initial portion of the curve (< 30 weeks) was confirmed. The proposed function [y = ? 1.943 + 0.43 × ? 0.62 exp(0.058 ×)] was compared with an asymptotic function. Although serial sonographic assessment of the biparietal diameter is very useful in this respect, its applicability for calculation of the expected date of delivery is subject to the degree of variability characterizing any biological measurement.     

Investigation of correlation between diameters of pelvic inlet and outlet planes and female pelvic floor dysfunction

Objective

To investigate correlation between key diameters of pelvic inlet and outlet planes and female pelvic floor dysfunction (FPFD).

Study design

Correlation with incidence of FPFD was analyzed by measuring the two diameters of pelvic inlet and outlet planes (i.e. anteroposterior diameter of pelvic inlet and transverse diameter of pelvic outlet) in 298 patients with FPFD and 508 patients in control group taking into account of other relevant factors.

Results

The transverse diameter of pelvic outlet was significantly larger in experimental group than in control group (9.55 cm vs. 8.50 cm, P < 0.01); while the difference in anteroposterior diameter of pelvic inlet between the two groups was not statistically significant (11.63 cm vs. 11.26 cm, P = 0.205 > 0.01); Binary logistic regression analysis indicated that the anteroposterior diameter of pelvic inlet was not correlated with incidence of FPFD, but the transverse diameter of pelvic outlet was one of the influencing factor for FPFD.

Conclusions

The transverse diameter of pelvic outlet is closely correlated with incidence of FPFD and represents one of the risk factors for FPFD; a transverse diameter of pelvic outlet greater than 9.5 cm is the threshold for onset of FPFD and can be used as an early predictive index for FPFD.     

The diameter of coronary arteries in healthy newborns at birth, 1 and 6 months of ages

Objective: The aim of this study was to determine accurate and validated Z-score equations for the normal values of coronary diameters adjusted with growth changes of the neonates by testing three different time periods. Methods: Echocardiography was performed on 200 healthy neonates at birth, 1 and 6 months of ages. Several regression models for the left (LCA) and right coronary artery (RCA) diameters were tested with weight, height, body surface area and aortic annulus diameter. Reliable standards for the coronary artery diameters for healthy newborns by determining Z-score equations with appropriate statistical validations were established. Results: The coronary diameters on birth measurements were strongly correlated with birth weight, height, surface area and the diameter of the aortic annulus (Pearson’s R > 0.8, all p < 0.01). There were significant associations between the mean data of weight, height, body surface area, aortic annulus and the LCA and RCA diameters measurements of study subjects at birth, 1 and 6 months of ages (p < 0.05). Z-score graphs of coronary artery diameters and weight of the subjects at three different time (LCA vs. weight at birth, R = 0.82, p < 0.001; LCA vs. weight at 1 month, R = 0.64, p < 0.001; LCA vs. weight at 6 months, R = 0.55, p < 0.001; RCA vs. weight at birth, R = 0.80, p < 0.001; RCA vs. weight at 1 month, R = 0.59, p < 0.001; RCA vs. weight at 6 months, R = 0.49, p < 0.001) were constructed. Conclusion: We present a new set of equations for neonatal Z-score calculation on the basis of a large number of healthy neonates on three different time period consisting of birth, 1 and 6 months of ages. It is clear with this study that the growth in caliber of the coronary arteries is definite and progressive during postnatal time.     

Fetal biacromial diameter as a new ultrasound measure for prediction of macrosomia in term pregnancy: a prospective observational study

Objective: The current study aims to evaluate a simple method for sonographic measurement of the fetal biacromial diameter for prediction of fetal macrosomia in term pregnancy.

Materials and methods: The current study was a single center prospective observational study conducted in a tertiary University Hospital from January 2015 to May 2017. We included all consecutive term (37–42 weeks) pregnant women presented to the labor ward for delivery. Ultrasound parameters were measured as biparietal diameter, head circumference, transverse thoracic diameter, mid arm diameter, abdominal circumference, femur length, estimated fetal weight, and amniotic fluid index. The proposed ultrasound formula “Youssef’s formula” to measure the fetal biacromial diameter is: [Transverse thoracic diameter +2?×?midarm diameter]. The accuracy of proposed formula was compared to the actual biacromial diameter of the newborn after delivery. The primary outcome of the study was accuracy of sonographic measurement of fetal biacromial diameter in prediction of fetal macrosomia in terms of sensitivity and specificity

Results: The study included 600 participants; 49 (8.2%) of them delivered a macrosomic neonates and 551 (91.8%) delivered average weight neonates. There was no statistical significant difference between the proposed fetal biacromial diameter measured by ultrasound and the actual neonatal biacromial diameter measured after birth (p?=?.192). The area under the curve (AUC) for prediction of macrosomia at birth based on the fetal biacromial diameter and the abdominal circumference was 0.987 and 0.989, respectively, on receiver operating characteristic (ROC) curve analysis. Using the biacromial diameter cutoff of 15.4?cm has a PPV for prediction of macrosomia (88.4%) and 96.4% sensitivity with overall accuracy of 97%. Similarly, with the abdominal circumference (AC) cutoff of 35.5?cm, the PPV for prediction of macrosomia (87.7%) and 96.4% sensitivity with overall accuracy of 96.83%. No statistical significant difference between both of them was observed for prediction of fetal macrosomia (p?=?.841)

Conclusions: The sonographic measurement of fetal biacromial diameter seems to be a new simple and accurate method for prediction of fetal macrosomia and shoulder dystocia at birth.     

Tumor diameter and volume assessed by magnetic resonance imaging in the prediction of outcome for invasive cervical cancer

OBJECTIVE: The aim of this study was to evaluate the predictive value of pretherapeutic magnetic resonance imaging (MRI)-based measurements of tumor diameter and volume with regard to recurrent disease. METHODS: MRI on 0.5- or 1.5-T scanners was performed in 126 consecutive women with invasive carcinoma of the uterine cervix. Initial tumor diameter and volume were determined on T(2)-weighted images; volume was calculated by the standard technique of multiplying the sum of the areas by the slice thickness. Patients were treated by radical surgery, radiotherapy, or a combined approach based on clinical International Federation of Gynecology and Obstetrics (FIGO) stage and individual patient criteria. Clinical data (patient age and FIGO stage), MRI-derived tumor dimensions (diameter and volume), and histological findings (tumor invasion depth and lymph-node involvement) were associated and linked to patient outcome. RESULTS: MRI-based tumor diameter correlated strongly with histological tumor invasion depth and lymph-node status (P < 0.01 and P = 0.01) while tumor volume on MRI was significantly associated only with tumor invasion depth into adjacent tissues (P < 0.01). Univariate analysis demonstrated graphically that MRI-derived tumor diameter and volume and clinical FIGO stage are associated with progression-free survival. Correlation analysis showed a strong association between MRI-derived tumor diameter and volume on MRI (r = 68%, P < 0.01) and also demonstrated a correlation between tumor diameter on MRI and FIGO stage Ib (Ib1 versus Ib2) cervical tumors (r = 46.7%, P < 0.01). CONCLUSION: Tumor diameter and volume, determined by pretreatment MRI examinations, predict progression-free survival for patients with invasive cervical carcinoma. This study demonstrates the value of MRI as an adjunct to clinical evaluation of invasive cervical cancer, providing more complete assessment of morphological risk factors important in patient prognosis and treatment planning.     

Fetal growth retardation in the second trimester.

Growth of the fetal head was assessed by serial ultrasonic measurements in a prospective study of a randomly selected group of 126 mothers. Three cases exhibiting second trimester fetal head growth retardation with varying degrees of catch-up growth before term are illustrated.     

Effect of Pneumoperitoneum and Patient Positioning on Intracranial Pressures during Laparoscopy: A Prospective Comparative Study

Study Objective

To evaluate the effect of pneumoperitoneum and head position during laparoscopic surgery on intracranial pressures (ICPs) using sonographic measurements of optic nerve sheath diameter (ONSD).

Follicular response and pregnancy among infertile women undergoing ovulation induction and intrauterine insemination

OBJECTIVE: To determine the relationship between ovarian follicular response (number and diameter of follicles) to ovulation induction agents and pregnancy. DESIGN: Retrospective cohort study.Hospital-based center of reproductive medicine. PATIENT(S): Three hundred twenty-two clinically diagnosed infertile couples undergoing 1483 cycles of ovulation induction and IUI.Oral and injectable fertility drugs were administered for 2-10 cycles; ultrasound follicular measurements were recorded around time of ovulation; hCG was administered when follicles were 18-20 mm or more in diameter; IUI was performed 36-40 hours after administration of hCG. MAIN OUTCOME MEASURE(S): A first positive pregnancy test as indicative for conception.Women with follicular diameters >or=20 mm were less likely to become pregnant as compared to women with diameters between 15.00 and 19.99 mm (risk ratio [RR] = 0.58, 95% confidence interval [CI] = 0.35, 0.97). Women >or=30 years of age were half as likely to become pregnant as compared to women <30 years (RR = 0.51, 95% CI = 0.30, 0.85). Likelihood of pregnancy increased by 21% for each prior pregnancy (RR = 1.21, 95% CI = 1.00, 1.47). CONCLUSION(S): Maternal age, gravidity, and follicular diameters around the time of insemination are prognostic factors in the likelihood of pregnancy.     

Subarachnoid space diameter in chromosomally abnormal fetuses at 11–13 weeks’ gestation

Objectives: To examine the subarachnoid space diameters in chromosomally abnormal fetuses at 11–13 weeks’ gestation.

Methods: Stored three-dimensional (3D) ultrasound volumes of the fetal head at 11–13 weeks’ gestation from 407 euploid and 88 chromosomally abnormal fetuses (trisomy 21, n?=?40; trisomy 18, n?=?19; trisomy 13, n?=?7; triploidy, n?=?14; Turner syndrome, n?=?8) were analyzed. The subarachnoid space diameters, measured in the sagittal and transverse planes of the fetal head, in relation to biparietal diameter (BPD) in each group of aneuploidies was compared to that in euploid fetuses. A total of 20 head volumes were randomly selected and all the measurements were recorded by two different observers to examine the interobserver variability in measurements.

Results: In euploid fetuses, the anteroposterior, transverse and sagittal diameters of the subarachnoid space increased with BPD. The median of the observed to expected diameters for BPD were significantly increased in triploidy and trisomy 13 but were not significantly altered in trisomies 21 and 18 or Turner syndrome. In triploidy, the subarachnoid space diameters for BPD were above the 95th centile of euploid fetuses in 92.9% (13 of 14) cases. The intraclass reliability or agreement was excellent for all three subarachnoid space diameters.

Conclusion: Most fetuses with triploidy at 11–13 weeks’ gestation demonstrate increased subarachnoid space diameters.     

First-trimester reference centiles of fetal biometry in Indian population

Aim and objective: To create crown-rump length (CRL)-based biometric chart for fetus in the first trimester among the Indian population.

Material and methods: Cross-sectional data were obtained from 400 singleton pregnancies between 11 and 14 weeks gestation with a normal outcome. Linear regression models were constructed; the mean and SD were derived as a function of CRL.

Results: There was a positive correlation of CRL with nuchal translucency (NT) (y?=?0.0102x?+?0.6307 R^2?=^?0.1177), biparietal diameter (BPD) (BPD?=?0.032*CRL +0.185 R^2?=^?0.765), occipito-frontal diameter (OFD), lateral ventricular diameter (LV), abdominal circumference (AC) (AC?=?0.944*CRL +9.684 R^2?=^?0.668), femur length (FL) (FL?=?0.222*CRL ?4.734 R^2?=^?0.661), fetal weight (FW) (FW?=?1.328*CRL ?10.41 R^2?=^?0.662). The regression models and centile charts of NT, BPD, OFD, LV, AC, and FW were constructed. Taking FW as the independent variable, a linear equation of BPD, AC, and FL to calculate weight was constructed.

Conclusions: The first-trimester centile charts of fetal parameters can be used as a reference for Indian population in the determination of gestational age or other adverse outcomes.     

Increment of the fetal biparietal diameter during normal pregnancy,as determined by ultrasound

The fetal biparietal diameter was measured by ultrasound during normal pregnancy. 1076 measurements were performed. For each week of pregnancy, from 23 until 43 weeks, the mean, percentiles and smoothed percentiles were determined. From statistical analysis no influence of fetal sex and maternal parity on the fetal biparietal diameter was found. From the 50th percentile the weekly increment of the fetal biparietal diameter was calculated.     

Zygote Diameter and Total Cytoplasmic Volume as Useful Predictive Tools of Blastocyst Quality

Introduction According to the Embryo Protection Act, the selection of embryos with the greatest potential for successful implantation in Germany must be performed in the pronucleus stage. The main aim of this study was to identify morphokinetic parameters that could serve as noninvasive biomarkers of blastocyst quality in countries with restrictive reproductive medicine laws. Materials and Methods The sample comprised 191 embryos from 40 patients undergoing antagonist cycles for intracytoplasmic sperm injection. Blastocysts were cultured in an EmbryoScope chamber and video records were validated to determine the post-injection timing of various developmental stages, cleavage stages, and blastocyst formation. The Gardner and Schoolcraft scoring system was used to characterize blastocyst quality. Results Morphokinetic data showed that the zygote diameter and total cytoplasmic volume were significantly different between good and poor blastocysts quality groups, where zygotes, which formed better blastocyst quality, had smaller diameter and smaller total cytoplasmic volume. Zygotes with more rapid pronuclear disappearance developed in better-quality blastocysts. Differences between good- and poor-quality blastocysts were also observed for late-stage parameters and for the spatial arrangement of blastomere where tetrahedral embryos more frequently forming good-quality blastocyst compare to the non-tetrahedral. Conclusions The study findings could be used to enhance embryo selection, especially in countries with strict Embryo Law Regulations. Further studies, including those in which the implantation potential and pregnancy rate are considered, are warranted to confirm these preliminary results.     

Association between tumor diameter and lymphovascular space invasion among women with early-stage endometrial cancer

Objective

To investigate the association between tumor diameter and intratumoral risk factors that might predict the need for full surgical staging among women with endometrial cancer (EC).

Methods

Data from patients with early-stage EC treated at the Istituto Nazionale dei Tumori, Milan, Italy, between January 2004 and December 2012 were retrospectively analyzed. Associations between tumor diameter and tumor grade, myometrial invasion, risk group, lymphovascular space invasion (LVSI), and lower uterine segment (LUS) involvement were assessed by bivariate and multivariate analysis.

Results

In total, 181 patients met the inclusion criteria. The tumor diameter was 2 cm or less in 110 women (60%). χ² analysis showed that tumor grading, myometrial invasion, risk group, and LVSI were significantly associated with tumor size (P < 0.001), whereas LUS involvement was marginally associated (P = 0.051). By multivariate analysis, LVSI and myometrial invasion had an independent association with tumor size greater than 2 cm (P < 0.018).

Conclusion

Tumor size greater than 2 cm was significantly and independently associated with LVSI and myometrial invasion among patients with early-stage EC. Given the difficulty of obtaining reliable LVSI data from frozen sections, tumor size might be used as a surrogate at the time of surgery to provide additional information to triage patients for full surgical staging.     

Three case reports of fetal growth retardation in the second trimester.

Antenatal and postnatal growth and development were assessed in a prospective study involving 100 children. 3 cases of second trimester growth retardation exhibiting varying degrees of catch-up growth are described.     

The fetal cheek-to-cheek diameter and abdominal circumference: are they correlated?

Objective  The cheek-to-cheek diameter (CCD) has been shown to be an indicator of subcutaneous tissue mass in the fetus. However, the correlation between CCD and the abdominal circumference (AC) has not been investigated yet. The objective of the present study was to demonstrate whether a correlation exists between fetal CCD, AC, estimated fetal weight (EFW), and the 1 h, 50 g, glucose challenge test (GCT) levels in patients with and without gestational diabetes mellitus. Methods  A prospective, institutional review board approved study was performed. The CCD was obtained as part of the ultrasound for obstetric interval growth scans and biophysical profiles. Exams were performed during the third trimester. The CCD was obtained on a coronal view of the fetal face, at the level of the nostrils and lips. Patients were enrolled between November 2005 and May 2006. Pearson correlation coefficient and linear regression modeling were used as appropriate. Results  Eighty-three patients were enrolled, 29 (33%) of them were diabetic. The mean gestational age is 34.8 ± 3 weeks and the mean maternal age is 29.9 ± 5.1. A significant linear association was found between CCD and EFW (Pearson coefficient of correlation being 0.51, P = 0.01). The Pearson correlation coefficient of the relationship between the CCD and AC was 0.47 (P = 0.01). Using a linear regression model, controlling for gestational age at performance of the ultrasound, the association between CCD and EFW remained significant (P = 0.021). There were no significant differences between diabetic and non-diabetic patients regarding the CCD (6.2 ± 0.9 vs. 6.3 ± 0.9 respectively, P = 0.669) or the EFW (2,527.9 ± 705 vs. 2,645 ± 760 g). While AC was significantly correlated with the GCT levels (Pearson coefficient of correlation = 0.46, P = 0.024), no such correlation was demonstrated for CCD (Pearson correlation coefficient = 0.23, P = 0.160). Conclusions  The cheek-to-cheek diameter is significantly correlated to the abdominal circumference and the estimated fetal weight. However, the abdominal circumference has a tighter correlation with the glucose challenge test.