Liverpool Ultrasound Pictorial Chart: the development of a new method of documenting anal sphincter injury diagnosed by endoanal ultrasound

Objective  To develop and validate a pictorial chart that documents ultrasound examination of the anal sphincter.
Design  A new pictorial chart (Liverpool Ultrasound Pictorial Chart [LUPIC]) depicting the normal anatomy of the anal sphincter was developed.
Methods  To validate LUPIC, two observers documented the findings of 296 endoanal scans. Reliability was assessed between observers using kappa agreement for presence and position of sphincter defects. To validate the use of LUPIC by different observers, a video of ten endoanal ultrasound scans was reviewed by our local expert (gold standard). Seven clinicians underwent test-retest analysis. Kappa agreement was calculated to assess intra-observer and gold standard versus observer agreement for the overall presence of sphincter defects and compared with the gold standard. Complete agreement for the position and level of sphincter defects was assessed for the five abnormal scans.
Main outcome measures  Excellent agreement between the two observers was found for the presence (kappa 0.99), position and level of external anal sphincter defects documented using LUPIC. The intra-observer and gold standard versus observer kappa values of experienced clinicians (A–E) showed good agreement for the overall presence of sphincter defects. Complete agreement for the position and level of sphincter defects was found in 23 of 35 (66%) observations.
Conclusions  LUPIC is designed and validated method of documenting anal sphincter injury diagnosed by endoanal ultrasound. Standardisation of endoanal ultrasound findings by using LUPIC may help correlate the degree of damage with patient symptoms.     

Outcome of anaemic monochorionic single survivors following early intrauterine rescue transfusion in cases of feto-fetal transfusion syndrome

Objective  To evaluate the outcome of severely anaemic monochorionic (MC) twins surviving the death of their co-twin following early intrauterine rescue transfusion in cases of feto-fetal transfusion syndrome (FFTS).
Study design  We reviewed all MC pregnancies complicated with FFTS following primary management, in which a single intrauterine fetal death (IUFD) was diagnosed with certainty within 24 hours between January 1999 and December 2006. We included MC survivors who presented ultrasound or Doppler features of fetal anaemia following the death of their co-twin. Intrauterine transfusion (IUT) was given to all survivors who were anaemic.
Results  Nineteen MC twin pregnancies presented a single intrauterine death (IUD) associated with an anaemic co-twin. Median gestational age at IUD was 23 [20–28] weeks. The median interval between IUD and IUT was 12 [8–24] hours. There were 58% (11/19) healthy survivors. Perinatal death rate was 26% (5/19) including 16% (3/19) intrauterine and 10% (2/19) neonatal deaths. Abnormal prenatal cerebral findings developed in 21% (4/19) cases, always within 1 month after the death of the co-twin. Considering occlusive techniques and other management separately, there were 64% (7/11) and 50% (4/8) healthy survivors, respectively, and perinatal death occurred in 36% (4/11) and 12.5% (1/8) of fetuses, respectively. Prenatal fetal cerebral lesions developed in 9% (1/11) of cases following occlusive techniques and in 37.5% (3/8) of fetuses when managed differently. The median gestational age at delivery in the survivors was 31 [25–38] weeks.
Conclusion  In cases of FFTS with single anaemic survivors, early IUT could be offered following extensive counselling and close follow up.     

A standardised ultrasonic diagnosis and an accurate prevalence for the retroverted uterus in general gynaecology patients

Transvaginal ultrasound with an empty bladder is recommended as a standardised ultrasonic technique for the accurate diagnosis of the retroverted uterus. Using this method, the prevalence of the retroverted uterus in 480 general gynaecological patients attending for subspecialist gynaecological ultrasound was 18%. The anteverting effect of the full bladder required for transabdominal ultrasound reduces the prevalence of the retroverted uterus to 13% (P < 0.001).     

Applications of real-time ultrasound in obstetrics: the linear and dynamically focused phased arrays.

Real-time ultrasound is a dynamic imaging technique that allows in utero orientation to the fetus. It permits rapid and efficient examination of fetal anatomy and provides a dynamic assessment of fetal well-being. The energy dissipation can be comparable to that in conventional ultrasonic B-mode scanning. We have used both linear and dynamically focused phased arrays for fetal examinations in conjunction with conventional gray scale B-mode scanners. The sophisticated phased-array real-time systems have demonstrated higher resolution and an improved gray scale as compared with the linear arrays. Applications of real-time ultrasound in obstetrics are discussed, and appropriate clinical examples are cited that illustrate the value of the technique for study of both normal and abnormal fetal development. We believe that this technique is the most sensitive method of detecting intrauterine fetal demise. The relative advantages and disadvantages of linear and dynamically focused phased arrays in obstetric evaluation are considered.     

探究三维超声成像诊断乳腺肿块的临床应用价值

目的：探究与分析三维超声成像诊断乳腺肿块的临床应用价值。方法方便选取并回顾性分析该院自2013年9月—2015年9月收治的90例乳腺肿块患者的临床资料,该组患者均接受了二维超声、三维超声及弹性成像检查,将上述3种检查结果与术后病理结果进行对照。结果二维超声敏感性为79.03%,特异性为70.83%,准确性为74.63%,三维超声敏感性为89.83%,特异性为78.95%,准确性为84.33%,弹性超声成像敏感性为92.60%,特异性为82.5%,准确性为86.57%,三维超声与弹性超声成像敏感性、特异性及准确性相比均差异无统计学意义(P>0.05)。三维超声与弹性超声成像敏感性、特异性及准确性与二维超声相比均明显增高,差异有统计学意义(P<0.05)。结论三维超声的诊断准确率明显高于二维超声,且与弹性超声成像无明显差异,临床医生可将其应用于乳腺肿块的诊断过程中,为进一步治疗提供合理依据。     

超声靶向破坏微泡技术介导小鼠肝癌细胞株JNK1基因表达、细胞迁移和侵袭抑制

目的: 探讨应用超声靶向破坏微泡 (UTMD) 技术介导小鼠肝癌细胞株JNK1基因的表达、细胞迁移和侵袭抑制的作用,阐明其作用机制。方法: 构建并筛选RNA干扰效果最好的短发夹RNA(shRNA)。将小鼠肝癌细胞株Hca-F分为正常Hca-F细胞组、shRNA质粒组、脂质体组、超声微泡结合超声辐照组及脂质体结合超声微泡加超声辐照组。采用倒置荧光显微镜观察各组细胞转染率,荧光定量PCR和Western blotting 法检测JNK1基因mRNA和蛋白表达水平,CCK-8法检测各组细胞的细胞活性,应用Transwell 实验检测各组细胞的体外迁移能力。结果: 脂质体结合超声微泡加超声辐照组细胞转染率高于shRNA质粒组、脂质体组和超声微泡结合超声辐照组(均P<0.05),脂质体组和超声微泡结合超声辐照组比较差异无统计学意义(P>0.05)。脂质体结合超声微泡加超声辐照组JNK1 mRNA和蛋白表达水平低于其他各组(P<0.05);脂质体结合超声微泡加超声辐照组细胞活性和平均穿膜细胞数均低于其他各组(P<0.05)。结论: UTMD技术结合脂质体转染法可以提高小鼠肝癌细胞株JNK1 shRNA的转染效率,增强其对基因表达、细胞活力、迁移和侵袭能力的抑制。     

术中超声辅助下环形减压术治疗多节段胸椎后纵韧带骨化症

目的：分析多节段胸椎后纵韧带骨化症(ossification of the posterior longitudinal ligament, OPLL)术中超声辅助下环形减压术的手术疗效和术后神经功能改善情况。方法：选择2016年1月至2021年1月北京大学第三医院多节段胸椎OPLL患者的病例资料进行回顾性分析,所有病例均完成后壁切除后行术中超声检查确定环形减压节段,并进行环形减压。纳入研究的30例患者男性14例,女性16例,平均年龄(49.3±11.4)岁。首发症状以下肢麻木无力为主(83.3%),平均症状持续时间为(33.9±42.9)个月(1～168个月)。神经功能通过术前及末次随访时改良日本骨科协会(modified Japanese Orthopedic Association, mJOA)评分(0～11分)评估,神经功能改善率根据Harabayashi法计算。根据神经功能改善率是否大于25%将患者分为较优改善组和较差改善组,收集两组患者的年龄、体重指数(body mass index, BMI)、病程时间、手术时间、出血量、mJOA评分、手术节段、脑脊液漏并进行分析比较。结...     

声触诊组织量化技术在子宫肌层病变中的应用初探

目的初步探讨声触诊组织量化技术（VTQ）在子宫肌层病变中的应用价值。方法应用VTQ技术检测78例子宫肌瘤患者及16例子宫腺肌症患者的宫壁病变区以及83例正常子宫宫壁,并对记录测量数值进行统计分析。结果子宫肌瘤VTQ均值3.58±0.76、子宫腺肌症VTQ均值3.53±1.08,均明显大于正常子宫宫壁VTQ均值2.84±0.89（P〈0.05）。结论正常宫壁与病变宫壁之间弹性比较有统计学差异,说明弹性超声应用在子宫肌壁病变有一定价值。     

三维超声自由解剖成像技术对早期宫角与间质部妊娠的诊断价值

目的 探讨三维经阴道超声自由解剖成像技术(3DTVUOT)对早期宫角妊娠(CP)与间质部妊娠(ITP)的定性诊断价值.方法 回顾性分析35例CP和36例ITP患者的临床资料.均因临床疑诊早期CP或ITP被序贯予以二维经阴道超声(2DTVU)和3DTVUOT检查,对妊娠病灶与宫腔的相通情况、病灶周围肌层完整性和厚度情况等...