高危孕妇胎儿心室内强回声点与染色体核型异常的相关性研究

目的 探讨高危孕妇胎儿心室内强回声点（EIF）与染色体核型异常的相关性。方法 提取2007年2月至2010年1月在广西壮族自治区妇幼保健院行产前检查高危孕妇的临床和胎儿EIF结果资料。以胎儿EIF筛查阳性者为EIF病例组,胎儿EIF筛查阴性者为EIF对照组。统计EIF的分布、径线和数量,染色体核型检查结果,超声所见其他系统畸形,其他染色体异常软指标的检出情况以及EIF的随访结果。分析高危孕妇胎儿EIF与染色体核型异常的相关性。结果 4 008例高危孕妇进入分析。EIF病例组227例（5.7%）,EIF对照组3 781例（94.3%）。①EIF病例组中213例（93.8%）胎儿EIF为单个性;215例（94.7%）分布于左心室,8例（3.5％）分布于右心室,4例（1.8%）分布于左右心室。EIF径线为1.6～6.5 mm,216例（95.2%）EIF径线在2～3 mm。②EIF病例组染色体核型异常8例（3.5％）,其中唐氏综合征5例、特纳综合征1例及平衡易位2例。EIF对照组染色体核型异常88例（2.3％）,其中唐氏综合征41例、18-三体综合征12例、13-三体综合征2例、特纳综合征12例、家族性平衡易位16例及倒位5例。EIF与染色体核型异常总体上无显著相关性,OR=1.53（95%CI: 0.73~3.20）;EIF与唐氏综合征无显著相关性,OR＝2.05（95%CI:0.80~5.25）。③EIF病例组检出其他染色体异常软指标18例,其中1例染色体核型检查诊断为唐氏综合征;EIF联合其他超声软指标与唐氏综合征无显著相关性,OR=5.37（95％CI：0.70～41.27）。EIF对照组检出染色体异常软指标64例。④EIF病例组33例高危孕妇中止妊娠。余194例按期来院随访, 其中181例（93.3%）在孕期内随着孕周的增加EIF变淡、变小或消失;7例（3.6％）于分娩后3～9个月消失,6例（3.1％）于1年后复查EIF仍存在。结论 高危孕妇胎儿EIF与染色体核型异常无显著相关性,EIF联合其他超声软指标与染色体核型异常的相关性仍需扩大样本量进一步观察。     

Adverse Perinatal Conditions Associated With Prenatally Detected Fetal Echogenic Bowel in Nova Scotia

Objective

This study sought to estimate the association of adverse perinatal outcomes with pregnancies complicated by fetal echogenic bowel.

Sonographic Patterns of the Gallbladder in Acute Viral Hepatitis

Ultrasound was used for a serial evaluation of gallbladder modifications in 61 patients with acute viral hepatitis during both the acute phase of the illness and recovery. Most of the patients studied within 7 days from the onset of symptoms and/or jaundice showed sonographic abnormalities of the gallbladder (increased wall thickness, reduced volume, abnormal bile content). A normal ultrasound pattern of the gallbladder was progressively restored during the clinical recovery in most of the patients. A statistical correlation was found between the gallbladder wall thickness and the alanine transferase index.     

强回声晕术前评估甲状腺结节良恶性的价值

目的 探讨强回声晕在甲状腺良恶性结节中的诊断价值及其病理成分。方法 回顾性分析2015年1月~2016年5月在舟山医院就诊的306例患者410个结节,所有结节均经手术切除并且病理证实。患者术前均进行常规超声检查,并由经验丰富的超声医生记录结节直径、位置、数目、纵横比、边缘、边界、回声水平、钙化、血流分级、声晕、强回声晕、与包膜关系、淋巴结转移情况。先进行单因素分析筛选出有统计学意义的指标,然后再进行多因素Logistic回归分析。以病理上结节周围出现纤维浸润带为金标准,构建ROC曲线,探讨强回声晕的病理成份。结果 二元Logistic回归分析筛选出强回声晕（Ps）进入回归模型。强回声晕（常规超声）的ROC曲线下面积为0.748,强回声晕（Ps）的ROC曲线下面积为0.761,强回声晕（常规超声）的阳性预测值为87%,阴性预测值为92.7%,强回声晕（Ps）的阳性预测值为83.3%,阴性预测值为89%。结论 强回声晕对甲状腺结节良恶性的诊断具有一定的价值。强回声晕的病理成分多为癌细胞浸润伴纤维组织及炎性细胞。     

胎儿心内强回声灶的临床价值

目的探讨胎儿心内强回声灶的临床价值。方法本研究对95例产前发现胎儿心内强回声灶孕妇进行临床追踪随访,并仔细进行胎儿心脏结构检查。对存在其他染色体高危因素的孕妇行羊水或脐静脉穿刺,进行胎儿染色体核型分析,其余孕妇在引产或分娩时取脐带静脉血进行染色体核型分析。结果 （1）95例孕妇中,存在染色体异常高危因素有13例,不伴其他高危因素者有82例。（2）95例孕妇进行了产前超声检查,3例被发现合并胎儿结构异常,其中1例为法络四联症,1例为十二指肠梗阻伴21-三体,1例为露脑畸形。（3）1例被发现胎儿染色体异常,为21-三体,发生于高危妊娠组（1/13,7.7%）。结论 （1）孤立存在的胎儿心内强回声灶与胎儿染色体异常、心脏畸形无明显相关性。（2）伴有其他染色体异常高危因素的胎儿有心内强回声灶时,胎儿染色体异常和心脏畸形的发生风险明显增高。     

Ultrasound-enhanced thrombolysis with tPA-loaded echogenic liposomes

Background and PurposeCurrently, the only FDA-approved therapy for acute ischemic stroke is the administration of recombinant tissue plasminogen activator (tPA). Echogenic liposomes (ELIP), phospholipid vesicles filled with gas and fluid, can be manufactured to incorporate tPA. Also, transcranial ultrasound-enhanced thrombolysis can increase the recanalization rate in stroke patients. However, there is little data on lytic efficacy of combining ultrasound, echogenic liposomes, and tPA treatment. In this study, we measure the effects of pulsed 120-kHz ultrasound on the lytic efficacy of tPA and tPA-incorporating ELIP (t-ELIP) in an in-vitro human clot model. It is hypothesized that t-ELIP exhibits similar lytic efficacy to that of rt-PA.MethodsBlood was drawn from 22 subjects after IRB approval. Clots were made in 20-µL pipettes, and placed in a water tank for microscopic visualization during ultrasound and drug treatment. Clots were exposed to combinations of [tPA] = 3.15 µg/ml, [t-ELIP] = 3.15 µg/ml, and 120-kHz ultrasound for 30 minutes at 37 °C in human plasma. At least 12 clots were used for each treatment. Clot lysis over time was imaged and clot diameter was measured over time, using previously developed imaging analysis algorithms. The fractional clot loss (FCL), which is the decrease in mean clot width at the end of lytic treatment, was used as a measure of lytic efficacy for the various treatment regimens.ResultsThe fractional clot loss FCL was 31% (95% CI: 26-37%) and 71% (56-86%) for clots exposed to tPA alone or tPA with 120 kHz ultrasound. Similarly, FCL was 48% (31-64%) and 89% (76-100%) for clots exposed to t-ELIP without or with ultrasound.ConclusionsThe lytic efficacy of tPA containing echogenic liposomes is comparable to that of tPA alone. The addition of 120 kHz ultrasound significantly enhanced lytic treatment efficacy for both tPA and t-ELIP. Liposomes loaded with tPA may be a useful adjunct in lytic treatment with tPA.     

Echogenic Carotid Artery Plaques are Associated with Vertebral Fractures in Postmenopausal Women with Low Bone Mass

Although low bone mass has been associated with atherosclerosis even after adjustment for age, little is known about the association between vertebral fractures and calcified atherosclerotic plaques. Our objective was to investigate whether osteoporotic vertebral fractures are independently related to the prevalence of atherosclerotic carotid plaques in postmenopausal women with low bone mass. We enrolled 195 postmenopausal women with osteopenia or osteoporosis. Bone mineral density and the presence of vertebral fractures were assessed. Intima media thickness and atherosclerotic plaques of the carotid artery were assessed using ultrasonography. Of the 195 subjects in the study, 84 had no plaques and 111 had at least one. The percentage of women with vertebral fractures was significantly higher in subjects with echogenic carotid plaques than in those without (27% vs. 11%, respectively; P < 0.05). However, there was no difference in the prevalence of vertebral fractures between women with echolucent plaques and those without (10.9% vs. 10.7%, respectively; P = nonsignificant). By logistic regression analysis with multivariate adjustment, age (P < 0.01), dyslipidemia (P < 0.05), and the presence of vertebral fracture (P < 0.05) were independent risk factors for echogenic carotid plaques. Osteoporotic vertebral fractures are associated with an increased risk of echogenic atherosclerotic plaques in postmenopausal women with low bone mass. It appears that the high association of echogenic atherosclerotic plaques and vertebral fractures could partially explain why osteoporotic vertebral fractures are linked to increased mortality.     

Broadband Attenuation Measurements of Phospholipid-Shelled Ultrasound Contrast Agents

The aim of this study was to characterize the frequency-dependent acoustic attenuation of three phospholipid-shelled ultrasound contrast agents (UCAs): Definity, MicroMarker and echogenic liposomes. A broadband through-transmission technique allowed for measurement over 2 to 25 MHz with a single pair of transducers. Viscoelastic shell parameters of the UCAs were estimated using a linearized model developed by N. de Jong, L. Hoff, T. Skotland and N. Bom (Ultrasonics 1992; 30:95–103). The effect of diluent on the attenuation of these UCA suspensions was evaluated by performing attenuation measurements in 0.5% (w/v) bovine serum albumin and whole blood. Changes in attenuation and shell parameters of the UCAs were investigated at room temperature (25°C) and physiologic temperature (37°C). The attenuation of the UCAs diluted in 0.5% (w/v) bovine serum albumin was found to be identical to the attenuation of UCAs in whole blood. For each UCA, attenuation was higher at 37°C than at 25°C, underscoring the importance of conducting characterization studies at physiologic temperature. Echogenic liposomes exhibited a larger increase in attenuation at 37°C versus 25°C than either Definity or MicroMarker.     

胎儿心内强回声光斑的临床意义

目的：探讨胎儿心内强回声光斑（EIF）的临床意义。方法：选择2005年1月-2007年12月本院门诊产前超声检查发现EIF的151例患儿资料，对EIF病理检查随访。结果：EIF可存在于左心室，右心室，左右心室同时存在；可单发或多发；可自行消失；病理检查为心室乳头肌钙化灶。结论：高危组EIF的出现，提示了进一步产前诊断的线索；低危组，孤立的EIF无临床意义；高危组EIF的出现更有意义。     

Prognostic value of sonography in childhood nephrotic syndrome

This retrospective case review of 43 children with primary nephrotic syndrome was designed to evaluate the relationship among renal ultrasound findings at presentation, subsequent corticosteroid responsiveness and histological diagnoses. Fifty-one percent of patients had abnormal sonograms; nephromegaly was present in 42% and increased renal echogenicity in 35%. There was no relationship between nephromegaly and either response to corticosteroids or specific glomerular lesions causing nephrosis. Although the presence of echogenic kidneys did not denote a particular type of renal disease, it was significantly more frequent in corticosteroid-resistant than in corticosteroid-responsive patients (62% vs. 18%,P<0.05). We conclude that increased renal echogenicity at time of presentation is a possible indicator of corticosteroid resistance in children with primary nephrotic syndrome.