ABSTRACT
Objective To evaluate the diagnostic value of A-F mnemonic performed by sonographers with limited experience in patients with acute chest pain. Methods This was a prospective observational study. Bedside cardiac ultrasound for patients with chest pain was performed by six sonographers with limited experience using A-F mnemonic, evaluating indexes including aortic dissection(A), both ventricles (B), regional wall motion abnormality (RWMA), left ventricular ejection fraction (LVEF) ≤ 50％ (C ,contractility), dimensions (D), pleural and pericardial effusion (E) and further abnormalities (F). Afterwards, experienced cardiac sonographers performed the same examinations, and the difference in the time of ultrasound examination was calculated. The diagnosis of experienced sonographers were referred as the control group, and kappa test was applied to analyze the sensitivity, specificity, positive predictive value and negative predictive value. Results There were 245 cases eligible for study, and 20 cases were excluded. Finally 225 cases of acute chest pain were included in the analysis, containing 158 fatal chest pain and 67 low-risk chest pain. The experienced sonographers diagnosed 20 cases of ascending aortic dissection, 5 cases of right ventricular dilatation, 72 cases of RWMA, 12 cases of LVEF ≤ 50％, 45 cases of left ventricular dilatation, 6 cases of hydropericardium, and 6 cases of other abnormalities. The consistency between beginners and experienced sonographers were as follows:completely same (hydropericardium, Kappa=1.000), highly consistent (ascending aortic dissection, Kappa=0.853, right ventricular dilatation, Kappa=0.931, and other abnormalities, Kappa=0.829), moderately consistent (RWMA, Kappa=0.768, LVEF ≤ 50％, Kappa=0.713 and left ventricular dilatation, Kappa=0.766). The sensitivity and negative predictive value of RWMA and LVEF ≤ 50％ and the positive predictive value of left ventricular dilatation in the beginner sonographers were lower than those in the experienced sonographers. Conclusions A-F mnemonic was a simple and practical way for the beginner sonographers to perform bedside cardiac ultrasound. It was of significant value in making correct diagnosis of most acute chest pain patients and providing quick and reliable information for clinicians.
ABSTRACT
Objective To investigate the application of fetal intelligent navigation echocardiography ( FINE ,5D Heart) in the diagnosis of conotruncal anomalies ( CTD ) . Methods For prospective study , volume transducer was used to collect the three-dimensional data of fetal heart at 20th - 30th week of gestation . The STIC volume images were processed by three independent physicians of different hierarchies via 5D Heart software afterwards ,and the quality of the STIC diagnosis as well as the consistence among the physicians were analyzed according to the gold standard of postpartum ultrasonic follow-up or surgery results . Results Twelve out of 16 CTD cases were finally included in the study ,and the volume data were analyzed . Senior physicians A could apply 5D Heart diagnosis to achieve 2D-US diagnosis efficiency and gold standard consistently( P = 0 .157 ,0 .083) ,medium and low seniority physician B and C got roughly equal score using 5D Heart diagnosis( P = 0 .705) ,but the diagnostic performance could not reach 2D-US ( P =0 .000 ,0 .000) and gold standard( P = 0 .000 ,0 .000) . Conclusions Fetal cardiac anomalies of CTD can be diagnosed correctly by an expert using 5D Heart ,which has important application prospects in remote consultation , training and scientific research and teaching of congenital heart disease of fetus .
ABSTRACT
Objective To investigate the value of fetal intelligent navigation echocardiography (FINE,5D Heart)in displaying the normal fetal heart structure during 20 to 38 weeks'gestation.Methods Three-dimensional data of fetal heart during 20 to 38 weeks'gestation were acquired using volume transducer prospectively.The STIC volume images were post-processed with 5D heart software by three physicians with different levels of echocardiographic examination and the quality of the section images were analyzed.The intra-and interobserver repeatability was analyzed for the qualification of section images.The correlation between the quality of image and gestational age,body mass index,the placenta position,fetal initial plane position were evaluated using univariate and multivariable logistic regression analysis.Results Two hundreds and five cases of pregnant women were included,and 9 cases were excluded.Volume data acquisition was completed in 180 pregnant women,and the image acquisition rate was 91.8%.The data were assessed twice by three observers and qualified 9 section images were gotten in 156-180 cases(degree of qualification 86.7%-100%).The screening images were satisfied in 152 cases(84.4%),dissatisfied with 28 cases(15.6%).The intra-observer agreement by three observers was absolute concord in four chamber view and abdomen、stomach view;excellent in three vessel trachea view(3VT),five chamber view, left ventricular outflow tract view and superior and inferior vena cava view;good in right ventricular outflow tract view,ductal arch view and aortic arch view.The inter-observer agreement by each of three observers was absolute concord in four chamber view and abdomen、stomach view;excellent in superior and inferior vena cava view;excellent to good in five chamber view,left ventricular outflow tract view,right ventricular outflow tract view;good in 3VT,ductal arch view and aortic arch view.In a univariate analysis,the quality of the image was associated with obesity(χ2=15.338,P =0.000),gestational age(χ2=23.356,P =0.000).Multivariable analysis showed that the obesity(OR=5.587,P =0.001)and gestational age (OR=8.843,P=0.000)were factors affecting the quality of the image.The average time spent in post-processing the images for first time by three observers was(2.77±1.39)min,and there was no significant difference among observers(P > 0.05).Conclusions Fetal intelligent navigation echocardiography (FINE,5D Heart)based on STIC volumes can successfully generate 9 standard fetal echocardiography views in 86.7%-100% of fetuses in the 2nd and 3rd trimesters.This method can simplify examination of the fetal heart and reduce operator dependency.
ABSTRACT
Serum specific IgG (SIgG) antibodies of 32 patients with epidemic hemorrhagic fever (EHF) were sequentially determined by indirect immunofluorecent antibody test and their relationship to the types of the disease were analyzed in the present paper. The SIgG antibodies appeared practically on day 3 after the onset of the disease. Thereafter,the positive rates and the SIgG titres increased with the prolongation of the illness days and reached 100% positive rates and stable high titres till day 11 to day 12 after the onset of the disease. Furthermore, different types of the disease had.different SIgG response curves ,and there was a significant difference between the SIgG titres of different illness types statistically from day 7 to day 8 after the onset of the disease. These results suggest that the SIgG might be responsible for the immunopathogenesis of EHF.