ABSTRACT
Objective To investigate the predictive value of cervical length (CL) measured by transvaginal ultrasound for preterm birth<32 weeks,＜34 weeks in twin pregnancies in the second and the third trimester of pregnancy. Methods A total of 490 twin pregnant women with CL measured by transvaginal ultrasound during the second trimester of pregnancy (20-24 weeks) and the third trimester of pregnancy (28-32 weeks) delivered in Peking University Third Hospital, and Tongzhou Maternal and Child Health Hospital from January 2014 to December 2017 were collected, and 161 cases out of which were measured by CL during both the second trimester and the third trimester of pregnancy. Based on the measured gestational weeks, 427 cases were in the second trimester group and 224 cases in the third trimester group. The predictive value of CL for preterm birth was evaluated by calculating the optimal cut-off point with sensitivity and specificity. Logistic regression analysis was used to assess the relationship between CL and preterm birth after adjusting for confounding factors (age of pregnant women, chorionic status, mulipara, assisted reproductive pregnancy and pre-pregnancy body mass index). Results (1) The median CL of pregnant women in the second trimester group and the third trimester group were 36 mm (33-40 mm) and 28 mm (18-33 mm) respectively. In the second trimester group, 151 cases (35.4%, 151/427) were preterm birth and 276 cases (64.6%, 276/427) were full-term birth; the median CL of preterm and full-term pregnant women were 34 mm (30-37 mm) and 37 mm (34-40 mm), respectively, with significant difference (P<0.01). In the third trimester group, 100 cases (44.6%, 100/224) were preterm birth and 124 cases (55.4%, 124/224) were full-term birth; the median CL of preterm and full-term pregnant women were 22 mm (15-30 mm) and 31 mm (23-34 mm), respectively, with significant difference (P<0.01). (2) Prediction of preterm birth<32 weeks and<34 weeks was performed with CL in the second trimester group. The area under the receiver-operating characteristics curve were 0.78 (95% CI : 0.70-0.86) and 0.71 (95% CI : 0.64-0.79), respectively. The optimal cut-off points were 36.5 mm and 33.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth<32 weeks and<34 weeks of gestation. (3) Prediction of preterm birth <32 weeks and <34 weeks were performed with CL in the third trimester group. The area under the receiver-operating characteristics curve were 0.86 (0.75-0.96) and 0.75 (0.67-0.84), respectively. The optimal cut-off points were 17.5 mm and 18.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth at<32 weeks and<34 weeks of gestation. Conclusions CL measured by transvaginal ultrasound in the second and the third trimester is a good predictor for preterm birth of twin pregnancy. CL≤36.5 mm and≤33.5 mm at 20-24 weeks of gestation could predict preterm birth<32 weeks and<34 weeks respectively. CL≤17.5 mm and≤18.5 mm at 28-32 weeks of gestation could predict preterm birth<32 weeks and<34 weeks respectively.
ABSTRACT
Objective To explore the prenatal ultrasound image features and clinical significance of fetal ductus venosus abormalities . Methods Fifteen fetuses with ductus venosus abormalities diagnosed by prenatal ultrasonography at Peking University T hird Hospital were retrospective review . T he prenatal findings ,umbilical shunting type ,perinatal outcomes ,and autopsy reports were analyzed . Results Fourteen fetuses were found with absence of ductus venosus . In 6 fetuses the umbilical vein connected to the portal vein ,5 fetuses the umbilical vein connected to the inferior vena cava and 3 fetuses the umbilical vein connected to the right atrium . T he remaining 1 fetus was found obliteration of ductus venosus . Absence of ductus venous showed no normal ductus venous and the umbilical vein almost always drained directly into portal vein ,inferior vena cava or right atrium . Obliteration of ductus venous showed normal ductus venous was replaced by a tiny echogenic string without blood flow . T hree cases had intracardiac and extracardiac abnormalities ; 4 cases had extracardiac abnormalities only ; 8 of these ,ductus venosus abormality were isolated . T wo cases had trisomy 21 syndrome . Four patients underwent legal termination of pregnancy ; 2 were intrauterine fetal death ; and 8 carried to term wit normal outcome ; the remaining one underwent operation due to extracardiac abnormality and postoperative course was uneventful . Conclusions Prenatal ultrasound can be used to diagnose fetal ductus venosus abormalities . Hemodynamic depends on umbilical venous drainage site and diameter . T he prognosis for this group of anomalies depends on the chromosomal abnormalities and additional findings . Chromosome and ultrasonic monitoring are suggested for following pregnancy .
ABSTRACT
Objective To improve the quality of clinical biochemistry laboratory by quality indicators of pre-analytical,analytical,post-analytical phase and the whole process.Methods Analytical Phase:The Sigma values of items were calculated,applying the equation Sigma =(TEa％-Bias％)/CV％.Total allowable error (TEa) is from analyticalal specification defined in WS/T403-2012 of China,Bias％ is from the evaluation results of National Center for Clinical Laboratory (NCCL) trueness verification PT series and CV％ is from internal quality control data during the last 6 months in our lab.Normalized Sigma metrics plot was made to evaluate the analysis performance and the quality control strategies were designed accordingly.The quality goal indexes (QGI) were also calculated to propose improvement measures for items below 6 Sigma.Quality indicators of pre-,post-analytical and whole analytical phase,such as quality of specimen,critical value notification,critical value notification in time,TAT of hs-cTnT,TAT of emergency biochemical items,rewrite of laboratory reports and unacceptable performance in EQA-PT were measured in Sigma metrics too.The Sigma metrics changes before and after taking improvement measures were compared to conform the effectiveness.Results The average Sigma value of 17 biochemical tests was 5.29,of which 8 items (UA,K,ALP,CK,AMY,AST,TG,Na) achieved excellent to world class level (≥ 5 Sigma),6 items (LDH,Cre,TC,ALT,Mg,Glu) achieved marginal to good level (5 ＞ Sigma ≥ 3),BUN performed poorly (3 ＞ Sigma ≥ 2),Ca,TP performed unacceptably (Sigma ＜ 2) with serious quality defects.The Sigma values of unacceptable specimen,critical value notification,critical value notification in time,unacceptable turn around time (TAT) of hs-cTnT,unacceptable turn around time (TAT) of emergency biochemical items,rewrite of laboratory reports,unacceptable performance in EQA-PT were 4.17,3.60,2.75,1.72,3.27,4.52,3.33 respectively,rising to 4.30,4.30,2.90,2.45,3.75,4.80,3.60 accordingly after improvement.Conclusions Sigma metrics is potentially an ideal approach for clinical biochemistry laboratories management,which is helpful to find out problems,put forward improvement measures,and confirm the effectiveness,so as to achieve the purpose of continuous quality improvement.
ABSTRACT
Objective:To evaluate the association of oral lichen planus (OLP) with Candida albicans infection by Meta-analysis,and to provide basis for the antifungal treatment of OLP.Methods:Bibliographic searches were conducted in PubMed,EMBase,Medline,The Cochrane Library,CNKI,VIP,and Wanfang databases from inception to December 30 in 2016.The literatures were screened according to the inclusion and exclusion criteria by two reviewers independently,the methodology quality was evaluated after data abstraction,and then the RevMan 5.3 and Stata 12.0 software were used for Meta-analysis to calculate the crude odd ration (OR) and 95％ confidence intervals (95％ CI).Funnel plot and Egger's methods were used for the evaluation on the publication bias of papers.Results:Thirteen trials were included in this study.Collectively,1 073 OLP patients and 766 controls were available for analysis.The detection rate of Candida albicans in the OLP patients was significantly higher than that in healthy controls (OR:2.30,95％ CI:1.60-3.31,P＜0.01).Seven studies of these included literatures were performed on clinical typing of the OLP patients,and the risk of Candida albicans infection in the patients with erosive-atrophic OLP (E-OLP) was significantly increased (OR =10.12,95％ CI:4.05-25.28,P＜0.01).Conclusion:OLP has a clear association with Candida albicans infection,and this association is particularly significant in the E-OLP patients.
ABSTRACT
Objective:To evaluate the association of oral lichen planus (OLP) with Candida albicans infection by Meta-analysis,and to provide basis for the antifungal treatment of OLP.Methods:Bibliographic searches were conducted in PubMed,EMBase,Medline,The Cochrane Library,CNKI,VIP,and Wanfang databases from inception to December 30 in 2016.The literatures were screened according to the inclusion and exclusion criteria by two reviewers independently,the methodology quality was evaluated after data abstraction,and then the RevMan 5.3 and Stata 12.0 software were used for Meta-analysis to calculate the crude odd ration (OR) and 95％ confidence intervals (95％ CI).Funnel plot and Egger's methods were used for the evaluation on the publication bias of papers.Results:Thirteen trials were included in this study.Collectively,1 073 OLP patients and 766 controls were available for analysis.The detection rate of Candida albicans in the OLP patients was significantly higher than that in healthy controls (OR:2.30,95％ CI:1.60-3.31,P＜0.01).Seven studies of these included literatures were performed on clinical typing of the OLP patients,and the risk of Candida albicans infection in the patients with erosive-atrophic OLP (E-OLP) was significantly increased (OR =10.12,95％ CI:4.05-25.28,P＜0.01).Conclusion:OLP has a clear association with Candida albicans infection,and this association is particularly significant in the E-OLP patients.
ABSTRACT
Objective To explore the clinical significance of abnormal fetal genitalia detected by routine prenatal ultrasound. Methods In Peking University Third Hospital from January 2014 to January 2016, the ultrasonic diagnosis and sonographic features in 14 suspected cases of abnormal fetal genitalia were analyzed retrospectively and compared with postpartum morphological and pathological characteristics. Results The fetal ultrasound findings and clinical outcomes in 14 cases were: (1) There were 4 cases of partial penoscrotal transposition (28.6%, 4/14), in which all fetus hadshort penis and hypospadias. In 2 termination cases, unilateral hydronephrosis and anal atresia was found in one case, while ventricular septal defect was found in the other case. In 2 term-birth cases, there was one case of recessive spina bifida. In the 4 cases, prenatal ultrasonographic manifestation showed that the short penis was located between the division of the scrotum, named as ″tulip sign″. (2) There were 2 cases (14.3%, 2/14) of complete penoscrotal transposition, in which all the pregnancies were terminated. On prenatal ultrasound of external genitalia, the location of the penis and scrotum was reversed. In one case, anal atresia and small eye malformation were found. In one case, the tetralogy of Fallot, duodenal atresia and anal atresia were found. (3) There were 4 cases of the micropenis (28.6%, 4/14). On prenatal ultrasound, the penis was difficult to demonstrated and was shown merely as an echoic dot. Among 2 cases of FGR, one infant dies for unexplained reasons after birth, and one infant has hypospadias after birth. The pregnancy was terminated in two cases of 18-trisomia and microdeletion in chromosome 9. (4) There were 2 cases of penis absence (14.3%, 2/14), in which all pregnancies were terminated. The sonographic manifestations show the absence of penis and bladder eversion. (5) In 2 cases, sex couldn`t be identified (14.3%, 2/14). In one case, the 46 xy infant showed a female external genitalia appearance after birth. In one case, the clitorism and congenital adrenal cortical hyperplasia were found in a 46 xx infant after birth. Conclusions Prenatal ultrasonography is effective and feasible in detecting genitalia abnormalities, especially for penis scrotal transposition and penis absence. When the fetal gender cannot be identified on ultrasound, chromosome examination is warranted. For indeterminable cases, ultrasound follow-up in 2nd and 3rd trimester is necessary.
ABSTRACT
Objective To summarize the sonographic features and the diagnostic value of transvaginal three dimensional OmniView sonography for congenital uterine malformation. Methods Thirty-six patients who were suspected as uterus septus on transvaginal two-dimensionalultrasound (2D US) were examined by transvaginal three dimensional ultrasound (3D US) of OmniView. The coronal plane images were acquired. The fundus,cavity and cervix of the uterus were analyzed. The depths of fundal cleft were measured.In comparison with the test results of hysterosalpingography (HSG), hysteroscopy, hysteroscopy combined with laparoscope or magnetic resonance imaging (MRI), the sonographic features and the diagnostic value of transvaginal three dimensional OmniView sonography were summarized. Results Among the 36 cases underwent transvaginal three-dimensional ultrasound (3D US), 16 cases were diagnosed as incomplete septate uterus, 5 cases as complete septate uterus, 5 cases as arcuate uterus, 4 cases as bicornuate uterus, 4 cases as gemini and 2 cases as unicornuate uterus. The results of all 36 cases were confirmed by surgery or magnetic resonance imaging (MRI). The sonographic features of transvaginal three dimensional OmniView sonography:(1) Twenty-one septate uterus had convexes (in 12 cases) or minimally depressed fundus (in 9 cases, depth of cleft ≤ 1.0 cm) and had Y-shaped (16 incomplete septate uterus without septum extending into cervix) or V-shaped cavity (5 complete septate uterus with septum extending into cervix). (2) Five arcuate uterus had an obtuse angle at the central point of septum. (3) Four bicornuate uterus had fundal depression more than 1.0 cm and were divided into two cornuas. (4) Four gemini had two complete uterus and cervix. (5) Two uterus unicornis had single endometrial and smaller than normal. Conclusions Transvaginal 3D OmniView sonopgraphy of uterine may display a good coronal plane, on which the relationship of the cavity and the fundus, the depth of fundal cleft and the angle at the central point of the septum can be well depicted and measured. It is a practical, reliable and noninvasive method, and superior to 2D US in the diagnostic classification of complex uterus malformation.
ABSTRACT
Objective To evaluate the clinical effect and safety of umbilical cord ligation in the fetocide of complicated monochorionic multiple gestations.Methods From January 2009 to December 2012,clinical data of 18 women with complicated monochorionic multiple gestations who experienced intrauterine percutaneous umbilical cord ligation in Peking University Third Hospital were collected.Among the patients,6 were selective intrauterine growth restriction (1 with type Ⅰ,4 with type Ⅱ,1 with type Ⅲ) ; 4 were acrania or hydropic twins; 4 were aeardiac twins,2 were complicated triplet gestation; 1 was twin-twin transfusion syndrome with right ventricular dysplasia and 1 was monochorionic diamniotic (MCDA) with caesarean section history.The procedure was performed under both endoscopic and sonographic guidance.The gestational age at the time of the procedure were 17-27 +6 weeks.The procedure and perinatal outcome were analyzed.Results (1) The procedure was performed successfully in all the 18 cases.The average duration of the procedure was 63 min (24-156 min).The blood loss was 7.6 ml (5-20 ml).The mean gestational age at the time of the procedure was 20 weeks (17-27 +6 weeks).The average birth weight of the neonates was 2441 g(1000-3400 g).(2) There were 20 fetuses survived.Two fetuses had cardiac anomalies and were terminated in the following 2-3 weeks.Intrauterus fetal demise occured in 3 twin reverse arterial perfusion syndrome (TRAP) cases 3-14 weeks after the procedure.1 case delivered as early preterm birth at 28 weeks and the neonate died of respiratory distress syndrome (RDS) and hypoxie-ischemicencephalopathy (HIE).Fourteen neonates were in healthy and normal development by 3-51 months' followup.(3) Fourteen cases delivered at more than 28 weeks (28-38 weeks,averagely 33 + 1 weeks).The gestational weeks were prolonged by 5-21 weeks (averagely 13 +4 weeks).Among them,3 case were early preterm birth (28-33 weeks) and 3 were late preterm birth (34-36 weeks).Conclusion Percutaneous umbilical cord ligation is a reliable technique for the fetocide of complicated monochrionic mutilple gestations,especially for monochronic monoamniotie pregnancies.