The classification and clinical significance of twin reversed arterial perfusion by prenatal ultrasound / 中华超声影像学杂志

Objective:To retrospectively analyze the classification of twin reversed arterial perfusion(TRAP) by prenatal ultrasound diagnosis, and to explore the clinical significance of this classification method.Methods:One hundred and fourteen TRAP cases were selected for prenatal ultrasound examination from January 2001 to January 2020 in Maternal and Child Health Hospital of Hubei Province, and were studied following the classification: hemiacardius(type Ⅰ), anceps trunk(type Ⅱ), acephalus trunk(type Ⅲ), acephalus acormus(type Ⅳ), acardius amorphous(type Ⅴ). Natural pregnancy outcomes were analyzed between group A(type Ⅰ, type Ⅱ, type Ⅲ) and group B(type Ⅳ, type Ⅴ).Results:Among 114 cases of TRAP, 27 cases (23.7%) were live birth, 33 cases (29.0%) were intrauterine death, 7 cases (6.1%) were perinatal death, 22 cases (19.3%) were induced labor complicated with heart failure, 4 cases (3.5%) were induced labor with malformation of pump twin, 21 cases (18.4%) were induced without heart failure of pump twim. Among 114 cases of TRAP, 20 cases (17.5%) were type Ⅰ, 27 cases (23.7%) were type Ⅱ, 48 cases (42.1%) were type Ⅲ, 8 cases (7.0%) were type Ⅳ and 11 cases (9.7%) were type Ⅴ. The prognosis of group B was better than group A during natural pregnancy ( P=0.007). Conclusions:Based on the diagnosis of prenatal ultrasound, the prognosis of type Ⅳ and type Ⅴ TRAP is better than that of type Ⅰ, type Ⅱ and type Ⅲ. The classification by prenatal ultrasound has positive significance for the clinical prognosis of pump twin.

Association between metal cobalt exposure and the risk of congenital heart defect occurrence in offspring: a multi-hospital case-control study

BACKGROUND@#Many studies have investigated heavy metal exposure could increase the occurrence of congenital heart defects (CHDs). However, there are limited data regarding the relationship between cobalt exposure and CHD occurrence in offspring. The aim of this study was to analyze the association between cobalt exposure in mothers and the risk of CHDs in offspring.@*MATERIALS AND METHODS@#In order to explore the association between cobalt exposure and occurrence of congenital heart defect (CHD), a case-control study with 490 controls and 399 cases with CHDs in China were developed. The concentrations of cobalt in hair of pregnant woman and fetal placental tissue were measured and processed by a logistic regression analysis to explore the relationship between cobalt exposure and risk of CHDs.@*RESULTS@#The median concentration of hair cobalt in the control and case group was 0.023 ng/mg and 0.033 ng/mg (aOR, 1.837; 95% CI, 1.468-2.299; P < 0.001), respectively. And the median (5-95% range) fetal placental cobalt concentrations were 19.350 ng/g and 42.500 ng/g (aOR, 2.924; 95% CI, 2.211-3.868; P < 0.001) in the control and case groups, respectively. Significant differences in the middle level of cobalt in hair were found in the different CHD subtypes, including septal defects, conotruncal defects, right ventricular outflow tract obstruction, and left ventricular outflow tract obstruction (P < 0.001). Dramatically, different cobalt concentrations in fetal placental tissue were found in all subtypes of cases with CHDs (P < 0.01).@*CONCLUSIONS@#The finding suggested that the occurrence of CHDs may be associated with cobalt exposure.

MicroRNA-200a Targets Cannabinoid Receptor 1 and Serotonin Transporter to Increase Visceral Hyperalgesia in Diarrhea-predominant Irritable Bowel Syndrome Rats

BACKGROUND/AIMS: MicroRNAs (miRNAs) were reported to be responsible for intestinal permeability in diarrhea-predominant irritable bowel syndrome (IBS-D) rats in our previous study. However, whether and how miRNAs regulate visceral hypersensitivity in IBS-D remains largely unknown. METHODS: We established the IBS-D rat model and evaluated it using the nociceptive visceral hypersensitivity test, myeloperoxidase activity assay, restraint stress-induced defecation, and electromyographic (EMG) activity. The distal colon was subjected to miRNA microarray analysis followed by isolation and culture of colonic epithelial cells (CECs). Bioinformatic analysis and further experiments, including dual luciferase assays, quantitative real-time polymerase chain reaction, western blot, and enzyme-linked immunosorbent assay, were used to detect the expression of miRNAs and how it regulates visceral hypersensitivity in IBS-D rats. RESULTS: The IBS-D rat model was successfully established. A total of 24 miRNAs were differentially expressed in the distal colon of IBS-D rats; 9 were upregulated and 15 were downregulated. Among them, the most significant upregulation was miR-200a, accompanied by downregulation of cannabinoid receptor 1 (CNR1) and serotonin transporter (SERT). MiR-200a mimic markedly inhibited the expression of CNR1/SERT. Bioinformatic analysis and luciferase assay confirmed that CNR1/SERT are direct targets of miR-200a. Rescue experiments that overexpressed CNR1/SERT significantly abolished the inhibitory effect of miR-200a on the IBS-D rats CECs. CONCLUSIONS: This study suggests that miR-200a could induce visceral hyperalgesia by targeting the downregulation of CNR1 and SERT, aggravating or leading to the development and progression of IBS-D. MiR-200a may be a regulator of visceral hypersensitivity, which provides potential targets for the treatment of IBS-D.

Prenatal ultrasound in diagnosis of omphalocele-exstrophy-imperforate anus-spinal defects complex in first trimester / 中国医学影像技术

Objective To explore the value of prenatal ultrasound in diagnosis of omphalocele-exstrophy-imperforate anusspinal defects (OEIS) in first trimester.Methods Prenatal ultrasonic characteristics of 10 fetuses with OEIS complex in first trimester were retrospectively analyzed and compared with autopsy results.Results Cystic bulging in the lower anterior abdominal wall was observed in all 10 fetuses.Spinal scoliosis dysplasia was found in 10 fetuses,with myelomeningocele in 3 fetuses.No normal bladder was visualized in 8 fetuses.Thickened nuchal translucency was noticed in 5 fetuses,among which neck lymphatic hydrocele was found in 1 fetus.The bilateral clubbed feet and left lower mutilation was observed in 1 fetus,respectively.All 10 OEIS complex fetuses were found accompanied with short umbilical cord,while single umbilical artery and umbilical cord cyst were found in 4 and 1 fetus,respectively.Autopsy showed abdominal wall defects with exstrophy in 10 fetuses.However,no complete cystic bulging was found.Besides,autopsy also showed pubic symphysis separation and bladder exstrophy in 10 fetuses without obvious genitalia nor anus.Conclusion Cystic bulging in the lower anterior abdominal wall is the most common prenatal ultrasonic characteristic of OEIS complex in first trimester.

Efficacy and Safety of Compound Kushen Colon-release Capsule versus Related Chemical Drugs in the Treatment of Colitis: A Meta-analysis / 中国药房

OBJECTIVE: To systematically evaluate therapeutic efficacy and safety of Compound kushen colon-release capsule versus related chemical drugs in treatment of ulcerative colitis (UC).METHODS: Retrieved from PubMed, Embase, Cochrane library, China Journal Full-text Database (CJFD), VIP, CBM and Wanfang database, RCTs about therapeutic efficacy (response rate, TCM syndrome, therapeutic efficacy of mucosal lesion) and safety (the incidence of ADR) of Compound kushen enteric-release capsule versus related chemical drugs in the treatment of UC were collected. Meta-analysis was conducted by using Rev Man 5. 3 statistical software after data extraction and quality evaluation with Cochrane 5. 1. 0. RESULTS: A total of 9 RCTs were included, involving 649 patients. The results of Meta-analysis showed that response rate [OR=2. 16, 95％CI(1. 28, 3. 63), P=0. 004] and therapeutic efficacy of mucosal lesion [OR=2. 42, 95％ CI(1. 07, 5. 47), P=0. 03] of Compound kushen colon-release capsule were significantly higher than that of chemical drugs in the treatment of UC, with statistical significance. There was no statistical significance in therapeutic efficacy of TCM syndrome [OR=1. 70, 95％CI(0. 87, 3. 32), P=0. 12] or the incidence of ADR between 2 groups. CONCLUSIONS: Therapeutic efficacy of Compound kushen colon-release capsule is better than that of related chemical drugs in the treatment of UC with similar safety.

Prenatal diagnosis of triplet pregnancy complicated by twin reversed arterial perfusion sequence through ultrasonography / 中华医学超声杂志（电子版）

Objective To explore the characteristics of prenatal ultrasound image of triplet pregnancy complicated by twin reversed arterial perfusion sequence (TRAPS) and improve early diagnosis of this rare fetal malformation. Methods Compare the ultrasound and pathological findings of 6 cases of triplet pregnancy with TRAPS fetus by prenatal ultrasound diagnosis and postnatal diagnosis from April 2001 to April 2017 in Hubei Maternal and Child Health Hospital, and summarize the characteristics of prenatal ultrasound images of TRAPS fetus. Results Sonographic findings of the six triplet pregnancy were as follows: (1) Acardiac fetus: all acardias were absence of heart and beat, with hypogenetic lower limbs, five with skin edema and lymphoedema, five were absence of fetal head while one with stunted head, one with hypogenetic upper limb, four with spin and abdominal cavity, four acardias had single umbilical artery and were supplied by umbilical artery draining towards the fetus, two cases showed no blood flow in umbilical artery and fetal body. (2) Pump fetus: all of the six cases with normal anatomical structure, two showed normal amniotic fluid volume while four showed polyhydramnios, three cases had prenatal cardiac dysfunction (one case survived, two cases of intrauterine demise). (3) The third fetal of the triplets (TRAP co-twin ): during the Prenatal ultrasound follow-up five fetus had normal morphology with normal heart function, one fetal with multiple malformations. Prognosis of the triplet pregnancy: one triplet cesarean delivery two normal boys, five triplets were of poor prognosis (four pump fetus of intrauterine demise, one pump fetal of premature death: one TRAP co-twin of intrauterine demise, two TRAP co-twins of premature death, two TRAP co-twins of induced labor), four acardia twins of intrauterine spontaneous blood blocking, two still birth. Fetal chorionic and amniotic membrane: four cases were dichorionic triamniotic triplet pregnancy, one case was monochorionic triamniotic triplet gestation, one case was monochorionic diamniotic triplet pregnancy. Six cases were confirmed by pathologic anatomy. Conclusion Triplet pregnancy complicated by TRAPS is a rare and severe multiple pregnancy complication, with its characteristic acoustic image characteristics, combined with color doppler, prenatal ultrasound has a high diagnostic value.

Combined application of prenatal ultrasound and magnetic resonance imaging in diagnosis of fetal bladder exstrophy / 中华医学超声杂志（电子版）

Objective To summarized the ultrasound and MRI characteristics of fetuses with bladder exstrophy. Methods Four cases of bladder exstrophy (3 cases of single birth were conceived naturally, 1 twins were artificial pregnated) were diagnosed by ultrasound combined MRI which were confirmed by autopsy in Hubei Maternal and Child Heath Hospital, from February 2013 to December 2017, We summarized the ultrasonographic features of the four cases. Results The common abnormal ultrasound images of the 4 cases: the bladder in the pelvic cavity was not shown, the umbilical cordinsertion was low, the symphysis pubis was separated, the gender was difficult to be determined, and the amniotic water was normal. In one case, one of the twins combined with the absence of the right kidney and abdominal wall mass below the umbilical cord insertion, and 1 case was suspected to tethered cord syndrome. Four cases of fetal antenatal MRI showed the same abnormal imaging findings as ultrasonography, but none of the 4 cases of pubic symphysis separation were showed, excluding the ultrasonographic diagnosis of tethered cord syndrome. In comparison with the X-ray and pathological examination results after the labor induction, the prenatal MRI was supplemented with 4 cases of abdominal wall defects, and 3 cases more than ultrasound. Ultrasonography and MRI combined examination were performed to correctly diagnose 4 cases of fetal bladder exstrophy. No bladder showed in pelvic nor the abdominal cavity, the abdominal wall defect with bulging content, the umbilical cord insertion was low, pubic symphysis separation, genital malformation, normal kidney andamniotic fluid were the main clues for ultrasound and MRI diagnosis of bladder exstrophy. Conclusion The combination of US and MRI can further improve the diagnostic accuracy and avoid missed diagnosis of fetal BE.

Prenatal ultrasound diagnosis and clinical follow-up analysis of fetal isolated double aortic arch / 中华超声影像学杂志

Objective To investigate the value of clinical follow-up in prenatal diagnosis of isolated double aortic arch (DAA) . Methods The clinical follow-up materials were retrospectively reviewed in 17 fetuses . Of all the isolated DAA fetuses ,the accuracy rate of prenatal diagnosis was confirmed by CT ,MRI , autopsy or echocardiography ,and pregnant outcomes were summarized . Results A total of 17 fetuses had a sonographic diagnosis of isolated DAA in our centers at a mean gestational age of 23 -32(27 ± 3) weeks , with mother mean age 19 -44 (28 ± 6) years old . One case of DAA type-A was misdiagnosed ,15 cases were delivered with 2 cases occurred respiratory distress or mild dysphagia ,who received surgical treatment , and 13 cases clinical findings were unremarkable at the fellow-up of 24 months ,the silent-rate of clinical symptoms was 86％ . Termination of pregnancy happened in 2 cases ,with 1 (6％ ) had additional ventricular septal defects ,another ( 6％ ) had additional anomalies of congenital high airway obstruction syndrome . In 17 cases of fetuses with isolated DAA ,there were 15 ( 88％ ) cases with dominant right-sided arch ,1 case (6％ ) with dominant left arch ,and 1 case (6％ ) with equal arches in size .Karyotyping prenatal testing was offered to 15 parents with normal results . Conclusions Prenatal ultrasound can accurately diagnose isolated DAA by multiple sections scan ,expanding diagnostic ideas by combination with other medical imaging data to prevent apparent life-threatening event ,or to guide for ex-utero intrapartum treatment . Isolated DAA clinical follow-up results in good outcome .

Cyclosporine A improves spatial memory following chronic cerebral hypoperfusion in rats by down-regulation of NADPH oxidase 4 / 国际脑血管病杂志

Objective To investigate the protection effect of cyclosporine A on spatial memory following chronic cerebral hypoperfusion in rats and its possible mechanism.Me,ods Sixty SD rats were randomly divided into sham operation,vehicle,low-dose cyclosporine A,medium-dose cyclosporine A,and high-dose cyclosporine A groups.A chronic cerebral hypoperfusion model was prepared by permanent bilateral ligation of bilateral common carotid arteries.From 46 days after modeling,olive oil 1 ml/d was used for intragastric administration in the sham-operation group and the vehicle group.Cyclosporine A 3 mg/kg,6 mg/kg,and 12 mg/kg were administrated intragastrically in the low-dose,medium-dose and high-dose cyclosporine A groups,respectively,once a day for 14 days.The spatial memory was assessed using Morris water maze test.Reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect the expression of NADPH oxidase 4 (NOX4) mRNA in the cerebral cortex.Immunohistochemical staining and Western blot were used to detect the expression of NOX4 protein in the cerebral cortex.Results The Morris water maze test showed that the escape latencies in all cyclosporine A groups were significantly shorter than the vehicle group (all P ＜0.05).Immunohistochemical staining showed that the percentages of the NOX4-positive cells in the sham-operation,vehicle,low-dose,medium-dose,and high-dose cyclosporine A groups were4.43％ ±0.37％,37.44％ ±4.76％,18.05％ ±2.91％,12.51％ ±3.4％,and 11.06％ ±1.74％,respectively (F =262.021,P ＜ 0.001),the vehicle group was significantly higher than the sham-operation group (P ＜ 0.01),and all cyclosporine A groups were significantly less than the vehicle group (all P ＜ 0.01).RT-PCR showed that the expression levels of NOX4 mRNA in cerebral cortex in the sham-operation,vehicle,low-dose,medium-dose,and high-dose cyclosporine A groups were 0.36 ± 0.03,1.04 ± 0.04,0.58 ± 0.02,0.49 ± 0.01,and 0.40 ± 0.02,respectively (F =1 324.941,P ＜ 0.001),all cyclosporine A groups were significantly lower than the vehicle group (all P ＜ 0.01).Western blot showed that the expression levels of NOX4 protein in cerebral cortex in the sham-operation,vehicle,low-dose,medium-dose,and high-dose cyclosporine A groups were 0.02 ± 0.01,0.27 ± 0.04,0.09 ± 0.02,0.06 ± 0.02,and 0.06 ± 0.01,respectively (F =222.692,P ＜ 0.001),all cyclosporine A groups was significantly lower than the vehicle group (all P＜0.01).Conclusion Cyclosporine A may improve spatial memory following chronic cerebral hypoperfusion in rats by down-regulation of NOX4.

Meta-analysis of Shenling Baizhu Powder Combined with Western Medicine in Treating Ulcerative Colitis / 广州中医药大学学报

Objective To make a Meta-analysis of the effectiveness and safety of Shenling Baizhu Powder (SBP) for the treatment of ulcerative colitis(UC),thus to provide evidence for the clinical treatment of ulcerative colitis.Methods Randomized controlled trials (RCTs) of SBP combined with western medicine vs western medicine in treating ulcerative colitis were included.The quality of RCTs was assessed by the Cochrane scale.A Meta-analysis was performed for the clinical efficacy,improvement of disease activity index (DAI) levels of the included trials.Results A total of 19 RCTs were included,involving 1498 cases.The results of Metaanalysis showed that compared with the western medicine group,the combined risk ratio(RR) of clinical efficacy in the SBP combined group was 1.55,95％ confidence interval (CI) being (1.39,1.72).The subgroup analysis based on control medicine showed that the combined RR of combined use of sulfasalazine or mesalazine/Olsalazine was 1.46,1.59 [95％CI (1.19,1.77) vs 95％CI (1.40,1.80)].The subgroup analysis based on different treatment courses showed that the combined RR of 1-30 days,31-60 days,61-90 days was 1.42,1.69,1.47 [95％CI (1.18,1.70) vs 95％CI (1.44,1.97) vs 95％CI (1.15,1.88)] respectively.The differences were significant (P ＜ 0.05).(2) The differences of the two groups on the improvement of DAI and inflammatory factors levels of interlekin-17(IL-17),IL-23,tumor necrosis factor alpha(TNF-α),C-reactive protein(CRP) were statistically significant(P ＜ 0.05).(3)The sensitivity analysis of the primary outcomes showed a higher homogeneity in the literatures and the funnel plot analysis showed no evidence of publication bias.Conclusion Compared with western medicine,SBP combined with western medicine has better clinical efficacy for the treatment of UC,and the combined use of mesalazine/Olsalazine medicated for 30-60 days is more effective on improving DAI and inflammatory factors levels.However,for the low quality of the included literatures and insufficient experimental design,the conclusion needs more evidence from large sample-size randomized double-blind controlled trials.

Meta-analysis of Acupuncture as Adjuvant Therapy in Improving Gastrointestinal Function of Acute Pancreatitis Patients / 广州中医药大学学报

Objective To evaluate the clinical effect of acupuncture as an adjuvant therapy for acute pancreatitis (AP).Methods We retrieved the databases ofCNKI,VIP,Wanfang,PubMed,EMBase,and Cochrane Library,selected the relevant randomized clinical trials (RCTs) of AP treated with routine western medicine as control group and treated with routine western medicine combined with acupuncture therapy as trial group.And then,the quality of the qualified RCTs was evaluated,and the end-point outcomes of the RCTs were analyzed by Meta-analysis.Results A total of 7 RCTs involving 371 AP patients were included into the analysis.The time for abdominal pain relief(WMD =-1.44;95％CI:-2.38,-0.50),time for abdominal distension relief (WMD =-2.50;5％CI:-4.07,-0.73),time for the restart of anal exhaust(WMD =-1.79;95％CI:-3.73,-0.14),time for defecation (WMD =-1.95;95％CI:-3.51,-0.39),time for the restart of bowel sound(WMD =-1.39;95％CI:-2.44,-0.34),time for blood amylase becoming normal(WMD =-2.09;95％CI:-3.22,-0.96),and hospitalization time (WMD =-3.70;95％CI:-6.04,-1.36) in the trial group were less than those in the control group,and the differences of the above indexes except for the time for the restart of anal exhaust were significant (P ＜ 0.05).Conclusion Acupuncture as an adjuvant therapy is effective for improving the gastrointestinal function of AP patients,and shortening time for blood amylase becoming normal and hospitalization time.However,due to the low methodological quality,more well-designed randomized controlled trials are needed to confirm the therapeutic effect of acupuncture therapy for AP.

Effects of thymus transplantation combined with CD4--DLI on T cell reconstitution after allogeneic hemato-poietic stem cell transplantation / 实用医学杂志

Objective To study the effects of thymus transplantation(TT)combined with CD4--DLI on T cell reconstitution after allogeneic hematopoietic stem cell transplantation(allo-HSCT). Methods BALB/c mice were randomly divided into three groups:hematopoietic stem cell transplantation (HSCT group),hematopoietic stem cell transplantation combined with thymus transplantation(TT group)and hematopoietic stem cell transplanta-tion combined with thymus transplantation plus CD4+ T cell-depleted lymphocyte infusion(CD4--DLI group). On day-1,the mice were treated with the lethal dose of radiotherapy. On day 0,C57BL/6 mice were used as donor for hematopoietic stem cell transplantation. The mice were sacrificed on 5 days,2 weeks,4 weeks and 3 months after transplantation,respectively. The peripheral blood and spleen cells of mice were collected for determinations of T cell surface antigen,T cell receptor,naive T cells and intracellular cytokines. HE staining was used to assess the development of donor thymus. Results TT and CD4--DLI did not impair each other′s effects on T cell reconstitu-tion. TT combined with CD4--DLI increased the number of T cell reconstruction. CD4--DLI promoted the effect of TT on enlargement naive CD4+and CD8+T cell pool. Combination of TT and CD4--DLI enhanced the cytokine pro-duction of T cells. Conclusion TT combined with CD4--DLI had no side effects on TCR repertoire and thymus. Conclusion TT combined with CD4--DLI can enhance the reconstitution of T cell number and function via thymus dependent and thymus independent mechanism.

Meta-analysis of Compound Huangbo Liquid Combined with Chemical Medicine in the Treatment of Ulcerative Colitis / 中国药房

OBJECTIVE:To systematically evaluate the clinical efficacy and safety of Compound Huangbo liquid combined with chemical medicine in the treatment of ulcerative colitis (UC),and to provide evidence-based reference.METHODS:Re trieved from CBM,Wanfang Database,VIP,CJFD,PubMed,EMBase and Cochrane Library,randomized controlled trials(RCTs) about Compound Huangbo liquid combined with chemical medicine (trial group) vs.chemical medicine alone (control group) in the treatment of UC were collected.Meta-analysis was performed by using Rev Man 5.3 statistical sofetware after literature scanning,data extraction and quality evaluation according to Cochrane reviewer's handbook 5.1.0.RESULTS:A total of 8 RCTs were included,involving 737 patients.The results of Meta-analysis showed that,response rate of trial group was significantly higher than that of control group,with statistical significance [OR=4.69,95 ％ CI(3.00,7.34),P＜0.001];there was no statistical significance in the incidence of ADR between 2 groups [OR=0.94,95 ％ CI (0.48,1.84),P=0.86].CONCLUSIONS:Compound Huangbo liquid combined with chemical medicine is better than chemical medicine alone for UC,and both have similar safety.

Prenatal diagnosis of ultrasound and MRI in the vein of Galen aneurysmal malformation / 中华医学超声杂志（电子版）

Objective To explore the clinical value of prenatal ultrasound and magnetic resonance imaging in the vein of Galen aneurysmal malformation. Methods The ultrasonographic characteristics and magnetic resonance imaging features of 17 fetuses who were diagnosed as the vein of Galen aneurysmal malformation in Maternal and Child Heath Hospital of Hubei from January 2011 to December 2016 were compared. Results Fifteen cases of Galen aneurysmal malformation. Were diagnosed by prenatal ultrasound during the third trimester. The sonographic feature was a hypoechogenic structure located in the middle line with arteriovenous fistula waveform in doppler analysis, and the cerebral venous sinus of all cases were dilated. Real time three dimensional power doppler can display the angioarchitecture and the communications between widened vascular sinus. MRI feature was the expansion of venous aneurysm located in the middle line, greater cerebral venous pool and quadrigeminal area and tortuous flow void vessels. Among 17 cases, 2 cases of Galen venous aneurysm malformation were misdiagnosed and 7 cases were diagnosed by MRI. There were 15 terminations and 2 neonatal died after birth. Conclusions Galen aneurysmal malformations have typical sonographic findings, and MRI can show neurologic development and impairment. Combined application of ultrasound and magnetic resonance imaging technology can more accurately and comprehensively observe the pathological features of Galen venous aneurysm malformation and diagnose the related complications early.

The role of prenatal ultrasound and MRI in diagnosis of fetal agenesis of corpus callosum / 中华医学超声杂志（电子版）

Objective To discuss the value of prenatal ultrasound and MRI in diagnosis of fetal agenesis of corpus callosum (ACC). Methods Sixty-seven fetuses from Hubei Maternal and Children's Hospital performed fetal MRI from July 2013 to December 2014 were included in this study. All fetuses (67 cases) with suspected ACC were studied with a 1.5T MR unit within 3 days after ultrasound examination. Prenatal ultrasound and MRI findings were studied. Results All the 67 ACCs previously suspected on ultrasound were confirmed by MRI. Among the 67 ACCs, 58 cases were complete ACC and 9 cases were partial ACC. Corpus callosum body and/or splenium absence was found in all 9 partial ACC cases. In all cases, on MRI, corpus callosum complete or partial absence was showed on the median sagittal images, and mild to moderate ventriculomegaly and abnormal morphology in lateral ventricle was shown on the axial or coronary images. Conclusions MRI has high value in diagnosis of ACC. When ACC is found or suspected by ultrasonophy, MRI examination is suggested to confirm the diagnosis.

The value of ultrasound and MRI in the diagnosis of pulmonary sequestration / 中华医学超声杂志（电子版）

Objective To investigate the diagnostic value of ultrasound and MRI in fetal bronchopulmonary sequestration (BPS). Methods The 7 pregnant women with suspected fetal BPS were examined with a 1.5 T MR unit within 24 h after prenatal ultrasound in Hubei Maternal and Children's Hospital during July 2013 to February 2015. The imaging protocol included half-fourier acquisition single shot turbo SE (HASTE), true fast imaging with steady state precession (True FISP) in axial, frontal and sagittal planes relative to the fetal thorax. Prenatal MRI findings have been compared with postnatal enhanced computed tomography or biopsy. Results The locations of BPS were in left side in 5 cases and in right side in 2 cases. One case was complicated with congenital cystic adenomatoid malformation (CCAM) of lung. Ultrasound showed the intrathoracic mass as a hyperechoic lesion and the feeding artery could be found by Doppler ultrasonography. T2WI could reveal not only the hyperintense lesions with clear boundary, but also the hypointense feeding artery originating from systemic circulation. Compared with pathological examination or enhanced CT, both of the ultrasound and the MRI could locate the lesions;however 2 feeding arteries were misjudged. Conclusions Prenatal ultrasound is the first-choice diagnostic modality for BPS. MRI can demonstrate the location, morphology and the feeding arteries of the fetal BPS, and also estimate the volume of normal lungs, which could be an important supplement to prenatal ultrasound in prenatal diagnosis and prognostic prediction of BPS.

Prenatal diagnosis of ultrasound and MRI in the simple fetal indirect hernia / 中华医学超声杂志（电子版）

ObjectiveTo explore the clinical value of ultrasound and MRI in diagnosis of simple fetal indirect hernia.MethodsA total of 671 558 fetuses were examined in maternal and child healthcare hospital of Hubei from February 2003 to February 2015. Once inguinal hernia or testicular tumors was suspected, MRI examination was performed after prenatal ultrasound. Final diagnosis was confirmed by postnatal follow-up. The ultrasonographic characteristics of fetal indirect hernia were compared with prenatal MR image characteristics and postnatal follow-up results.ResultsThree cases were conifrmed after birth. The simple fetal indirect hernia was uncommon clinical entity which occurred during 3rd trimester. The ultrasonic characteristics in prenatal period were: (1) Right enlarged scrotum was iflled with heterogeneous lesion; intestinal peristalsis within the scrotum was found in real-time ultrasonography. (2) The contralateral testis in left scrotum and penis could be found. MRI could display the characteristicsof indirecthernia contents and its extension from abdominal cavity intoinguinalregion, which may help diagnose fetal simple indirect hernia. One case of fetal indirect hernia was misdiagnosed as testicular tumors, which was correctly diagnosed by MRI.ConclusionsThe simple fetal indirect hernia can be prenatally diagnosed by characteristic ultrasonic features, which can present with abnormal mass ininguinalregion. Prenatal ultrasound is the primary screening method of fetal indirect hernia. MRI can serve as a supplement approach. The combination of US and MRI can further improve the diagnostic accuracy of fetal indirect hernia.

Prenatal diagnosis of fetal tuberous sclerosis complex with ultrasonography and magnetic resonance imaging / 中华医学超声杂志（电子版）

ObjectiveTo explore the imaging features of fetal tuberous sclerosis complex by ultrasonography and magnetic resonance imaging.MethodsRetrospective analysis on the imaging characteristics of the 10 cases of fetuses confirmed as tuberous sclerosis complex who were examined in Hubei Maternal and Child Healthcare Hospital in July 2013 to December 2014 by ultrasonography and MRI, which was compared with the pathological data of specimens and follow-up after birth.ResultsEighteen cases were diagnosed as fetal cardiac rhabdomyoma by ultrasonography among all of the 996 fetuses, in which lesions were located on the ventricular wall near septum or elsewhere in the heart cavity on ultrasonography. Fetal cardiac rhabdomyoma was characterized by circular, homogeneous high echo (singleton in 4 cases, multiple in 14 cases). Among them no subependymal nodule was found by ultrasonographic. Ten cases of subependymal nodule were found by magnetic resonance imaging, which were diagnosed as tuberous sclerosis complex with cardiac rhabdomyomas, including 3 cases of brain subcortical tubers. The subependymal nodules under the lateral ventricle wall showed characteristic low signal nodules on T2WI, protruding from the ependymal surface. Of 18 cases, only 4 cases of fetal cardiac rhabdomyoma were found by MRI. Nine cases of ifnally had termination of pregnancy. Two cases were conifrmed as cardiac rhabdomyoma with intracranial nodules after pathological examination, and 1 case was conifrmed as tuberous sclerosis complex after birth. ConclusionsPrenatal ultrasonography can diagnose fetal cardiac rhabdomyoma successfully, and MRI can diagnose the fetal brain nodules sensitively. Once ultrasonography finds cardiac rhabdomyoma, it may be promising to diagnose fetal tuberous sclerosis complex by ultrasonography combined with MRI.

Prenatal diagnosis of sirenomelia with 3D skeletal ultrasound mode imaging, 3D spiral CT and MRI / 中华医学超声杂志（电子版）

ObjectiveTo explore the clinical value of three-dimensional (3D) skeletal ultrasound mode imaging, 3D helical computer tomography (3D-HCT) and MRI in diagnosing lower limb skeletal malformations of fetal sirenomelia.MethodsSeven fetuses were suspected of sirenomelia with routine prenatal ultrasonography examination. Three-dimensional skeletal ultrasound mode imaging and MRI were used to conifrm the diagnosis, and the results were compared to those of pathology, 3D spiral CT or X-ray after termination. Five of them underwent chromosome examination including chorionic villus or umbilical cord biopsy.ResultsSix fetuses were singletons and one fetus was a conjoined twin. Three fetuses were male, while four fetuses were female. All fetuses with sirenomelia showed varying degrees of skeletal abnormalities: 1 case of typeⅢ, 2 cases of typeⅣ, 3 cases of typeⅤ and 1 case of typeⅥ. No foot was detected in one case and only single foot was detected in other 6 cases. In 7 cases, 3D skeletal ultrasound mode imaging could demonstrate all the lower limb skeletal malformations, including abnormal femur and tibioifbula, single foot or no feet. Prenatal MRI could demonstrate abnormal femur in 4 cases, abnormal tibioifbula in 1case, and no foot malformation. The results of 3D spiral CT after termination were consistent with X-ray and pathological examination results.ConclusionsAs a new imaging technology for detecting fetal skeletal malformations, prenatal 3D skeletal ultrasound mode imaging and postnatal 3D spiral CT both can display fetal bone clearly. They both have important clinical value in diagnosing lower limb skeletal malformations.

The value of clinical in diagnosis of implanted placenta postpartum by contrast-enhanced ultrasonography / 中华医学超声杂志（电子版）

ObjectiveTo explore the contrast-enhanced ultrasonography features of postpartum placenta implantation and its clinical value in diagnosis of postpartum placenta implantation.MethodsBetween April 2009 and May 2013, twelve patients with clinically suspected placenta implantation underwent contrast-enhanced ultrasonography in Hubei Maternal and Child Health Hospital. The location and extent of intrauterine lesions and perfusion features of contrast agent were observed. The contrast-enhanced ultrasonography features of postpartum placenta implantation were analyzed and compared with postoperative pathological diagnosis.ResultsIn twelve patients with placenta implantation, eleven showed enhancement. Only one lesion showed no enhancement, which was diagnosed as placental degeneration and calcification on postoperative pathology. One case was placenta adhesions conifrmed by postoperative pathological diagnosis, which presented with a hyperenhanced lesion in uterine cavity with a clear boundary to myometrium. Six cases were placenta implantation confirmed by postoperative pathological diagnosis, which presented with a residual placenta surrounded with extremely thin or evendiscontinuous uterine serosa. Five cases were placenta penetration confirmed by postoperative pathological diagnosis, which presented with a residual placenta penetrating the uterine serosa and contrast agent spilling out. All cases in this study were cured by operation.ConclusionsContrast-enhanced ultrasound could diagnose placenta implantation via the difference of tissue perfusion. The lesion of placenta implantation showed enhancement after injection of contrast agent. If discontinuous uterine serosa and contrast agent spilling was observed, placenta penetrating uterine serosa should be considered. Contrast-enhanced ultrasound has important clinical value in diagnosing postpartum placenta implantation and observing postoperative recovery processes of uterine rupture.