Establishment of a risk model of placental accreta spectrum by ultrasound combined with clinical high risk factors / 中华超声影像学杂志

Objective:To establish a risk model of placenta accreta spectrum(PAS) based on the clinical risk factors and ultrasound signs of patients with placenta accreta, and identify severe placenta accreta prenatal.Methods:A retrospective analysis was performed on 121 PAS patients admitted to Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from January 2018 to June 2022 who were clinically classified or pathologically diagnosed during delivery. The two groups were divided into light and severe groups according to the implantation type. The clinical risk factors and ultrasound signs between the two groups were compared. A risk model of PAS was established based on the clinical risk factors and ultrasound signs to predict the perinatal complications.Results:A total of 130 cases of PAS were clinically diagnosed or pathologically diagnosed with placenta, 9 cases with incomplete clinical data or irregular ultrasound images were excluded, and the remaining 121 cases were included in the study. Among the 121 patients, 64 cases were placental accreta, 39 cases were placental increta, and 18 cases were placenta percreta. The placental accreta was defined as mild group, and the combination of placental increta and placenta percreta were referred to as severe group. There were no significant differences in placenta previa, and the number of uterine cavity operations (all P>0.05). There were significant differences in the number of cesarean section, myometrium thinning, placental lacunae, abnormal vascularization at the utero-bladder junction, bridging vessels at the utero-bladder junction, placental protuberance and cervical involvement (all P<0.05). Binary logistic regression analysis showed that placental lacunae, abnormal vasculization of the utero-bladder interface and the number of cesarean sections were independent risk factors for severe PAS. Based on this, a risk model was established and the ROC curve of each independent risk factor and risk model was plotted respectively. The AUC of the risk model was 0.826, which had better diagnostic efficacy than other independent risk factors. Conclusions:In the prenatal ultrasound classification diagnosis of high-risk patients with PAS, the placental lacunae, abnormal vascularization of utero-bladder interface and the number of cesarean section are combined to establish the risk model of PAS, which has a good diagnostic efficacy for severe placenta accreta.

Screening of ultrasound markers for predicting selective fetal growth restriction in monochorionic twins at 11-13 + 6 weeks / 中华超声影像学杂志

Objective:To screen the ultrasound markers of predictive value at 11-13 + 6 weeks for selective fetal growth restriction (sFGR) in monochorionic (MC) twins. Methods:A retrospective analysis of MC twin pregnancies collected prospectively from June 2020 to December 2021 at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, with standardized ultrasound examinations performed at 11-13 + 6 weeks.According to the expert consensus on the diagnostic criteria for sFGR, collected MC twin pregnancies were divided into sFGR group and control group (normal MC twin group). Maternal age, maternal history, mode of conception, the incidence of increased nuchal translucency (NT) thickness, NT discordance, crown-rump length (CRL) discordance, abnormal ductus venous Doppler waveform and abnormal umbilical cord insertion position were compared between the two groups, and those markers that differed between groups were further analyzed for screening early ultrasound markers that could be used to predict sFGR. Results:A total of 106 cases were included in the analysis, 30 cases in sFGR group and 76 cases in control group. ①Compared with control group, sFGR group had a higher incidence of low fetal birth weight (below the 10th and 3rd percentile) in both surviving cases, large birth weight discordance and a higher incidence of birth weight inconsistency (difference >25%) ( P<0.001). ②Compared with control group, the CRL discordance was larger in sFGR group [7.8% (3.8%, 9.2%) versus 3.8% (1.5%, 7.2%)] and the incidence of abnormal cord insertion position (33.3% versus 6.6%) was higher, the differences were statistically significant ( P=0.004 and <0.001, respectively), whereas the differences of NT discordance, incidence of increased NT and abnormal ductus venous Doppler waveform were not statistically significant (all P values >0.05). ③CRL discordance was a risk factor for sFGR ( OR=1.136, 95% CI=1.021-1.264), with an area under the ROC curve of 0.682 (95% CI=0.576-0.787) for predicting sFGR, the sensitivity and specificity were 0.567 and 0.737 at a cut-off value of 6.5%. Abnormal umbilical cord insertion position was a risk factor for sFGR ( OR=7.100, 95% CI=2.176-23.167) with a sensitivity of 0.333 and specificity of 0.934 for predicting sFGR. Conclusions:CRL discordance and abnormal cord insertion position are risk factors for the development of sFGR and are of value in predicting sFGR in MC twins.

Ultrasonographic manifestations of thyroid with subclinical thyroid serological anomalies during pregnancy / 中华医学超声杂志（电子版）

Objectives To investigate the features of thyroid ultrasonographic manifestations in patients with subclinical thyroid serological anomalies during pregnancy. Methods In present study, a total of 53 women who attended the obstetrics clinic in Beijing Obstetrics and Gynecology Hospital from January 2014 to December 2015 underwent thyroid ultrasound scanning. All women included in this study were checked up for the serological levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibody (TPoAb) in the first trimester and were diagnosed as thyroid dysfunction or abnormal level of serological antibody for the first time. The χ2test was used to compare the incidences of abnormal thyroid echogenicity and increased blood flow in thyroid between groups with serological TPoAb level≥1300 IU/L and＜1300 IU/L. Results Among 53 cases, 21 were subclinical hyperthyroidism, 10 were subclinical hypothyroidism, and 22 were isolated elevated serum TPoAb cases. Among 21 subclinical hyperthyroid patients, 16 cases without elevated TPoAb were unremarkable on thyroid scanning, while 2 out of the rest 5 cases (40.0%) with increased serum TPoAb demonstrated mild thyroid diffuse abnormal echogenicity. Among 10 subclinical hypothyroid cases, 2 out of 5 cases (40.0%) without elevated TPoAb manifested mild thyroid diffuse abnormal echogenicity, while 4 of 5 cases (80.0%) with elevated TPoAb showed diffuse abnormal echogenicity of thyroid. In 22 women with isolated elevated serum TPoAb, 11(50.0%) demonstrated diffuse thyroid abnormal echogenicity. In all 32 cases with elevated serum TPoAb, the serum TPoAb level was ≥ 1300 IU/L in 9 cases and ＜ 1300 IU/L in 23 cases. The incidence of thyroid abnormal echogenicity was higher in women with serum TPoAb level≥1300 IU/L than in women with＜1300 IU/L (8/9 vs 9/23), which was statistically significant ( χ2=6.432, P=0.018); while no significant difference in the incidence of increased blood flow in both groups was identified(6/9 vs 9/23, χ2=1.970, P=0.080). Conclusion The thyroid ultrasonographic manifestations varied in patients with thyroid serologic anomalies during pregnancy, and were not closely consistent with the serological findings.

Identification and Genotypic Characterization of Potentially Pathogenic Acanthamoeba Isolated from Tap Water in Wuxi, China

Members of genus Acanthamoeba are widely distributed in the environment. Some are pathogenic and cause keratitis and fatal granulomatous amoebic encephalitis. In this study, we isolated an Acanthamoeba CJW/W1 strain from tap water in Wuxi, Jiangsu Province, China. Its 18S rDNA was sequenced and a phylogenetic tree was constructed. The isolated cysts belonged to morphologic group II. Comparison of 18S rDNA sequences of CJW/W1 strain and other isolates showed high similarity (99.7%) to a clinical isolate Asp, KA/E28. A phylogeny analysis confirmed this isolate belonged to the pathogenic genotype T4, the most common strain associated with Acanthamoeba-related diseases. This is the first report of an Acanthamoeba strain isolated from tap water in Wuxi, China. Acanthamoeba could be a public health threat to the contact lens wearers and, therefore, its prevalence should be monitored.

The diagnosis value of transvaginal three-dimensional ultrasonography in polycystic ovary syndrome diagnosis / 中华医学超声杂志（电子版）

Objective To investigate the diagnosis value of the three-dimensional transvaginal ultrasound volume technology in polycystic ovary syndrome (PCOS).Methods Totally 75 patients with PCOS and 50 normal subjects as controls from Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University were chosed. The volume of the endometrium and ovaries were measured with virtual organ computer-aided analysis techniques (VOCAL). While the follicular numbers and the volumes were measured by sono follicle technique. The ovarian volumes, the follicular volumes and the endometrial volumes were compared between the two groups. Independent samplest test was used to compare PCOS group patients and healthy subjects with endometrial volumes, ovarian volumes, follicle volumes and the average numbers of follicle. Pearson correlation analysis was used to analyze the correlation between the number of total follicles and the volume of ovary, follicle volume and serum sex hormone concentration in PCOS group.Results With the endometrial volume of PCOS patients about (1.6±0.9) cm3 was less than that of the control group [(3.1±1.7) cm3]. The ovarian volume, follicular volume and the average number of follicles were (13.6±4.6) cm3, (1.9±0.7) cm3 and (27.7±7.4). All of them were higher than those in healthy subjects [(7.4±2.9) cm3, (1.1±0.7) cm3, (8.4±3.4)], and the differences were statistically significant (t=6.013, P<0.001;t=8.087,P=0.015;t=7.222,P<0.001;t=15.637,P<0.001). The total number of follicles in PCOS patients were positively correlated with ovarian volume, follicle volume and serum testosterone concentrations (r=0.467,P=0.000;r=0.446,P=0.000;r=0.383,P=0.001). There was no correlation with luteinizing hormone (LH)/thyroid stimulating hormone (TSH) (r=0.048,P=0.702).Conclusion The sono follicle and VOCAL technology provide a new and objective measurement method for PCOS diagnosis.

Genotype identification of the 18S rDNA in Acanthamoeba species isolated from tap water in Yanji city of Jilin province / 中国人兽共患病学报

To identify the genotype of the 18S rDNA in Acanthamoeba species isolated from tap water inYanji city of Jilin province, the full genomic DNA sequence of the CJY/W1 strain of Acanthaqmoeba was amplified by PCR and then the amplified products were sequenced. The full-length of DNA sequence was analyzed with Clustal and Genedoe softwares. It was found that the full-length of gene of the Acanthamoeba CJY/W1 strain isolated from tap water was 2252 bps. The 18S rDNA genotype of this strain appeared to be near to the T1 type. But the percentage of the genetic difference between T1 type was 8%. According to the classification criteria of 18S rDNA, the genotype of the CJY/W1 strain might be a new one.