Manejo de Linfangioma en la edad pediátrica: presentación de caso / Management of Lymphangioma in pediatric age: case presentation / Manejo do Linfangioma em idade pediátrica: apresentação de caso

Las malformaciones vasculares congénitas afectan con mayor frecuencia al sistema tegumentario y se hacen evidentes al nacer o en las primeras semanas de vida con una prevalencia estimada del 4,5%. Las anomalías linfáticas, suelen tener una presentación variable, y en la mayoría de ocasiones su manejo se convierte en un desafío. Se estima que su incidencia global oscila entre 1 en 2.000 y 1 en 16.0004,5 casos. Objetivo: Determinar la importancia de un adecuado manejo por cirugía vascular en el contexto de un paciente pediátrico con Linfangioma en miembro inferior tomando como metodología la presentación de un caso clínico. Descripción del caso: Paciente de 7 meses de edad sin antecedentes clínicos o quirúrgicos de interés, quien es traído por su madre a consulta de cirugía vascular por presencia de masa en miembro inferior derecho que progresivamente ha mostrado crecimiento, cuadro que se acompaña de tumefacción en partes blandas y roce o dolor a la distensión en la zona de la malformación, de acuerdo a la clasificación de Mulliken y Glowacki se concluye que se trata de un Linfangioma, diagnóstico que se corroboró por ultrasonografía Doppler, Angiotac y flebografía ascendente. Para su manejo se realizó drenaje percutáneo ecoguiado y escleroterapia mediante espuma de polidocanol al 1% para sellar la malformación vascular, obteniendo mejoría clínica con resultados estéticos y funcionales satisfactorios. Conclusión: El Linfangioma es una malformación vascular poco frecuente que no se ha documentado localmente, por lo tanto, la presentación de este caso pretendió proporcionar información científica actualizada sobre el tratamiento de la patología vascular y abogar por un manejo basado en la evidencia médica existente, que contribuya a resultados favorables para los pacientes pediátricos

Congenital vascular malformations most frequently affect the integumentary system and become evident at birth or in the first weeks of life with an estimated prevalence of 4.5%. Lymphatic anomalies usually have a variable presentation, and in most cases their management becomes a challenge. Its global incidence is estimated to range between 1 in 2,000 and 1 in 16,0004.5 cases. Objective: Determine the importance of adequate management by vascular surgery in the context of a pediatric patient with Lymphangioma in the lower limb using the presentation of a clinical case as a methodology. Description of the case: A 7-monthold patient with no clinical or surgical history of interest, who was brought by his mother to a vascular surgery consultation due to the presence of a mass in the right lower limb that has progressively shown growth, a condition that is accompanied by swelling in the soft tissues and friction or pain upon distension in the area of the malformation, according to the classification of Mulliken and Glowacki, it is concluded that it is a Lymphangioma, a diagnosis that was confirmed by Doppler ultrasonography, Angiotac and ascending phlebography. For its management, ultrasound-guided percutaneous drainage and sclerotherapy using 1% polidocanol foam was performed to seal the vascular malformation, obtaining clinical improvement with satisfactory aesthetic and functional results. Conclusion: Lymphangioma is a rare vascular malformation that has not been documented locally, therefore, the presentation of this case aimed to provide updated scientific information on the treatment of vascular pathology and advocate management based on existing medical evidence. that contributes to favorable outcomes for pediatric patients

As malformações vasculares congênitas afetam mais frequentemente o sistema tegumentar e tornam-se evidentes ao nascimento ou nas primeiras semanas de vida, com prevalência estimada em 4,5%. As anomalias linfáticas costumam ter apresentação variável e na maioria dos casos seu manejo torna-se um desafio. Estima-se que sua incidência global varie entre 1 em 2.000 e 1 em 16.0004,5 casos. Objetivo: Determinar a importância do manejo adequado por cirurgia vascular no contexto de um paciente pediátrico com Linfangioma em membro inferior utilizando como metodologia a apresentação de um caso clínico. Descrição do caso: Paciente de 7 meses, sem antecedentes clínicos ou cirúrgicos de interesse, que foi trazido pela mãe à consulta de cirurgia vascular devido à presença de uma massa no membro inferior direito que apresentava crescimento progressivo, quadro que vem acompanhado de inchaço nos tecidos moles e fricção ou dor à distensão na área da malformação, segundo a classificação de Mulliken e Glowacki, conclui-se que se trata de um Linfangioma, diagnóstico que foi confirmado por Ultrassonografia Doppler, Angiotac e flebografia ascendente. Para seu manejo foi realizada drenagem percutânea guiada por ultrassom e escleroterapia com espuma de polidocanol a 1% para selar a malformação vascular, obtendo melhora clínica com resultados estéticos e funcionais satisfatórios. Conclusão: O linfangioma é uma malformação vascular rara e não documentada localmente, portanto, a apresentação deste caso teve como objetivo fornecer informação científica atualizada sobre o tratamento da patologia vascular e defender uma gestão baseada na evidência médica existente que contribua para resultados favoráveis para a pediatria. pacientes

Manejo de Linfangioma en la edad pediátrica: presentación de caso

Las malformaciones vasculares congénitas afectan con mayor frecuencia al sistema tegumentario y se hacen evidentes al nacer o en las primeras semanas de vida con una prevalencia estimada del 4,5%. Las anomalías linfáticas, suelen tener una presentación variable, y en la mayoría de ocasiones su manejo se convierte en un desafío. Se estima que su incidencia global oscila entre 1 en 2.000 y 1 en 16.0004,5 casos. Objetivo: Determinar la importancia de un adecuado manejo por cirugía vascular en el contexto de un paciente pediátrico con Linfangioma en miembro inferior tomando como metodología la presentación de un caso clínico. Descripción del caso: Paciente de 7 meses de edad sin antecedentes clínicos o quirúrgicos de interés, quien es traído por su madre a consulta de cirugía vascular por presencia de masa en miembro inferior derecho que progresivamente ha mostrado crecimiento, cuadro que se acompaña de tumefacción en partes blandas y roce o dolor a la distensión en la zona de la malformación, de acuerdo a la clasificación de Mulliken y Glowacki se concluye que se trata de un Linfangioma, diagnóstico que se corroboró por ultrasonografía Doppler, Angiotac y flebografía ascendente. Para su manejo se realizó drenaje percutáneo ecoguiado y escleroterapia mediante espuma de polidocanol al 1% para sellar la malformación vascular, obteniendo mejoría clínica con resultados estéticos y funcionales satisfactorios. Conclusión: El Linfangioma es una malformación vascular poco frecuente que no se ha documentado localmente, por lo tanto, la presentación de este caso pretendió proporcionar información científica actualizada sobre el tratamiento de la patología vascular y abogar por un manejo basado en la evidencia médica existente, que contribuya a resultados favorables para los pacientes pediátricos.

Congenital vascular malformations most frequently affect the integumentary system and become evident at birth or in the first weeks of life with an estimated prevalence of 4.5%. Lymphatic anomalies usually have a variable presentation, and in most cases their management becomes a challenge. Its global incidence is estimated to range between 1 in 2,000 and 1 in 16,0004.5 cases. Objective: Determine the importance of adequate management by vascular surgery in the context of a pediatric patient with Lymphangioma in the lower limb using the presentation of a clinical case as a methodology. Description of the case: A 7-month-old patient with no clinical or surgical history of interest, who was brought by his mother to a vascular surgery consultation due to the presence of a mass in the right lower limb that has progressively shown growth, a condition that is accompanied by swelling in the soft tissues and friction or pain upon distension in the area of the malformation, according to the classification of Mulliken and Glowacki, it is concluded that it is a Lymphangioma, a diagnosis that was confirmed by Doppler ultrasonography, Angiotac and ascending phlebography. For its management, ultrasound-guided percutaneous drainage and sclerotherapy using 1% polidocanol foam was performed to seal the vascular malformation, obtaining clinical improvement with satisfactory aesthetic and functional results. Conclusion: Lymphangioma is a rare vascular malformation that has not been documented locally, therefore, the presentation of this case aimed to provide updated scientific information on the treatment of vascular pathology and advocate management based on existing medical evidence. that contributes to favorable outcomes for pediatric patients.

As malformações vasculares congênitas afetam mais frequentemente o sistema tegumentar e tornam-se evidentes ao nascimento ou nas primeiras semanas de vida, com prevalência estimada em 4,5%. As anomalias linfáticas costumam ter apresentação variável e na maioria dos casos seu manejo torna-se um desafio. Estima-se que sua incidência global varie entre 1 em 2.000 e 1 em 16.0004,5 casos. Objetivo: Determinar a importância do manejo adequado por cirurgia vascular no contexto de um paciente pediátrico com Linfangioma em membro inferior utilizando como metodologia a apresentação de um caso clínico. Descrição do caso: Paciente de 7 meses, sem antecedentes clínicos ou cirúrgicos de interesse, que foi trazido pela mãe à consulta de cirurgia vascular devido à presença de uma massa no membro inferior direito que apresentava crescimento progressivo, quadro que vem acompanhado de inchaço nos tecidos moles e fricção ou dor à distensão na área da malformação, segundo a classificação de Mulliken e Glowacki, conclui-se que se trata de um Linfangioma, diagnóstico que foi confirmado por Ultrassonografia Doppler, Angiotac e flebografia ascendente. Para seu manejo foi realizada drenagem percutânea guiada por ultrassom e escleroterapia com espuma de polidocanol a 1% para selar a malformação vascular, obtendo melhora clínica com resultados estéticos e funcionais satisfatórios. Conclusão: O linfangioma é uma malformação vascular rara e não documentada localmente, portanto, a apresentação deste caso teve como objetivo fornecer informação científica atualizada sobre o tratamento da patologia vascular e defender uma gestão baseada na evidência médica existente que contribua para resultados favoráveis para a pediatria. pacientes.

Madurez fetal: utilidad de la estimación de la presión de la arteria pulmonar fetal / Fetal maturity: utility of estimation of fetal pulmonary artery pressure

Objetivo: Evaluar la utilidad de la estimación de la presión de la arteria pulmonar fetal obtenida por ecografía doppler como indicador de madurez fetal y su correlación con los resultados neonatales en un grupo de pacientes que asistan al área de sala de parto del Hospital Central de San Cristóbal, entre marzo y julio de 2023. Métodos: Se trata de un estudio observacional, descriptivo, correlacional. La muestra fue de 90 mujeres (90 fetos) con embarazo simple entre 34 y 40 semanas de gestación. Resultados: De las variables doppler analizadas, se evidenció que la presión de la arteria pulmonar fetal disminuyó significativamente (p < 0,001) con el avance de la edad gestacional. Se determinó que existe una asociación significativa inversa entre la presión de la arteria pulmonar fetal y la madurez fetal (p < 0,001), de manera que a menor valor de la presión de la arteria pulmonar fetal se tiene un mayor porcentaje de madurez fetal. Un punto de corte de la presión de la arteria pulmonar fetal ubicado en 55,9 mm Hg determinó la sensibilidad y especificidad más alta conjuntamente para el diagnóstico de madurez pulmonar fetal, siendo su sensibilidad de 93,75 % y especificidad de 80,77 %. Con un valor predictivo positivo de 92,31 % y un valor predictivo negativo de 84 %. Conclusión: La estimación de la presión de la arteria pulmonar fetal obtenida mediante ecografía doppler es útil como indicador de madurez fetal(AU)

Objective: To evaluate the usefulness of the estimation of fetal pulmonary artery pressure obtained by doppler ultrasound as an indicator of fetal maturity and its correlation with neonatal outcomes in a group of patients attending the delivery room area of the Hospital Central de San Cristobal, between March and July 2023. Methods: This is an observational, descriptive, correlational study. The sample consisted of 90 women (90 fetuses) with a single pregnancy between 34 and 40 weeks of gestation. Results: From the doppler variables analyzed, it was evidenced that the fetal pulmonary artery pressure decreased significantly (p < 0.001) with advancing gestational age. It was determined that there is a significant inverse association between fetal pulmonary artery pressure and fetal maturity (p < 0.001), such that the lower the fetal pulmonary artery pressure value, the higher the percentage of fetal maturity. A fetal pulmonary artery pressure cut-off point located at 55.9 mm Hg jointly determined the highest sensitivity and specificity for the diagnosis of fetal lung maturity, its sensitivity being 93.75% and specificity being 80.77%. With a positive predictive value of 92.31% and a negative predictive value of 84%. Conclusion: The estimation of fetal pulmonary artery pressure obtained by doppler ultrasound is useful as an indicator of fetal maturity(AU)

Asociación entre sistemas venosos insuficientes y manifestaciones clínicas en enfermedad venosa crónica de miembros inferiores / Association between insufficient venous systems and clinical manifestations in chronic venous disease of the lower limbs

RESUMEN Introducción: La clasificación clínica, etiológica, anatómica y fisiopatológica (CEAP) estandariza las manifestaciones de la enfermedad venosa de miembros inferiores. Objetivo: Investigar la asociación entre los sistemas venosos insuficientes y la clasificación clínica del CEAP. Método: Se realizó una investigación tipo cuantitativa, transversal, con diseño analítico, correlacional. El muestreo es no probabilístico por conveniencia. El tamaño de muestra fue136 miembros inferiores de 71 pacientes. Se utilizó las pruebas estadísticas de Chi-cuadrado, Monte Carlo y Odd ratio (OR) con intervalos de confianza del 95 %, mediante regresión logística bivariada (p<0,05). Resultados: El 71,8 % fue femenino con edad media de 66,1. El sistema venoso insuficiente más frecuente fue el superficial: 61,7 %. El 100% de las venas safenas mayores (VSM) dilatadas tenían insuficiencia. La clase clínica CEAP más frecuente fue la C2: 44,9 %; el 35,1 % de C1 (telangiectasia) tenían un sistema venoso insuficiente; el 50 % de C2, insuficiencia de la VSM (p=0,227). Hubo una asociación entre la insuficiencia de los sistemas venosos superficial y profundo y la clasificación clínica del CEAP (p=<0,001). El sistema venoso profundo estuvo asociado a la enfermedad venosa crónica de miembros inferiores grave OR (6,04) con IC95 % (1,02-35,73) y p=0,047. Conclusiones: Se evidenció una asociación entre la insuficiencia de los sistemas venosos superficial y profundo con la clasificación clínica del CEAP. Un tercio de los miembros inferiores con C1 (telangiectasias) tenían un sistema venoso insuficiente.

ABSTRACT Introduction: The clinical, etiological, anatomical and pathophysiological classification (CEAP) standardizes the manifestations of lower limb venous disease. Objetive: To investigate the association between insufficient venous systems and the clinical classification of CEAP. Method: A quantitative, cross-sectional, analytical, correlational design was carried out. Non-probability sampling for convenience. Sample size was 136 lower limbs from 71 patients. Chi-square, Monte Carlo and Odd ratio (OR) statistical tests were used with 95% confidence intervals through bivariate logistic regression (p<0.05). Results: 71.8% were female, average age of 66.1. The most frequent insufficient venous system was the superficial one (61.7%). 100% of the dilated great saphenous veins (GSV) had insufficiency. The most frequent CEAP clinical class was C2: 44.9%); 35.1% of C1 (telangiectasia) had an insufficient venous system and 50% of C2 had GSV insufficiency (p=0.227). There was an association between insufficiency of the superficial and deep venous systems and the CEAP clinical classification (p=<0.001). The deep venous system was associated with severe chronic venous disease of the lower limbs OR (6.04) with 95% CI (1.02-35.73) and p=0.047. Conclusions: An association was evident between the insufficiency of the superficial and deep venous systems with the clinical classification of CEAP. One third of lower limbs with C1 (telangiectasias) had an insufficient venous system.

Predictive value of renal venous Doppler waveform pattern for 28-day renal dysfunction in critically ill patients / 中华急诊医学杂志

Objective:This study aimed to explore the performance of renal resistive index (RRI), semiquantitative power Doppler ultrasound (PDU) score, and renal venous Doppler waveform (RVDW) pattern in predicting 28-day renal dysfunction in critically ill patients and establish nomogram model.Methods:This was a prospective, observational study. Critically ill patients admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 2018 to October 2022 were included. Patients underwent renal ultrasound examination to obtain RRI, PDU score and RVDW pattern within 24 h after ICU admission. The following clinical variables were collected during the renal ultrasound examination session, including heart rate, mean arterial pressure, type and dose of vasoactive drugs, oxygen therapy parameters, and average urine volume per hour derived from a period of 6 h prior to the ultrasound examination. The data on duration of AKI and mortality were recorded on the 28th day of follow-up. Patients were divided into 28-day normal renal function group and 28-day renal dysfunction group according to 28-day renal dysfunction. 28-days of renal dysfunction was defined as failure to achieve renal function recovery within 28 days of ICU admission. The difference of each index between the two groups was compared. Associated factors for 28-day renal dysfunction were determined by univariate and multivariate COX regression analyses. A nomogram was developed based on the independently factors associated with 28-day renal dysfunction. Survival receiver operator characteristic (ROC) curves were plotted to assess diagnostic performance in predicting 28-day renal dysfunction. Delong’s test was used to compare area under the curves (AUC) between each predictor.Results:187 patients were enrolled for the final analysis: 97 with no AKI, 48 with AKI stage 1, 24 with AKI stage 2, and 18 with AKI stage 3 upon enrollment. At 28-day follow up, 16 patients had renal dysfunction and 2 required continuous renal replacement therapy (CRRT). The multivariate COX regression showed that RVDW and SCr upon enrollment were the independent risk predictors. Nomogram based on RVDW and SCr upon enrollment showed the best performance in predicting 14-day renal dysfunction (AUC = 0.918, 95% CI:0.871-0.964, P<0.05), and the AUC was statistically significantly higher than single index (all P<0.05). Nomogram also showed the best performance in predicting 28-day renal dysfunction (AUC = 0.924, 95% CI:0.865-0.983, P<0.05), and the AUC was statistically significantly higher than single index (all P<0.05) except for SCr upon enrollment. The optimal cutoff for nomogram in predicting 28-day renal dysfunction was ≤89.5 (sensitivity, 81.2%; specificity, 90.6%; Youden index, 0.719). Kaplan-Meier analysis showed that the median duration of renal dysfunction in the groups with total nomogram score >85.9 and ≤85.9 was 0 and 22 days (HR=0.220, 95% CI:0.129-0.376, P<0.001). Conclusions:SCr and RVDW pattern within 24 h from ICU admission were independent factors associated with 28-day renal dysfunction in critically ill patients. The value of the nomogram model based on these two factors in predicting 28-day renal dysfunction is superior to each single intrarenal Doppler spectrum indicator and clinical indicator.

The Association between Ophthalmic Artery Doppler Variables and the Severi-ty of Pre-eclampsia:a Meta-analysis / 实用妇产科杂志

Objective:To investigate the association between the Doppler variables of the ophthalmic artery with the severity of preeclampsia(PE).Methods:Systematic literature was searched between January 1995 and March 2023 in PubMed,Web of Science,Embase,and the Cochrane Library.Studies comparing ophthalmic artery Doppler variables,including peak systolic velocity(PSV),end-diastolic velocity(EDV),resistive index(Rl),pulsa-tility index(PI),and peak ratio(PR,the ratio of the flow velocity of the second peak to that of the initial peak)in patients with PE,severe preeclampsia(sPE),and healthy pregnant women were included.The random-effects model was adopted as the method of pooled analysis,and the I2value was used to assess heterogeneity.The pooled standardized mean difference(SMD)with 95％confidence interval(CI)was used to estimate the associa-tion between ophthalmic artery Doppler variables and PE patient's characteristics.Results:Eight retrospective studies were eventually included in this Meta-analysis.Our pooled results suggested that compared with PE ca-ses,sPE patients had lower PI levels(SMD-0.56,95％CI-0.92～-0.20,P=0.000),higher EDV levels(SMD 0.47,95％CI 0.12～0.83,P=0.028)and higher PR levels(SMD0.96,95％CI 0.13～1.78,P=0.023).Howev-er,there was no significant difference between PE and sPE patients about the PSV and RI(P=0.361,P=0.626).Conclusions:This review demonstrates that ophthalmic artery Doppler variables(PI,EDV and PR)could be useful for predicting PE and PE development(especially in identifying sPE),which in turn may help the practitioner in the management of these complicated cases and in taking early necessary precautions.

Characteristics of myocardial injury in patients with acute myocardial infarction complicated with pleural effusion and its influence on long-term prognosis / 天津医药

Objective To explore the characteristics of myocardial injury in patients with acute myocardial infarction(AMI)complicated by pleural effusion and its effect on long-term prognosis.Methods It was a prospective single-center study.Patients with AMI who were admitted to hospital within 15 days from symptom onset and performed echocardiography and cardiac magnetic resonance imaging(CMR)during hospitalization were consecutively enrolled and assigned to the with-pleural effusion group and the without-pleural effusion group according to the echocardiography result.Baseline data,cardiac magnetic resonance myocardial injury index and echocardiography characteristics were compared between the two groups.The occurrence of major adverse cardiovascular and cerebrovascular events(MACCE)was recorded through outpatient follow-up and telephone follow-up,including all-cause death,re-infarction,revascularization,rehospitalization for congestive heart failure and stroke.Cox regression analysis was performed to analyze influencing factors of all-cause death.Results Among 211 patients,31(14.7%)patients had pleural effusion and 180(85.3%)had no pleural effusion.Compared with the group without pleural effusion,the left ventricular end-diastolic diameter was larger,and left ventricular ejection fraction assessed by echocardiography was lower in the group with pleural effusion(P＜0.05).There were no significant differences in infarct size,left ventricular end-diastolic volume,left ventricular end-systolic volume,left ventricular ejection fraction and the presence of microvascular obstruction and intramyocardial hemorrhage between the two groups in CMR(all P＞0.05).At a median follow-up of 31 months,MACCE occurred in 43(20.4%)patients,and there was no significant difference between the two groups(χ2=3.160,P=0.075).Six cases(2.8%)had all-cause death.The incidence of all-cause death was higher in the group with pleural effusion than that in the group without pleural effusion(9.7%vs.1.7%,P<0.05).There was no significant difference in the incidence of other adverse events between the two groups(P＞0.05).Multivariate Cox regression analysis showed that advanced age and presence of pleural effusion were independent risk factors of all-cause death during follow-up.Conclusion Patients with AMI combined with pleural effusion have more severe myocardial injury and higher all-cause mortality.

Effect of high intensity focused ultrasound treatment on ovarian reserve capacity in adenomyosis / 医疗卫生装备

Objective To explore the impact of high intensity focused ultrasound(HIFU)treatment on ovarian reserve capacity in adenomyosis.Methods Clinical data of 106 adenomyosis patients who underwent HIFU treatment from May 2019 to December 2020 at some hospital were analyzed retrospectively.All the patients were treated with HIFU,and color Doppler ultrasonography was performed before and after 6 months of treatment,respectively.The resistance index,pulsatility index,vascularization index,blood flow index,vascularization blood flow index and sinus follicle number were obtained,and serum anti-Mullerian hormone(AMH),follicle-stimulating hormone(FSH)and luteinizing hormone(luteinizing hormone)were measured.The correlation between serum AMH levels and FSH and LH levels was analyzed.SPSS 21.0 statistical software was used for data analysis.Results After 6 months of treatment serum FSH,LH,value of FSH/LH,resistance index and pulsatility index significantly decreased while vascularization index,blood flow index,vascularization blood flow index,number of sinus follicles,and serum AMH level obviously increased when compared with those before treatment,with the differences being statistically significant(P＜0.05).Serum AMH levels were negatively correlated with FSH and LH levels(r=-0.448,-0.527,P＜0.05)after 6 months of treatment.Conclusion HIFU treatment reduces sex hormone levels,elevates serum AMH levels and sinus follicle number,and may improve ovarian reserve capacity in patients with adenomyosis.[Chinese Medical Equipment Journal,2024,45(1):67-70]

Relationship between serum miR-665 and miR-144 levels and cardiac function in elderly patients with chronic heart failure / 中华老年心脑血管病杂志

Objective To investigate the serum levels of miR-665 and miR-144 in the elderly pa-tients with chronic heart failure(CHF)and their relationship with cardiac function.Methods A total of 120 elderly CHF patients who were diagnosed and treated in our hospital from March 2021 to March 2023 were collected and then divided into NYHA grade Ⅱ(n=39),Ⅲ(n=51)and Ⅳ(n=30)subgroups according to the results of NYHA classification.Another 120 elderly healthy volunteers during the same period were recruited as the control group.Clinical data and cardiac function indicators were collected,and the expression levels of miR-665 and miR-144 in se-rum were detected.Pearson correlation analysis was applied to analyze the relationship of miR-665 and miR-144 levels with cardiac function indicators.Results The CHF group had significantly de-creased LVEF,increased left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD),and elevated serum levels of miR-665 and miR-144 than the control group(P＜0.01).Sequentially reduced LVEF and raised LVEDD and LVESD values and serum miR-665 and miR-144 levels were observed in the patients with NYHA grades Ⅱ,Ⅲ,and Ⅳ in turn(P＜0.01).Pearson correlation analysis showed that there was a positive correlation of the serum level of miR-665 with that of miR-144 in CHF patients(r=0.693,P=0.000),of the miR-665 and miR-144 levels with LVEDD(r=0.485,r=0.507,P＜0.01)and LVESD(r=0.539,r=0.494,P＜0.01),and a negative correlation of the serum levels with LVEF(r=-0.577,r=-0.591,P＜0.01).Conclusion The serum levels of miR-665 and miR-144 are elevated in elderly CHF patients,and are closely associated with their cardiac function.

Quantity detection of substantia nigra hyperechogenicity based on digital analysis for diagnosing Parkinson′s disease / 中华神经科杂志

Objective:To apply digital analysis to quantify hyperechogenicity of substantia nigra, and explore its clinical value for diagnosis of Parkinson′s disease (PD).Methods:The cross-sectional study included 652 PD patients (PD group) and 99 healthy controls (healthy control group) from November 2017 to October 2020 in Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology. All subjects underwent transcranial sonography. The diagnostic accuracy of substantia nigra hyperechogenicity using digital analysis was compared with that in a manual measurement in PD. Furthermore, the receiver operating characteristic (ROC) curve analysis was applied to explore its diagnosis value in PD.Results:There were 482 subjects including 400 in the PD group and 82 in the healthy control group, whose quantified results of substantia nigra hyperechogenicity could be used for analysis. The ROC analysis showed that the area under the curve of the quantified larger substantia nigra hyperechoic region detection for diagnosing PD was 0.858 (95% CI 0.805-0.910), the sensitivity was 87.8%, and the specificity was 73.2%, consistent with that of doctors (area under the curve: 0.884). Further more, among these PD patients, there was no correlation between larger substantia nigra hyperechogenicity and age, age of onset, course of disease, non-motor symptoms, and motor symptoms (all P>0.05). Conclusions:Digital analysis was used to quantify the changes in substantia nigra hyperechogenicity in this seudy. The results showed that diagnostic accuracy for PD based on digital analysis was consistent with that of experienced clinicians.

Clinical and imaging characteristics of cryptogenic stroke combined with right-to-left shunt / 中华神经科杂志

Objective:To investigate the clinical and imaging characteristics of patients with cryptogenic stroke with different right-to-left shunt (RLS) and possible mechanisms.Methods:Acute ischemic stroke patients aged 18-65 years, who admitted to the Department of Neurology, the First Affiliated Hospital of Fujian Medical University from April 2012 to July 2022, were etiologically classified according to the TOAST criteria. Cryptogenic stroke patients further underwent contrast-enhanced transcranial Doppler (cTCD) examination. Patients with RLS (RLS grade Ⅰ-Ⅳ) were divided into large shunt group (RLS grade Ⅲ-Ⅳ, under normal breathing or after Valsalva manoeuvre) and small shunt group (RLS grade Ⅰ-Ⅱ, under normal breathing or after Valsalva manoeuvre). The chi-square test,Fisher's exact probability method and one-way analysis of variance were used to compare clinical and neuroimaging data between the 2 groups. And the RLS related factors as well as mechanisms of RLS-related stroke were further discussed through Spearman correlation and multiple Logistic regression analysis.Results:A total of 167 cryptogenic stroke patients with RLS were included in this study. The male to female ratio was 88∶79. The onest age was (45.27±9.02) years. In the large shunt group, there were 92 patients (55.1%) with onset age of (45.61±9.32) years. In this group, 35 patients (38.0%) were males, 9 (9.8%) had hypertension, and 18 (19.6%) had smoking history; the Risk of Paradoxical Embolism (RoPE) score was 7.08±0.12. In the small shunt group, there were 75 patients (44.9%) with onest age of (44.85±8.68) years. In this group, 53 patients (70.7%) were males, 29 (38.7%) had hypertension, and 31 (41.3%) had smoking history; the RoPE score was 6.20±0.14. Males (χ 2=17.640, P<0.001) as well as hypertension (χ 2=19.611, P<0.001) and smoking history (χ 2=9.443, P<0.01) were significantly less common in the large shunt group than in the small shunt group, while the RoPE score in the large shunt group was higher than that in the small shunt group ( F=21.580, P<0.001). All 6 pulmonary arteriovenous fistula cases (6.5%, 6/92) belonged to the large shunt group. There was no pulmonary arteriovenous fistula patient in the small shunt group ( P<0.05). There were no statistically significant differences in age of onset, hyperlipidemia, diabetes, previous stroke/transient ischemic attack, or family history of stroke between the 2 groups (all P>0.05). Multiple Logistic regression analysis showed that female ( OR=2.848, 95 %CI 1.223-6.632, P<0.05) and no history of hypertension ( OR=3.937, 95 %CI 1.593-9.727, P<0.01) were significantly associated with large shunt. The neuroimaging features were analyzed through comparing offending vessels as well as spatial distribution of lesions between the 2 groups. Results:showed that infarct location of 54 cases (58.7%) was in the unilateral anterior circulation area, 34 cases (37.0%) in the posterior circulation area, no case in the bilateral anterior circulation area, and both of anterior and posterior circulation areas were involved in 4 cases (4.3%) in the large shunt group. Of all the large shunt group patients, 31 (33.7%) had cortical infarcts, 9 (9.8%) had subcortical infarcts, 36 (39.1%) had deep infarcts, and 16 (17.4%) had mixed multiple infarcts. In the small shunt group, infarct location of 36 cases (48.0%) was in the unilateral anterior circulation area, 29 cases (38.7%) in the posterior circulation area, 4 cases (5.3%) in the bilateral anterior circulation area, and both of anterior and posterior circulation areas were involved in 7 cases (9.3%). Of all the small shunt group patients, 7 (9.3%) had cortical infarcts, 8 (10.7%) had subcortical infarcts, 39 (52.0%) had deep infarcts, and 21 (28.0%) had mixed multiple infarcts. Logistic regression analysis showed that cortical infarction was associated with large shunt ( OR=5.981,95 %CI 1.882-19.007, P<0.01), and there was no statistically significant difference in other types of infarction distribution between the 2 groups (all P>0.05). Conclusions:Among cryptogenic stroke patients with RLS, large shunt was more common in females, patients with no history of hypertension, and those with higher RoPE score as well as more cortical infarction, suggesting that there was a strong link between stroke and large RLS, which revealed the underlying mechanism of embolism in patients with stroke and large RLS. In the small shunt group, there were more males and hypertensive patients, suggesting atherosclerosis was more likely involved in pathogenic mechanism of stroke patients with small RLS.

Application of color doppler flow imaging in the diagnosis of ocular toxocariasis in children / 中华眼底病杂志

Objective:To summarize the characteristics of color doppler flow imaging (CDFI) of ocular toxocariasis (OT) in children.Methods:A retrospective clinical study. From July 2014 to June 2020, 61 OT patients with 61 eyes diagnosed through clinical and laboratory testing in the Department of Ophthalmology of Beijing Tongren Hospital of Capital Medical University were included in the study. There were 45 males with 45 eyes and 16 females with 16 eye (male: female=2.81:1). Age were (6.93±2.50) years. The right eye and left eye were 29 and 32 eyes, respectively. Both eyes of the patient underwent two-dimensional ultrasound and CDFI examination. Two dimensional ultrasound was used to estimate the axial length (AL) of the affected eyes and healthy eyes on the opposite side. Among them, 52 cases were measured for AL using optical biometry and/or A-mode ultrasound. Vitreoretinal surgery was performed within one week after ultrasound examination. Two-dimensional ultrasound was used to observe the morphology of vitreous opacity, its connection to the eyeball wall, and whether posterior vitreous detachment and retinal detachment have occurred. CDFI examination was used to observe the presence of blood flow signals on the pathological membrane. The detection rates of different forms of vitreous opacity and traction retinal detachment were calculated. The location of proliferative lesions in the eye was analyzed. Paired t-test was performed to compare the AL of the affected eye and the healthy eye on the opposite side. Perform Kappa consistency test on the location of proliferative lesions was used during CDFI examination and vitreoretinal surgery. Results:All affected eyes have varying degrees of vitreous opacity. Among them, 23 eyes (37.7%, 23/61) showed typical "Christmas tree" like turbidity; 27 eyes (44.3%, 27/61) had clustered and striped echoes; 9 eyes (14.8%, 9/61) had weak punctate and strip echoes. Two eyes (3.3%, 2/61) showed a large amount of dense punctate and strip-shaped echoes. There were 50 eyes (82.0%, 50/61) with traction retinal detachment, of which 46 eyes (92.0%, 46/50) had visible blood flow signals on the detached retina, and the remaining 4 eyes (8.0%, 4/50) had no blood flow signals. During CDFI and surgery, there were 5 (8.2%, 5/61) and 4 (6.6%, 4/61) eyes with visible proliferative lesions in the periphery, respectively; 18 (29.5%, 18/61) and 14 (23.0%, 14/61) eyes were distributed in the posterior pole, respectively; there were 38 (62.3%, 38/61) and 43 (70.5%, 43/61) eyes with both peripheral and posterior polar regions, respectively. The consistency between CDFI and surgery in detecting the location of proliferative lesions was good ( κ=0.832, 95% confidence interval 0.691-0.973, P<0.001). The two-dimensional ultrasound measurement results showed that the AL of the affected eye was shorter than that of the contralateral healthy eye in 46 cases (75.4%, 46/61). Among the 52 patients who underwent AL biometry, the AL of the affected eye was shorter than that of the contralateral healthy eye by (0.63±0.68) mm, and the difference was statistically significant ( t=-6.738, P<0.05). Conclusions:CDFI can clearly display various intraocular lesions (vitreous opacity and traction retinal detachment) and eyeball sizes in children with OT. Vitreous opacity is often manifested as "Christmas tree" like, clustered, strip-shaped.

Correlation of uterine artery Doppler flow velocimetry and β-human chorionic gonadotropin levels during postmolar evacuation surveillance: A pilot study in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Background@#During postmolar evacuation surveillance, beta-human chorionic gonadotropin (β-hCG) regression levels can predict invasive disease while Doppler ultrasound can assess in vivo tumor neovascularization and quantify uterine blood supply. As an ancillary tool to β-hCG monitoring, ultrasound can detect the early presence of viable trophoblastic tissues and identify patients at risk of developing postmolar gestational trophoblastic Neoplasia (PMGTN). @*Objective@#The objective of this study was to correlate uterine artery Doppler ultrasound with β-hCG levels during pre- and postmolar evacuation surveillance among patients with complete mole.@*Materials and Methods@#A cohort of patients with sonographic diagnosis of complete hydatidiform mole and managed with suction curettage in the same institution were prospectively followed up after evacuation. The pre- and postmolar evacuation surveillance period was at days 1, 7, 14, 21, 28, and 35. Monitoring of serum β-hCG levels was based on the standard regression curve. For Doppler ultrasound parameters, monitoring of the systolic/diastolic (S/D) ratio, pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) was based on its relationship with its serum β-hCG levels. The ultrasound images generated were archived and reviewed by the authors. Descriptive and inferential statistics were utilized to analyze median differences. For the correlation of uterine artery Doppler flow parameters, analysis for the test of difference used Pearson correlation and multiple linear regression analysis for the odds ratio.@*Results@#Sixteen of the 23 enrolled patients completed the protocol (16 of 23, 69.50%). A majority had spontaneous remission (13; 81%) while 3 cases (19%) presented increasing and plateauing β-hCG levels. The pre- and post evacuation median β-hCG levels showed a significant decrease (P = 0.001). As post evacuation β-hCG levels decreased, PSV also decreased (r = 0.478, P = 0.061) while Doppler parameters, RI, PI, and S/D ratio increased. However, when post evacuation β-hCG levels rose or plateaued, Doppler parameters decreased. These changes had statistical correlation (all P < 0.05). Moreover, the magnitude of the relationship for β-hCG and Doppler parameters was moderate and ranged from 0.524 to 0.581. Among the Doppler parameters, the S/D ratio and RI of the right uterine artery strongly predicted a rise in β-hCG levels. The odds ratio of predicting increased β-hCG levels and risk of gestational trophoblastic neoplasia by the right S/D ratio were − 2683.67 (confidence interval [CI] = −271.692–5095.655; P = 0.034) and by the right RI − 66,193.34 (CI = −161,818.107–29,431.433; P = 0.046). Notably, Doppler parameter changes appeared early at day 14 up to day 35 and before the appearance of abnormal β-hCG regression patterns.@*Conclusion@#There is a strong correlation between uterine artery Doppler flow changes and β-hCG levels during postmolar evacuation surveillance. The inverse relationship of the S/D ratio, PI and RI, and β-hCG regression patterns confirms spontaneous remission of the disease. For patients with abnormal β-hCG patterns, this relationship is altered. The Doppler changes become erratic, unpredictable, and significantly decreased. These changes were detected as early as 2 weeks post evacuation. Thus, the use of ultrasound as an adjunct to β-hCG post evacuation surveillance can predict abnormal β-hCG regression patterns and identify patients at risk of developing postmolar gestational trophoblastic neoplasia (PMGTN).

A prospective study of super-thin anterolateral thigh flap harvesting assisted by high-frequency color Doppler ultrasound in detecting perforators in deep adipose layers / 中国修复重建外科杂志

OBJECTIVE@#To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF).@*METHODS@#Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m 2, with an average of 23.62 kg/m 2. The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured.@*RESULTS@#A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory.@*CONCLUSION@#Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.

Therapeutic effect of sequential therapy with butylphthalein on acute cerebral infarction and increased middle cerebral artery blood flow in 48 patients / 中国基层医药

Objective:To investigate the therapeutic effect of sequential therapy with butylphthalein on acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow in patients.Methods:The clinical data of 92 patients with acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow who received treatment at the Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to October 2021 were retrospectively analyzed. These patients were divided into a study group and a control group using a random number table method. The control group was given an intravenous infusion of butylphthalein sodium chloride injection, while the study group took oral butylphthalein soft capsules after intravenous infusion of butylphthalein sodium chloride injection. The baseline data, hemodynamics, neurological function, and clinical outcomes were compared between the two groups. At 90 days after treatment, the National Institutes of Health Stroke Scale (NIHSS), the Activity of Daily Living Scale (ADL), and the modified Rankin Scale (mRS) were used to evaluate clinical outcomes. Transcranial Doppler ultrasound (TCD) examination was performed to evaluate hemodynamic changes.Results:A total of 92 patients completed all the observation indices as required, including 48 patients in the study group and 44 patients in the control group. There were no significant differences in demographics, vascular risk factors, laboratory results, NIHSS score, ADL score, or arterial hemodynamics of the diseased brain between the two groups (all P > 0.05). At 90 days after treatment, the NIHSS score in the study group was significantly lower than that in the control group [(4.00 ± 1.95) points vs. (4.91 ± 2.08) points; t =-2.16, P = 0.033]. The ADL score in the study group was significantly higher than that in the control group [(82.71 ± 9.56) points vs. (76.25 ± 11.47) points; t = 2.94, P = 0.004]. The good rate of outcomes in the study group was significantly higher than that in the control group [70.83% (34/48) vs. 50.00% (22/44); χ2 = 4.18, P = 0.041]. There were significant differences in the peak systolic velocity [(152.33 ± 9.58) cm/s vs. (157.41 ± 11.77) cm/s; t = 2.27, P = 0.025] and the mean velocity [(90.00 ± 8.30) cm/s vs. (94.45 ± 9.07) cm/s; t = -2.46, P = 0.016] of the middle cerebral artery between the study and control groups. The difference in pulsitility index between the two groups was not statistically significant [(0.97 ± 1.06) vs. (1.01 ± 1.21); t = 1.69, P = 0.093]. Compared with the poor outcome group, patients in the good outcome group had lower NIHSS and ADL scores after discharge (both P < 0.001), and the proportion of patients who received sequential therapy with butylphthalein in the good outcome group was higher [(60.70% (34/56) vs. 38.90% (14/36); χ2 = 4.18, P = 0.041]. Conclusion:Sequential therapy with butylphthalein can reduce neurological deficits, promote neurological function recovery, improve the hemodynamics of diseased blood vessels, and greatly improve daily living activities in patients with acute cerebral infarction complicated by mild to moderate increases in middle cerebral artery blood flow.

Correlation between serum Nesfatin-1, N-terminal pro-brain natriuretic peptide, and cystatin C levels and myocardial enzymes and cardiac function in patients with ST-elevation myocardial infarction / 中国基层医药

Objective:To correlate serum Nesfatin-1, N-terminal pro-brain natriuretic peptide (NT-proBNP), and cystatin C (CysC) levels with myocardial enzymes and cardiac function in patients with acute ST-elevation myocardial infarction (STEMI).Methods:This is a case-control study. A total of 100 patients with acute STEMI who received treatment at Lishui People's Hospital from January 2020 to December 2022 were included in the STEMI group. An additional 80 healthy controls who concurrently received physical examinations in the same hospital were included in the control group. Serum levels of Nesfatin-1, NT-proBNP, CysC, creatine kinase-MB (CK-MB), and cardiac troponin I (cTnI) levels were determined in each group. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDD), and left ventricular end-systolic diameter (LVDS) were measured using color Doppler ultrasound. Correlation analysis was performed.Results:Serum Nesfatin-1 level in the STEMI group was (89.96 ± 15.25) ng/L, which was significantly lower than (226.36 ± 37.47) ng/L in the control group ( t = 33.15, P < 0.05). Serum levels of NT-proBNP and CysC in the STEMI group were (1 325.12 ± 378.48) ng/L and (1.37 ± 0.24) mg/L, which were significantly higher than (78.95 ± 13.42) ng/L and (0.79 ± 0.16) mg/L in the control group ( t = -29.42, -18.56, both P < 0.05). Serum CK-MB and cTnI levels in the STEMI group were (46.51 ± 12.14) U/L and (1.13 ± 0.25) U/L, respectively, which were significantly higher than (12.23 ± 4.01) U/L and (0.09 ± 0.02) U/L in the control group ( t = -24.06, -37.09, both P < 0.05). The LVEF in the STEMI group was (37.84 ± 5.45)%, which was significantly lower than (72.41 ± 4.26)% in the control group ( t = 46.49, P < 0.05). The LVDD and LVDS in the STEMI group were (40.92 ± 5.25) mm and (58.98 ± 6.25) mm, which were significantly higher than (19.86 ± 3.36) mm and (34.21 ± 4.38) mm in the control group ( t = -31.13, -30.03, both P < 0.05). Serum Nesfatin-1 level was positively correlated with LVEF ( r = 0.572), but it was negatively correlated with serum CK-MB and cTnI levels, LVDD, and LVDS ( r = -0.498, -0.617, -0.506, -0.534, all P < 0.05). Serum NT-proBNP and CysC levels were negatively correlated with LVEF ( r = -0.653, -0.607), but they were positively correlated with serum CK-MB and cTnI levels, LVDD, and LVDS ( r = 0.582, 0.526, 0.712, 0.565, 0.631, 0.578, 0.659, 0.635, all P < 0.05). Conclusion:Serum Nesfatin-1 levels decrease, while serum NT-proBNP and CysC levels increase in patients with acute STEMI. Serum Nesfatin-1, NT-proBNP, and CysC levels are closely related to myocardial enzymes and cardiac function.

Evaluation of left ventricular function in patients with pregnancy-induced hypertension using echocardiography / 中国基层医药

Objective:To investigate the clinical value of tissue Doppler echocardiography in the evaluation of left ventricular function in patients with pregnancy-induced hypertension.Methods:This is a case-control study, including 100 patients with pregnancy-induced hypertension who received treatment at the Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to May 2022, and an additional 100 healthy pregnant women who underwent physical examination during the same period. All participants underwent two-dimensional echocardiography, pulsed Doppler echocardiography, and tissue Doppler echocardiography. Ultrasound parameters related to left ventricular morphology and function were collected from all participants. The ultrasound parameters related to left ventricular morphology and function between patients with different types of pregnancy-induced hypertension and healthy controls were compared. The correlation between left ventricular function ultrasound parameters and serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels was investigated.Results:Patients with pregnancy-induced hypertension, patients with mild preeclampsia, patients with severe preeclampsia, and healthy controls demonstrated differences in interventricular septum thickness during diastole [(10.24 ± 1.18) mm, (11.39 ± 1.24) mm, (11.57 ± 1.29) mm, (8.81 ± 0.95) mm], left ventricular end-diastolic diameter [(47.31 ± 2.81) mm, (49.82 ± 2.89) mm, (52.03 ± 2.94) mm, (46.82 ± 2.76) mm], left ventricular posterior wall thickness [(9.73 ± 1.06) mm, (10.62 ± 1.13) mm, (11.75 ± 1.21) mm, (8.96 ± 0.97) mm], left ventricular inner diameter [(32.82 ± 2.34) mm, (35.48 ± 2.39) mm, (36.04 ± 2.45) mm, (30.41 ± 2.27) mm], and left ventricular mass index [(98.41 ± 7.83) g/m 2, (105.73 ± 8.26) g/m 2, (108.63 ± 8.57) g/m 2, (96.59 ± 7.69) g/m 2]. All of these parameters showed significant differences between patients with different types of pregnancy-induced hypertension and healthy controls ( F = 13.47, 12.61, 16.59, 13.26, 19.73, all P < 0.001). Significant differences were also observed in echocardiographic indices of left ventricular function such as peak velocity ratio of E and A waves, systolic motor amplitude, early peak diastolic velocity to late peak diastolic velocity, and Tei index between patients with different types of pregnancy-induced hypertension and healthy controls ( F = 12.84, 11.27, 14.64, 21.43, all P < 0.001). In patients with pregnancy-induced hypertension, peak velocity ratio of E and A waves, systolic motor amplitude, and early peak diastolic velocity to late peak diastolic velocity were moderately negatively correlated with serum NT-proBNP level ( r = -0.56, -0.43, -0.54, P = 0.029, 0.042, 0.031), while Tei index showed a positive correlation with serum NT-proBNP level ( r = 0.77; P = 0.003). Conclusion:Two-dimensional echocardiography, pulsed Doppler echocardiography combined with tissue Doppler echocardiography can be used to effectively evaluate the changes in left ventricular structure and function in patients with different types of pregnancy-induced hypertension. Monitoring the Tei index using tissue Doppler echocardiography can accurately reflect myocardial injury and functional changes, which has a great clinical application value.

Qualitative and quantitative diagnosis of benign and malignant adnexal masses by transvaginal contrast-enhanced ultrasonography / 中国基层医药

Objective:To evaluate the qualitative and quantitative diagnostic value of transvaginal contrast-enhanced ultrasonography for benign and malignant adnexal masses.Methods:Forty-nine patients with adnexal masses detected by routine ultrasound examination at Wenzhou People's Hospital from January 2021 to December 2022 were included in this study. Initially, transvaginal two-dimensional ultrasound, two-dimensional ultrasound integrated with color Doppler, and contrast-enhanced ultrasonography were used to accurately classify the masses as benign or malignant. Using postoperative pathology as the gold standard, the qualitative diagnostic accuracy of various detection methods was compared. Subsequently, the receiver operating characteristic curve analysis was performed to assess the quantitative diagnostic accuracy of transvaginal contrast-enhanced ultrasonography-related parameters in distinguishing between benign and malignant adnexal masses.Results:Among the 49 patients, 10 were diagnosed with malignant tumors. The diagnostic accuracy of contrast-enhanced ultrasonography was 93.88% (46/49), with a sensitivity of 90.00% (9/10), a specificity of 94.87% (37/39), a positive predictive value of 81.82% (9/11), and a negative predictive value of 97.37% (37/38). The results of the diagnostic difference assessment (McNemar test) revealed that there was no significant difference between two-dimensional ultrasound ( χ2 = 0.37, P = 0.546), two-dimensional ultrasound combined with color Doppler ( χ2 = 0.17, P = 0.683), and contrast-enhanced ultrasonography ( χ2 = 0.00, P = 1.000), and the gold standard test results. The consistency assessment (Kappa test) revealed that the diagnostic results of contrast-enhanced ultrasonography exhibited the highest concordance with the gold standard, with a Kappa value of 0.82 ( P < 0.001). Furthermore, the receiver operating characteristic curve analysis indicated that the initial increase time, peak intensity, and mean transit time in contrast-enhanced ultrasonography demonstrated high quantitative diagnostic accuracy. The areas under the curve were 0.83, 0.82, and 0.84, respectively, and the diagnostic cutoff values were 17.30 s, 21.65 dB, and 92.60 seconds, respectively. Conclusion:Contrast-enhanced ultrasonography exhibits diagnostic value in the differential diagnosis of benign and malignant adnexal masses, both qualitatively and quantitatively. This method can provide valuable insights for further treatment.

Predictive value of serum PLGF/sFlt-1 combined with placental 3D-PDI in preeclampsia / 中国医科大学学报

Objective To investigate the predictive value of serum placental growth factor(PLGF)/soluble fms-like tyrosine kinase-1(sFlt-1),combined with the placental three-dimensional energy Doppler index(3D-PDI)in preeclampsia(PE).Methods From January 2021 to December 2022,120 pregnant women with PE risk factors were selected and followed up until 1 week after delivery.Serum PLGF and sFlt-1 levels were measured at routine prenatal check-ups at 14 to 20 weeks gestation.The PLGF/sFlt-1 ratio was calculated,and placental 3D-PDI was detected by ultrasound,including the vascularization index(VI),blood flow index(FI),and vascularization-blood flow index(VFI).Based on whether PE occurred after 20 weeks of pregnancy,cases were divided into PE(55 cases)and control groups(65 cases).The PE group was further divided into mild PE(35 cases)and severe PE groups(20 cases)based on the severity of the di-sease.The differences in PLGF/sFlt-1 and 3D-PDI between the groups were compared in terms of a statistical analysis of the correlation between PLGF,sFlt-1,and 3D-PDI.The receiver operating characteristic curve(ROC)was plotted,and the predictive value of each index on PE alone or in combination was analyzed.Results The systolic blood pressure(SBP),diastolic blood pressure(DBP),24 h protein-uria level,preterm birth rate,NICU admission rate,and preconception BMI in the PE group were higher than those in the control group(P＜0.05).The two groups had no differences in age,gestational age,pregnancy history,and fertility history(P＞0.05).The serum PLGF/sFlt-1 of the PE group was lower than that of the control group,and the serum PLGF/sFlt-1 of the severe group was lower than that of the mild group(P＜0.05).The 3D-PDI index of the PE group was lower than that of the control group,and the 3D-PDI index of the severe group was lower than that of the mild group(P＜0.05).Pearson's correlation analysis indicated that PLGF and VFI were signifi-cantly positively correlated(P＜0.01),and sFlt-1 was significantly negatively correlated with VFI(P＜0.01).ROC curve analysis showed that PLGF/sFlt-1,VI,FI,and VFI all had predictive value for PE and the value of VI,FI,and VFI jointly predicted PE,and was higher than that of various parameters(AUC = 0.951).Serum PLGF/sFlt-1,VI,FI,and VFI combined predicted the highest value(AUC=0.987).Conclusion In patients with PE,serum PLGF,sFlt-1,and placental VFI are significantly correlated.Serum PLGF/sFlt-1,placenta VI,FI,and VFI are reduced in early pregnancy,and the combined application of the four indicators has the highest efficacy in predicting PE,providing a possible reference for the early clinical screening or prediction of PE.

Research progresses of superb microvascular imaging in musculoskeletal diseases / 中国医学影像技术

Superb microvascular imaging(SMI)is a new kind of Doppler technology,being sensitive for displaying low-velocity microvascular blood flow in muscles,tendons,synovium,nerves and reflecting microcirculation changes,able to provide imaging evidences for diagnosing musculoskeletal system diseases,monitoring processes and evaluating therapeutic effect.The research progresses of SMI applicated in musculoskeletal diseases were reviewed in this article.