Application progress of SlowflowHD in prenatal ultrasound screening / 中国辐射卫生

@#Prenatal ultrasound screening is an important means to exclude fetal structural abnormalities. With the continuous development of technology, more vascular abnormalities can be found more early, which improves the quality of the social population. Traditional Doppler ultrasonic images have a low resolution and poorly display small blood vessels. SlowflowHD is a particularly sensitive power Doppler designed to detect small microvessels with a low flow rate, and can improve the resolution of fine blood vessels. SlowflowHD has been gradually applied to prenatal screening because of its unique characteristics such as high display frame rate, high line density (high resolution), and good sensitivity. This article aims to explore the clinical application progress of SlowflowHD in prenatal screening.

Prediction of Prenatal Ultrasound Screening Staff's Situation in Beijing Based on ARIMA Model / 中国医学科学院学报

Objective To understand the current situation and predict the trends in number and composition of prenatal ultrasound screening staff in Beijing. Methods We analyzed the region,age,professional title and other characteristics of prenatal ultrasound screening personnel in Beijing during 2007-2015.We then built an ARIMA model basing on the current situation to predict the number and composition of the staff in 2016-2020. Results The number of prenatal ultrasound screening staff showed an upward trend in 2007-2020 and was predicted to reach 1269 in 2020.During this period,the educational achievement and professional title of the staff showed a downward trend,and the working years became shorter,mainly below 5 years.The proportion of resident doctors remained at 26.6%,and that of the staff receiving further education would reach 43.2% by the end of 2020. Conclusion The prediction under ARIMA model suggests that efforts should be made to strengthen the training of young doctors and provide them opportunities for further study.

Frecuencia de la mamografía, ecografía, examen clínico y autoexamen de mama en población general / Frequency of mammography, ultrasound, clinical breast exam and self-exam in the general population

Introducción. El cáncer de mama es el cáncer que más afecta a las mujeres. Se estima que 1 en 8 mujeres desarrollarán cáncer de mama eventualmente. Una de las herramientas contra el cáncer de mama es crear estrategias de detección temprana de la enfermedad, y la mamografía ha demostrado ser de mucha utilidad. El objetivo del estudio fue determinar la frecuencia de la mamografía, ecografía, examen clínico y autoexamen mamario, y evaluar su uso como pruebas de tamización para cáncer de mama en una cohorte de pacientes atendidas en la Clínica del Prado en Medellín, Colombia. Metodología. Estudio descriptivo, transversal, efectuado a través de encuesta en 318 usuarias atendidas entre junio y diciembre de 2018. Se estimó la frecuencia de los diferentes métodos de tamización y se evaluaron las características sociodemográficas, antecedentes personales y antecedentes familiares. Adicionalmente, se buscó si había asociación significativa entre la práctica de la mamografía como prueba de tamización y las variables de estudio. Resultados. La media de la edad fue de 44,2 años. El método de tamización más usado fue el autoexamen (70,1%), en su mayoría mensual (76,7%), seguido por la mamografía (56%), en su mayoría ocasional (46%). El examen clínico de mama (ECM) se utilizó en el 45,9% de las pacientes, con una frecuencia anual en el 50% de ellas. Por último, la ecografía de mama se practicó en el 43,1% de las encuestadas, con una frecuencia en su mayoría ocasional (39,4%). Se realizó un análisis independiente para mujeres entre los 50 y 69 años, y aunque el 93,8% se habían realizado la mamografía, solo el 9,3% lo hizo bienal, como lo recomienda el Ministerio de Salud y Protección Social. No se hallaron diferencias estadísticamente significativas entre las variables de estudio y la realización de la mamografía como método de tamización. Conclusión. En la población estudiada, el autoexamen de mama es realizado por la mayoría de las mujeres con una frecuencia mensual. La frecuencia de la mamografía, el ECM y la ecografía de mama fue muy similar, y se esperaba encontrar un mayor porcentaje de mamografías realizadas como prueba de tamización. Se requiere fortalecer esta estrategia efectiva para la detección temprana de cáncer de mama, teniendo en consideración la situación particular de cada paciente, la efectividad y beneficio de la técnica, así como los costos asociados

Breast cancer is the most frequent cancer that affects women. It is estimated that 1 in 8 women will eventually develop breast cancer. One of the tools against breast cancer is to create early detection strategies, and mammography has proven to be very useful. The aim of this study was to determine the frequency of mammography, ultrasound, clinical breast exam and self-exam, and to evaluate their use as screening tests for breast cancer in a cohort of patients that attended at the Clinica del Prado in Medellin, Colombia. Methodology. Descriptive, cross-sectional study, carried out through a survey in 318 women between June and December 2018. The frequency of the different screening methods was estimated and the sociodemographic characteristics, personal history and family history were evaluated. Additionally, a possible association between the practice of mammography as a screening test and the different variables was analyzed. Results. Mean age was 44.2 years. The most used screening method was the self-exam (70.1%), mostly monthly (76.7%), followed by mammography (56%), mostly occasional (46%). The clinical breast exam was used in 45.9% of the patients, with an annual frequency in 50% of them. Lastly, breast ultrasound was performed in 43.1% of those surveyed, mostly occasional (39.4%). An independent analysis was carried out for women between 50 and 69 years old, and although 93.8% had mammograms, only 9.3% had them every 2 years, as recommended by the Ministry of Health and Social Protection guidelines. No statistically significant differences were found between the study variables and the use of mammography as a screening method. Conclusion. In the studied population, breast self-exam is performed by most women on a monthly basis. The frequency of mammography, clinical breast exam and ultrasound was very similar. A higher percentage of mammograms performed as a screening test was expected. It is necessary to strengthen this effective strategy for the early detection of breast cancer, taking into consideration the particular situation of each patient, the effectiveness and advantages of the technique, and the associated costs

Efficiency of Prenatal Ultrasound Screening Service in Beijing: A Malmquist-Data Envelopment Analysis / 中国医学科学院学报

To analyze the efficiency of prenatal ultrasound screening service in Beijing and thus optimize the secondary prevention system for birth defects in Beijing. Data were collected from the prenatal screening work reports of Beijing from 2010-2016.Key variables were extracted after data quality control.Data envelopment analysis was performed to analyze the efficiency and changing trend of ultrasound-based screening service and to compare the service efficiency between urban and suburban areas in Beijing. From 2010 to 2016,the technical efficiency of ultrasound screening services showed an increasing trend,and the geometric mean of technical efficiency in suburban areas was higher than that in urban areas.From 2010 to 2016,the total factor productivity of ultrasound screening service increased by 12.3% annually,in which the technical change increased by 12.0% annually;the technical efficiency increased by 0.3%,the pure technical efficiency increased by 13.9% annually,and the scale efficiency decreased by 0.4%. The technical efficiency of ultrasound screening service in Beijing increased from 2010 to 2016,and the total factor productivity improved.Technical change and pure technical efficiency change were the main reasons for the improvement.The resource allocation should be further optimized to improve the scale efficiency and enhance the training of prenatal ultrasound screening technicians.

Congenital cystic adenomatoid malformation, antenatal diagnosis: about one case

Antenatal ultrasound screening of fetal malformations requires for management, the immediate nature of which at certain birth, conditions the survival of the newborn. The Objectives Describe a case of pulmonary cystic adenomatoid malformation discover during antenatal ultrasonography. It was a 36 years old primary patient, referred to the maternity of Lafontaine hospital (France) for the presence, on obstetrical ultrasound screening, of suspected lesions on the foetal right lung’s field in a 21 weeks gestation pregnancy. After successive obstetric ultrasound scan, it was discovered that the left lungs were big with some parenchymal cysts of different sizes more than 3 mm in diameter. We made a diagnosis of type I left pulmonary cyst adenoma with excess amniotic fluid, without associated anomalies. The pregnancy progressed to 40 weeks gestation and a caesarean section was done with extraction of a live female new born weighing 2730 gr. The new born had 40 days later a successful surgical lobectomy for a cystic adenomatoid dysplasia. Histological examination revealed type I Stocker congenital pulmonary cystic adenomatoid malformation. During obstetrical ultrasound screening, we paid more attention to the brain, the heart, the face. Through this study we realised that during routine antenatal ultrasound for morphology, we should also pay more attention to the lungs.

Clinical value of asymmetric skin folds for screening of developmental dysplasia of the hip in infant / 中华实用儿科临床杂志

Objective@#To investigate the clinical significance of asymmetric skin folds in the diagnosis of developmental dysplasia of the hip (DDH) in infant.@*Methods@#The clinical data of 3 266 infants aged up to 6 months who were evaluated because of suspicious findings for DDH, hospitalized at Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University between January 2012 and April 2019 were reviewed retrospectively, including 1 185 boys and 2 081 girls, with a mean age of 2.8 months (ranging from 1 d to 6 months). The referred reasons included regular screening for DDH without suspicious findings [379 cases(11.6%)], clunk of the hip[59 cases(1.8%)], limb-length discrepancy[188 cases (5.8%)], limitation of hip motion or asymmetrical range of motion[58 cases(1.8%)], asymmetric skin folds[2 107 cases(64.5%)], and combined conditions of musculoskeletal disorder[475 cases(14.5%)]. The Graf′s ultrasound method was used to define the hip conditions.A type Ⅰ or Ⅱa hip was graded as normal, and a type Ⅱb or more serious was graded as DDH.The percentages of DDH for various reasons were compared.@*Results@#Among 3 266 patients (6 532 hips), a total of 194 infants(230 hips)were diagnosed as DDH, and the total diagnostic rate was 5.94%, including 31 males and 163 females; there were 109 cases involving in the left, 49 cases in the right, and 36 cases in the bilateral.The DDH diagnosed rate for regular screening was 8.71%(33/379 cases), 6.78%(4/59 cases) for clunk of the hip, 10.34%(6/58 cases) for limitation of hip motion, 14.36%(27/188 cases)for limb-length discrepancy, 4.79%(101/2 107 cases) for asymmetric skin folds, 4.84%(23/475 cases) for combined conditions of musculoskeletal disorder, and the DDH diagnosed rate for asymmetric skin folds was the lowest(χ2=37.14, P<0.05).@*Conclusions@#Although asymmetric skin folds is the most common reason for DDH screening in infant up to 6 months, its clinical significance is limited, asymmetric skin folds should not be considered as an independent indication for DDH screening.

SCREENING THE NEWBORN FOR DYSPLASIA OF THE HIP / Шинэ санаа Шинэ нээлт

Developmental Dysplasia of the Hip (DDH) is a major health problem which can lead to lifelong handicapped condition of individuals if early diagnosis is missed. Cost for treatment, surgery and rehabilitation of these cases is much higher than that for prevention. According to Graf, hip ultrasound screening method is simple, reproducible, innocuous and can be performed by well- trained neonatologists. The purpose of this study is to determine prevalence and types of hip dysplasia by Graf standard screening method. A prospective study was carried out. Hip ultrasound screening using Graf method was performed by neonatologists at the Amgalan of maternity of the Capital city from January 2013 to March 2015.Totally 6154 neonates were eligible for the study and 50.9% of them were male, 93.27% term and 6.72% preterm, in 8.53% of babies, type IIa (physiological retardation of ossification)was found. Dysplasia or dislocation of hips (type III and IV) was found in 5 (0.08%) neonates. Babies diagnosed with type I on both hips were discharged. Type IIa cases were stopped being swaddled and reassessed after 4 weeks. Cases with type III and IV cases were all treated with abduction treatment or Tubinger. This study is an ongoing project. The implementation of the hip ultrasound screening according to Graf is feasible and can be performed by well-trained neonalogists in Amgalan of maternity of the Capital city.

Early diagnosis for developmental dysplasia of the hip:what can we do in China? / 中华实用儿科临床杂志

Universal uhrasound screening in newborn has been accepted for reducing the incidence of late detected developmental dysplasia of the hip (DDH).Unfortunately, the neonatal ultrasound screening strategy has not been applied in the mainland of China, which leads to a high incidence of late-detected DDH.Before implementing the neonatal ultrasound screening strategy, the clinical screening by limited abduction is valid to early diagnose the dislocated hip joint.Additionally,it is necessary to screen all the newborn with high risk factors of DDH, such as positive family history, breech presentation and postnatal hip extended swaddling.Early screening of DDH is the common responsibility of child care doctors, including community health physician, pediatrician or pediatric orthopedist.Currently, it is imperative to build regional neonatal ultrasound screening system for DDH in the regions with tertiary pediatric orthopedic center.

Carotid ultrasound screening of ischemic cerebral apoplexy in high-risk group and exploration of behavioral influence factors / 中华行为医学与脑科学杂志

Objective To investigate carotid atherosclerosis and its relevant risk factors of ischemic cerebral apoplexy in high-risk population and to explore new modes of behavioral influencing factors based on health management platform.Methods Using the carotid ultrasound screening of personnel undergoing physical examination,the differences of the related risk factors were studied among 1 152 cases of carotid atherosclerosis with differ ent gender and different age and different disease periods.Results High-risk population between 40-49 years wasmainly focused on mild lesions,and the numbers of serious lesions increased significantly among people older than 70;male patients numbered 51 were significantly much more than the females numbered 21 (P＜0.01)during mild lesion period,there was no statistical significance between male numbered 36 and female numbered 29 during serious lesion period (P＞0.05).Setting mild and serious period respectively as the dependent variables,and hypertension,overweight,dyslipidemia,diabetes mellitus,smnoking,physical activity and atrial fibrillation as the independent variables to conduct logistic regression analysis,it showed that mild lesions were related to overweight,hypertension and dyslipidemia.The risk factors of serious lesion period included hypertension,overweight,diabetes mellitus,dyslipidemia,atrial fibrillation,smoking and lack of physical activity.The female detection rates of hypertension and dyslipidemia in female patients,which were 83.8％ and 44.1％ respectively,were higher than those in male patients,which were 67.6％ and 31.0％ respectively.The detection rates of smoking and arterial fibrillation in female patients,which were 0.7％ and 0.3％ respectively,were lower than those in male patients,which were 20.7％ and 1.0％ respectively.Conclusions Early detection of carotid atherosclerosis lesions and its relevant risk factors as soon as possible,and early intervention influencing factors to mild lesions to prevent the atherosclerosis from getting worse.A new model of zero level prevention can be developed to control of ischemic stroke based on health management platform.

Experiencia en la aplicación del algoritmo de la Fundación de Medicina Fetal en el tamizaje de aneuploidías entre las 11-13+6 semanas

Objetivos: Evaluar nuestra experiencia en la aplicación del algoritmo de la Fundación de Medicina Fetal (FMF) en el tamizaje prenatal de aneuploidías en el primer trimestre en una población no seleccionada. Diseño: Estudio descriptivo, retrospectivo, transversal. Institución: Servicio de Medicina Fetal, Clínica Santa Isabel, Lima, Perú. Participantes: Gestantes y sus fetos. Intervenciones: Entre el 1 de marzo de 2012 y el 24 de setiembre de 2012, en 324 pacientes con 11 a 13+6 semanas de edad gestacional y fetos con longitud corona nalga (LCC) de 45 a 84 mm, se logró medir la translucencia nucal (TN) mediante ecografía transabdominal. Principales medidas de resultados: Factibilidad de la aplicación del algoritmo de la FMF en el tamizaje de 11 a 13+6 semanas. Resultados: La curva observada de los valores de la TN en relación a la LCC se ajustó a la ecuación cuadrática descrita por la FMF, y la distribución de las medidas presentó una disposición normal, teniendo la mediana una desviación de 0,2 mm respecto al esperado. El porcentaje de valores por encima de la mediana fue 43,3%. Se observó una TN >percentil 95 en 4,6% de casos y TN ≥ 3,5 mm en 1,2%. Se encontró un valor de riesgo por encima del punto de corte de 1:100 en 10 casos para T21 y en un caso para T13. Los resultados del estudio citogenético en tres pacientes fueron un cariotipo femenino normal, una trisomía 18 y una trisomía extra-estructural (47XY+mar). Conclusiones: Nuestros resultados concuerdan con lo comunicado en la literatura y muestran que es factible la aplicación del algoritmo de la FMF en el tamizaje de 11 a 13+6 semanas en un entorno de práctica clínica, en nuestro medio.

Objectives: To determine our experience in applying the Fetal Medicine Foundation (FMF) algorithm for first trimester aneuploidy screening in an unselected population. Design: Descriptive, retrospective, cross-sectional study. Setting: Fetal Medicine Service, Clinica Santa Isabel, Lima, Peru. Participants: Pregnant women and their fetuses. Interventions: Between March 1 and September 24 2012, nuchal translucency (NT) was measured by transabdominal ultrasound in 324 women with 11-13+6 weeks pregnancies and crown-rump length (CRL) between 45.0-84.0 mm. Main outcome measures: Factibility of FMF algorithm in 11-13+6 weeks screening. Results: NT curve in relation to CRLs was consistent with the quadratic equation described by FMF, and measurements followed a normal distribution with median deviation 0.2 mm lower than expected. The percentage of values above the median was 43.3%. A TN >95th percentile was observed in 4.6% of cases and TN ≥3.5 mm in 1.2%. A risk value above the 1:100 cut-off was found in 10 cases for T21 and in one case for T13. Cytogenetic study was performed in 3 patients; results were one normal female karyotype, one trisomy 18 and one extra-estructural trisomy (47XY+mar). Conclusions: Results agree with literature reports and show feasibility of FMF algorithm application in 11-13+6 weeks screening in a clinical practice setting in our country.

Ultrasound soft markers in screening for fetal chromosomal abnormality during first-trimester / 中华围产医学杂志

Objective To investigate the clinical values of multiple ultrasound soft markers in screening for fetal chromosomal abnormality during first-trimester.Methods Two thousand seven hundred and eighty-nine nulliparas in Department of Obstetrics,the First Affiliated Hospital of Jinan University during early pregnancy (11-13+6 gestational weeks) were selected for this study.Fetalnuchal translucency (NT),facial angle (FA),ductus venosus (DV),fetal heart rate (FHR),tricuspid reverse (TR),nasal bone (NB) and fetal structures were scanned and measured.Risk calculation software (Astraia) was used to calculate the chromosomal abnormal risk (cut-off line:＞1/300) based on ultrasound records.The chorionic villi or amniotic fluid of high risk patients was collected with informed consent for karyotype analysis (prenatal diagnosis).All patients were followed up until six months after delivery.Chi-square test or Fisher exact test was used to compare the difference.Results One hundred and seven cases were high-risk of trisomy 21 among which 96 cases accepted invasive prenatal diagnosis.Sixteen chromosomal anomaly and six trisomy 21 cases were diagnosed out the 96 fetuses.Among 2789 cases,four were high-risk of trisomy 21 according to ultrasound screening.Six cases were diagnosed as trisomy 21.The false positive rate of ultrasound screening was 3.6％(101/2783).There were 196 cases whose NT ≥2.5 mm,in which 66 cases were high risk of chromosomal abnormality,and 16 fetal chromosomal abnormalities were diagnosed after chorionic villus sampling.The invasive procedure rate was 2.3％ (66/2789).Totally,186 pregnant women were older than 35 years,among which 32 cases were high risk.There was no significantly difference on the of rate fetal chromosomal abnormality between the groups of age≥ 35 pregnant women and the general population (P=0.055).But 29.9％ (32/107) high risk cases were detected in the group of age≥35.Five of thirteen fetal malformations cases were associated with abnormal karyotype.Conclusions Multiple ultrasound soft markers screening during early pregnancy could increase the diagnosis rate of chromosomal abnormality and decrease the false positive rate,false negative rate and invasive procedure rate.Early ultrasound screening might be effective in not only identifying chromosomal abnormality,but also diagnosing severe structure deformity of fetus.

Diagnosis and treatment of early-stage hepatic artery thrombosis after adult liver transplantation / 中华肝胆外科杂志

Objective To evaluate the diagnosis and treatment of early-stage hepatic artery thrombosis(HAT) after adult liver transplantation.Methods387 consecutive adult patients who underwent liver transplantation from June 2007 to October 2010 by the same surgery team in the Transplant Center,First Affiliated Hospital of Sun Yat-sen University were retrospectively studied.Hepatic arterial blood flow was monitored by color Doppler ultrasound (DUS) daily during the first week after transplantation.Ultrasonic contrast or hepatic artery angiography was performed on recipients with suspected HAT.Results10 patients developed HAT on 7(2-18)d after operation.The incidence of HAT was 2.6％ (10/387).Interventional therapy was performed in 2 patients with one patient who received a stent because of hepatic artery stricture.Three patients underwent emergent hepatic artery revascularization combined with intra-arterial urokinase thrombolysis treatment.One developed a rethrombosis and died.The remaining 2 patients received re-transplantation.Three patients died of liver failure and severe infection.The mortality rate was 40％ (10/387).ConclusionsIt is essential to diagnoses HAT by monitoring the artery flow by Doppler ultrasound screening in the early period after operation.Interventional therapy,emergent hepatic artery revascularization and re-transplantation are effective rescue treatments.Prevention of HAT is most important.

Ultrasound Profile of Hips of South Indian Infants.

One thousand consecutive infants, 437 girls and 563 boys, attending their first DPT vaccination at a mean age of 48 days underwent ultrasonological screening of the hips by Graf’s technique at the immunization clinic of a tertiary hospital in South India. Graf I (mature) hips were seen bilaterally in 925 children. The incidence of Graf type II hips was 74/1000 infants. The incidence of sonographically abnormal hips (II, III and IV) in this population was 7.5%. The hip dislocation rate was 1 in 1000 (0.1%).

The cost analysis of ultrasound screening for fetal anomalies.

Objectives : To determine the effectiveness of ultrasound screening for fetal anomalies at different gestational ages and to define an appropriate cost for each ultrasound screening. Materials and methods: 470 pregnant women participated in our ultrasound screening programme from October 1st, 2002 to September 15th, 2003. 757 scans were appointed throughout the first, second and third trimesters, numbering 240,257 and 260 scans, respectively. The ultrasound cost were reduced to about 30% of the normal price (800 baht for 2-3 scans). Results : out of757 scans, 7 abnormal fetuses were found. All abnormalities were detected around 18-20 weeks of gestation No abnormalities were found at other gestational ages. The abnormalities included infantile polycystic kidney, cleft lip, trisomy 13,gastroschisis and 3 cases of echogenic foci of hearts. Using this reduced cost, these pregnant women were easily able to participate in this research Programme. Conclusion: In order to reduce perinatal morality and morbidity, ultrasound screening for fetal anomalies can be performed between 18-20 weeks gestation. If the fetus is found to be abnormal, proper management and care can be planned before delivery. An important obstacle is the high cost of having a scan performed. Therefore, a reduced cost should be considered to recruit more pregnant women to participate in this policy. A reasonable cost for each ultrasound was found to be 425 baht.

Fetal Nuchal Translucency Measurement for Detection of Chromosomal Abnormalities in the First Trimester of High Risk Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To determine the value of sonographic nuchal translucency measurement for the detection of chromosomal abnormalities in high risk pregnancies. METHOD: The feasibility of nuchal translucency was tested in a prospective study of 1260 pregnancies at 10- 13 weeks' gestation. RESULTS: The nuchal translucency of 3 mm or greater was identified in 41 fetuses (3.2%), 19 of whom proved subsequently by either amniocentesis or postnatal follow-up have chromosomal abnormalities. The sensitivity of nuchal translucency for chromosomal abnormalities was 82.6% (19 of 23 cases), the positive predictive value of nuchal translucency for chromosomal abnormalities detection was 46.3% (19 of 41 cases). CONCLUSION: The observed sensitivity, false-positive rate and predictive value suggest that sonographic nuchal translucency should be undertaken at 10 to 13 weeks of gestation.