Left ventricular systolic function in children with repaired tetralogy of Fallot by pressure-strain loops / 中华超声影像学杂志

Objective:To quantify the left ventricular myocardial work in patients with repaired tetralogy of Fallot (TOF), and to evaluate the changes in left ventricular systolic function after TOF repair by pressure-strain loops (PSL).Methods:Seventy-six cases of children after TOF complete surgery in Shenzhen Children′s Hospital from September 2015 to September 2021 were analyzed retrospectively. There were 41 cases in the ≤4-year group and 35 cases in the >4-year group. Seventy-six healthy children with matched body surface area in the same period were selected as the control group. All subjects underwent complete echocardiography and quantitative analysis of left ventricular myocardial work, including global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Compared with the normal control group, the changes of left ventricular myocardial work after TOF repair were analyzed. For patients with complete echocardiographic data before and after surgery, the correlation between postoperative left ventricular myocardial work and preoperative degree of right ventricular outflow tract (RVOT) obstruction was analyzed.Results:①In the ≤4-year group, compared with control subjects, GLS, GWI, GCW, GWE decreased, and GWW increased in patients with repaired TOF. All the differences were statistically significant [(-20.00±1.52)% vs (-21.59±1.73)%, (1 349.37±133.63)mmHg% vs (1 553.51±246.09)mmHg%, (1 589.39±167.85)mmHg% vs (1 749.12±249.45)mmHg%, 94.0%(94.0%, 95.0%) vs 96.0%(95.0%, 97.0%), (78.80±20.53)mmHg% vs (62.27±21.44)mmHg%; all P<0.05]. ②In >4-year group, compared with the control group, GLS, GWI, GWE decreased, and GWW increased in patients with repaired TOF. All the differences were statistically significant [(-19.89±1.66)% vs (-21.31±1.60)%, (1 486.09±172.42)mmHg% vs (1 713.14±227.05)mmHg%, 96.0%(94.0%, 96.0%) vs 97.0%(96.0%, 97.0%), 75.00(65.00, 95.00)mmHg% vs 55.00(42.00, 71.00)mmHg%; all P<0.05]. ③GWW was negatively correlated with preoperative RVOT diameter and RVOT-Z score( r=-0.422, -0.433; both P<0.05). GWE was positively associated with preoperative RVOT diameter and RVOT-Z score( r=0.441, 0.540; both P<0.05). ④GLS, GWI, GCW, GWW, GWE had good repeatability within and between observers.All the differences were not statistically significant (all P>0.05). Conclusions:Left ventricular systolic function in patients with repaired TOF is lower than that in healthy children of the same age by echocardiography PSL, although traditional indicators are still within the normal range. Patients with more severe RVOT obstruction before surgery have worse left ventricular systolic function after operation. Quantification of left ventricular myocardial work by echocardiography PSL is helpful for long-term follow-up of children after TOF repair.

Diagnostic accuracy of ultrasonography and radiography in children with acute chest trauma / 中华超声影像学杂志

Objective:To compare the diagnostic accuracy of lung ultrasonography and radiography in detection of acute traumatic intrathoracic injuries in children.Methods:A retrospective analysis was performed in 46 cases of children with chest trauma in Shenzhen Children′s Hospital from January 2017 to January 2021. The diagnostic efficiency of lung ultrasound and radiography in children with acute traumatic hemopneumothorax and lung contusion were compared. Computed tomography scan was used as gold standard.Results:The sensitivity and specificity of lung ultrasound were 0.79 and 0.98 for pneumothorax, 0.86 and 0.75 for hemothorax, 0.86 and 0.80 for pulmonary contusion, respectively. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion was 0.889 (95% CI=0.798-0.979, P<0.001), 0.804 (95% CI=0.707-0.901, P<0.001), and 0.831 (95% CI=0.623-1.000, P=0.013), respectively. Area under the ROC curve of radiography was 0.674 (95% CI=0.544-0.803, P=0.008) for detection of pneumothorax, 0.645 (95% CI=0.517-0.772, P=0.026) for hemothorax, and 0.547 (95% CI=0.289-0.805, P=0.724) for pulmonary contusion. Comparison of area under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax, hemothorax and pulmonary contusion (all P<0.05). Conclusions:Lung ultrasound has higher sensitivity and accuracy than chest radiography in the initial evaluation of chest trauma. For children with acute chest trauma, lung ultrasound should be the first choice.

The effectiveness and safety of ultrasound-guided hydrostatic reduction for pediatric acute intussusception / 中华超声影像学杂志

Objective:To evaluate the effectiveness and safety of ultrasound-guided hydrostatic reduction for pediatric acute intussusception.Methods:One thousand eight hundred and thirty patients with acute intussusception diagnosed by ultrasound in Shenzhen Children′s Hospital from September 2017 to July 2020 were treated with ultrasound-guided hydrostatic reduction method. The therapeutic effects, complications and ultrasonic features were observed.Results:Among 1 830 cases, 1 791 cases were diagnosed as primary intussusception, and 39 cases were secondary intussusception. The overall rate of successful ultrasound enema reduction were 1 780/1 830(93.7%) patients. All 50/1 830(2.7%) patients underwent surgery after unsuccessful enema reduction, including 42 cases of primary intussusception, and 8 cases of secondary intussusception. The complication of intestinal perforation occurred in 3 cases (0.16%), and there were no deaths.Conclusions:Ultrasound-guided enema reduction for pediatric acute intussusception is an effective and safe method without radiation exposure, and can be used as the preferred method for non-operative treatment of intussusception.

The application of shear wave elastography in sternocleidomastoid muscle in the early diagnosis of congenital muscular torticollis in infantile infants / 中华医学超声杂志（电子版）

Objective To discuss the application of shear wave elastography and strain elasticity imaging diagnosis of infants with congenital muscular torticollis. Methods Children with congenital muscular torticollis in 50 patients and 100 healthy infants were recruited for the research at Shezhen Children′s Hospital in the period of September to December, analyzing factors in normal sternocleidomastoid two mode ultrasonic elastography, including the young′s modulus, shear wave velocity, shear modulus and the ratio of strain results, comparing the change of elasticity between the patients and normal. Results The elastic parameters of the sternocleidomastoid showed no statistically significant difference between the genders, the left side and the right side. The results of young′s modulus, shear wave velocity and shear wave modulus were higher in long axis section than the short axis section, and the difference was statistically significant (P<0.05). However, the results of the strain ratio and thickness was not statistically significant. The young′s modulus, shear wave velocity and shear wave modulus are higher in the stretch back position than symmetrical supine position, and the difference is statistically significant (P<0.05). But those of strain ratio and thickness was not statistically significant. The thickness of the sternocleidomastoid muscle and the young′s modulus, shear wave velocity, shear modulus and the ratio of strain results ultrasound elastic results were higher in the lesion side than the healthy side, and the difference is statistically significant (P<0.05). Conclusion The ultrasound elastic imaging of multimodal technique can quantify the elasticity of the normal infant and the patients sternocleidomastoid, be used for diagnose for the infants with the congenital muscular torticollis.

Ultrasound measurement and analysis of the hip in healthy infants:a multicenter study / 中华超声影像学杂志

Objective To analysis the change of hip joint in healthy infants by ultrasound,and establish the normal reference value of the developmental dysplasia of the hip(DDH). Methods A total of 8 000 healthy infants from 0 to 24 weeks were collected from the Multi-center study of 10 children′s medical centers. Among them,3 855 infants(2 065 females and 1 790 males) with complete data and follow-up were included in this study. All subjects were divided into 6 groups ( ＜4,4～7,8～11,12～15,16～19 and≥20 weeks group). α angle,femoral head length and width,femoral head coverage ratio by acetabulum ( FHC) were measured in the coronal view on the neutral position;distance from pubis to femoral head ( P-H) and distance from ischium to femoral head ( I-H ) were measured in the transverse view on neutral position;distance from femoral head topubis ( H-P) was measured in the posterolateraltransverse view on the flexion position. The results of each group changes with age were analysised. Results ① The α angle of healthy infants from 0 to 20 weeks were increased with age,the difference among the groups were statistically significant( P ＜0.05),but there was no significant difference between 16～19 and ≥20 weeks group( P ＞0.05). ②The femoral head length and width of all age groups were increased with age,the difference among all the groups was statistically significant( all P ＜0.05). ③ FHC from 0 to 20 weeks were increased with age,the difference among the groups were statistically significant( P ＜0.05) except between 16～19 and ≥20 weeks group( P ＞0.05). ④ The P-H and I-H in all age groups showed no statistically significant ( all P＞0.05). ⑤The H-P of all age groups were increased with age,the difference between the groups were statistically significant(all P ＜0.05).Conclusions The development of hip joints have the certain regular developmental pattern in healthy infants less than 5 months of birth and are relatively constant after birth more than 5 months. The ultrasound normal reference value of the hip joints can be used for the early diagnosis of the DDH.

Echocardiographic assessment of coronary artery Z scores in children with Kawasaki disease after 7-14 years / 中国医学影像技术

Objective To assess long-term outcomes of coronary artery (CA) Z scores in children with Kawasaki disease (KD) with echocardiography.Methods Echocardiographic data of 100 KD children during 7-14 years interval follow-up were analyzed retrospectively.The children were divided into dilatation group (n =54,CA dilated) and non-dilatation group (n=46,CA not dilated) at the acute phase.Fifty one children were selected simultaneously as the controls (control group).Diameters and Z scores of left main coronary artery (LMCA),left anterior descending (LAD) and proximal right coronary artery (pRCA) were compared,and factors affecting CA diameter during the recovery phase were analyzed.Results CA diameters in dilatation group were larger than those in non-dilatation group and control group (all P＜0.05),whereas no statistical difference of CA diameter was found between non-dilatation group and control group (all P＞0.05).In dilatation group,Z score of LMCA,LAD and pRCA was 0.569 5 ± 1.061 6,0.420 (-0.029,1.078) and 0.640(0.283,1.250),while in non dilatation group,Z score of LMCA,LAD and pRCA was-0.0313±0.8467,-0.0662±0.6612 and 0.1887±0.5935,respectively.In control group,Z score of LMCA,LAD and pRCA was-0.1246±1.0167,-0.2558±1.0848 and 0.1943±0.6101,respectively.Z scores in dilatation group were larger than those in non-dilatation group and control group (all P＜0.05),while no statistical differences of Z scores was found between nondilatation group and control group (all P＞0.05).Dilation degree of CA at the acute phase was the factor affecting longterm CA dilation (odds ratio=39.146,P＜0.001).Conclusion During 7-14 years of follow-up,CA diameters and Z scores kept to increase in KD children with CA dilatation at the acute phase.The dilation degree of CA at the acute phase in KD children affects the long-term CA dilation.

Developmental dislocation of the hip in infants: the hip's ultrasound quantitative analysis / 中华医学超声杂志（电子版）

Objective To evaluate the biological characteristics of hip joint in infants with developmental dislocation of the hip (DDH).Methods From January 2013 to June 2016,30 patients (age from 1 to 8 months,25 females and 5 males) who were diagnosed as DDH,underwent ultrasound examination in Shenzhen Children's Hospital,in these patients 20 cases were treated surgically,and 10 cases were treated with non-surgical treatment.There were 34 hips (26 unilateral dislocation and 4 bilateral dislocation) dislocation in 60 hips.All the patients were confirmed by X-ray,magnetic resonance imaging (MRI) examination or operation.All the patients were examined by ultrasound through the coronal and transverse plane of the hip joint.The α angle,femoral head coverage ratio by acetabulum (FHC),femoral head length and width,distance from pubis to femoral head (P-H) and distance from ischium to femoral head (I-H) were measured.The dislocation joints were compared with contralateral joints.Results The α angle in the hip dislocation group was smaller than the contralateral group [(50.5±3.75)° vs (64.8±3.38) °],and there was significant difference between the two groups (t=-15.181,P ＜ 0.001).The FHC,femoral head length and width in the hip dislocation group were all smaller than the contralateral group [(23.4t17.63)％ vs (64.3±6.45)％,(0.98 ±0.15) cm vs (1.19 ±0.11) cm,(1.38±0.21) cm vs (1.61 ±0.16) cm],and there were significant differences between the two groups (t=-12.469,-6.034,-4.568,all P ＜ 0.001).The P-H and I-H in the hip dislocation group were larger than the contralateral group [(0.97±0.45) cm vs (0.27±0.05) cm,(0.75±0.30) cm vs (0.17±0.05) cm],and there were significant differences between the two groups (t=8.805,10.696,both P ＜ 0.001).The α angle,femoral head length and width in bilateral dislocation of hip group were slightly smaller than the unilateral dislocation of hip group [(50.3±2.75)° vs (51.3±4.77)°,(0.90 ±0.15) cm vs (0.97 ±0.12) cm,(1.25±0.20) cm vs (1.37 ±0.17) cm],but there were no significant differences between the two groups.The P-H and I-H in bilateral dislocation of hip group were slightly larger than the unilateral dislocation of hip group [(0.97 ± 0.49) cm vs (0.80±0.31) cm,(0.92±0.26) cm vs (0.68±0.18) cm],but there were no significant differences between the two groups.The value of acetabular index in the ultrasound group was slightly larger than the X-ray group [(33.13 ± 7.82)° vs (31.20 ± 8.31)°],and there were no significant differences between the two groups.Conclusions The characteristics of DDH includes acetabulum and femoral head dysplasia,and femoral head and acetabulum position relationship abnormalities.Quantitative ultrasonography of the hip can be used to quantitatively evaluate the structural features of DDH,and it is helpful to the early diagnosis and follow-up of DDH.

Ultrasonic diagnosis of radial head subluxation and clinical value / 中国医学影像技术

Objective To investigate the diagnostic value of ultrasonography in radial head subluxation (RHS).Methods The clinical data and ultrasonographic findings of 34 children with RHS were retrospectively analyzed.All patients were routinely treated by bilateral compared and multi-sectional elbow joints ultrasonography.And the X ray results were negative.Results Ultrasonographic manifestations of RHS included increased radiocapitellar distance in 29 cases (29/34,85.29％);widened joint space and enhanced echo in 25 cases (25/34,73.53％);hook sign,supinator muscle above the radial head in 32 cases (32/34,94.12 ％);annular ligament entrapment in 33 cases (33/34,97.06％).Conclusion Ultra sonographic manifestations of RHS have certain characteristics.Comparation of bilateral elbow joints and the application of continuous scanning ultrasound are helpful to make a quick and accurate diagnosis of X-ray negative RHS.

Feasibility and clinical significance of lung ultrasound score in assessment on pulmonary lesions and prognosis in neonates with respiratory distress syndrome / 中国医学影像技术

Objective To evaluate the value of lung ultrasound score (LUS) in the quantitative assessment of the severity of neonatal respiratory distress syndrome (NRDS) and the value of clinical diagnosis and treatment.Methods Totally 74 NRDS cases and 30 normal neonates were studied.LUS was compared with X-ray examination,clinical data,ventilator assisted ventilation and ventilator parameters.ROC curve was used to calculate sensitivity and specificity of LUS to predict the severity of NRDS and application of invasive ventilator treatment.Results The main findings of the lung ultrasound in NRDS included diffuse distribution of dense B line,disappeared A line,pleural line abnormalities,decreased pulmonary slip sign and pulmonary consolidation.LUS in patients with NRDS was significantly correlated with X ray grades,clinical grades,assisted ventilation mode grades,number of days on ventilator and ventilator parameters (all P＜0.05).LUS value to predict mild,moderate and severe NRDS were 13.0,22.5,and 29.5,respectively.The best cutoff point for LUS to predict the adoptation of invasive assisted ventilation was 22.5,which had sensitivity of 86.0 ％ and specificity of 64.5 ％.Conclusion LUS can be used to diagnose and evaluate the severity of the desease,and to guide the clinical diagnosis and treatment.

DNA damage effects on human skin keratinocytes induced by sulphur mustard / 军事医学

Objective To investigate the toxic effects and mechanisms of sulphur mustard on DNA damage of human immortalized epidermal keratinocytes (HacaT cells).Methods The inhibitory effect of sulphur mustard on the proliferation of HacaT cells was detected by CCK-8 method.The apoptosis index of cells was measured by Annexin V-FITC method.The effects of sulphur mustard on DNA damage were detected by single cell gel electrophoresis.The expression levels of DNA damage and repair related proteins were detected by Western blot.Results The proliferation rate of HacaT cells was inhibited in a dose-dependent manner after treatment with sulphur mustard for 24 h (IC50 value was 121 mol/L).The apoptotic and comet tailing rates of cells treated with sulphur mustard also increased in a dose-dependent manner.The expression levels of DNA damage and repair related proteins were changed after treatment with sulphur mustard.Conclusion Sulphur mustard has significant cytotoxic effect on HacaT cells,and can induce apoptosis and DNA damage.In addition,ATM-P53-γH2AX-PARP signaling pathway plays an important role in the repair of DNA damage induced by sulphur mustard.

New phenotype caused by a NR5A1 heterozygous mutation—— 46, XX disorder of sex development / 中华内分泌代谢杂志

Objective To summarize the clinical manifestations of 46, XX ovotesticular disorder of sex development (DSD) caused by a NR5A1 heterozygous mutation. Methods The first case of 46,XX ovotesticular DSD was caused by a NR5A1 heterozygous mutation in China and was reported with a review of 11 similar cases in the literatures since July 2016. Results A 5. 6-year-old child raised as female was born with ambiguous genitalia. The left gonad was palpable in the inguinal region while the right one was located in abdomen. Gonadal histology showed both ovotestis. Vaginoscopy revealed a short, blind-ending vagina. No uterine was detected by laparoscopy. Repeated karyotype results were 46, XX with SRY gene negative. A heterozygous de novo mutation ( p. Arg92Trp) in the accessory DNA-binding region of NR5A1 gene was found in that child. Conclusions We reported for the first time in China a new phenotype caused by a NR5A1 heterozygous mutation-46,XX ovotesticular DSD. According to the review of literatures, such mutation seemed with incomplete penetrance. It could cause both 46, XX DSD and 46, XY DSD with varied manifestations. The possible underlying mechanism might relate to the impairment of the binding between the mutant protein and target DNA which might lead to a decreased inhibition of the male developmental pathway through downregulation of female antitestis genes.

New phenotype caused by a NR5A1 heterozygous mutation—— 46, XX disorder of sex development / 中华内分泌代谢杂志

Objective To summarize the clinical manifestations of 46, XX ovotesticular disorder of sex development (DSD) caused by a NR5A1 heterozygous mutation. Methods The first case of 46,XX ovotesticular DSD was caused by a NR5A1 heterozygous mutation in China and was reported with a review of 11 similar cases in the literatures since July 2016. Results A 5. 6-year-old child raised as female was born with ambiguous genitalia. The left gonad was palpable in the inguinal region while the right one was located in abdomen. Gonadal histology showed both ovotestis. Vaginoscopy revealed a short, blind-ending vagina. No uterine was detected by laparoscopy. Repeated karyotype results were 46, XX with SRY gene negative. A heterozygous de novo mutation ( p. Arg92Trp) in the accessory DNA-binding region of NR5A1 gene was found in that child. Conclusions We reported for the first time in China a new phenotype caused by a NR5A1 heterozygous mutation-46,XX ovotesticular DSD. According to the review of literatures, such mutation seemed with incomplete penetrance. It could cause both 46, XX DSD and 46, XY DSD with varied manifestations. The possible underlying mechanism might relate to the impairment of the binding between the mutant protein and target DNA which might lead to a decreased inhibition of the male developmental pathway through downregulation of female antitestis genes.

Accuracy of three-dimensional ultrasound volumetric measurements for bladder of children / 中华医学超声杂志（电子版）

Objective To investigate the accuracy of three-dimensional ultrasound volumetric measurements for children's bladder. Methods The bladder volumes of 238 children aged 9 months to 16 years (male:106;female:132) in Shenzhen Children's Hospital underwent real-time three-dimensional ultrasound for volume measurements. These cases were divided into six groups according to the body surface area:(0.36~0.60) m2 (27 cases), (0.61~0.78) m2 (66 cases), (0.79~0.89) m2 (52 cases), (0.90~1.05) m2 (33 cases), (1.06~1.20) m2 (30 cases) and (1.21~1.78) m2 (30 cases). The bladder volume measured by GE Voluson E8 and Philips iU22 were compared with the actual volumes of discharge urine. The relation between bladder volume measurements and the actual volume of discharge urine was analyzed. Results Children's bladder volume increasesd with the body surface area (F=33.53, P<0.05) and showed positive correlations with the body surface area (r=0.679, P <0.05). Compared with the actual volume of discharge urine, each group's bladder volume measurements obtained by three-dimensional ultrasound were lower and the results were as follows:[(47.80±30.33) ml vs (82.24±49.63) ml, (77.20±39.72) ml vs (139.98±79.03) ml, (95.96±50.79) ml vs (175.96±101.70) ml, (117.46±54.17) ml vs (206.62±86.22) ml, (145.53±73.60) ml vs (253.33±135.09) ml and (220.27±110.34) ml vs (327.42±165.45) ml]. The differences between children's bladder volume measurements and the actual volume of discharge urine were statistically significant (t=3.19, 5.53, 5.08, 4.49, 3.84 and 3.00, all P <0.05), but children's bladder volume showed positive correlations with the actual urine volume (r=0.881, P<0.05). The bladder volume measurements by spheroid formula based on two-dimensional ultrasound are lower than the actual volume of discharge urine, and the results were as follows:[(50.38±36.94) ml vs (82.24±49.63) ml, (86.77±62.34) ml vs (139.98±79.03) ml, (102.69±60.21) ml vs (175.96±101.70) ml, (107.94±55.14) ml vs (206.62±86.22) ml, (145.31±66.01) ml vs (253.33±135.09) ml and (222.77±132.59) ml vs (327.42±165.45) ml]. The differences were statistically significant (t=3.03, 4.01, 4.47, 4.95, 3.94 and 2.75, all P <0.05), but children's bladder volume showed positive correlations with actual urine volume (r=0.326, P <0.05). Conclusions Three-dimensional ultrasound volumetric measurements for children's bladder is feasible and in clinical application, the factors of children's growth should be take into account. Combing regression equation, children's bladder volume can be more accurately quantified.

Ultrasound in tethered cord syndrome in infants / 中华医学超声杂志（电子版）

Objective To investigate the value of ultrasound in tethered cord syndrome (TCS) in infants. Methods From December 2005 to July 2013, 25 cases TCS were confirmed by surgery in Shenzhen children's hospital. The ultrasonogram and MRI of 25 infants were analysed retrospectively. The diagnostic accuracy of ultra-sound and its clinical significance were evaluated. Results In 25 cases of TCS confirmed by surgery, the coincidence rate of conus level detected by ultrasound [96%(23/24)] was lower than that by MRI (100%(25/25)). Ultrasound showed reduced spinal cord vibration in 4 cases, disappeared spinal cord vibration in 21 cases. Two cases of reduced spinal cord vibration detected by ultrasound were confirmed as disappeared spinal cord vibration by surgery. The coincidence rate of disappeared spinal cord vibration detected by ultrasound was 91%(21/23). The sacral spinal seg-ments form showed by ultrasound were entirely consistent with those of MRI, including 4 cases of enlarged spinal cord, 13 cases of spinal cord without enlargement and 8 cases of spinal cord ended with rat caudate. Twenty-five cases of TCS had malformations:7 cases meningocele (3 cases combined lipoma), 14 cases myelomeningocele (5 cases combined lipoma, 1 case combined hydromyelia), 3 cases spinal canal-epidermis fistula (all combined lipoma) and 1 case solitary lipoma. Compared with the operation findings, ultrasound misdiagnosed 2 cases of myelomeningo-cele as meningocele, missed 1 of case lipoma which combined with meningocele. MRI missed two cases of spinal canal-epidermis fistula. Conclusions Infantile spinal ultrasound examination can accurately locate the position of conus, accurately display the spinal cord. Compared with MRI, ultrasound examination can real-time visually display spinal cord vibration and help to diagnose tethered cord. Ultrasound examination are convenient, repeatable opera-tion with low cost, therefore it can be used as the preferred screening method to diagnose of tethered spinal cord.

The Z scores value of cardiac structure by preoperative echocardiography in children with tetralogy of Fallot / 中华医学超声杂志（电子版）

Objective To evaluate the value and clinical application of cardiac structure Z scores in children with preoperative tetralogy of Fallot (TOF) by echocardiography. Methods Considering the result of 31 patients who underwent echocardiography in Shenzhen Children’s Hospital before TOF repair from January 2011 to September 2013, the median age was 10 months (range:3 days to 14 years). Other 31 normal children were selected as normal control group with age-and sex-matched, the median age was 10 months (range: 6 days to 13 years). Echocardiographic measurements included the diameter of right ventricular outflow tract (RVOT), pulmonary valve diameter (PVD), left pulmonary artery diameter (LPAD), right pulmonary artery diameter (RPAD), pulmonary valve peak velocity (PV-Vmax), tricuspid annulus diameter (TVD), mitral annulus diameter (MAD), left ventricular end-diastolic volume (LVEDV) and left ventricular mass (LVmass). Shenzhen Children’s Hospital pediatric echocardiography normal reference values and the regression equation are applied to obtain the forecast average, and using the Z-score formula into the standard value (Z=[M-y]/ MSE ). Results There was no significant difference in body surface area between the TOF group and control group (P>0.05). Compared with control group, the true value of RVOT reduced significantly in TOF group, its Z-score showed negative values increase (-4.87±1.86 vs 0.33±0.93, t=-13.90, P0.05), but the Z scores of TOF were significantly reduced than the control group (0.25±0.78 vs 0.76±0.65, t=-2.75;-0.92±1.94 vs 0.03±1.01, t=-2.41;-0.83±1.59 vs 0.67±0.69, t=-4.71; all P0.05). For the Z scores of PV-Vmax, there were no significant difference between transannular patch surgery and pulmonary valve-sparing repair (8.58±1.20 vs 8.12±1.16, t=1.07, P>0.05). Conclusions The Z scores value of cardiac structure can be used in quantitative analysis of RVOT obstruction and development of left ventricular backward of TOF. The Z score of transannular patch surgery is more lower than pulmonary valve-sparing repair patients. The normalized Z score by body surface area correction is important for the preoperative diagnosis and the surgical planning.

A comparative study of two methods to quantify Z scores of aortic root diameters measured in children by echocardiography / 中华医学超声杂志（电子版）

Objective To investigate the calculation method and its inlfuencing factors of Z scores in the aortic root diameters measured by echocardiography in children. Methods A total of 105 children with median age 19 months, who came to Shenzhen Children′s Hospital from March 2012 to October 2012 were included. The diameters of aortic ring (ARD) and aortic sinus (ASD) were measured by two dimension echocardiography, Z scores of ARD and ASD were calculated using two different normal reference values regression equation and mean square error derived from Shenzhen children′s hospital (C method) and Pettersen et al (P method). The regression equation from C method and body surface area (BSA) formula from P method were adopted to calculate Z scores of ARD and ASD (ZH method). The Z results of ARD and ASD calculated by those three methods were compared and were analyzed for their normality probability distributions. Results Z scores of ARD and ASD derived from C method were all showed as normal distribution (P=0.067 and 0.650). Z scores of ARD and ASD derived from P method were all showed as normal distribution (P=0.208 and 0.970). Z score of ARD derived from ZH method was showed as non-normal distribution (P=0.027), but Z score of ASD was normal distribution (P=0.430). There were no significant differences in ARD-Z calculated by C method (0.41±0.89), P method (0.23±0.85) and ZH method (0.36±0.94) (F=1.117, P=0.309). There were signiifcant differences in the Z scores of ASD calculated by C method (0.38±0.89), P method (0.58±0.71) and ZH method (0.36±0.84) (F=5.443, P=0.005). Z scores of ARD (r=0.917, P=0.000) and ASD (r=0.900, P=0.000) calculated by C method correlated well with that by P method. Conclusions Calculation method of BSA and normal reference values regression equation were the main influencing factors of Z score value in quantifying children aortic root diameters by echocardiography. For the clinical applications. The normal reference value should be used which is suitable for the Chinese children.

Analysis of coronary artery Z-scores of children with Kawasaki disease on echocardiography / 中华医学超声杂志（电子版）

Objective To investigate the clinical value of coronary artery Z-scores on echocardiography in diagnosing coronary artery abnormalities. Methods The echocardiography results of 612 patients with Kawasaki disease (KD) at the acute and recovery phase were retrospectively studied. Coronary artery luminal diameters were converted to body-surface-area-adjusted Z-scores. According to coronary Z-scores classiifcation, all the subjects were divided to four groups:415 cases with no dilation (ND), 133 cases with small coronary artery abnormalities (SCAAs), 47 cases with large coronary artery abnormalities (LCAAs), and 17 cases with giant coronary artery abnormalities (GCAAs). Clinical features (gender, age, typical clinical manifestations, fever duration) and laboratory results (CRP, ESR, WBC, PLT) were compared among all the four groups. Coronary artery diameters and the Z-scores were compared between acute and convalescence phase. Results Along with the increase of coronary Z-score, fever duration was prolonged [ND group:(7.75±3.12) d, SCAAs group (8.50±4.12) d, LCAAs group: (8.57±3.58) d, GCAAs group: (11.88±4.33) d, F=22.375, P0.05). No significant different coronary diameters were found in ND cases between recovery and acute phase [(2.24±0.34) mm vs (2.33±0.36) mm, t=1.926, P > 0.05]. But there were significant difference in the coronary Z-scores of ND patients between recovery and acute phase (0.41±0.82 vs 1.17±0.75, t=8.332, P < 0.05). The coronary Z-scores in SCAAs group (1.32±0.89 vs 3.40±0.62, t=11.073, P < 0.05), LCAAs group (3.12±2.27 vs 6.20±1.28, t=4.579, P<0.05) and GCAAs group (11.88±6.77 vs 20.4±9.70, t=3.480, P<0.05) at recovery phase were smaller than values at acute phase. Conclusions The KD coronary Z-scores are the body-surface-area-adjusted standard value, and not subject to the influence of children growth and development. Therefore, it may accurately evaluate the severity of coronary artery abnormalities and its recovery process. Accurate quantitative of the coronary artery luminal dimensions is important in KD clinical management and prognosis prediction.

The reference values and Z scores regression equations of normal newborns undergoing echocardiography / 中华医学超声杂志（电子版）

Objective To investigate the reference values and Z scores regression equations of newborn undergoing echocardiography. Methods Two hundred and eighty-eight newborns (aged 0-28 days) of Shenzhen Children′s Hospital underwent echocardiography examination, including M-mode, two-dimensional (2D) and real-time three-dimensional (3D) echocardiography, color Doppler lfow imaging (CDFI) and tissue Doppler imaging. The correlation between echocardiography results and weight were analyzed and Z scores were calculated. Results The normal values of right ventricular diameter (RV) and left ventricular end-diastolic diameter (LVEDD) measured by M-mode, the mitral annulus diameter in four chamber view (MV-D1), mitral annulus diameter in two chamber view (MV-D2), mitral annulus diameter in longitudinal view (MV-D3), aortic ring diameter (ARD), aortic sinus diameter (ASD), ascending aorta diameter (AAO), transverse aorta diameter (TA), aortic isthmus diameter (AI), aorta diaphragm diameter (AO-Dia), tricuspid annulus diameter in four chamber view (TV-D1), tricuspid annulus diameter in right ventricular inlfow tract view (TV-D2), right ventricular outlfow tract diameter (RVOT), pulmonary valve diameter (PVD) and main pulmonary artery diameter (PA) measured by 2D echocardiography and the normal values of mitral valve inflow Doppler component during early diastole (MV-E), mitral valve inlfow Doppler component during atrial contraction (MV-A), tricuspid valve inlfow Doppler component during early diastole (TV-E), tricuspid valve inflow Doppler component during atrial contraction (TV-A), aortic valve peak velocity (AV-max), aortic valve velocity-time integral (AV-VTI), pulmonary valve peak velocity (PV-max), pulmonary valve velocity-time integral (PV-VTI) measured by pulse Doppler, the mitral annular tissue Doppler component during systole (MV-s′), mitral annular tissue Doppler component during early diastole (MV-e′), mitral annular tissue Doppler component during atrial contraction (MV-a′), tricuspid annular tissue Doppler component during systole (TV-s′), tricuspid annular tissue Doppler component during early diastole (TV-e′), tricuspid annular tissue Doppler component during atrial contraction (TV-a′), interventricular septum annular tissue Doppler component during systole (IVS-s′), interventricular septum annular tissue Doppler component during early diastole (IVS-e′), interventricular septum annular tissue Doppler component during atrial contraction (IVS-a′) measured by tissue Doppler, the normal values of left atrial volume (LAV), left ventricular end-systolic volume (LVEDV), stroke volume (SV) and cardiac output (CO) measured by bi-plane method and the normal values of LVEDV, SV and CO measured by real-time tri-plane method, together with the normal values of left ventricular (LV) mass, left ventricular mass index [LV mass/BSA, LV mass/H2.7, body surface area (BSA) and height (H)], all showed nonlinear positive correlations with body weight (all P0.05). Except for RV, MV-D1, MV-D2, MV-D3, TV-D1, TV-E, MV-s′, IVS-a′, TV-s′and TV-e′, all R2 obtained by nonlinear regression method (lnY=a+bX+cX2+dX3) were larger than those obtained by linear regression method (Y=a+bX). The Z score showed a normal distribution and no correlation with body weight. Conclusions The normal reference values of newborn undergoing echocardiography reflect the variation in weight. The Z scores can be obtained by the predicted nonlinear regression equations and show standard normal distribution. The echocardiography normal reference values have important significance for the diagnosis and treatment of neonatal heart disease.

Complete genomic analysis of a novel infectious bronchitis virus isolate / 病毒学报

The genome of CK/CH/SD09/005, an isolate of infectious bronchitis virus (IBV), was characterized to enable the further understanding of the epidemiology and evolution of IBV in China. Twenty-five pairs of primers were designed to amplify the full-length genome of CK/CH/SD09/005. The nucleotide sequence of CK/CH/SD09/005 was compared with reference IBV strains retrieved from GenBank. The phylogenic relationship between CK/CH/SD09/005 and the reference strains was analyzed based on S1 gene sequences. The complete genome of CK/CH/SD09/005 consisted of 27691 nucleotides (nt), excluding the 5' cap and 3' poly A tail. The whole-genome of CK/CH/SD09/005 shared 97 - 99% nucleotide sequence homology with the GX-NN09032 strain, which was the only complete genome that was closely related to CK/CH/SD09/005. When compared with all reference strains except GX-NN09032, CK/CH/SD09/005 showed the highest similarity to ck/CH/LDL/091022 and SDIB821/2012 (QX-like) in the replicase gene (Gene 1) and 3'UTR, with a sequence identity rate of 97% and 98%, respectively. However, CK/CH/SD09/005 exhibited lower levels of similarity with ck/CH/LDL/091022 and SDIB821/2012 in S-3a-3b-3c/ E-M-5a-5b-N with a sequence identity of 72% - 90%. CK/CH/SD09/005 showed the highest level of nucleotide identity with Korean strain 1011, and Chinese strains CK/CH/LXJ/02I, DK/CH/HN/ZZ2004 and YX10, in ORF 3c/E (97%), 5a (96%), 5b (99%) and N (96%), respectively. ORFs 3a, 3b and M of CK/CH/SD09/005 exhibited no more than 90% homology with the reference strains, excluding GX-NN09032. The phylogenic analysis based on the S1 gene revealed that CK/CH/SD09/005 and 39 published strains were classified into seven clades (genotypes). CK/CH/SD09/005 was distributed in clade IV with several isolates collected between 2007 and 2012. CK/CH/SD09/005 showed 66% - 69% and 72% - 81% nucleotide identities with the IBV strains of other six clades in the S1 and S2 subunits, respectively. More over, multiple substitutions were found throughout the entire S gene of CK/CH/SD09/005, while insertions and deletions were located within the S1 gene. These results indicated that CK/CH/SD09/005 is a novel variant that may be derived from the QX-like strains that are prevalent in China. Multiple genetic mechanisms, including recombinations, mutations, insertions and deletions, are likely to have contributed to the emergence of this IBV strain.

Biological characteristics of three Newcastle disease virus isolates and entire genome sequences analysis / 病毒学报

Three Newcastle disease virus (NDV) strains recovered from ND outbreaks in chickens and duck flocks in north china during 2009 to 2011 were completely sequenced and biologically characterized. All the strains were velogenic and had the velogenic motif 112R-R-Q-K-R-F117 which was consistent with the results of biological tests. Analysis of the variable region (nucleotide 47 to 420) of the F gene indicated that the three isolates belonged to genotype VII d. Cross hemagglutination inhibition test indicated that the antigen homology between three isolates and LaSota were 82.5%-89.4%, the homology between the two isolates from chicken was 90%. A cross-protection experiment in which specific-pathogen-free chickens vaccinated with LaSota were challenged by SDLY01 isolate showed that LaSota vaccine could provide complete protection against SDLY01, however virus discharge could be detected on fifth day. Challenge experiment in which Cherry Valley duck of 30 day old challenged with SD03 strain indicated that cherry valley duck had no disease in experiment period, but virus discharge could be detected from Larynx and cloaca until fifth day. Genome length of three NDV isolates was 15192bp and belonged to genotype VII d. Sequence analysis clarified that the whole genomic sequence of these three isolates shared high homology with NDV virus strains isolated from goose and duck over the same period, which elucidated that NDV isolated from goose, duck or chicken had close genetics and epidemiological relationship.