Comparison of calf muscle architecture between Asian children with spastic cerebral palsy and typically developing peers.

OBJECTIVE: To compare the muscle thickness, fascicle length, and pennation angle of the gastrocnemius, soleus, and tibialis anterior between Asian children with spastic cerebral palsy (CP) and typically developing (TD) peers. METHODS: This cross-sectional study involved a total of 72 children with hemiplegic CP (n = 24), and diplegic CP (n = 24) and their TD peers (n = 24). Muscle architecture was measured at rest using ultrasound. Clinical measures included gross motor function and a modified Ashworth scale. RESULTS: The thicknesses of the tibialis anterior and medial gastrocnemius muscles were smaller in the affected calf of children with CP (p<0.05) than in those of their TD peers. Additionally, the lengths of the lateral gastrocnemius and soleus fascicle were shorter (p<0.05) in children with diplegic CP than in their TD peers. The fascicle length was shorter in the affected calf of children with CP (p<0.05) than in the calves of their TD peers or the unaffected calf of children with hemiplegic CP. However, the length of the lateral gastrocnemius fascicle was similar between the two legs of children with hemiplegic CP. The pennation angles of the medial gastrocnemius and soleus muscles were larger (p<0.05) in the affected calf in children with hemiplegic CP than in the calves of their TD peers. The fascicle length of the lateral gastrocnemius and the thickness of the soleus muscle were positively correlated with gross motor function scores in children with CP (p<0.05). CONCLUSIONS: Muscle thickness and fascicle length were lower in the affected tibialis anterior, gastrocnemius, and soleus in children with spastic CP. These changes may limit the ability to stand and walk, and indicate a need to strengthen the affected muscle.

[An ultrasonographic study of the correlation between developmental dysplasia of the hip and congenital muscular torticollis in children].

OBJECTIVE: To investigate the significance of early screening of pediatric developmental dysplasia of the hip (DDH) and congenital muscular torticollis (CMT) using ultrasonography and establish a simultaneous screening model for pediatric DDH and CMT. METHODS: From January, 2013 to January, 2016, a total of 5060 pediatric patients with suspected DDH and CMT underwent ultrasonic examinations. The diagnostic results of the two diseases were classified into different clinical types, and Chi-square test was used to analyze the one-way relationship between different types of DDH and CMT; correspondence analysis was used for multivariate analysis of the variables. Chi-square test was used to analyze the difference between the detection rates in suspected CMT patients and the normal population. RESULTS: GrafIIa type DDH was associated with mass-type CMT in the children (χ2=331.800, P<0.001). DDH of GrafIIb, GrafIIc, Graf III, and Graf IV types were related with non-tumor type of CMT. The children with a suspected diagnosis of CMT showed a significantly higher detection rate of DDH than the normal subjects (χ2=321.889, P<0.001). CONCLUSION: DDH is closely related with CMT. Early simultaneous screening of DDH and CMT can help to improve the early diagnosis rate of CMT in children.

Hemodynamics as Measured With Color Doppler Sonography in Early-Stage Obesity-Related Nephropathy in Children.

OBJECTIVES: We retrospectively studied hemodynamic changes in the interlobar artery to assess the clinical value of color Doppler sonography for detecting preclinical obesity-related nephropathy. METHODS: Color Doppler renal sonography was performed in 52 children with obesity-related nephropathy and 51 control children with simple obesity. The interlobar artery resistive index (RI) was measured and compared with clinical data and laboratory indicators. RESULTS: The left RI (mean ± SD, 0.65 ± 0.05 versus 0.60 ± 0.08; t = 3.85), right RI (0.64 ± 0.03 versus 0.59 ± 0.02; t = 10.00), and mean RI (0.64 ± 0.05 versus 0.59 ± 0.06; t = 5.00) revealed large statistically significant increases in the obesity-related nephropathy group (all P < .01). In the obesity-related nephropathy group, a positive correlation was found between the mean RI and 24-hour urine trace albumin (r = 0.47; P < .01), triglycerides (r = 0.98; P < .01), and body mass index (r = 0.28; P < .05). The 24-hour urine trace albumin and triglycerides were higher in the obesity-related nephropathy group than the control group (P < .05). In the control group, a mild positive correlation was also found between the mean RI and body mass index (r = 0.24; P < .05). CONCLUSIONS: Color Doppler sonography successfully indicated renal hemodynamic changes and has diagnostic value for early-stage obesity-related nephropathy.

Quantitative dynamic contrast-enhanced magnetic resonance imaging in a VX2 rabbit liver tumour model using different gadolinium-based contrast agents: comparison of DCE-MRI quantitative results between Magnevist and Eovist.

Quantitative dynamic contrast enhanced MRI (DCE-MRI) can offer information related to tumour perfusion and permeability (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve) and distribution volume (Vd). Different types of gadolinium-based contrast agents (GBCAs) may traverse the vascular wall with different velocities owing to their physicochemical characteristics. The purpose of this article was to compare the DCE-MRI quantitative results (Ktrans, Kep, Ve and Vd) between Magnevist and Eovist in a VX2 rabbit liver tumour model. Sixteen rabbits (body weight, 3 Kg; random gender) containing implanted hepatic VX2 carcinomas were randomly divided into two groups based on the regimen of MRI contrast agent administered, eight rabbits in each group. All rabbits underwent a liver DCE-MRscan before tumour transplantation. Fourteen days after tumour transplantation, the eight rabbits in Group A (Magnevist group) underwent a liver DCE-MR scan in a 3.0 T Magnetom Verio MR scanner (Siemens Healthcare, AD, Germany) after the administration of Magnevist at the flow rate of 1 ml s-1. The Group B rabbits underwent the same scan except for the administration of Eovist at the same flow rate. Twenty-four hours after the initial DCE-MRI, repeat DCE-MRI was performed with the cross-over GBCA at the same flow rate in each group. Every rabbit received 0.6 ml GBCA (0.2 ml Kg-1) during each DCE-MRI. Ktrans, Kep, Ve and Vd were measured in the tumour lesion and compared with normal liver tissue in the same slice. A pathologic examination was also performed. Hepatocellular carcinoma was diagnosed in all 16 rabbits by pathologic examination. There were no significant differences in Ktrans, Ve, Kep and Vd between the two groups of rabbits (p > 0.05). The Ktrans, Ve, Kep and Vd of the VX2 rabbit liver tumour model were significantly higher than the normal liver parenchyma (0.742 ± 0.086 vs 0.027 ± 0.002, 7.345 ± 0.043 vs 6.721 ± 0.035, 0.101 ± 0.005 vs 0.101 ± 0.005, 0.419 ± 0.083 vs 0.037 ± 0.005, respectively; p < 0.01). The Ktrans, Ve and Vd of Eovist group were significantly higher compared with the values in the Magnevist group (0.116 ± 0.016 vs 0.010 ± 0.002, respectively, p < 0.01; 0.101 ± 0.005 vs 0.004 ± 0.0009, respectively, p < 0.01; 0.419 ± 0.083 vs 0.037 ± 0.005, respectively, p < 0.001). There was no significant difference in Kep between the Eovist and Magnevist groups (7.345 ± 0.043 vs 6.721 ± 0.035, respectively; p > 0.05). In the VX2 rabbit liver tumour model, DCE-MRI performed with different types of GBCA can develop different quantitative results with respect to Ktrans, Ve and Vd. The liver-specific GBCA, Eovist, is more sensitive than the general GBCA, Magnevist, in detecting tumour perfusion and permeability.

Comparison of 2 Dosages of Stretching Treatment in Infants with Congenital Muscular Torticollis: A Randomized Trial.

OBJECTIVE: To compare the short-term efficacy of 2 dosages of stretching treatment on the clinical outcomes in infants with congenital muscular torticollis. DESIGN: This was a prospective randomized controlled study. Fifty infants with congenital muscular torticollis who were randomly assigned to 100-times stretching group and 50-times stretching group received stretching treatment for the affected sternocleidomastoid muscle. The outcomes including the head tilt, the cervical passive range of motion, and the muscle function of cervical lateral flexors determined by the muscle function scale were assessed at baseline and at 4 and 8 weeks after treatment. The sternocleidomastoid muscle growth analyzed by the thickness ratio of sternocleidomastoid muscles was measured using ultrasonography at baseline and 8 weeks after treatment. RESULTS: Except the ratio of muscle function scale scores, the postintervention outcomes were all significantly improved in both groups compared with baseline (P < 0.05). The 100-times stretching group showed greater improvement compared with 50-times stretching group in head tilt and cervical passive range of motion at 4 and 8 weeks after treatment (P < 0.05). CONCLUSIONS: Stretching treatment of 2 dosages may effectively improve head tilt, cervical passive range of motion, and sternocleidomastoid muscle growth in infants with congenital muscular torticollis. The stretching treatment of 100 times per day is likely to associate with greater improvement in head tilt and cervical passive range of motion.

[Evaluation of neonatal hypoxic-ischemic encephalopathy by ultrasound measurement of the hemodynamics in the central branches of the middle cerebral artery].

OBJECTIVE: To evaluate the hemodynamic changes in the central branches of the middle cerebral artery in different stages of neonatal hypoxic-ischemic encephalopathy (HIE) and provide new evidence for clinical diagnosis of HIE. METHODS: From March, 2013 to July, 2013, a total of 136 newborn infants were diagnosed to have HIE in our center. We performed two-dimensional ultrasonography and color Doppler ultrasound for assessments of systolic velocity (Vs) and resistant index (RI) of the central branches of the middle cerebral artery. The data were compared with the results of a control group consisting of 251 normal full-term infants. RESULTS: Infants with mild HIE showed hyperechoic changes in the white matter around the ventricle, while in moderate and severe HIE, such hyperechoic changes were diffuse in both hemispheres with unclear echoes of the brain structures. Pulse Doppler assessments of hemodynamics of the central branches of the middle cerebral artery demonstrated a significant decrease in Vs and an increase in RI regardless of HIE severity (P<0.05). In addition, Vs and RI values in mild HIE infants differed significantly (P<0.05) from those in infants with moderate and severe HIE, who had comparable Vs and RI values (P>0.05). CONCLUSION: Transcranial ultrasonography may provide dynamic information on cerebral blood flow in neonates and hemodynamic parameters of the central branches of the middle cerebral artery are valuable for clinical diagnosis and early intervention of HIE.

Independent risk factors for morphological abnormalities of the internal carotid artery.

PURPOSE: Whether carotid abnormalities (CAs) are congenital or acquired, and whether they are risk factors for cerebrovascular diseases or medical curiosities, is still under debate. The aim of this study was to identify the independent risk factors for CAs. METHODS: In this study, subjects (aged 3 days to 102 years) were divided into nine age groups, divided by 10-year intervals. The observed CAs were prospectively classified, according to the nature of the abnormality. Analyses of the factors associated with CAs were performed by univariate and multivariate logistic regression models. RESUITS: Of the 1,838 internal carotid arteries studied, 552 had CA (30%). There were peaks in the prevalence of CA in the 0-9-year-old group and in the above 80 years group; the lowest rate was found among the subjects in the 20-39-year-old group. The significant predictors of CA were age (OR 1.986, in the60-69-year-old group; OR 2.283, in the 70-79-year-old group; and OR 3.566, in the > 80-year-old group vs the 40-49-year-old group reference group), female gender (OR 1.799), hypertension (OR 1.52), and carotid artery atherosclerosis (OR3.176). CAs in youngersubjects were also associated with age (OR 9.894 in the 0-9-year-old group; and OR 3.294 in the 10-19-year-old group vs the 30-39-year-old group reference group). CONCLUSIONS: Both congenital and acquired factors may be involved in CAs. In subjects> or = 40years old, CAs seem to be more associated with acquired factors, including ageing, gender, hypertension, and atherosclerosis.

[Ultrasonography and magnetic resonance imaging for diagnosis of neonatal agenesis of the corpus callosum: a comparative study].

OBJECTIVE: To summarize the ultrasonography features of neonate corpus callosum agenesis for better diagnosis of this condition. METHODS: A total of 8563 neonates were screened by cerebral ultrasound in neonate care unit of our hospital from June 2010 to December 2012, and 37 cases of agenesis of the corpus callosum were identified. The diagnostic accuracy of ultrasonography and magnetic resonance imaging (MRI) for this condition was evaluated. RESULTS: The sensitivity, specificity, and accuracy of ultrasound diagnosis for complete and incomplete absence of neonate corpus callosum were 100% and 90%, 90.9% and 94.1%, 94.6% and 91.9% in the 37 cases, respectively. The Kappa value of ultrasonography and MRI were 0.890 and 0.837, with a consistent rate of 91%. CONCLUSION: Ultrasonography and MRI show a high consistency in the diagnosis of neonatal agenesis of the corpus callosum.

Objective differential characteristics of cystic biliary atresia and choledochal cysts in neonates and young infants: sonographic findings.

OBJECTIVES: To prospectively evaluate the objective differential characteristics between cystic biliary atresia and choledochal cysts on sonography among neonates and young infants. METHODS: Twenty-three patients who had sonographic findings of a portal cyst and a final diagnosis were included. Their final diagnoses were cystic biliary atresia in 12 patients and choledochal cysts in 11. All of them underwent detailed sonographic scanning. Data for cystic biliary atresia and choledochal cyst groups were compared by the χ(2) test for categorical variables and an unpaired t test for continuous variables. RESULTS: The triangular cord sign was detected in 11 patients in the atresia group but in none in the cyst group (P < .001). Nine of 11 patients in the cyst group had dilatation of intrahepatic bile ducts, whereas none in the atresia group had that feature (P < .001). Sonography also showed sludge deposits in the cysts in 6 of 11 patients in the cyst group, whereas none in the atresia group had sludge deposits (P = .005). The mean width and length of the cysts in the cyst group were significantly larger than those in the atresia group (P< .05 for both). The mean hepatic artery diameter was significantly larger in the atresia group than in the cyst group (P < .001). The difference in gallbladder abnormalities between the atresia (n = 11) and cyst (n = 0) groups was also significant (P < .001). When all specific sonographic features were used, all patients were correctly classified into the atresia and cyst groups. CONCLUSIONS: The triangular cord sign, intrahepatic bile duct dilatation, and echoic cysts might be regarded as objective sonographic features for differentiating cystic biliary atresia and choledochal cysts. Other sonographic features might be very supportive.