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To establish and validate a nomogram for predicting lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) in the cervical central region. This retrospective study included 287 PTC patients with 309 nodules treated from December 2018 to May 2020 at our hospital. The cohort was divided randomly into a training set and a testing set according to a 7:3 ratio. The training set contained 216 nodules, and the testing set contained 93 nodules. The nomogram was developed using the training set, and the data of the testing set were used to validate the performance of nomogram. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index) and calibration curve. The study showed multifocality, thyroid lesion size, and American College of Radiology Thyroid Imaging, Reporting and Data System (TI-RADS) score were significantly independently associated with LNM in the cervical central region. In the testing set, the calibration curve showed that the nomogram had good discrimination with a C-index of 0.775 (95% confidence interval, 0.680-0.869) and adequate calibration (P = 0.808). By decision curve analysis and clinical impact curve analysis, the nomogram was shown to have a satisfactory net benefit between thresholds of 0.40 and 0.75. The nomogram can be used for predicting LNM of PTC in the cervical central region and may provide valuable guidance for planning the surgical treatment of PTC patients.

To estimate the value of gynecologic imaging reporting and data system (GI-RADS) combined with 3-dimensional contrast-enhanced ultrasound (3D-CEUS) scoring system in the differential diagnosis of ovarian tumor. Both of 2-dimensional ultrasound (2D-US) and 3D-CEUS were performed on 114 patients with ovarian masses by Voluson E8 with SonoVue (Bracco, Italy). Besides, dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) (Siemens Magneton Verio 3.0T, Germany) was performed on the patients. There were totally 62 benign and 52 malignant ovarian tumors in all patients. The ability of GI-RADS combined with 3D-CEUS scoring system to distinguish benign and malignant ovarian tumors was superior to conventional ultrasound GI-RADS classification. The sensitivity, specificity, and accuracy of GI-RADS combined with 3D-CEUS scoring system were 96.2% and 98.1%, 87.10%, whereas those of MRI were 87.10%, 91.23%, and 92.11% respectively, indicating that there was high concordance in ovarian tumors assessment between the 2 diagnostic methods. The new scoring system has a good correlation with microvessel density (P = 0.000, r = 0.73), estrogen receptor (P = 0.000, r = 0.59), progesterone receptor (P = 0.000, r = 0.56), and matrix metalloproteinase-9 (P = 0.000, r = 0.61). The GI-RADS combined with 3D-CEUS scoring system was valuable in clinical diagnosis and differential diagnosis of ovarian tumor and show good agreement with MRI.

To assess the diagnostic performance of quantitative parameters for virtual touch tissue imaging quantification by the mechanical arm probe, 128 women with 152 breast lesions (90 benign and 62 malignant) were included and maximum elasticity (Vmax), median elasticity (Vmean), maximum elasticity minus minimum (Vmax-min), and minimum elasticity (Vmin) were measured. Intercorrelation coefficients and Bland-Altman plots were used to compare the repeatability and consistency of handheld probe and mechanical arm measurements. Receiver operating characteristic curve was used to evaluate the diagnostic efficiency. The results showed that intercorrelation coefficients were 0.694 to 0.951 by the mechanical arm and 95% limits of agreement were wider than handheld probe. Using 4.36 m/s as cutoff value for Vmax by the mechanical arm, we achieved sensitivity (88.7%) and specificity (90.0%). We concluded that the mechanical arm can reduce the influence of different scanning pressures on the elastic modulus of breast tissue.

The aim of the work described here was to investigate the value of point-of-care ultrasound (POCUS) in the early assessment of the severity of pulmonary edema in rabbits. A rabbit oleic acid (OA)-induced pulmonary edema model was used. Thirty-two New Zealand rabbits were randomly divided into four groups: a control group and three pulmonary edema groups (mild, moderate and severe). Features of transthoracic B-line artifacts (BLA), blood pH, PaO2 and PaCO2, serum inflammatory factors, lung coefficient (LC), lung wet-to-dry weight ratio (W/D) and lung histopathology were assessed. BLA features and severity of pulmonary edema were semiquantitatively scored. Correlations between the number of BLA and PaO2, PaCO2, serum inflammatory factors, LC and W/D were analyzed. An additional 8 rabbits with severe pulmonary edema were used as the verified group, in which the lung was divided into ex vivo BLA (BLA-ev)-free (BLA-ev-free) and BLA-ev-clustered subregions depending on the features of BLA-ev recorded by ex vivo lung ultrasound. Lung specimens from each subregion were collected for histopathological examination. Relationships between features of BLA-ev and lung histopathological abnormalities were analyzed. With increasing doses of OA, number of BLA, W/D and levels of serum inflammatory factors decreased. Meanwhile, lung pathologic abnormalities were aggravated. In addition, time of appearance of BLA, blood pH and PaO2, and PaCO2 decreased dose dependently on OA (p

To investigate the clinical significance of prenatal diagnosis and prognostic evaluation of fetal intestinal malrotation with midgut volvulus via ultrasonography.Ultrasonographic findings and clinical outcomes of fetal intestinal malrotation with midgut volvulus prenatally diagnosed via ultrasound at the Zhangzhou Hospital Affiliated of Fujian Medical University from January 2013 to May 2020 were summarised and analyzed.Eleven cases of fetal intestinal malrotation with midgut volvulus were accurately prenatally diagnosed according to the specific ultrasound signs, such as 'whirlpool sign' and 'twining sign'. Indirect and nonspecific ultrasonographic signs included ascites in four cases and echogenic bowel in nine, all of which were accompanied by intestinal dilatation at various degrees. Among all cases, two were complicated with other system abnormalities, and one had a chromosome abnormality. Three pregnant women chose termination of pregnancy, and eight neonates were transferred to the pediatric department for surgery after obtaining written informed consent. An accurate prenatal diagnosis was confirmed postoperatively, and the fetus recovered well postoperatively.S: : Fetal intestinal malrotation with midgut volvulus has typical sonographic features, and ultrasonography is the method of choice for prenatal diagnosis of this disease. Fetal intestinal malrotation with midgut volvulus is a non-fatal congenital malformation that can be treated. Prenatal diagnosis is essential for early postnatal treatment, and early surgery can often obtain good efficacy and prognosis.

Objective: To evaluate the efficacy of ultrasound-guided intra-articular injection of triptolide-loaded solid lipid nanoparticle (TP-SLN) for treatment of antigen-induced arthritis (AIA) in rabbits. Material and Methods: Knee joints of 33 New Zealand rabbits with AIA were injected intra-articularly with triptolide (TP: n = 7), TP-SLN (n = 7), betamethasone (BS: n = 7) and dimethyl sulfoxide (DMSO: n = 6). The remaining six rabbits were untreated as the control group. The injection therapy in intervention groups was initiated 1 week after the last immunization in order to avoid irreversible joint damage in the later induction. The ultrasonic scores of the joints were assessed based on synovitis, synovial blood flow and bone erosion. Meanwhile, the correlations of ultrasonic scores and pathological scores were determined. The efficacy and side effects of each group were determined by combining ultrasonic scores, pathological scores, behavior, appetite, weight, joint diameter, skin temperature and biochemical examination.Results: 1) Compared with the control group, the diameters of knee joints of the TP, TP-SLN and BS groups began to reduce 1 week after intra-articular injection (p < 0.01). 2) With the exception of the DMSO group, the interventions were effective in treating synovitis compared with the control group, with TP-SLN and BS being the best. The ultrasonic and pathological scores in synovitis of the TP group were lower than that of model group (Z = -2.726 and -2.530, p < 0.05). The ultrasonic scores differed significantly between BS group and TP-SLN group (Z = −2.17 and -2.360, respectively, p < 0.05) and pathological scores (Z = −2.687 and −2.082, respectively, p < 0.05). 3) Compared with the control group, the TP, BS and TP-SLN were all effective in treating synovial blood flow and bone erosion and there were no significant differences of ultrasonic and pathological scores among them (p > 0.05). The ultrasonic scores of synovial blood flow (Z = −3.033, −2.842, −3.277, p < 0.01) were lower than in the controls. The ultrasonic scores (Z = -2.948, -3.141, -3.210, p < 0.01) and pathological scores (Z = −2.216, −2.505, −2.505, p < 0.05) of bone erosion were also lower than in the model group.4) There were significant correlations between the ultrasonic and pathological scores of synovial inflammation and bone erosion (r = 0.832 and 0.859 respectively, p < 0.001).Conclusions: The therapeutic effect of TP-SLN on arthritis is better than that of TP, but there is no difference between BS and TP-SLN. Therefore, TP-SLN may be used as an alternative to BS in the treatment of rheumatoid arthritis in the future. The ultrasonic and pathological scores showed significant correlation in synovitis and bone erosion. Ultrasound can provide a useful assessment of synovitis in early arthritis.

In the process of prenatal ultrasound diagnosis, accurate identification of fetal facial ultrasound standard plane (FFUSP) is essential for accurate facial deformity detection and disease screening, such as cleft lip and palate detection and Down syndrome screening check. However, the traditional method of obtaining standard planes is manual screening by doctors. Due to different levels of doctors, this method often leads to large errors in the results. Therefore, in this study, we propose a texture feature fusion method (LH-SVM) for automatic recognition and classification of FFUSP. First, extract image’s texture features, including Local Binary Pattern (LBP) and Histogram of Oriented Gradient (HOG), then perform feature fusion, and finally adopt Support Vector Machine (SVM) for predictive classification. In our study, we used fetal facial ultrasound images from 20 to 24 weeks of gestation as experimental data for a total of 943 standard plane images (221 ocular axial planes, 298 median sagittal planes, 424 nasolabial coronal planes, and 350 nonstandard planes, OAP, MSP, NCP, N-SP). Based on this data set, we performed five-fold cross-validation. The final test results show that the accuracy rate of the proposed method for FFUSP classification is 94.67%, the average precision rate is 94.27%, the average recall rate is 93.88%, and the average F 1 score is 94.08%. The experimental results indicate that the texture feature fusion method can effectively predict and classify FFUSP, which provides an essential basis for clinical research on the automatic detection method of FFUSP.

To distinguish malignant cervical lymphadenopathy, we established a new scoring system based on ultrasound features. Two hundred sixty-three patients with cervical lymphadenopathy received ultrasonic examination and underwent ultrasound-guided core needle biopsy or fine needle aspiration. The scoring system was proposed by multivariate logistic regression analysis and compared with Liao scoring system (0.06 × age + 4.76 × shortest-to-longest axis ratio + 2.15 × internal echo + 1.80 × vascular pattern). A new scoring system model, 1.346 × margin + 1.339 × hilum + 2.411 × calcification + 2.619 × vascular pattern + 0.837 × shortest-to-longest axis ratio, was generated. Lymph nodes were regarded as malignancy when the score was ≥2.4. Compared with the Liao scoring system, the new scoring system had larger area under the curve (0.86 versus 0.76, P = 0.036), specificity (86.7% versus 75.0%, P = 0.001), accuracy (87.1% versus 80.6%, P = 0.007), and positive predictive value (89.0% versus 80.0%, P = 0.043). Sensitivity (87.4% versus 85.3%, P = 0.647) and negative predictive value (85.0% versus 81.0%, P = 0.395) did not differ. We concluded that the new scoring system is more reliable and can play an important role in the differential diagnosis of cervical lymph nodes.

Ultrasound is one of the critical methods for diagnosis and treatment in thyroid examination. In clinical application, many reasons, such as large outpatient traffic, time-consuming training of sonographers, and uneven professional level of physicians, often cause irregularities during the ultrasonic examination, leading to misdiagnosis or missed diagnosis. In order to standardize the thyroid ultrasound examination process, this paper proposes using a deep learning method based on residual network to recognize the Thyroid Ultrasound Standard Plane (TUSP). At first, referring to multiple relevant guidelines, eight TUSP were determined with the advice of clinical ultrasound experts. A total of 5,500 TUSP images of 8 categories were collected with the approval and review of the Ethics Committee and the patient’s informed consent. Then, after desensitizing and filling the images, the 18-layer residual network model (ResNet-18) was trained for TUSP image recognition, and five-fold cross-validation was performed. Finally, through indicators like accuracy rate, we compared the recognition effect of other mainstream deep convolutional neural network models. Experimental results showed that ResNet-18 has the best recognition effect on TUSP images with an average accuracy rate of 91.07%. The average macro precision, average macro recall, and average macro F1-score are 91.39%, 91.34%, and 91.30%, respectively. It proves that the deep learning method based on residual network can effectively recognize TUSP images, which is expected to standardize clinical thyroid ultrasound examination and reduce misdiagnosis and missed diagnosis.

Background Carpal tunnel syndrome (CTS) is the most common entrapment symptom in the peripheral nerves. High-frequency ultrasound (HFUS) is widely used in the diagnosis of CTS. Virtual Touch Tissue Imaging and Quantification (VTIQ), which provides more information about the hardness of organization, is used to diagnose CTS. However, the data of diagnostic value of them in various degrees of CTS are limited. Whether the combination of HFUS and VTIQ can improve the diagnostic efficiency also remains unknown. The study aimed to explore the diagnostic value of HFUS and VTIQ in various degrees of CTS and whether combination of HFUS and VTIQ could improve the diagnostic efficiency of CTS. Methods A collection and analysis of 133 CTS patients and 35 volunteers from January 2016 to January 2019 were performed. We compared the clinical characteristics, cross-sectional area (CSA) value and shear wave velocity SWVmean value of CTS group with volunteer group. Results The CSA value and SWVmean value of CTS cohort were significantly higher than volunteer group (10.79 ± 2.88 vs. 8.06 ± 1.39, p p < 0.001, respectively). The area under the curve (AUC) of receiver operating characteristic (ROC) curve of CSA value and SWVmean value were 0.794 and 0.757, respectively. Hierarchical analysis of CSA value and SWVmean value showed that the AUC in the moderate and severe CTS group were higher than in mild CTS group. Furthermore, the CSA value combined with SWVmean value used to diagnose mild CTS was 0.758, which was higher than that of single CSA value or single SWVmean value. Conclusions Both HFUS and VTIQ technology were feasible to evaluate CTS. HFUS was suitable for use in diagnosis of moderate and severe CTS. For mild CTS, combination of HFUS and VTIQ was relevant to improve the diagnostic efficiency of CTS.

Objectives To investigate the applicability and value of ultrasound (US) in the diagnosis of anorectal atresia. Methods Between January 2008 and January 2016, we prospectively evaluated 63,101 fetuses (gestational age, 20-38 weeks), including low- and high-risk populations using 2-dimensional US scans. An abnormal imaging finding was defined as an anal canal diameter of less than the 95% confidence interval (small anal canal) of the normal range or the absence of an anal canal and rectum. Imaging findings were considered normal on detection of an anal canal with a normal width and the absence of abnormalities. Prenatal imaging findings were confirmed by a postnatal or postmortem examination. Results Among the investigated fetuses, 28 showed evidence of anorectal atresia on US scans, and 22 of those with anorectal atresia had additional anomalies. Six cases of isolated anorectal atresia were successfully detected during the preclusive prenatal US scans. Four cases of a low imperforate anus (including 2 covered anuses) yielded false-negative results, indicating a diagnostic rate of 87.5% (28 of 32). The normal appearance of the fetal rectum and anal canal ruled out anorectal atresia in 30 fetuses with a dilated colon. Additionally, there were 3 false-positive cases, in which a narrow anal canal was observed. Conclusions Identifying the abnormal appearance or absence of the fetal anal canal and rectum on preclusive US anomaly scans is useful for prenatal diagnosis or exclusion of anorectal atresia, which may help improve the detection of isolated anorectal atresia. Furthermore, a combined evaluation of the longitudinal and axial appearances of the fetal anal canal and rectum can improve diagnostic accuracy.

The present study was aimed to compare application of contrast enhanced ultrasound (CEUS) in diagnosis of endometrial carcinoma (EC) and endometrial hyperplasia (EH). A total of 81 patients with EC and simple EH were selected in this study. Among all patients, 39 cases were diagnosed as EC and 42 cases were diagnosed with EH. All patients were diagnosed by CEUS examination. The diagnosis of EC and EH was also confirmed by endometrial biopsy. CEUS was conducted for all patients. Eendometrial thickness was measured and the mean arrival time, time-to-peak, enhancement time, arrival intensity, peak intensity, enhancement intensity, rising rate, washout half-time and clearance half-time were recorded. Myometrial invasion was categorized into 2 stages 50%. No significant difference was observed in clinical basis between the two groups. Endometrial thickness of EC was significantly higher than that of EH, P50%. The total diagnostic accuracy of CEUS is 82.62% (33/39). We conducted a comparison study to analyze different diagnostic effects of CEUS for EC and EH. The study may give more clinical basic data in the field of CEUS application in diagnosis of EC and can give a reference to the difference between EC and EH.

Objectives The purpose of this study was to use transcranial 2- and 3-dimensional sonography with the Virtual Organ computer-aided analysis (GE Healthcare, Milwaukee, WI) technique to observe the morphologic characteristics of the hippocampal formation and to analyze its correlation with the corrected gestational age. Methods Transcranial sonography was performed from the sagittal plane of the anterior fontanel to the sagittal plane of the posterior horn of the lateral ventricle. The morphologic characteristics of the hippocampal formation in 183 singleton neonates with a corrected gestational age of 32 to 43 weeks were observed. The long diameter, short diameter, area, and perimeter of the hippocampal formation were all quantitatively measured. The volume of the hippocampal formation was measured by 3-dimensional sonography using the Virtual Organ computer-aided analysis technique. The correlation between the corrected gestational age and each parameter was analyzed. Results The display rate of the hippocampal formation was 100% in the neonates with a typical hippocampus shape. In healthy neonates with a corrected gestational age of 32 to 43 weeks, the long and short diameters, area, perimeter, and volume of the hippocampal formation were all positively correlated with the gestational age. Conclusions Transcranial sonography could be used as a conventional approach for evaluation of the development of the hippocampal formation in neonates.

The aim of the current study was to investigate the importance of strain elastography (SE) in the differential diagnosis of benign and malignant soft tissue masses. SE was adopted to examine 61 patients with superficial masses, classify their elastic scores and assess their strain ratios (SRs) between the masses and the surrounding structures. Significantly increased SR values and elastic scores were observed in the malignant masses compared with the benign masses (5.42±3.47 vs. 1.80±2.10, P2.295 as the optimal threshold value, the sensitivity, specificity and positive and negative predictive values for diagnosing a malignant mass were 93.8, 80.5, 65.2 and 97.1%, respectively; whilst using an elastic score of ≥3 as the optimal threshold value, the sensitivity, specificity and positive and negative predictive values for diagnosing a malignant mass were 100, 51.6, 51.6 and 100%, respectively. SR values and elastic scores were significantly different between the malignant and benign soft tissue masses. Therefore, SE may be used to effectively differentiate between malignant and benign soft tissue masses.

Objective This study aimed to examine the associations between contrast-enhanced ultrasound (CEUS) imaging and synovial hypervascularity and synovitis score in a rabbit model of antigen-induced arthritis (AIA), compared with power Doppler ultrasound (PDUS). Methods We investigated 50 knee joints in 25 AIA rabbits (AIA group), and 10 knee joints in five sham-injected rabbits (control group). PDUS and CEUS images were evaluated at the 8th week. Ultrasound-guided synovial biopsies were targeted in the area with hypervascularity, and synovial microvessel density (MVD) was evaluated by immunohistochemical staining of CD31. Results The PDUS score was significantly higher in the AIA group (2.61 ± 0.78) compared with the control group (0.50 ± 0.53). CEUS in the AIA group revealed a fast-in/slow-out pattern of contrast enhancement. MVD revealed by CD31+ vessel count and the synovitis score were significantly higher in the AIA group compared with the control group. In the AIA group, CEUS findings showed a better correlation with MVD revealed by CD31+ and synovitis score than PDUS findings. Conclusion CEUS is superior to PDUS for estimating synovial hypervascularity and hyperplasia in experimental rheumatoid arthritis.

To discriminate between malignant and benign liver lesions, we evaluated the ultrasound features of the target lesions in 266 patients and established a prediction model using a logistic regression algorithm. The prediction model based on independent factors was expressed as predictive score = 1.129 × interaction of irregular shape and unclear boundary + 1.398 × occupying effect + 2.363 × hypo-echoic halo + 1.987 × marginal vascular sign + 3.627 × cirrhosis background + 2.976 × nodule in nodule sign + 3.690 × metastasis sign. Receiver operating characteristic curve analysis revealed that the optimal cutoff predictive score was 2.8 (area under the curve = 0.942). The specificity of the prediction model was not significantly different from that of computed tomography/magnetic resonance imaging (91.7% vs. 98.8%, p = 0.077), whereas the prediction model had a lower sensitivity (90.1% vs. 97.8%, p0.001) and accuracy (90.6% vs. 98.1%, p0.001) than computed tomography/magnetic resonance imaging. We conclude that the ultrasound prediction model exhibited good diagnostic performance in discriminating malignant from benign liver lesions.

OBJECTIVE This study aimed to discuss clinical application value of contrast-enhanced ultrasonography on lesion skeletal muscle microcirculation and arterial perfusion reserve in type 2 diabetes mellitus and complicated microvessels. METHODS Patients in the control group, type 2 diabetes mellitus (DM) group, diabetic microangiopathy (DM + MC) group underwent contrast-enhanced ultrasonography before and after temporary arterial occlusion to observe blood perfusion of gastrocnemius muscle; draw the time-intensity curve of arteriole, muscular tissue, and venule, and obtain perfusion parameters such as contrast agent arrival time and contrast agent transit time. Blood glucose, insulin, insulin resistance index, and relevant blood rheology parameters were measured. RESULTS Contrast agent transit time of the DM + MC group before arterial occlusion was significantly longer than that of the DM group and control group (P < 0.05). Contrast agent transit time of the DM + MC group after temporary arterial occlusion was significantly longer than that of the DM group and control group (P < 0.05). Contrast agent transit time of △artery-muscle, △artery-vein, and △muscle-vein of the DM group and control group and △artery-muscle of the DM + MC group after arterial occlusion was significantly shortened, when compared with that before arterial occlusion (P < 0.05). For △muscle-vein and △artery-vein contrast agent transit time in the DM + MC group, the difference was not statistically significant. By comparing blood glucose, insulin, insulin resistance index, and relevant blood rheology parameters among the DM + MC group, DM group, and control group, the difference was statistically significant, and there was a good correlation. CONCLUSION Contrast-enhanced ultrasonography can be used to evaluate skeletal muscle microcirculation disturbance and arterial reserve function of patients who had type 2 diabetic microangiopathy.

To assess the role of ultrasonography for assessing middle cerebral arteries (MCAs) in rheumatoid arthritis (RA). Middle cerebral arteries of 32 RA patients and 32 healthy volunteers were examined by ultrasonography. Peak systolic blood flow velocity (PSV), end-diastolic velocity, and resistance index (RI) of MCA were measured using Doppler ultrasound. Results were expressed as mean ± SD. No significant difference in peak systolic velocity was obtained between RA patients (52.44 ± 19.56 cm/s) and healthy volunteers (51.59 ± 16.83 cm/s, P > 0.05). End-diastolic velocity in RA patients was significantly lower (15.41 ± 5.44 cm/s vs 24.54 ± 8.45 cm/s, P < 0.01) and RI markedly higher (0.66 ± 0.10 vs 0.60 ± 0.06, P < 0.05) compared with control values. Resistance index in 32 RA patients increased with disease duration (2 months to 31 years), from a median value of 0.350 to 0.830; there was a strong correlation between RI and disease duration (r = 0.965, P < 0.05). A point of 0.64 in receiver operating characteristic curve was chosen as the cutoff point, and the area under the curve was 0.918. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 90.6%, 87.5%,87.9%, 90.3%, and 89.1%, respectively. Color Doppler ultrasound in RA patients with hemodynamic changes of MCAs could be a relatively sensitive tool for the detection of cerebral atherosclerotic lesions. This could enable timely intervention for early clinical reference.

To obtain three-dimensional ultrasonic (3D US) structural details and biometrics of the fetal cerebellar vermis and evaluate the value of developmental and malformation identification. The 3D US minute structure of the fetal cerebellar vermis in mid-sagittal view was detected in normal fetuses (n = 438; 16–41 weeks). Biometric sizes were measured to establish the stage-specific norms and reproducibility analysis. Additionally, 28 fetuses with suspected abnormal posterior fossa contents were assessed to analyze the clinical value. The minute structure of normal fetuses, including cerebellar vermis contours and the fastigial recess of the fourth ventricle, were visible around Week 19. The main lobules and fissures were apparent around Week 22, and all nine lobules, fissures, and the fourth ventricle were clearly displayed by Week 28. Cerebellar vermis biometric sizes (anterior–posterior length, cranio-caudal length, circumference, and surface area (SA)) grew in a linear fashion with high reliability, especially SA measurements (for intraclass, ICC 0.989, 95% CI (0.980–0.994); for interclass, ICC 0.992, 95% CI (0.984–0.996)). On the middle sagittal section of 3D US, the SA reduced at least 50% in the Dandy–Walker group with no recognizable cerebellar vermis structures showing. The SA in vermian hypoplasia malformation reduced during $$\bar{x} - 2{\text{SD}}$$ to 50% with the primary/secondary fissures absent or partly absent and arborization of the lobules reduced. That would be an important diagnosis and antidiastole clue. Combined with minute structural observation, sonographic diagnoses were accurate in 88% of cases. Minute structures obtained by 3D US were clinically useful in the evaluation of cerebellar vermis development and cerebellar vermis malformations.

Chronic prenatal hypoxia is a damaging to fetal development and may have various consequences, including hearing loss. Connexin 26 (Cx26) is one of the major protein subunits required for gap junction formation, and has an important role in maintaining homeostasis in the cochlea and normal hearing. Cx26 mutation and expression abnormality are closely associated with inherited nonsyndromic deafness, but the association between Cx26 and prenatal hypoxia is less established. The present study aimed to examine Cx26 expression and aberrant methylation the Cx26 promoter region in the cochlea from rats exposed to chronic prenatal hypoxia. Hematoxylin and eosin staining demonstrated that the number of hair cells in the organ of Corti were less in the hypoxia group. Reverse transcription‑quantitative polymerase chain reaction and western blot analysis revealed that protein and mRNA levels of Cx26 were decreased in the hypoxia group compared with the control group. Further bisulfite sequencing analysis revealed that prenatal hypoxia significantly increased the methylation status of the promoter region of the Cx26 gene. These results demonstrate that chronic prenatal hypoxia caused hearing impairment, and suggest that promoter region hypermethylation and expression downregulation of Cx26 underlie the mechanism of action.

The purpose of this study was to use transcranial 2- and 3-dimensional sonography with the Virtual Organ computer-aided analysis (GE Healthcare, Milwaukee, WI) technique to observe the morphologic characteristics of the hippocampal formation and to analyze its correlation with the corrected gestational age.Transcranial sonography was performed from the sagittal plane of the anterior fontanel to the sagittal plane of the posterior horn of the lateral ventricle. The morphologic characteristics of the hippocampal formation in 183 singleton neonates with a corrected gestational age of 32 to 43 weeks were observed. The long diameter, short diameter, area, and perimeter of the hippocampal formation were all quantitatively measured. The volume of the hippocampal formation was measured by 3-dimensional sonography using the Virtual Organ computer-aided analysis technique. The correlation between the corrected gestational age and each parameter was analyzed.The display rate of the hippocampal formation was 100% in the neonates with a typical hippocampus shape. In healthy neonates with a corrected gestational age of 32 to 43 weeks, the long and short diameters, area, perimeter, and volume of the hippocampal formation were all positively correlated with the gestational age.Transcranial sonography could be used as a conventional approach for evaluation of the development of the hippocampal formation in neonates.

In order to explore the accuracy of ultrasonic whole stomach cylinder measurement (UWSCM) in the evaluation of gastric emptying, we measured the gastric emptying times (ET) at 25% (T1), 50% (T2) and 75% (T3) of healthy subjects and patients with diabetic gastropathy by UWSCM and scintigraphy. The ET of patients were compared with their clinical symptom scores. We found that the ET measured by UWSCM showed no significant difference with scintigraphy (p > 0.05). The correlation between them was good, and the correlation coefficient of T3 reached 0.744 (p < 0.05). All emptying times in the diabetic patients were longer than those in the healthy subjects (p < 0.05). The T3 in the diabetic group measured by UWSCM had the best correlation with the symptom index (r = 0.469, p < 0.05). We conclude that ET measured by UWSCM is accurate and T3 combining the symptoms index provides an accurate clinical basis for gastropathy.

Aim The aims of this article are to establish three-dimensional ultrasonographic nomograms of normal fetal spleen size and to evaluate the clinical application value. Methods An observational, cross-sectional study was performed on 455 women with a normal singleton pregnancy between 18 and 38 weeks' gestational age (GA). Fetal spleen volume was measured using three-dimensional ultrasound equipped with virtual organ computer-aided analysis, and biometric parameters were assessed in multiplanar mode to create reference ranges to GA. Thirty cases were randomly selected to conduct reliability analyses via intraobserver and interobserver ultrasonographic measurement. Moreover, 50 cases of suspected splenic malformations were evaluated by the newly established nomograms and followed up subsequently. Results Using regression formulas, we found that fetal spleen size increased with GA. We observed strong reliability in intraobserver and interobserver volume measurements with intraclass correlation coefficients of 0.994 and 0.962. Bland–Altman analyses showed narrow limits of agreement [intraobserver: (−3.2 to 3.5)%; interobserver: (−3.2 to 4.3)%]. Of the 50 cases with suspected splenic malformations, six cases of splenomegaly and one case of splenic cyst were diagnosed. Conclusion Three-dimensional ultrasound nomograms of normal fetal spleen size across a range of GA have a strong diagnostic value. Volume measurements with good reliability were optimal in clinical practice. © 2014 John Wiley & Sons, Ltd.

Objective To investigate the correlation between the pulmonary B-line artifact and the severity of the pathologic changes in pulmonary edema. Methods Twenty New Zealand rabbits were randomly divided into the control group (5) and the treatment groups (15) which were injected oleic acid with severe pulmonary edema(0.04 ml/kg). The lung were divided into mild-lesioned area, moderate-lesioned area, and-lesioned area according to the visual observation and examed by ex vivo lung ultrasound. The lung specimens were collected from each subregion for histopathological examination. The relationship among the severity of visual observation lesions, the B-line score and the lung histopathological abnormalities was analyzed. Results The score of the ex vivo B-line and the score of the histopathologic changes of the lung tissue were increased with the increasing degree of the visual observation of the lung tissues (P Conclusions The severity of the pathologic changes in pulmonary edema could be evaluated by the pulmonary B-line artifact. The feature of pulmonary B-line artiface is useful in the semi-quantitative evaluation of pulmonary edema.

Exposure to an adverse intrauterine environment increases the risk for adult metabolic syndrome. However, the influence of prenatal hypoxia on the risk of fatty liver disease in offspring is unclear. The purpose of the present study was to evaluate the role of reduced fetal oxygen on the development and severity of high-fat (HF) diet-induced nonalcoholic fatty liver disease (NAFLD). Based on design implicating 2 factors, ie, maternal hypoxia (MH) and postnatal HF diet, blood lipid and insulin levels, hepatic histology, and potential molecular targets were evaluated in male Sprague Dawley rat offspring. MH associated with postnatal HF diet caused a significant increase in plasma concentration of triglycerides, free fatty acids, low-density lipoprotein cholesterol, and insulin. Histologically, a more severe form of NAFLD with hepatic inflammation, hepatic resident macrophage infiltration, and progression toward nonalcoholic steatohepatitis was observed. The lipid homeostasis changes and insulin resistance caused by MH plus HF were accompanied by a significant down-regulation of insulin receptor substrate 2 (IRS-2), phosphoinositide-3 kinase p110 catalytic subunit, and protein kinase B. In MH rats, insulin-stimulated IRS-2 and protein kinase B (AKT) phosphorylation were significantly blunted as well as insulin suppression of phosphoenolpyruvate carboxykinase and glucose-6-phosphatase. Meanwhile, a significant up-regulation of lipogenic pathways was noticed, including sterol-regulatory element-binding protein-1 and fatty acid synthase in liver. Our results indicate that maternal hypoxia enhances dysmetabolic liver injury in response to an HF diet. Therefore, the offspring born in the context of maternal hypoxia may require special attention and follow-up to prevent the early development of NAFLD.

Objectives To evaluate the influence of congenital heart disease (CHD) or congestive heart failure (CHF) on fetal urine production rate (UPR) and to establish normal reference intervals. Methods A cross-sectional study was performed on normal fetuses (n = 314) and on fetuses with CHD (n = 49). CHD cases were divided into groups on the basis of heart function as defined by Huhta score: with CHF (n = 11) and without CHF (n = 38). Fetal bladder volume was measured by two-dimensional as well as three-dimensional ultrasound with the Virtual Organ Computer-aided Analysis technique. Results In normal fetuses, UPR increased with gestational age from a mean value of 4.5 mL/h at 21 weeks to 66.5 mL/h at 40 weeks. There were no significant differences in UPR between CHD cases without CHF and controls (P = 0.581). However, fetuses with CHF had decreased UPR values (Controls vs. CHF, P = 0.007) compared with the controls. The interobserver and intraobserver variability for assessment of UPR was better using three-dimensional rather than two-dimensional US. Conclusions Fetal UPR can be reproducibly measured by the Virtual Organ Computer-aided Analysis technique. It appears that heart function, rather than CHD, affects fetal UPR. Fetal UPR may therefore be an additional indicator of CHF. © 2012 John Wiley & Sons, Ltd.

Background Recent evidence has demonstrated that cardiac progenitor cells play an essential role in the induction of angiomyogenesis in infarcted myocardium. We and others have shown that engraftment of c-kit+ cardiac stem cells (CSCs) into infarcted hearts led to myocardium regeneration and neovascularization, which was associated with an improvement of ventricular function. The purpose of this study is aimed at investigating the functional role of transcription factor (TF) Oct3/4 in facilitating CSCs to promote myocardium regeneration and preserve cardiac performance in the post-MI heart. Methods c-kit+ CSCs were isolated from adult hearts and re-introduced into the infarcted myocardium in which the mouse MI model was created by permanent ligation of the left anterior descending artery (LAD). The Oct3/4 of CSCs was inhibited by transfection of Oct3/4 siRNA, and transfection of CSCs with control siRNA serves as control groups. Myocardial functions were evaluated by echocardiographic measurement. Histological analysis was employed to assess newly formed cardiogenesis, neovascularization, and cell proliferations. Terminal deoxynucleotidyltransferase (TdT) nick-end labeling (TUNEL) was carried out to assess apoptotic cardiomyocytes. Real time polymerase chain reaction and Western blot were carried out to evaluate the level of Oct 3/4 in CSCs. Results Two weeks after engraftment, CSCs increased ventricular functional recovery as shown by a serial echocardiographic measurement, which is concomitant with the suppression of cardiac hypertrophy and attenuation of myocardial interstitial fibrosis. Suppression of Oct 3/4 of CSCs abrogated functional improvements and mitigated the hypertrophic response and cardiac remodeling. Transplantation of c-kit+ CSCs into MI hearts promoted cardiac regeneration and neovascularization, which were abolished with the knockdown of Oct3/4. Additionally, suppression of Oct3/4 abrogated myocyte proliferation in the CSC-engrafted myocardium. Conclusion Our results indicate that CSCs-derived cardiac regeneration improves the restoration of cardiac function and is mediated through Oct 3/4.

Objective To determine the effects of increased ultrasound probe pressure and maternal Valsalva maneuver (VM) on the middle cerebral artery (MCA) Doppler ultrasonography in fetuses. Methods A total of 120 healthy pregnant women in second and third trimesters were enrolled in the study. MCA blood flow was measured by pulsed Doppler sonography in 60 fetuses (24 and 40 weeks' gestation) before and after the application of increased ultrasound probe pressure. In the other 60 fetuses (32 and 36 weeks' gestation), sonography was performed before and after maternal VM. Statistical analysis was performed by paired t-test. Results The pressure induced by the ultrasound probe induced a significant increase in the pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV); however, a significant decrease was found in the end-diastolic velocity (EDV) (p < 0.05). No statistically significant difference was found in the mean flow velocity (MFV). Moreover, maternal VM did not have any effect on the PI, RI, EDV, or MFV. Conclusion Fetal MCA Doppler assessment is affected by increased probe pressure but not by maternal VM. Thus, the application of the MCA Doppler sonography should be undertaken in the head of fetuses without any probe pressure and without maternal VM. Copyright © 2010 John Wiley & Sons, Ltd.

The aim of the present study is to evaluate the effect of reduced fetal oxygen supply on cerebral white matter in the adult offspring and further assess its susceptibility to postnatal hypoxia and high-fat diet. Based on a 3 x 2 full factorial design consisting of three factors of maternal hypoxia, postnatal high-fat diet, and postnatal hypoxia, the ultrastructure of myelin, axon and capillaries were observed, and the expression of myelin basic protein (MBP), neurofilament-H+L(NF-H+L), and glial fibrillary acidic protein (GFAP) was analyzed in periventricular white matter of 16-month-old offspring. Demyelination, injured axon and damaged microvasculars were observed in maternal hypoxia offspring. The main effect of maternal hypoxia lead to decreased expression of MBP or NF-H+L, and increased expression of GFAP (all P < 0.05). Moreover, there was positive three-way interaction among maternal hypoxia, high-fat diet and postnatal hypoxia on MBP, NF-H+L or GFAP expression (all P < 0.05). In summary, our results indicated that maternal hypoxia during pregnancy in rats lead to changes of periventricular white matter in adult offspring, including demyelination, damaged axon and proliferated astroglia. This effect was amplified by high-fat diet and postnatal hypoxia.

OBJECTIVES Progress in developing novel rational treatments for rheumatoid arthritis (RA) critically depends on preclinical work in experimental animals. However, there is lack of insight into the most appropriate mode of noninvasive measurement of disease status in experimental RA. This study compared sonography with serum biomarkers in a rabbit model of RA. METHODS Six-month-old male New Zealand White rabbits were randomized into 2 groups: antigen-induced arthritis group (n = 25), which was subjected to ovalbumin immunization and intra-articular injection; and control group (n = 5). Pathologic changes in the knee joints were evaluated by sonography, and serum C-reactive protein, tumor necrosis factor TNF-α, and interleukin 1 were measured by enzyme-linked immunosorbent assay. Synovial pathologic scores were obtained by ultrasound-guided biopsy. RESULTS A total of 23 rabbits (2 rabbits died before the end of the study) in the antigen-induced arthritis group and 5 rabbits in the control group completed the study. Sonographic scores for all rabbits were graded from 0 to 3, according to grayscale sonography, synovitis, and blood flow. Synovial lesions were evident on sonography before week 4; however, serum biomarkers slowly increased until weeks 5 and 6 (P < .05). Although both sonography and serum biomarkers correlated significantly with synovitis scoring, the correlations for the sonographically derived parameters were better. The correlation indices between pathologic scores and synovial membranes thickness, blood flow, and resistive index were 0.798, 0.557, and -0.320, respectively, whereas the correlation indices between pathologic scores and tumor necrosis factor α, interleukin 1, and C-reactive protein levels were 0.451, 0.503, and 0.529. CONCLUSIONS Sonographic findings had better correlations with histologic scoring than serologic biomarkers of disease activity in the RA rabbit model, especially at early stages. Local pathologic assessment of disease status by sonography is possible.

Background Recent evidence indicates that inhibition of histone deacetylase (HDAC) protects the heart against myocardial injury and stimulates endogenous angiomyogenesis. However, it remains unknown whether HDAC inhibition produces the protective effect in the diabetic heart. We sought to determine whether HDAC inhibition preserves cardiac performance and suppresses cardiac remodeling in diabetic cardiomyopathy. Methods Adult ICR mice received an intraperitoneal injection of either streptozotocin (STZ, 200 mg/kg) to establish the diabetic model or vehicle to serve as control. Once hyperglycemia was confirmed, diabetic mice received sodium butyrate (1%), a specific HDAC inhibitor, in drinking water on a daily basis to inhibit HDAC activity. Mice were randomly divided into following groups, which includes Control, Control + Sodium butyrate (NaBu), STZ and STZ + Sodium butyrate (NaBu), respectively. Myocardial function was serially assessed at 7, 14, 21 weeks following treatments. Results Echocardiography demonstrated that cardiac function was depressed in diabetic mice, but HDAC inhibition resulted in a significant functional improvement in STZ-injected mice. Likewise, HDAC inhibition attenuates cardiac hypertrophy, as evidenced by a reduced heart/tibia ratio and areas of cardiomyocytes, which is associated with reduced interstitial fibrosis and decreases in active caspase-3 and apoptotic stainings, but also increased angiogenesis in diabetic myocardium. Notably, glucose transporters (GLUT) 1 and 4 were up-regulated following HDAC inhibition, which was accompanied with increases of GLUT1 acetylation and p38 phosphorylation. Furthermore, myocardial superoxide dismutase, an important antioxidant, was elevated following HDAC inhibition in the diabetic mice. Conclusion HDAC inhibition plays a critical role in improving cardiac function and suppressing myocardial remodeling in diabetic heart. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0262-8) contains supplementary material, which is available to authorized users.

The aim of our study was to investigate the rate of nonalcoholic fatty pancreas disease (NAFPD) in the south China province of Fujian and its relationship to nonalcoholic fatty liver disease (NAFLD) and metabolic parameters. NAFPD is frequently identified on transabdominal ultrasound examination. The incidence of NAFPD varies from 16% to 69.7% depending on the country. A total of 256 subjects were recruited. Each was assessed by abdominal sonography to diagnose NAFLD and NAFPD. The ages, sexes, heights, weights, blood pressure, and detection of peripheral blood biochemical indices (cholesterol, triglycerides, high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL], and glucose) were recorded. The relationships among metabolic parameters and NAFPD or NAFLD were evaluated, and the positive rates of NAFLD and NAFPD in the general population were compared. The age, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), cholesterol, triglycerides, HDL, LDL, and glucose were significantly associated with NAFPD and NAFLD but the positive rate of NAFPD was significantly higher than that of NAFLD. The BMI, age, and NAFLD were the independent risk factors of NAFPD. The sex distribution, weight, SBP, DBP, BMI, LDL, HDL, triglycerides, glucose, cholesterol, NAFPD, and NAFLD were different significantly between metabolic syndrome and normal subjects. NAFPD and NAFLD can reflect the body metabolism, but NAFPD has a higher detection rate.

Exposure to an adverse intrauterine environment increases the risk of cardiovascular disease later in adult life. It has been shown that hypoxia plays a critical role in vascular remodeling and directly affects vascular smooth muscle cells functions. In the present study, we aimed to investigate the effect of hypoxia on neonatal rat aorta smooth muscle cells (NRSMCs). Our study demonstrated that hypoxia stimulation at 2% oxygen could significantly enhance NRSMCs proliferation in a time dependent manner. Moreover, hypoxia treatment resulted in an increased percentage in the S + G2/M phase and decreased apoptosis rate in NRSMCs. On the molecular level, the protein levels of pro-apoptotic proteins BNIP3 and bax were obviously reduced, while the anti-apoptotic factor bcl-2 was enhanced under hypoxia condition. Furthermore, we found that hypoxia activated hypoxia-inducible factor-1α (HIF-1α) expression and subsequently promoted NRSMCs proliferation. Specific down-regulation of HIF-1α partly abolished the proliferative effect of hypoxia on NRSMCs growth. Taken together, the present study demonstrated that hypoxia treatment promoted NRSMCs growth through activation of HIF-1α, which may contribute to the understanding of the pathogenesis of atherosclerosis.

The purpose of this study was to develop a novel open-window needle aspiration method and evaluate its efficacy in drainage and sclerotherapy of cystic thyroid nodules that cannot be aspirated with an 18-gauge needle.Two rectangular windows 5.0 mm in length and 1.0 mm wide were placed at the end of the percutaneous transhepatic cholangiography (PTCA) needle trocar to develop a new open-window intervention needle. The efficiency of the open-window intervention needle was compared either to a porous interventional needle or to an ordinary PTCA needle by assessing the aspiration efficiency. The efficacy of the modified open-window approach was tested by carrying out sclerotherapy and drainage on 21 thyroid cystic nodules that could not be aspirated with an 18-gauge needle and comparing it to aspiration with an 18-gauge PTCA needle of 50 cystic thyroid nodules.The efficacy of aspirating coupling agents of various specifications using the new open-window intervention was superior to aspiration using the PTCA trocar needle or a porous needle (p0.05). Ethanol ablation efficacy in the treatment of 21 cystic thyroid nodules that could not be aspirated with an 18-gauge needle and the aspiration efficacy of 50 cystic thyroid nodules with an 18-gauge PTCA needle were not significantly different (p0.05).The new open-window intervention needle approach was highly effective in conducting ethanol ablation of cystic thyroid nodules that could not be aspirated using conventional methodologies.