Z scores of the fetal trachea and bronchial dimension.

OBJECTIVE: To develop Z scores for the trachea and main bronchi in normal fetuses. METHODS: This was a prospective cross-sectional study in 823 normal singleton fetuses. The tracheal diameter immediately proximal to the bifurcation and the left and right main bronchial diameters were measured from their inner to inner edge in the coronal view. Z scores were created for the trachea and main bronchial diameters using gestational age (GA), femur length (FL), and biparietal diameter (BPD) as independent variables. RESULTS: Between gestational weeks 20 and 40, the inner diameters of the trachea, left principal bronchi (LPB), and right principal bronchi (RPB) increased from 1.8 to 4.7 mm, 0.8 to 2.2 mm, and 0.9 to 2.3 mm, respectively. A simple linear regression equation was fitted to model the mean of each diameter. There was however significant heteroscedasticity of the standard deviation (SD) with increasing GA, FL, or BPD. Eventually, the following formula was used to calculate Z scores for the diameters: [measured value - equation for mean]/equation for SD. CONCLUSION: We have developed Z scores for the fetal trachea and main bronchi by applying standard statistical methods. These Z scores may be useful to evaluate the early development of the respiratory system.

[Clinical value of the evolution of left ventricular global strain in anterior myocardial infarction patients treated with emergency percutaneous coronary intervention].

OBJECTIVE: To investigate the evolution of left ventricular global strain in anterior myocardial infarction patients treated with emergency percutaneous coronary intervention (PCI).
 Methods: A total of 54 patients with PCI were enrolled as a PCI group. Forty healthy subjects were enrolled as a control group. Dynamic cardiac images were collected. All of these images were analyzed off-line by velocity vector imaging (VVI) software. N-terminal pro-B-type natriuretic peptide (NT-proBNP) was measured with an electrochemiluminescence immunoassay through the Elecsys 1010/2010 system. Correlation analysis were undertaken between VVI and NT-proBNP levels in blood.
 Results: In PCI group, only globle longitudinal strain (GLS) was significantly increased 3 day after operation (P<0.05). GLS and globle circumferencial strain (GCS) were markedly increased 6 months after operation (P<0.05). In PCI group, left ventricular GLS 1 d to 6 months after PCI shows positive correlation with lgNT-proBNP levels (r=0.66, P<0.001). GLS value was -12.50% at the 3rd day after operation, indicating the improvment of cardiac function in the first and sixth month after PCI.
 Conclusion: The change of Left ventricular globle longitudinal systolic function after emergency PCI may be more sensitive to the improvement of myocardial stunning after STEMI reperfusion; GLS value (-12.50%) at the 3rd day after operation predict the improvment of cardiac function in the first and sixth months after PCI.

Isolated Coronary Artery Fistula in Fetal Heart: Case Reports and Literature Review.

We report two cases of prenatally diagnosed isolated coronary artery fistula. The first fetus had a fistulous communication between the left circumflex coronary artery and the right atrium. The second fetus had right coronary artery to left ventricle fistula. In addition, we have also reviewed previously published reports on prenatally diagnosed coronary artery fistulae, focusing on their clinical profiles, outcome and postnatal treatment.

Prenatal and Postnatal Survival of Fetal Tetralogy of Fallot: A Meta-analysis of Perinatal Outcomes and Associated Genetic Disorders.

OBJECTIVES: The aim of this systematic review was to compare the postnatal outcomes, genetic testing results, and sonographic findings in 3 subtypes of tetralogy of Fallot. METHODS: Thirty-six articles from the MEDLINE and EMBASE databases were selected for this review. The postnatal outcomes, karyotyping results, and sonographic findings of fetal tetralogy of Fallot with pulmonary stenosis, tetralogy of Fallot with pulmonary atresia, and tetralogy of Fallot with an absent pulmonary valve were collected and compared. RESULTS: The survival rates (termination of pregnancy was considered fetal death) for prenatally diagnosed tetralogy of Fallot with pulmonary atresia and tetralogy of Fallot with an absent pulmonary valve at the end of neonatal period were significantly lower than the rate for tetralogy of Fallot with pulmonary stenosis (P < .05). The survival rate for tetralogy of Fallot with pulmonary atresia was also lower at birth (P < .001). Major chromosomal anomalies were more frequently detected in tetralogy of Fallot with pulmonary stenosis (P< .05); conversely, 22q11 deletion was present more often in fetuses with tetralogy of Fallot with pulmonary atresia and tetralogy of Fallot with an absent pulmonary valve (P < .001). Compared to tetralogy of Fallot with pulmonary stenosis, a right aortic arch was more associated with tetralogy of Fallot with pulmonary atresia (32.6%; P < .05), and the ductus arteriosus was almost always absent in tetralogy of Fallot with an absent pulmonary valve (87.5%; P < .001). CONCLUSIONS: The postnatal outcomes, genetic testing results, and sonographic findings are different among subtypes of tetralogy of Fallot. Documenting those details at diagnosis can help specialists better counsel their patients.

Ventricular non-compaction cardiomyopathy: prenatal diagnosis and pathology.

OBJECTIVE: The objective of this study is to evaluate the prenatal diagnosis of ventricular non-compaction cardiomyopathy (NCCM) and to report the pathologic features and the characteristic myocardial ultrastructure of fetal NCCM. METHOD: We examined nine cases of fetal NCCM by prenatal echocardiography from 2004 to 2013. These cases were evaluated with respect to prenatal diagnosis, outcomes, pathology, and characteristics of the myocardial ultrastructure. RESULTS: Trabeculated myocardium and non-compaction/compaction ratio (N/C ratio) ≥2.0 is the echocardiographic feature that allowed diagnosis. Among the nine fetuses with a prenatal diagnosis of NCCM, six were diagnosed with left ventricular non-compaction (LVNC), two with non-compaction of both ventricles (biventricular NCCM), and one with right ventricular non-compaction. Among the nine fetuses, the LVNC diagnosis was confirmed by postnatal echocardiography in 2; the other patients chose to terminate their pregnancies, and those cases were confirmed at autopsy. Muscle biopsies were performed on three of the aborted fetuses, and abnormal mitochondria, sarcomeres, and myocardial fibers were observed. CONCLUSION: Non-compaction can be identified in the fetus. Fetal non-compaction most often involves the left ventricle, but can involve the right ventricle or both ventricles. The myocardial ultrastructure of fetal ventricular non-compaction has certain unique characteristics regarding the maturation of the mitochondria, sarcomeres, and myocardial fibers. © 2014 John Wiley & Sons, Ltd.

[Real-time ultrasound guided placement of permanent internal jugular vein catheters in maintenance hemodialysis patients].

OBJECTIVE: To investigate the value of real-time ultrasound guided placement of permanent internal jugular vein (IJV) catheterization in maintenance hemodialysis patients, and analyze its technical success and complication rate. METHODS: We prospectively analyzed 63 patients (39 males, 24 females) who underwent permanent IJV cannulation with real-time ultrasound guidance from January to October in 2012. Under the real-time guidance of Logiq 5 color Doppler, we placed the tunneled cuffed catheters into the jugular vein by Seldinger technique. The number of needle punctures, technical success, the operation time, and complications were recorded. The patients were divided into a normal-risk group and a high-risk group: those who suffered multiple catheter insertions, previous difficulties during catheterization, poor compliance, obesity, impaired consciousness, skeletal deformity, disorder of haemostasis were regarded as high-risk patients. RESULTS: Cannulation of IJV was done in all patients. Of the 63 catheters, 20 (31.7%) were placed in the high-risk patients; 60 (95.2%) were successfully placed at the first attempt, with the average number of punctures of (1.23±0.21) (range 1-3); Only 3 immediate complications (4.7%) developed; 3 (4.7%) catheter infections occurred in the course of using. Cannulation of IJV took longer time in the high-risk group than that in the normal-risk group [(30.6±0.11) min vs (19.1±0.09) min, P<0.05]. The number of needle punctures, percent of successful cannulation, and the frequency of immediate complications were similar in the high- and normal-risk groups. It was more likely to form catheter thrombosis during long-term use in the high-risk group (4/20, 20%) which might cause poor blood flow. CONCLUSION: Permanent IJV cannulation under real-time ultrasound guidance is very safe with high success rates. Nephrologists can use this technique with ease and with minimal complications in both normal- and high-risk patients.

Accuracy of Endorectal Endoscopic Ultrasound (EUS) for Locally Advanced Rectal Cancer (LARC) Restaging After Neoadjuvant Chemoradiotherapy (NAT): A Meta-Analysis.

BACKGROUND/AIMS: Endorectal endoscopic ultrasound (EUS) can provide accurate and reliable information for initial staging of locally advanced rectal cancer (LARC) in both the depth of rectal cancer penetration (T-stage) and regional lymph node involvement (N-stage). However, there is still no consensus about its accuracy in retagging LARC after neoadjuvant chemoradiotherapy (NAT). METHODOLOGY: In this study, we retrieved previous studies and performed a meta-analysis for assessing the accuracy of EUS for retagging of LARC after NAT. RESULTS: It was found the accuracy of EUS for T restaging of LARC was relatively low and over-staging was common, although the accuracy for assessing T3/4 was significantly higher than T0-T2 stage. The specificity of EUS for assessing N stage was relatively high, but the sensitivity was relatively low. CONCLUSIONS: Data obtained in this study confirmed the overall accuracy of EUS is not sufficient to serve as a basis for decisions on restaging Exploring the possible application of new techniques is necessary for better restaging.

Role of electricity production in the anaerobic decolorization of dye mixture by exoelectrogenic bacterium Shewanella oneidensis MR-1.

This study investigated the anaerobic decolorization of the dye mixture containing methyl orange (MO) and naphthol green B (NGB) by Shewanella oneidensis MR-1. S. oneidensis MR-1 showed a strong ability to decolorize the dye mixture. MO was easier to get the electrons and inhibited the reduction of NGB, despite of its lower redox potential than NGB. The Mtr respiratory pathway played an important role in this process. Meantime, addition of extracellular electron shuttles accelerated the decolorization. Those results suggest that the decolorization capacity of S. oneidensis MR-1 is associated with the electricity production. The operating parameters, such as electron acceptors, temperature, and pH, were also investigated in this study. Thus, this work may facilitate a better understanding of the extensive nonspecific reduction capacity of exoelectrogens and is beneficial for promoting their application in bioremediation.

Decolorization and detoxification of a sulfonated triphenylmethane dye aniline blue by Shewanella oneidensis MR-1 under anaerobic conditions.

In this work, the extracellular decolorization of aniline blue, a sulfonated triphenylmethane dye, by Shewanella oneidensis MR-1 was confirmed. S. oneidensis MR-1 showed a high capacity for decolorizing aniline blue even at a concentration of up to 1,000 mg/l under anaerobic conditions. Maximum decolorization efficiency appeared at pH 7.0 and 30 °C. Lactate was a better candidate of electron donor for the decolorization of aniline blue. The addition of nitrate, hydrous ferric oxide, or trimethylamine N-oxide all could cause a significant decline of decolorization efficiency. The Mtr respiratory pathway was found to be involved into the decolorization of aniline blue by S. oneidensis MR-1. The toxicity evaluation through phytotoxicity and genotoxicity showed that S. oneidensis MR-1 could decrease the toxicity of aniline blue during the decolorization process. Thus, this work may facilitate a better understanding on the degradation mechanisms of the triphenylmethane dyes by Shewanella and is beneficial to their application in bioremediation.

Quantitative assessment of left ventricular systolic function in patients with coronary heart disease by velocity vector imaging.

OBJECTIVE: To assess the left ventricular (LV) longitudinal systolic function and asynchrony in patients with coronary atherosclerotic heart disease (CAD) by syngo velocity vector imaging (VVI). METHODS: Twenty-eight control subjects and 79 patients with CAD were examined, including 28 patients with myocardial infarction, 26 patients with coronary lumen stenosis <50%, and 25 patients with myocardial ischemia. According to the results of coronary arteriography and electrocardiogram (ECG), the myocardial segments of the LV of CAD patients were divided into four groups: ischemic, infarcted, nonischemic, and normal. Dynamic imaging was performed on all subjects. The systolic peak strain (Smax), systolic strain rate (SRmax), time to peak strain (PTs), and time to peak strain rate (PTsr) in every cardiac cycle were measured. RESULTS: A total of 1,253 out of 1,712 (96.5%) segments were successfully analyzed with VVI. Smax and SRmax of the ischemic and infarcted segments were impaired in CAD patients. Optimal sensitivity and specificity were obtained with strain and strain rate cutoffs of -14.08% and -0.83 s(-1) , respectively, for detecting ischemic segments and -6.65% and -0.38 s(-1) , respectively, for detecting infarcted segments. The PTs and PTsr were significantly longer in the ischemic and infarcted segments compared to those of the control group. CONCLUSIONS: Utilizing VVI, the longitudinal strain, strain rate, and peak time in CAD patients are easy to obtain and reproducible. Strain and strain rate cutoff values of abnormal myocardium are valuable for detecting ischemia and infarction. The PTs and PTsr values possibly estimate myocardium asynchrony in CAD patients.

[Comparison of five different ultrasonographic parameters for diagnosis of lethal fetal pulmonary hypoplasia].

OBJECTIVE: To evaluate the clinic value of five different ultrasonographic fetal parameters for prenatal diagnosis of pulmonary hypoplasia. METHODS: Two hundred and seventy-one normal singleton pregnancies with well-established dates between 20 and 40 weeks of gestation were studied to establish normal reference range of five different ultrasonographic fetal parameters. The five parameters, which could reflect fetal lung mass, were as follows: lung area/body weight ratio, lung area, thoracic circumference/ abdominal circumference ratio, lung area/thoracic area ratio and lung area/head circumference. Thirty pregnancies with risk factors for pulmonary hyperplasia were studied for the usefulness of five parameters. Two or more standard deviations below the mean control group measurement were considered abnormal. The prenatal ultrasonic diagnoses of pulmonary hyperplasia were confirmed at neonatal follow-up examinations, on autopsy and by pathologic findings. RESULTS: Lung area and lung area/head circumference increased with gestational age, lung area /body weight ratio decreased with gestational age. The relationships among the two ratios (thoracic circumference/abdominal circumference ratio, lung area/thoracic area ratio) and gestational age were relatively constant. Abnormal lung area/body weight ratio had a higher diagnostic accuracy than other parameters. Sensitivity of the parameters, including lung area, lung area/body weight ratio, thoracic circumference/abdominal circumference ratio, lung area/thoracic area ratio and lung area/head circumference were 83%, 97%, 50%, 70% and 87% , respectively. Sensitivity of the lung area/body weight ratio was 95% (20/21 fetuses); specificity, 9/9 fetuses; positive predictive value, 100% (20/20 fetuses); negative predictive value, 9/10; and accuracy 97% (29/30 fetuses). CONCLUSION: Lung area/ body weight ratio is a good predictor of pulmonary hypoplasia.

Utilising ductus venosus Doppler waveform and four-chamber view to screen for foetal cardiac malformation in early second trimester of pregnancy.

BACKGROUND: Foetal echocardiography has become a diagnostic method to detect foetal congenital heart disease with high probability. However, it is not only time consuming and but also difficult to visualize outflow tract of foetus early in the second trimester of pregnancy, even for an experienced obstetric ultrasonographer. Recently, many methods for screening foetal cardiac anomalies were explored, but much more work is needed to develop an effective and suitable screening method. The aim of this study was to investigate the clinical significance of utilising the ductus venosus (DV) Doppler examination and the four-chamber view of heart to screen for foetal cardiac malformation in early second trimester of pregnancy. METHODS: Heart and DV of 401 consecutive foetuses in early second trimester (12(+1) - 17(+6) weeks) in high risk pregnancies were examined with Acuson 128 xp/10 or Sequoia 512 ultrasound diagnostic systems. Absent or reversed flow during atrial contraction (A-wave) in the DV was defined as sufficiently abnormal to screen for foetal cardiac malformations. The foetal echocardiographic diagnosis was confirmed by postnatal echocardiography (or postmortem). The sensitivities of screening tests were compared among the three methods: DV Doppler examination, four-chamber view alone, and the combination of both techniques. RESULTS: Satisfactory examinations were obtained in 383/401 foetuses (95%). Thirty foetuses with cardiac abnormalities were confirmed by neonatal echocardiography (or postmortem). The sensitivity of DV Doppler examination or four-chamber view alone is 63% (19/30) and 60% (18/30), respectively. The sensitivity of combining information, DV Doppler flow waveform and four-chamber view, to screen for foetal cardiac malformation is 83% (25/30) and significantly better than that of either DV Doppler flow waveform or four chamber view alone (P < 0.05). CONCLUSION: Doppler flow waveform of DV can be used to screen for foetal cardiac malformation early in the second trimester. Combining information from Doppler flow waveform of DV and four-chamber view will improve the overall sensitivity of the screening.