Effects of Adding Ultrasound Biofeedback to Individualized Pelvic Floor Muscle Training on Extensibility of the Pelvic Floor Muscle and Anterior Pelvic Organ Prolapse in Postmenopausal Women.

The aim of the study was to determine effects of adding transperineal ultrasound (TPUS) biofeedback to individualized pelvic floor muscle training (PFMT) on extensibility of the pelvic floor muscle and anterior pelvic organ prolapse (POP) in postmenopausal women. A total of 77 patients with POP at stage I or stage II were admitted to Beijing Shijitan Hospital, China, from January 2017 to October 2018. They were randomly divided into a control group (CG) (n = 37) or a study group (SG) (n = 40). Both SG and CG received a 12-week PFMT including health education, verbal instruction, and home training. However, the SG, but not the CG, received additional TPUS biofeedback. Data of these patients were retrospectively reviewed. The distance from the lowest point of the bladder to the inferior-posterior margin of the symphysis pubis (BSP) and the levator hiatus area (LHA) were measured on maximal Valsalva via TPUS before and after the 12-week PFMT. Correct pelvic floor muscle contraction (PFMC) rates before and after PFMT were compared between the two groups. The correct PFMC rate was higher in the SG than that in the CG (92.5% vs. 73%; x 2 = 5.223, p=0.022). The BSP was increased but the LHA was reduced after the 12-week PFMT in both groups compared to those before PFMT (all p < 0.05). However, after the PFMT, the SG showed greater improvement than the CG for both BSP (0.77 ± 0.71 cm vs. 0.11 ± 0.66 cm, p < 0.05) and LHA (20.69 ± 2.77 cm2 vs. 22.85 ± 3.98 cm2, p < 0.05). TPUS might be an effective biofeedback tool for PFMT in clinical practice. Individualized PFMT with TPUS biofeedback could significantly attenuate POP severity and strengthen the extensibility of pelvic floor muscle in postmenopausal women when they are under increased intraabdominal pressure.

Investigating the effectiveness of COVID-19 pandemic countermeasures on the use of public transport: A case study of The Netherlands.

During the COVID-19 pandemic, public transport in many cities faces dramatic reduction of passenger demand. Various countermeasures such as social distancing and in-vehicle disinfection have been implemented to reduce the potential risks concerning infection, the effectiveness in promoting the use of public transport however remains unclear. Unlike the usual situation where time and cost are the main factors affecting travel decisions, the uncertainty hiding behind the behavior change of public transport users in a pandemic might be greatly affected by the control measures and the perception of people. This paper therefore aims to examine the effects of COVID-19 related countermeasures implemented in public transport on individuals' travel decisions. We explore the extent to which do policy countermeasures influence different groups of people on the use of public transport. An error component latent class choice model was estimated using the data collected in the Netherlands. Results show that the restrictions policy lifted by the Dutch central government have significant effect on individuals' transportation mode choice decision during the pandemic. The related measures adopted by the public transport sector, by contrast, present different effects on different people. The older and highly educated people are more susceptible to enforcement measures, whereas young and single Dutch citizens are more accessible to non-compulsory measures. Moreover, compared with other private modes, public transport is generally identified as a riskier option, and the average willingness to travel descends. Findings of this study are helpful for the authorities in designing and promoting effective policies in the context of pandemics.

Role of latent factors and public policies in travel decisions under COVID-19 pandemic: Findings of a hybrid choice model.

Policy measures to control the spread of COVID-19 imposed by different countries have a devastating impact on people's travel behaviors. Differing from the normal situation where general concerns on travel time and cost determine the travel choices, the uncertainty underlying behavior change in the case of a pandemic might be largely attributed to the latent aspects, i.e., social responsibility, risk perception, attitudes, which could diminish the effects of main attributes on travel decisions. Therefore, this paper examines the effects of COVID-19 related policies on individuals' travel choices influenced by the latent aspects. A stated choice experiment was designed to collect people's responses under policy measures to various transportation modes. Results of a hybrid choice model show that COVID-19 related policies significantly affect individuals' transportation mode choice decisions during pandemic situations. The attributes, like travel time and travel cost, which significantly impact travel behavior in normal situations, become less relevant. Moreover, the travel preferences during the pandemic are significantly associated with latent factors of social responsibility, fear of infection, perceived risk, and travel anxiety. In general, public transportation is identified as an insecure alternative compared with other private modes, and people who are more socially responsible tend to travel less during the pandemic. Outcomes of this study could be of value to policymakers and public health emergencies, e.g., government authorities to utilize such knowledge in providing social support for these COVID-19 countermeasures and designing customized policies for specific population groups.

Resting Energy Expenditure, Fetal Biometric Parameters by Ultrasound, and Birthweight in Chinese Pregnant Women With Gestational Diabetes Mellitus.

OBJECTIVES: To explore the relationships between resting energy expenditure (REE) according to indirect calorimetry, fetal biometric parameters by ultrasound, and birthweight in gestational diabetes mellitus (GDM). METHODS: Sixty-five women with GDM and 60 in the control group were enrolled. The REE, birthweight, and fetal biometric parameters according to ultrasound, including biparietal diameter, head circumference, abdominal circumference (AC), and femur length, were measured. RESULTS: The AC at 29 to 32 weeks and 37 to 40 weeks was larger in the GDM than in the control group (P < 0.01), birthweight was higher in the GDM than in the control group (P < 0.01), and women in the GDM group had higher REE than those in the control group at all stages of pregnancy (P < 0.01). In the control group, all fetal biometric parameters were correlated with birthweight at 37 to 40 weeks (r = 0.418, 0.678, 0.741, and 0.635 for biparietal diameter, head circumference, AC, and femur length, respectively, P < 0.05); however, in the GDM group, only AC was correlated with birthweight at 37 to 40 weeks (r = 0.707; P < 0.05). In the GDM group, REE was correlated with birthweight at all three stages of pregnancy (r = 0.369, 0.381, and 0.446 for 21 to 24, 29 to 32, and 37 to 40 weeks, respectively, P < 0.05), and REE was correlated with AC at 37 to 40 weeks (r = 0.431; P < 0.05). CONCLUSIONS: REE is correlated with birthweight in women with GDM from the middle to the end of pregnancy. REE by indirect calorimetry might be potential index for medical nutrition therapy in GDM.

Contrast-enhanced ultrasound in uterine artery embolization treatment of cesarean scar pregnancy.

OBJECTIVE: The current study aimed to investigate the application of contrast-enhanced ultrasound (CEUS) in diagnosis and treatment of cesarean scar pregnancy (CSP). METHODS: A retrospective study was performed in 35 patients with clinically suspected CSP who requested termination of pregnancy and underwent contrast-enhanced ultrasound (CEUS). The patients were classified into two groups on the basis of whether they received uterine artery embolization (UAE). The CEUS characteristics of the two groups were reviewed. RESULTS: CEUS features of CSP were early enhancement of the cesarean scar and continuous infusion of contrast agent between the gestational sac and cesarean scar. Myometrial thickness in the cesarean scar was thinner in the UAE group than in the non-UAE group by CEUS and transvaginal ultrasound. Myometrial thickness measured by CEUS was thinner than that measured by transvaginal ultrasound in both groups. The parameters of the time-intensity curve in the UAE group were characterized by a faster arrival time, shorter time to peak, higher peak intensity, and greater enhancement rate compared with the non-UAE group. CONCLUSIONS: CEUS may be a novel supplementary method to diagnose and assess CSP, and to help evaluate whether UAE is required.

Application of contrast-enhanced ultrasound for scar pregnancy cases misdiagnosed as other diseases.

OBJECTIVE: To demonstrate the feasibility of utilizing contrast-enhanced ultrasound (CEUS) in scar pregnancies misdiagnosed by transvaginal ultrasound (TVS). METHODS: CEUS was performed in three patients with clinically suspected abnormal pregnancy, and the diagnosis were inconclusive by TVS. Clinical manifestations and features of TVS and CEUS in these cases were analyzed. RESULTS: Three cases included an intramural pregnancy (IMP) after hysteromyomectomy, and two mass-based cesarean scar pregnancy (CSP), the mass was caused by curettage and spontaneous abortion, respectively. In all these cases, early enhancement with high intensity was observed by CEUS at the site of implantation. Moreover, prominently enhanced signal was detected inside the mass, with or without peritrophoblastic ring. No enhancement was detected in clots or masses after effective treatment. CONCLUSION: CEUS can be used as a supplementary method to diagnose scar pregnancy and evaluate the treatment efficacy, especially in cases with ambiguous results by TVS.

The ultrasonic whirlpool sign combined with plasma d-dimer level in adnexal torsion.

OBJECTIVES: The whirlpool sign (WS) and plasma d-dimer are used as a sonographic marker and laboratory index for adnexal torsion (AT), respectively. The aim of this study was to evaluate whether their combination improved diagnostic efficiency of AT in patients presenting with a benign ovarian mass and abdominal pain and clinically suspected AT. MATERIALS AND METHODS: Fifty-four patients with clinically suspected AT with benign ovarian mass and abdominal pain were analyzed and divided into an AT group (n = 28) and control group (n = 26). Ultrasonography and venous blood collection were performed before surgery to observe the WS and plasma d-dimer level. All cases were confirmed by surgery. Diagnostic efficiency of the WS, plasma d-dimer level, and their combination was compared. RESULTS: There was a significant increase in the WS and plasma d-dimer level in AT patients (all p < 0.01). The sensitivity, specificity, Youden Index and area under the curve (AUC) of the WS (cut-off value of >1 circle), d-dimer level (cut-off value of 248 ng/ml) and their combinations were 71.43, 67.86 and 96.43%; 92.31, 100 and 100%; 0.637, 0.679 and 0.964; and 0.909, 0.899 and 0.995, respectively. There was a significant difference in AUC between the WS and d-dimer and their combination (all p < 0.01). CONCLUSIONS: The WS and d-dimer were useful for diagnosis of AT in patients with ovarian mass and abdominal pain. Combination of the WS and d-dimer may improve diagnostic efficiency for AT compared with each method alone.

Fetal Hemodynamics and Fetal Growth Indices by Ultrasound in Late Pregnancy and Birth Weight in Gestational Diabetes Mellitus.

BACKGROUND: The offspring of women with gestational diabetes mellitus (GDM) are prone to macrosomia. However, birth weight is difficult to be correctly estimated by ultrasound because of fetal asymmetric growth characteristics. This study aimed to investigate the correlations between fetal hemodynamics, fetal growth indices in late pregnancy, and birth weight in GDM. METHODS: A total of 147 women with GDM and 124 normal controls (NC) were enrolled in this study. Fetal hemodynamic indices, including the systolic/diastolic ratio (S/D), resistance index (RI), pulsatility index (PI) of umbilical artery (UA), middle cerebral artery (MCA), and renal artery (RA), were collected. Fetal growth indices, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length, were also measured by ultrasound. Birth weight, newborn gender, and maternal clinical data were collected. RESULTS: The independent samples t-test showed that BPD, HC, and AC were larger in GDM than in NC (P < 0.05). Fetal hemodynamic indices of the UA and MCA were lower (P < 0.05), but those of the RA were higher (P < 0.001) in GDM than in NC. Birth weight was higher in GDM than in NC (P < 0.001). Pearson's correlation analysis showed that hemodynamic indices of the UA were negatively correlated with birth weight, BPD, HC, and AC in both groups (P < 0.05). MCA (S/D, PI, and RI) was negatively correlated with birth weight, HC, and AC in GDM (r = -0.164, -0.206, -0.200, -0.226, -0.189, -0.179, -0.196, -0.177, and - 0.172, respectively, P< 0.05), but there were no correlations in NC (P > 0.05). RA (S/D, PI, and RI) was positively correlated with birth weight in GDM (r = 0.168, 0.207, and 0.184, respectively, P< 0.05), but there were no correlations in NC (P > 0.05). CONCLUSION: Fetal hemodynamic indices in late pregnancy might be helpful for estimating newborn birth weight in women with GDM.

[The application value of BI-RADS lexicon and high-frequency CDFI scoring in differentiation of benign from malignant lesions of the breast].

OBJECTIVE: To explore the diagnostic value with BI-RADS lexicon and high-frequency color doppler ultrasonic scoring for breast diseases. METHODS: A total of 108 breast lesions were studied with BI-RADS lexicon and high-frequency color doppler ultrasonic scoring, and compared with pathologic results. Calculated the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. RESULTS: Of these 108 lesions, 65(60.19%) were pathologically confirmed to be benign and 43(39.82%) to be malignant. There were no statistically significant differences between BI-RADS lexicon and high-frequency color doppler ultrasonic scoring in the diagnosis of breast lesions (P > 0.05). CONCLUSION: Both of BI- RADS lexicon and high-frequency color doppler ultrasonic scoring have a higher value for diagnosing breast disease in clinical application, and BI-RADS lexicon provides the normalized and standardized reporting data for clinical doctor in diagnosing breast disease, It is more conducive to guide clinicians with correct judgment and active treatment for breast disease.

[Diagnostic values of breast imaging and reporting data system and ultrasonic elastography for benign and malignant breast lesions].

OBJECTIVE: To explore the diagnostic values of breast imaging and reporting data system (BI-RADS) and ultrasonic elastography (UE) for benign and malignant breast lesions. METHODS: A total of 122 breast lesions were studied with BI-RADS and UE scoring to compare the sensitivity and specificity according to the pathologic results. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of BI-RADS, UE and combination. RESULTS: Among them, pathological examinations showed that there were 72 benign and 50 malignant cases. Statistically significant differences in specificity existed between BI-RADS lexicon (as ≥ 4) and UE or combination (P < 0.05) while sensitivity showed no difference (P > 0.05); Statistically significant differences in sensitivity existed between BI-RADS (as ≥ 4B) and UE or combination (P < 0.05) while there was no difference in specificity (P > 0.05); No statistically significant differences existed between UE or combination. The area under the ROC curve was above 0.7. CONCLUSION: Both BI-RADS and UE have a great diagnostic value for breast disease. UE is somewhat superior to BI-RADS. However, the value of combination may be more significant.

Neck circumference positively related with central obesity, overweight, and metabolic syndrome in Chinese subjects with type 2 diabetes: Beijing Community Diabetes Study 4.

OBJECTIVE: To investigate the association between neck circumference and central obesity, overweight, and metabolic syndrome in Chinese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 3,182 diabetic subjects (aged 20-80 years) were recruited from 15 community health centers in Beijing using a multistage random sampling approach. RESULTS: Receiver operating characteristic analysis showed that the area under the curve for neck circumference and central obesity was 0.77 for men and 0.75 for women (P<0.001). Furthermore, a neck circumference of ≥38 cm for men and ≥35 cm for women was the best cutoff point for determining overweight subjects. A neck circumference of ≥39 cm for men and ≥35 cm for women was the best cutoff point to determine subjects with metabolic syndrome. CONCLUSIONS: In the present study, neck circumference is positively related with BMI, waist circumference, and metabolic syndrome in Chinese individuals with type 2 diabetes.