With the development and universal use of sonographic technique,prenatal ultrasonography has become an essential part of prenatal diagnosis.The doctor-patient contradicts and medial tangles occur more due to safety and limitation of prenatal ultrasonography.This article puts forward some relevant policies to resolve the doctor-patient contradicts and medial tangles via analysing relative factors and ethical problems.

This article suggests that doctors should keep the principle that patients’interest should be the first and respect the autonomy of pregnant woman during the prenatal diagnosis and intervention,and brings the ethical concept of fetus as a patient.Before prenatal diagnosis and intervention,doctors should tell the pregnant woman about the advantages and disadvantages of the project for her to make decision.For the fetus born with deformity but still having survival ability,fetal ethical principle prohibits against termination unless pregnant woman has diseases not permitting to continue pregnancy,although there is an increasing risk of morbidity and mortality.

Objective To investigate the changes in myocardial deformation in donor and reeipient hearts in response to selective fetoscopic laser photocoagulation (SFLP) for twin-twin transfusion syndrome (TTTS).Methods Totally 25 twin pairs before 24-hour and 1 week after SFLP had fetal echocardiography and digital dynamic two-dimensional four chamber views which were interrogated off-line using velocity vector imaging (VVI) software.Global longitudinal strain (S),systolic strain rate (SRs) and diastolic strain rate (SRd) were measured off-line in the left (LV) and right (RV) ventricles.Results In the donor,SFLP resulted in increase in cardiothoracic ratio ( CTR,0.29 ± 0.03 versus 0.34 ± 0.05,P ＜ 0.01 ),with development of new onset tricupid regurgitation ( n =7 ) and pericardial effusion ( n =5 ) and worsening of all measures of myocardial deformation in both systole and diastole for LV and RV [ LV-S:( - 19.24 ± 3.68 )％ versus (-13.78±3.64)％,P＜0.01; LV-SRs:(-2.28±0.53) versus (-1.43 ±0.41) s-1,P＜ 0.01 ; LV-SRd:( 1.67 ± 0.43 ) versus ( 1.15 ± 0.70) s - 1,P ＜ 0.01 ; RV-S:( - 20.20 ± 3.19) ％ versus (-16.10±3.07)％,P＜0.01; RV-SRs:(-2.03 ±0.65) versus (-1.72±0.38) s-1,P＜0.05; RV-SRd:( 1.71 ±0.30) versus ( 1.50 ±0.36) s-1,P ＜0.05].In the recipient,CTR decreased (0.42 ± 0.04 versus 0.37 ±0.04,P ＜0.01 ) and all parameters for both LV and RV improved substantially [ LV-S:( - 10.62 ± 2.72) ％ versus ( - 16.46 ± 3.23 ) ％,LV-SRs:( - 1.09 ± 0.30) versus ( - 1.60 ± 0.31 ) s-1,LV-SRd:(0.99 ± 0.34) versus (1.53 ± 0.32) s-1,RV-S:( - 11.66 ± 4.56)％ versus ( - 17.96 ± 3.97 ) ％,RV-SRs:( - 1.26 ± 0.39) versus ( - 1.74 ± 0.45 ) s-1,RV-SRd:( 1.15 ± 0.49) versus ( 1.63 ± 0.44 ) s- 1 ; all P ＜ 0.01 ].Conclusion Myocardial deformational mechanics improve in the recipient but worsen in the donor following SFLP for TTTS.

Objective To analyze MRI features of tuberculosis of spinal vertebra, spinal meninges and spinal cord. Methods Fifty cases with tuberculosis of spinal vertebra, spinal meninges or spinal cord confirmed by clinical and pathological evaluation were collected in this study. Findings of plain and Gd-DTPA enhanced MRI were retrospectively reviewed. Results In 40 patients with spinal vertebra tuberculosis, there were 137 involved vertebrae, 52 involved intervertebral discs, 30 peri-vertebra cold abscesses, 23 intraspinal abscesses and compression of spinal cord, 29 athological fractures, 12 posterior process of spinal columns, 2 involved appendix. There were 4 cases of spinal meninges tuberculosis, 4 of tuberculous myelitis and 2 combination of tuberculosis of spinal meninges and spinal column. Conclusion MRI, especially the contrast MRI, could accurately and early demonstrate the morphological and pathological changes of tuberculosis of spinal vertebra, spinal meninges and spinal cord.

Objective To investigate the clinical significance of Doppler flow waveform of ductus venosus (DV) in screening of fetal cardiac malformation.Methods Color Doppler ultrasonography was used to study DV flow in 240 normal fetuses and 20 fetuses with cardiac malformation that were screened out from the high-risk fetuses with congenital heart disease (CHD).Results ① The normal Doppler flow waveform of the DV was a characteristic triphasic pattern with forward flow during cardiac cycle,reflecting ventricular systole (S),ventricular diastole (D) and atrial systole (A).② In the group of 20 fetuses with cardiac malformation,eight had reverse flow and nine had decreased or absent flow during atrial contraction,the indices of the DV in fetuses with cardiac malformation were higher than those in gestational age-matched normal fetuses ( P

Objective To investigate the clinical value of fetal echocardiography in prenatal diagnosis of fetal truncus artery. Methods Retrospective analysis was made in 10 cases with fetal truncus artery for their fetal echocardiography and follow-up findings. Echocardiographic characteristics was summed up in various fetal heart views. Results Truncus artery was confirmed by autopsy in 7 fetuses,and 3 cases were correspondingly verified by postnatal echocardiography. Echocardiographic characteristic images of fetal truncus artery was larger ventricular septal defect, only 1 great artery arising from heart, and pulmonary artery arising from truncus artery. Conclusions Echocardiography has important value in accurate diagnosis of fetal truncus artery and caution should be paid in differential diagnosis with other fetal complicated congenital heart diseases.

Objective To describe the diagnostic approach and clinical outcomes of fetal intraabdominal extralobar pulmonary sequestration (IEPS).Methods Three cases of IEPS were diagnosed prenatally by ultrasound in our center.The data of these 3 cases and 43 cases in prior studies from 1986 to 2016 were retrospectively reviewed.The prenatal sonographic features,treatment,and outcomes were collected.Results The gestational age of diagnosis IEPS was (24.5±5.9)weeks,the male-to-female ratio was 3-4∶1,78.3% (36/46) of IEPS masses located on the left side,47.8% (22/46) of lesions were homogenous and hyperechoic,8.7% (4/46) of cases associated anomalies,78.3% (36/46) of patients were preformed resection and postoperative recovery and subsequent course were uncomplicated.Feeding arteries were detected in 15.2% (7/46) cases and confirmed by surgery or autopsy.Conclusions Prenatal ultrasound has the diagnostic accuracy of IEPS.Feeding arteries noted on color Doppler are strongly indicators of IEPS.Postsurgical outcomes are favorable.

Objective To investigate the differences in myocardial deformation between donor and recipient in twin-twin transfusion syndrome(TTTS) using vector velocity imaging( VVI). Methods Digital dynamic two-dimensional four chamber views were interrogated off-line using VVI software. Global longitudinal strain(S) , systolic strain rate(SRs) and diastolic strain rate(SRd) were measured in the left ventricles(LV) and right ventricles (RV) of 30 fetal pairs with TTTS and compared to 30 gestational age-matched normal controls. Results Donor LV-SRs was higher, while donor RV-SRd was significantly lower than controls. Recipient S, SRs and SRd were significantly lower for both LV and RV in comparison to controls. Conclusions In TTTS,donor LV systolic function is hyperdynamic while the RV diastolic function is low. Recipient RV and LV are both globally depressed with systolic and diastolic dysfunction.

Objective To evaluate regional right ventricular longitudinal function in fetus using velocity vector imaging(VVI),and establish nomogram of right ventricle,Methods One hundreed and seventy healthy fetuses were divided into 5 groups according to the gestational age.Dynamic digital views of four chamber view were collected and analyzed offline.Velocity,strain and strain rate were calculated in systolic and diastolic period,respectively.Results Normal systolic and diastolic values for velocity,strain and strain rate were established.Tissue velocity gradually decreased from the base segment to the apical segment(P＜0.05),whereas strain and strain rate were stable(P＞0.05).Tissue velocity was gestationalage dependent(P＜0.05),whereas strain and strain rate were stable throughout gestation (P＞0.05).Conclusions Fetal myocardial velocity,strain and strain rate measurements are easy to obtain and reproducible.Increase in tissue velocity throughout gestation probably reflects the growth of the fetal heart,whereas intrinsic myocardial properties as measured by strain and strain rate do not change.