Objective To explore the clinical significance of prenatal ultrasound examination in diagnosing twin reversed arterial perfusion sequence (TRAP). Methods This was a retrospective study on 5 cases of TRAP sequence conifrmed by prenatal ultrasound and clinical method. The clinical data and ultrasound images were analyzed. Cases were collected at Hubei Maternal and Child Health Hospital from 2001 January to 2013 February. Results Four-iffths of TRAP were not corrected diagnosed and another one was misdiagnosised as asymmetrical conjoined twins in early pregnancy. Five cases of TRAP were correctly diagnosed during the second trimester. Sonographic ifndings of ifve acardia without blood lfow were as follows:(1) All acardias had no blood perfusion in body and umbilical cord, were absence of the fetal head (acephalous) and heart (acaidia), without skin edema, and a linear object resemble as umbilical cord extend from umbilical region of acardia to plcenta could be seen. Four (case 2-5) had lower limbs or dysplasia of lower limbs (two had spine), and one (case 1) had an irregular mass with bone. (2) Four pump twins had no obvious abnormity, while one had two clubfeet (case 2). Three died in uterus, one underwent induced labor due to oligohydramnios and heart dysfunction, and another one survived. Prenatal ultrasound images were consistent with MRI, X-ray examination, autopsy and postnatal neonatal examination results. Conclusions Acardia without blood lfow which was generally misdiagnosed as single gestation in utero can be diagnosed according to the special disformity of acardia and the linear umbilical cord extend from umbilical region to placenta, besides, it still need to strengthen monitoring the pump twin even if there was no blood perfusion to acardia.

ObjectiveTo explore the contrast-enhanced ultrasonography features of postpartum placenta implantation and its clinical value in diagnosis of postpartum placenta implantation.MethodsBetween April 2009 and May 2013, twelve patients with clinically suspected placenta implantation underwent contrast-enhanced ultrasonography in Hubei Maternal and Child Health Hospital. The location and extent of intrauterine lesions and perfusion features of contrast agent were observed. The contrast-enhanced ultrasonography features of postpartum placenta implantation were analyzed and compared with postoperative pathological diagnosis.ResultsIn twelve patients with placenta implantation, eleven showed enhancement. Only one lesion showed no enhancement, which was diagnosed as placental degeneration and calcification on postoperative pathology. One case was placenta adhesions conifrmed by postoperative pathological diagnosis, which presented with a hyperenhanced lesion in uterine cavity with a clear boundary to myometrium. Six cases were placenta implantation confirmed by postoperative pathological diagnosis, which presented with a residual placenta surrounded with extremely thin or evendiscontinuous uterine serosa. Five cases were placenta penetration confirmed by postoperative pathological diagnosis, which presented with a residual placenta penetrating the uterine serosa and contrast agent spilling out. All cases in this study were cured by operation.ConclusionsContrast-enhanced ultrasound could diagnose placenta implantation via the difference of tissue perfusion. The lesion of placenta implantation showed enhancement after injection of contrast agent. If discontinuous uterine serosa and contrast agent spilling was observed, placenta penetrating uterine serosa should be considered. Contrast-enhanced ultrasound has important clinical value in diagnosing postpartum placenta implantation and observing postoperative recovery processes of uterine rupture.

Objective To assess the value of prenatal ultrasonography in diagnosing fetal absent pulmonary valve syndrome(APVS). Methods This was a retrospective study of 8 fetuses with absent pulmonary valve syndrome. Fetal echocardiography and segmental analysis were used to determine the atrial situs,atrioventricular connections and ventriculoarterial relationships. Cardiac chamber dimensions,Doppler studies of the atrioventricular valve and semilunar value were recorded, and cardiothoracic ratio were calculated. Results Levocardia,normal situs and atrioventricular connections were present in all cases. All cases showed typical signs:severe dilatation of the pulmonary trunk and it's branches, and concurrent occurrence of pulmonary valve stenosis and regurgitation. In 6/8 there was an associated ventricular septal defect,overriding aorta and absent arterial duct(Fallot-like APVS),while in 2/8 there was an assoiciated intact ventricular septal and patent arterial duct. Extracardiac malformations were detected in 5 cases.Conclusions APVS can be accurately diagnosed by prenatal ultrasonography but we should pay more attention to the ventricular septal and arterial duct,due to the existence of two variants.

OBJECTIVE: To explore the circadian distribution of premature ventricular contractions (PVCs) in patients with viral myocarditis (VM) according to the theory of chronomedicine in traditional Chinese medicine (TCM) in order to find out the scientific evidence for a reasonable administration time. METHODS: Two hundred and forty patients with VM were enrolled and electrocardiograms were examined for all by Holter monitor. The circadian distribution of PVCs was evaluated according to the theory of chronomedicine of TCM about time periods corresponding to five zang viscera. RESULTS: PVCs mostly happened in periods of 3:00-5:00, 5:00-7:00, 7:00-9:00 and 9:00-11:00, in which 5:00-7:00 was the most serious time. Less PVCs happened in periods of 17:00-19:00, 19:00-21:00 and 21:00-23:00. The frequency of PVCs in midnight also increased with aging. The time periods of the frequency peak of PVCs in patients with different syndromes were also different. In patients with syndrome of pathogenic heat invading heart (PHIH), the PVCs mostly appeared in midday. In patients with syndrome of flaring of fire due to yin-deficiency (FFYD), the PVCs were most serious in daytime and aggravated at noon. And in patients with syndrome of insufficiency of heart-qi and yang (IHQY), the PVCs mostly happened in early morning or midnight. CONCLUSION: There was a manifest regulation of the pathological circadian rhythm of PVCs in patients with VM. The circadian distributions of PVCs were variable in patients with different syndromes. Therefore the theory of chronomedicine of TCM may be used to guide the treatment based on syndrome differentiation.

Objective To study the relationship between Caspase-12 expression and the hyperoxia-induced corpus callosum damage. Methods A total of 12 groups of C57 / BL6 mice were randomly assigned into hyperoxia group (80% O2 ) and control group (21% O2 ) at day 6 after birth (P6). The pups were sacrificed after 24 h and 48 h of hyperoxia exposure and at P10, P12, P15 and P30. Immunohistochemical ( IHC) method was used to detect the expression of myelin basic protein (MBP) in corpus callosum. Real-time PCR, Western Blot and IHC were used to detect the expression of mRNA and protein of Caspase-12 in corpus callosum. The corpus callosum apoptosis was measured using terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling ( TUNEL ) method. Results The expression of MBP in hyperoxia group were significantly lower than the control group at P10 and P12 (P = 0. 004 and 0. 016); however, no significant differences existed between the two groups at P15 and P30 (P > 0. 05). The expression of Caspase-12 mRNA after 24 h and 48 h hyperoxia exposure were significantly higher than the control group [24 h: (1. 549 ± 0. 098) vs. (1. 080 ± 0. 101); 48 h:(1. 333 ± 0. 076) vs. (1. 022 ± 0. 089); P < 0. 05]. The expression of cleaved Caspase-12 protein after 24 h and 48 h hyperoxia exposure were also significantly higher than the control group [24 h: (1. 582 ± 0. 010) vs. (0. 994 ± 0. 078); 48 h: (1. 370 ± 0. 095) vs. (0. 978 ± 0. 069); P < 0. 05] . The Caspase-12 positive cell were significantly increased after 24 h and 48 h hyperoxia exposure comparing with the control group. The apoptosis index in hyperoxia group was significantly higher than the control group at P10 and P12 [P10: (18. 742 ± 2. 503) vs. (4. 587 ± 2. 353); P12 (36. 184 ± 3. 655) vs. (5. 351 ± 2. 678); P < 0. 05]. Conclusions Hyperoxia exposure induces corpus callosum damage in newborn mice. Over-expressed Caspase-12 may induce corpus callosum cell apoptosis excessively.

Objective To evaluate the quality of life (QOL) of nasopharyngeal carcinoma (NPC) tumorfree survivors,and analyze the factors affecting the QOL of NPC patients.Methods The QOL and demographic variables (gender,age,education,marital status,income,dialects,concomitant chronic disease,clinical stage,treatment method,radiation course,and radiotherapy stages) were collected.ANOVA and t test were used to compare the QOL of NPC patients among different demographic variables. Multivariate ANOVA was used to select the influencing factors. Results The influencing factors of psychological QOL included radiotherapy stage, radiation course and concomitant chronic disease. NPC patients had higher psychological domain QOL whose survival greater than five years, had a completed course of radiation, and without other diseases (P ＜0.05).The influencing factors of social QOL included radiotherapy stage and treatment method (P＜ 0.05). The influencing factors of side-effect QOL included radiotherapy stage(P ＜ 0.05).Conclusion The NPC tumor-free survivors who survival longer, have more course of radiation and with chronic diseases should be pay more attention.Prevention interventions should be preformed to reduce radiation injury to patients; side effects,and improve QOL of NPC tumor-free patients.

Objective To evaluate the value of two-dimensional strain imaging in assessing right ventricular function of recipient fetus in TTTS pregnancies.Methods Sixteen TTTS pregnancies and 19 normal monochorionic diamniotic pregnancies(controls) were included.Doppler studies of the umbilical artery,umbilical vein,ductus venosus,middle cerebral artery,atrioventricular valve and semilunar value were recorded in both fetus,and myocardial performance index of both ventricles was calculated.Longitudinal peak systolic strain of right ventricular were calculated and compared between recipient fetus and other fetus.Results Cardiothoracic ratio and myocardial performance index of right ventricular showed significant differences between recipient fetus and controls.Right ventricular strain was decreased in recipient fetus compared with controls.Conclusions Two-dimensional strain imaging can be used to evaluate right ventricular myocardial function in the recipient fetus of TTTS.

ObjectiveTo explore the clinical value of ultrasound and MRI in diagnosis of simple fetal indirect hernia.MethodsA total of 671 558 fetuses were examined in maternal and child healthcare hospital of Hubei from February 2003 to February 2015. Once inguinal hernia or testicular tumors was suspected, MRI examination was performed after prenatal ultrasound. Final diagnosis was confirmed by postnatal follow-up. The ultrasonographic characteristics of fetal indirect hernia were compared with prenatal MR image characteristics and postnatal follow-up results.ResultsThree cases were conifrmed after birth. The simple fetal indirect hernia was uncommon clinical entity which occurred during 3rd trimester. The ultrasonic characteristics in prenatal period were: (1) Right enlarged scrotum was iflled with heterogeneous lesion; intestinal peristalsis within the scrotum was found in real-time ultrasonography. (2) The contralateral testis in left scrotum and penis could be found. MRI could display the characteristicsof indirecthernia contents and its extension from abdominal cavity intoinguinalregion, which may help diagnose fetal simple indirect hernia. One case of fetal indirect hernia was misdiagnosed as testicular tumors, which was correctly diagnosed by MRI.ConclusionsThe simple fetal indirect hernia can be prenatally diagnosed by characteristic ultrasonic features, which can present with abnormal mass ininguinalregion. Prenatal ultrasound is the primary screening method of fetal indirect hernia. MRI can serve as a supplement approach. The combination of US and MRI can further improve the diagnostic accuracy of fetal indirect hernia.

Objective To observe the clinical efficacy of surround electroacupuncture in relieving pain after operation for mixed hemorrhoids. Method Seventy-two patients with mixed hemorrhoids were randomized into a treatment group and a control group, 36 cases in each group. The two groups both received the corresponding interventions once in 15 min after the operation: the treatment group received electroacupuncture treatment, and the control group was only placed in a simulated environment of electroacupuncture but without receivimg any needling treatment. The pain intensity was evaluated by using Verbal Rating Scale (VRS), Wong-Baker Faces Pain Rating Scale, and Visual Analogue Scale (VAS) at 11 different time points after the treatment: once every 1 h in 8 h after the treatment, once at the first defecation, once respectively 24 h and 48 h after the treatment. The data were statistically analyzed afterwards. Result At 3 h and 4 h after the treatment and at the first defecation after the treatment, the VRS scores of the treatment group were significantly lower than that of the control group (P<0.05); respectively at 4 h, 5 h, 6 h, 7 h, and 8 h after the treatment and at the first defecation, the Wong-Baker scores of the treatment group were significantly lower than that of the control group (P<0.05); respectively at 2 h, 3 h, 4 h, 5 h, 6 h, 7 h, and 8 h after the treatment, at the first defecation, as well as at 24 h after the treatment, the VAS scores of the treatment group were significantly lower than that of the control group (P<0.05); it indicates that the pain intensity of the treatment group should be lower than that of the control group at the above time points, and the analgesic effect in the treatment group lasts a longer time, running a lower risk of losing effectiveness compared to the control group (P<0.05). Conclusion Real-time acupuncture treatment after the operation is significantly effective in relieving pain after operation for hemorrhoids.

Objective To assess the clinical value of vascular enhancement technology (VET) in diagnosis of fetal pulmonary sequestration (PS).Methods Color Doppler velocity (CDV),color Doppler energy (CDE) and VET were performed in 11 fetus with PS to display the vessels in region of interest.Results The abnormal vessels in region of interest were displayed in distinct degree with CDV,CDE and VET.The courser and disposition of the great vessels were displayed with CDV and CDE,while lumen of blood vessel was clearly discriminated with VET,while CDV depicted the direction of blood flow.Satisfaction assessment of the VET image was superior than those of CDV and CDE image (P<0.05).No difference was found between the satisfaction assessment of the CDV and CDE images (P>0.05).Conclusion VET can improve the contrast resolution,having superiority in displaying vessels and fine branches,therefore has clinical value in the diagnosis of fetal PS.