Objective To establish the normal data of the fetal thorax,and to evaluate its values in the diagnosis of fetal thorax malformation.Methods Totally 398 normal singleton fetuses at 16 to 36 gestational weeks(GW) were enrolled,2D-US and 3D-US VOCAL technique were used to measure the 2D data and 3D volumes on the transverse section at the level of the four-chamber view,and the correlation among all measurements with GW was analyzed.Thirty fetuses collected randomly were examined to analyze the reliability.Nine fetuses with congenital thoracic dysplasia (CTD) and 10 fetuses with congenital diaphragmatic hernia (CDH) were assessed and compared with the normal fetuses.Results ① In healthy controls,the fetal thoracic 2D measurements and 3D volumes increased along with the growth of the GW.The regression equations were listed as follows:thoracic transverse diameter (cm) =-0.002 GW2 + 0.301 GW-1.510;thoracic anteroposterior diameter (cm) =0.003GW2 + 0.046GW + 0.666;thoracic area (cm2) =0.071GW2-1.466 GW + 14.728;thoracic circumference (cm) =0.01GW2 + 0.313GW + 3.341;thoracic volume (cm3) =0.285 GW2-7.797GW + 66.592;lung volume (cm3) =0.178 GW2-5.317GW + 45.539;the ratio of lung volume to thoracic volume =0.005GW + 0.396.② The reliabilities of the data obtained by the same/two different operators were good.③ CTD group was obviously lower than the healthy controls in all thoracic measurements (all P ＜0.01).There was no statistical difference in the 2D data between the CDH group and healthy controls (P ＞0.05),while the 3D volumes and the ratio of lung volume to thoracic volume were obviously lower than those in the healthy controls (P ＜0.01).Conclusions 2D-US can evaluate the fetal thoracic development and malformation preliminarily,but 3D-US VOCAL technology plays an important role in distinguishing different types of thoracic malformations.

Objective: To explore the repeatability and consistency of three transthoracic lung ultrasound (TLUS) technologies in diagnosis of interstitial lung disease (ILD). Methods: Totally 40 ILD patients were selected and examined separately using the simplified 14 intercostals space method, 28 intercostals space method and 72 intercostals space method by two ultrasound physicians. The repeatability, consistency and examination time of each ultrasonography method were calculated. Results: The intra-/inter-physicians repeatability and consistency of 3 ultrasonography methods in evaluating B line were high. The intra-physicians repeatability (ICC=0.989 1, 95%CI[0.977 2, 0.994 8]) and consistency (boundary width of 0.57±2.79,95%CI[-0.47, 1.61]) of measuring B lines using 14 intercostals space method were the highest, while the inter-physicians repeatability (ICC=0.979 5, 95%CI[0.957 5, 0.990 2]) and consistency (boundary width of 0.70±3.77, 95%CI[-0.71,2.11]) of measuring B lines using 14 intercostals space method were the highest. The intra-/inter-physicians consistency of pleural line observation using 14 intercostals space method were high (Kappa=0.948, 0.895, both P<0.001). The examination time of 3 ultrasonography methods were different, the 14 intercostals space method took the shortest time, while the 72 intercostals space method took the longest time (P<0.001). Conclusion: Diagnosing ILD with 14 intercostals space method is of great clinical value for high repeatability and consistency and short examination time.

Objective: To compare the repeatability and consistency of ultrasound and MRI in evaluating normal fetal thoracic development. Methods Thirty normal fetuses were selected. The thoracic transverse diameter, anteroposterior diameter, area, circumference, volume and lung volume of fetuses were measured with ultrasonography and MRI. The repeatability and consistency of the measurement results of the same physician and different physicians were analyzed by using intraclass correlation coefficient (ICC) and Bland-Altman, and the correlation of ultrasound and MRI in measuring the lung and thoracic volume was analyzed with Pearson correlation analysis. Results: The inter-/intra-physicians repeatability and consistency of fetal thorax of 2D ultrasound measurement were higher than those of MRI, while the intra-/inter-operator repeatability and consistency of fetal thoracic volume and lung volume measured with MRI were higher than those with ultrasound. The inter-physicians reproducibility and consistency of ultrasound in measuring fetal thoracic transverse diameter were the highest (ICC=0.996 4, 95%CI [0.992 5, 0.998 3]), boundary width=-0.004 7±0.057 3, 95%CI [-0.026 1, 0.016 7]). The fetal lung volume and thoracic volume measured with ultrasound were correlated with MRI (r=0.915, 0.957, both P<0.001). Conclusion: Ultrasonography and MRI are feasible in evaluating normal fetal thoracic development. Ultrasonography is superior to MRI in measuring 2D indexes of fetal thoracic development, while MRI is superior to ultrasound in measuring 3D indexes of fetal thoracic development, but the results have high correlation.

OBJECTIVETo observe the clinical effects of free musculo-cutaneous flap bridging with contralateral posterior tibial vessel on repair of lower extremity soft tissue defect.

METHODSFrom February 2006 to June 2013, 10 patients with soft tissue defect on lower shank and foot were included. The posterior tibial vessel on healthy lower extremity was chosen as recipient vessel and anastomosed with free latissimus dorsi musculo-cutaneous flap, or free latissimus dorsi musculo-cutaneous flap combined with thoracic-umbilical skin flap or anterolateral femoral musculo-cutaneous flap. The retrograde bridged flap was transposed to repair defect on contralateral lower shank and foot. The wound area ranged from 40 cm x 21 cm to 22 cm x 15 cm, with flap size from 48 cm x 26 cm to 25 cm x 18 cm. Meanwhile the defects on donor sites were covered with skin graft and both lower extremities were fixed with kirschner wires at middle tibia and calcaneus. The kirschner wires were removed at 4 weeks and pedicles were cut off 5-8 weeks postoperatively. Six patients received posterior tibial vessel reanastomosis at the same time of pedicle cutting.

RESULTSAll the 10 flaps survived and 3 patients received thinning of flaps due to excessive thickness. During the follow-up period of 3 months to 2 years follow up, the ambulatory function of injured legs recovered gradually with satisfactory appearance. The reanastomosed posterior tibial vessel on the healthy side was recovered.

CONCLUSIONSAppropriate bridged musculo-cutaneous flaps is suitable for extensive soft tissue defect of lower shank and foot. It is a safe and effective method for limb salvage.

Foot ; Free Tissue Flaps ; transplantation ; Humans ; Lower Extremity ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Wound Healing

Objective:To evaluate the diagnostic value of refined transthoracic lung ultrasound(TLUS) scoring method in interstitial lung diseases(ILD).Methods:The TLUS was performed in 39 ILD patients in respiratory department and immunology department of the Second Affiliated Hospital of Fujian Medical University from March 2019 to February 2020. The ultrasonic recordings were evaluated by Buda ultrasound scoring method and refined ultrasound scoring method. The diagnostic efficacies of the refined ultrasound scoring method, Buda ultrasound scoring method and high resolution computed tomography(HRCT) scoring method for ILD were analyzed. The correlations between refined ultrasound score and Buda ultrasound score/HRCT score were evaluated. The difference of diagnostic efficacy between refined ultrasound scoring method and Buda ultrasound scoring method were analyzed in different severity of ILD. Then, the HRCT Warrick scoring method was used as the criterion to judge the severity of ILD, and the receiver operator characteristic (ROC) curve was plotted to predict the cutoff values of the fefined ultrasound score for different degrees of ILD.Results:①The sensitivity of the refined ultrasound scoring method in diagnosing ILD was 92.3%, specificity was 92.3%, area under ROC curve(AUC)=0.978, 95% CI=0.941-1.000. The sensitivity of Buda ultrasound scoring method in diagnosing ILD was 87.2%, specificity was 87.2%, AUC=0.950, 95% CI=0.892-1.000. The sensitivity of HRCT scoring method in diagnosing ILD was 97.4%, specificity was 97.4%, AUC=0.999, 95% CI=0.994-1.000. ②The correlations between the refined ultrasound score, the HRCT Warrick score and the Buda ultrasound score were high ( r=0.929, 0.920, 0.862 respectively, P<0.001). ③The values of refined ultrasound scoring method and Buda ultrasound scoring method consistently and significantly increased with the increasing severity of ILD. With regards to the former one, there were significant differences among mild group, moderate group and severe group ( P<0.05). ④The ROC curve confirmed that refined ultrasound score cut-off points for predicting mild and severe interstitial lung diseases, were 34 [sensitivity of 100%, specificity of 87.5% respectively, AUC=0.891, 95% CI=0.686-1.000] and 64.5 [sensitivity of 91.3%, specificity of 87.5% respectively, AUC=0.954, 95% CI=0.877-1.000]. Conclusions:The severity of the interstitial lung diseases could be evaluated by the refined ultrasound scoring method, which is useful in the semi-quantitative evaluation of ILD.