Humans ; Pregnancy ; Female ; Umbilical Cord/diagnostic imaging* ; Pregnancy Outcome ; Ultrasonography ; Ultrasonography, Prenatal

Objective:To assess the value of acoustic radiation force impulse (ARFI) elastography in the diagnosis of children with biliary atresia.Methods:A prospective survey of infants with hepatitis syndrome and hyperbi-lirubinemia in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2017 to December 2018 was performed.The children with hepatitis syndrome were divided into the biliary atresia group( n=45) and non- biliary atresia group( n=30). Thirty children with hyperbilirubinemia were selected as the control group.Shear wave speed (SWS) of all infants was collected by ARFI ultrasound and compared among 3 groups.Receiver ope-rating characteristic curve(ROC curve) was used to analyze the optimal threshold value for SWS in the diagnosis of biliary atresia. Results:The mean SWS values in the biliary atresia group, non-biliary atresia group and the control group were (1.79±0.29) m/s, (1.26±0.12) m/s and (1.08±0.06) m/s, respectively.Compared with the control group, the mean SWS values in the biliary atresia group and non-biliary atresia group were significantly higher ( t=165.43, 15.75, all P<0.05). The mean SWS value in the non-biliary atresia group was significantly lower than that in the biliary atresia group ( t=90.27, P<0.05). With the non-biliary atresia group as reference, the area under the ROC curve of SWS for diagnosis of biliary atresia was 0.98(95% CI: 0.95-1.00), the optimal threshold was 1.45 m/s, and the sensitivity and specificity were 88.9% and 96.7%, respectively. Conclusions:Rapid non-invasive ARFI elastography is effective in the diagnosis of biliary atresia, and thus has important value for early diagnosis and treatment in clinical practice.

Objective To investigate the risk factors,management and prophylaxis of dangerous placenta previa.Methods The clinical data of 407 cases of placenta previa were reviewed,36 cases of them with dangerous placenta previa.Comparison was made between group A (dangerous placenta previa,36 cases) and group B (non dangerous placenta previa,371 cases) in terms of age,number of pregnancy and number of ceasarean delivery.Results The incidence rates of pregnant women in group A age ≥ 35years,number of pregnancy ≥3times,and cesarean delivery≥2times were 55.6％,61.1％,25.0％,which were significantly higher than those of group B (25.6％,27.7％,2.4％),the differences were statistically significant (x2 =7.71,8.99,21.97,all P ＜ 0.01).Among the 36 cases of dangerous placenta previa,12 cases were diagnosed with concomitant placenta increta.The specificity and sensitivity for detection of placenta increta were 90.5％ (19/21) and 83.9％ (10/12) of ultrasonography respectively,and those were 100.0％ (3/3) and 87.5％ (7/8) of MRI.Of the 36 dangerous placenta previa patients,two patients were treated with induced labour due to unexpected pregnancy under 28 weeks,while the others were refer to surgical operation.5 surgical patients experienced uncontrollable postpartum haemorrhage which necessitated histectomy,while the other 31 cases received conservative operation.Rate of histectomy was 13.9(5/36).Conclusion Dangerous placenta previa is associated with advanced age,multiple pregnancy and multiple cesarean delivery.Accurate preoperational evaluation of the placenta previa should be acquired with ultrasonography and MRI to detect placenta increta,provide information for treatment selection,and prevent postpartum haemorrhage.

Objective To analyze the ultrasonic features of interrupted inferior vena cava (IVC) and its relationship with related deformities so as to improve the prenatal diagnosis of isomerism.Methods Pregnant women who received prenatal care in Peking University People's Hospital or who were referred to our hospital for suspected malformation of fetus between January 2010 and December 2013 were enrolled in this study.Fetal echocardiography and abdominal transverse section were performed routinely.Spatio-temporal image correlation technology was used to further clarify interrupted IVC if azygos vein was broadened or IVC disappeared in the fetal abdominal transverse sections.Based on the presence of cardiac structural abnormalities,interrupted IVC was divided into isolated IVC interruption and complex IVC interruption.Neonatal echocardiography was performed in women with continued pregnancies.In women with terminated pregnancy,fetus was autopsied after induced labor.Results In total,12 cases of interrupted IVC were diagnosed,including 5 cases of isolated IVC interruption with full-term delivery and 7 cases of complex IVC interruption.Neonatal echocardiography,abdominal ultrasound were all normal in the 5 cases of isolated IVC interruption except for 3 cases complicated with sistus inversus viscerum.All the 7 cases of complex IVC interruption had induced labor because of some congenital cardiac abnormalities.Autopsy showed that 6 cases had left isomerism,and 1 case had right isomerism.Conclusions Interrupted IVC can be easily identified in prenatal diagnosis due to the typical ultrasonic features.Complication with some congenital cardiac abnormalities often indicates isomerism,especially left isomerism.

Objective To investigate the clinical features and gene mutation of a newborn with neonatal-onset ornithine transcarbamylase deficiency (OTCD) and report the multidisciplinary perinatal management of the mother with late-onset OTCD.Methods The clinical features,biochemical data and the treatment of a newborn boy with OTCD and his mother admitted by Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in April,2013,were collected.The ornithine transcarbamylase (OTC) gene in the family was analyzed.Results Serum ammonium in the male newborn gradually increased to 1 020 μ mol/L at 48 h after birth.His blood amino acids level and urine organic acid level showed a pattern indicative of OTCD [blood arginine (97.43 μ mol/L,reference 1.00-25.00 μ mol/L),citrulline (27.43 μ mol/L,reference 4.00-30.00 μ mol/L),ornithine (161.66 μ mol/L,reference 10.00-120.00 μ mol/L) and methionine (70.45 μ mol/L,reference 10.00-50.00 μ mol/L); urine uracil (67.11 μ mol/mol Crea,reference 0.00-7.00 μ mol/mol Crea) and orotic acid (1 372.66 μ mol/mol Crea,reference 0.00-1.50 μ mol/mol Crea)].DNA studies revealed a c.583G ＞ A (G195R) homozygous mutation of the OTC gene.His mother was heterozygous for OTCD and developed acute hyperammonemia during pregnancy.Her blood showed a normal-leveled arginine (8.44 μ mol/L,reference 1.50-25.00 μ mol/L),a normal-leveled citrulline(8.41 μ mol/L,reference 7.00-35.00 μ mol/L),an elevated glutamate(279.15 μ mol/L,reference 45.00-200.00 μ mol/L).Her urine uracil (51.55 μ mol/mol Crea,reference 0.00-7.00 μ mol/mol Crea) and orotic acid (38.75 μ mol/mol Crea,reference 0.00-1.50 μ mol/mol) were elevated.Successful management of her prenatal and postpartum blood ammonia level was achieved after administration of pharmacologic nitrogen scavengers and protein limitation.DNA studies revealed a c.583G ＞ A (G195R) heterozygous mutation in the newborn's mother and grandmother.Conclusions General management on pregnant OTCD women is effective.Male newborn patients often have a poor prognosis.

Objective To evaluate the effect of nursing intervention on the quality of life of patients with heart failure based on the transtheoretical model ( TTM).Methods Totals of 100 heart failure patients were divided into the control group and the intervention group , 50 cases each .The control group was treated with conventional health education .The intervention group was treated with the nursing intervention based on TTM . We evaluated the quality of life in the time of before intervention , 1 month and 3 months after the intervention , respectively , by the Minnesota living with heart failure questionnaire ( MLHFQ) , and compared the differences . Results 1 month and 3 months after discharge , 2 cases were died and 5 cases were lost during the follow-up in the intervention group , and 43 cases finished the investigation .3 cases were died and 7 cases were lost during the follow-up in the control group , and 40 cases finished the investigation .Before the intervention , 1 month and 3 months after the intervention, the total score of MLHFQ were (40.14 ±17.59), (59.98 ±17.44), (52.28 ±16.46) in the intervention group, and (38.45 ±16.00), (45.25 ±14.80), (41.30 ±14.40) in the control group .Before the intervention , there was no statistically difference between the two groups ( P>0.05).After the intervention for 1month and 3 months, the differences were significant ( t =3.29, 3.22, respectively;P<0.05).Conclusions Comparing with the conventional healthy education , the method based on TTM is one of the most effective ways , which can improve the quality of life of patients with heart failure . Thus, it is worthy of getting widely promoted in hospital .

Objective To investigate the application of reality cross-sectional assessment ( RCA) in the ability evaluation of young nurses .Methods 32 young nurses, who had worked for 3-10 years, were enrolled in the study.Each month, we randomly selected 10 nurses to finish the RCA.The clinical ability, quality ofcare and patients ’ satisfaction were compared before and after the assessment .Results The score of clinical ability was (80.41 ±10.76) before the application of RCA .After applied the RCA for 6 and 12 month, the scores of clinical ability were (90.78 ±5.71) and (89.25 ±6.36), the difference was significant ( F=15.932,P<0.01).After applied the RCA for 6 and 12 month, the scores of quality of care were (88.03 ±6.05) and (88.22 ±5.98), the difference was significant (F=3.179,P<0.05).The patients’ satisfaction improved from 90.38%to 100.00%, which was significant different (χ2 =18.152,P<0.05).Conclusions RCA combine with practical work can reflect the state of real work of nurses and their true level , which promotes the overall quality of care and clinical practice of working ability .

ObjectiveTo explore the metabolite status on prefrontal lobe and thalamus by proton magnetic resonance spectroscopy (1H-MRS) and affecting factors in patients of schizophrenia.Methods 159 schizophrenics met with CCMD-3 and 45 normal controls were examined at prefrontal lobe and thalamus by multi-voxel 1H-MRS.The N-acetylaspartate ( NAA),Choline-congtaining compounds ( Cho),and Creatine compounds (Cr)were measured and the ratios of NAA/Cr,Cho/Cr were determined. Positive and Negative Syndrome Scale (PANSS),Social Disability Screening Schedule (SDSS),and Wisconsin Card Sorting Test (WCST) were also assessed.ResultsOn left prefrontal lobe of patients,the NAA/Cr ratio demonstrated lower than that in normal controls (1.42 ±0.34 vs.1.64 ±0.39,t =3.70,P＜0.01 ).The same phenomenon were appeared on left thalamus (1.46±0.35 vs.1.66±0.38,t=3.32,P＜0.01) and on right thalamus (1.49±0.34 vs.1.62±0.37,t=2.04,P ＜ 0.05 ).Contributing to the NAA/Cr ratio,main influencing factors on left prefrontal lobe were age of onset,duration of illness,score of negative symptoms,antipsychotic treatment,total score of PANSS,Categories completed of WCST,total score of SDSS,year of education.Main influencing factors on left thalamus were age of onset,duration of illness,antipsychotic treatment.Main influencing factors on right thalamus were duration of illness,age of onset,score of negative symptoms,antipsychotic treatment,and family history.ConclusionsAbnormalities in neuronal function and/or integrity presented on prefrontal lobe and thalamus in schizophrenics are related to many respects,especially age of onset,duration of illness and antipsychotic treatment.

ObjectivesTo explore the characteristic of different subtypes of depression on prefrontal lobe and hippocampus by proton magnetic resonance spectroscopy (1H-MRS),and its relationship.Methods 46 patients of depression,which were met with the third edition of the Chinese Classification of Mental Disorders (CC-MD-Ⅲ ) since December 2010 to March 2012 from Mental Diseases Prevention and Treatment Institute,were examined at prefrontal lobe and hippocampus by multi-voxel 1 H-MRS.They were divided into male ( n =25) and female ( n =21 ),early-onset subtype ( n =26) and late-onset subtype ( n =20 ),short-duration of illness ( n =23 )and long-duration of illness ( n =23 ) by different criteria.The N-acetylaspartate ( NAA),Choline-congtaining compounds (Cho),and Creatine compounds (Cr) were measured and the ratios of NAA/Cr,Cho/Cr were determined.ResultsOn left prefrontal lobe,the NAA/Cr ratios in patients of male ( 1.83 ± 0.19),late-onset subtype (1.86 ±0.16),and short-duration of illness ( 1.83 ±0.17) showed higher than those in female ( 1.70 ±0.12,t=2.711,P ＜ 0.01 ),early-onset subtype ( 1.70 ± 0.19,t =3.028,P ＜ 0.01 ),and long-duration of illness ( 1.71±0.20,t =2.192,P＜0.05).Both on left prefrontal and on left thalamus,the ratios of NAA/Cr were positively correlated with the age of onset ( r=0.493 and 0.478,P＜0.01 ),and were negatively correlated with the duration of illness ( r =- 0.482 and - 0.470,P ＜ 0.01 ).ConclusionsDifferent subtypes of depression maybe have different characteristics of 1H-MRS due to the age of onset and the duration of illness.

Objective To compare the differences between the schizophrenics with negative and positive symptoms on prefrontal lobe and thalamus by proton magnetic resonance spectroscopy ( 1 H-MRS). Methods 58 negative subtype and 51 positive subtype schizophrenics were examined at prefrontal lobe and thalamus by multivoxel 1H-MRS before antipsychotic treatment The N-acetylaspartate (NAA), choline-containing compounds ( Cho), and creatine compounds (Cr) were measured and the ratios of NAA/Cr, Cho/Cr were determined. Results On right thalamus,the NAA/Cr ratio in negative subtype patients ( 1.40 ± 0.29 ) demonstrated lower than that in positive subtype ( 1.62 ± 0.33 ), the same phenomenon were appeared on male, female, non-first-episode, with-medicine and without-medicine patients (P ＜ 0.05 or 0.01 ). The Cho/Cr ratio on right thalamus in negative subtype of female,non-first-episode,without-medicine schizophrenics were lower than those in positive subtype (P ＜ 0.05 ).On left prefrontal lobe,left thalamus and right thalamus, the NAA/Cr ratios both in negative subtype and positive subtype schizophrenics were significantly negatively related with age of onset(P＜0. 05 or 0.01 ). In negative subtype schizophrenics,the Cho/Cr ratio on right thalamus was positively related with age of onset ( r = 0. 25, P ＜0.05 ). In negative subtype schizophrenics of non-first-episode, without-medicine, the correlation was negative between the NAA/Cr ratio and the course of disease( r= -0.48, -0.46, P＜0.05 ) ,and was positive between Cho/Cr ratio and the course of disease on right thalamus( r= 0.58,0.56, P＜ 0.01 ). Conlusion Compared with positive subtype schizophrenics,negative subtype schizophrenics have greater impairments on 1 H-MRS on right thalamus. The course of disease has greater effects on 1 H-MRS in negative subtype schizophrenics.