To assess the application value of two-dimensional speckle tracking imaging（2D-STI） in the evaluation of fetal left atrial strain in three phases， and to explore the correlation between the three phases of left atrial strain and gestational age， and whether the technique has angular dependence on the apex orientation in fetal heart examination.
Methods
A total of 180 normal singleton fetuses in the second and third trimesters who underwent fetal echocardiography at the Department of Diagnostic Ultrasound ＆ Echocardiography，Sir Run Run Shaw Hospital， Zhejiang University College of Medicine from November 2021 to January 2022 were selected. A total of 611 fetal four-chamber view video clips with different apex angles were obtained. 2D-STI analysis was used to obtain the peak storage strain （LASr_ED）， peak pipeline strain （LAScd_ED）， and peak systolic strain （LASct_ED） of the left atrium. 2D-STI could not identify the onset of atrial contraction in 11 fetuses （32 dynamic images）， and could not distinguish the atrial contraction phase from the conduit phase. Linear regression analysis was used to analyze the relationship between gestational age and 2D-STI parameters in patients in whom the three phases of left atrial strain with the apex orientation of 10：30 to 1：30 in the four-chamber view could be well tracked and identified. A total of 579 dynamic images with good tracking and recognition of the three phases of left atrial strain were selected， including 126 during 18-24 gestational weeks，190 during 25-28， 150 during 29-32， and 113 during 33-36. The patients were divided into four groups according to the apex orientation： group 1（apex orientation： 10：30-1：30）， group 2 （1：30-4：30）， group 3 （4：30-7：30）， and group 4 （7：30-10：30）. The F test and LSD-t test were used to compare the left atrial strain parameters between different groups of normal fetuses in the same gestational weeks.
Results
2D-STI could successfully track and identify the three temporal variations of the left atrium in 94.76% （579/611） of fetuses. LASr_ED and LASct_ED decreased with the increase of gestational age（r=-0.32， P＜0.001； r=-0.35， P＜0.001）， while LAScd_ED increased with the increase of gestational age （r=0.15，P＜0.05）. There was no statistical difference in the three strain parameters of the left atrium in different apex orientations among the four groups at 18-24 gestational weeks and 25-28 gestational weeks （all P＞0.05）. There were significant differences in LASr_ED among the four groups at 29-32 gestational weeks （F=2.759， P=0.044）.There were significant differences in LASr_ED and LAScd_ED among the four groups at 33-36 gestational weeks（F=2.919， P=0.037； F=4.234， P=0.007）. Pairwise comparisons were then made among the four groups. There were no significant differences in LASr_ED， LAScd_ED， and LASct_ED between group 1 and group 3 during the same gestational weeks （all P＞0.05）， and in LASr_ED， LAScd_ED， and LASct_ED between group 2 and group 4 during the same gestational weeks （all P＞0.05）.
Conclusion
LASr_ED and LASct_ED of normal fetuses in the second and third trimesters are weakly negatively correlated with gestational age. There is a very weakly positive correlation between LAScd_ED and gestational age in normal fetuses in the second and third trimesters. 2D-STI has no apex angle dependence in the practical application of fetal left atrial strain in the second trimester， but has certain apical angle dependence in the third trimester. Choosing axial or transverse four-chamber heart view as the unified image acquisition standard can help obtain fetal left atrial strain parameters more accurately， and provides a basis for quantitative assessment and continuous monitoring of fetal cardiac function.
To retrospectively analyze the prenatal ultrasound signs and characteristics of 12 cases of fetal 22q11.2 microdeletion syndrome （22q11.2DS）， and to assess the diagnostic value of prenatal ultrasound in detecting this condition.
Methods
This is a retrospective study in which the ultrasonic signs and characteristics of 12 cases of 22q11.2DS fetuses diagnosed by chromosome microarray analysis at the Center for Eugenics and Childbirth of Suzhou Hospital Affiliated to Nanjing Medical University from June 1， 2019 to May 31， 2022 were retrospectively analyzed， as well as the general clinical situation of pregnancy and prenatal diagnosis indications.
Results
Among the 12 22q11.2DS fetuses， 9 were male and 3 were female. Five fetuses had isolated cardiac malformation （41.6%）， and 3 were complicated with extracardiac malformation （25.0%）； thus， there were a total of 8 （66.7%） cases of congenital heart disease （CHD）.According to the ultrasonic signs， 5 cases （41.7%） were ventricular septal defect， 4 （33.3%） were pulmonary artery stenosis， and 3 （25.0%） were left cardiac axis deviation. However， from the perspective of heart complex malformation， there were 7 （58.3%） cases of truncus conus malformation， 2 cases of tetrad Fallot，2 cases of pulmonary atresia with ventricular septal defect， 2 cases of ventricular septal defect combined with pulmonary stenosis， and 1 case of right ventricular double outlet. There were 2 cases of right aortic arch with aberrant left subclavian artery and 1 case of interrupter aortic arch. The most common extracardiac malformation was thymic dysplasia （n=3， 25.0%）， of which 2 cases were combined with cardiac malformation and 1 was isolated thymic dysplasia. One case of urinary malformation was multicystic dysplastic kidney with short long bone development.
Conclusion
CHD and especially conotruncal anomalies， axial abnormality，thymic dysplasia， and skeletal and urinary system malformation are manifestations of 22q11.2DS， and prenatal ultrasound is an effective examination method for 22q11.2DS.
To investigate the clinical features of obstructed hemivagina and ipsilateral renal anomaly （OHVIRA） syndrome and analyze the value of ultrasonography in the diagnosis of this condition.
Methods
From January 2013 to June 2022， 32 cases of OHVIRA syndrome diagnosed and surgically treated at Maternal and Child Health Hospital of Hubei Province were retrospectively analyzed.
Results
Oblique septum occurred on the left side in 14 cases and on the right side in 18. Twenty-two cases underwent oblique vaginal septum resection， and ten underwent combined hysteroscopic and laparoscopic oblique septum resection. Four cases underwent unilateral hysterectomy due to cervical atresia or dysplasia，and two underwent nephroureterectomy due to pelvic renal ectopia with dysplasia and ectopic ureteral orifice.With regard to reproductive system involvement， there were 22 cases of duplex uterus， 7 cases of complete septate uterus， and 3 cases of bicornuate uterus； there were 2 cases of cervical atresia and 8 cases of cervical dysplasia； there were 30 cases of hematocolpos， 21 cases of hematometra， 17 cases of hematosalpinx， 2 cases of pyosalpinx， 5 cases of hemoperitoneum， and 10 cases of pelvic adhesion. Regarding urinary system involvement， all 32 cases were complicated with abnormal development of the urinary system. One of the kidneys was absent in 29 cases， and there was one case of renal cystic dysplasia and two cases of pelvic renal ectopia and renal dysplasia with ectopic ureteral orifice. Among the 32 cases of OHVIRA syndrome， there were 14 cases of type I， 9 cases of type II， 7 cases of type III， and 2 cases of type Ⅳ. Ultrasonography can accurately diagnose uterine malformation， hematocolpos， hematometra， hemoperitoneum， and renal dysplasia.
Conclusion
Ultrasonography is the preferred and reliable method for diagnosing OHVIRA syndrome.
To investigate the difference in ultrasonographic features and laboratory findings between low-grade appendiceal mucinous tumors （LAMN） and appendiceal mucinous adenocarcinoma （AMAC） in order to improve their diagnostic accuracy.
Methods
The ultrasonographic and contrast-enhanced ultrasound images of patients with appendiceal mucinous tumors confirmed by surgery and pathology at our hospital from January 2009 to October 2023 were retrospectively analyzed. According to the postoperative pathological results， the patients were divided into two groups： patients with LAMNs and those with AMAC. The Fisher exact probability method was used to compare the differences in ultrasound images and laboratory tests（tumor markers and infection indexes） between the two groups.
Results
Forty-six patients were included in the study， including 29 in the LAMN group and 17 in the AMAC group. Preoperative diagnostic accuracy was 59% in the LAMN group and 47% in the AMAC group. There were significant differences in the characteristics of mass （cystic/cystic-solid）， boundary， wall nodule， calcification， internal echo， “onion skin” appearance， septa， adhesion to surrounding tissue， contrast-enhanced ultrasound findings， and whether peritoneal pseudomyxoma （PMP） was combined between the two groups （P＜0.05）. The mass was cystic in 72% （21/29） of patients in the LAMN group and cystic-solid in 28% （8/29）， compared with cystic-solid in 100% （17/17） of patients in the AMAC group. The boundary was clear in 89% （26/29） of patients in the LAMN group and unclear in 76% （13/17） of patients in the AMAC group. Wall nodules were present in 14%（4/29） of patients in the LAMN group and 88% （15/17） in the AMAC group. The capsule wall was calcified in 7% （2/29） of patients in the LAMN group and 59% （10/17） in the AMAC group. Forty-two percent （15/29）of patients in the LAMN group had uniform internal echo， and 100% （17/17） of patients in the AMAC group had chaotic internal echo. Thirty-four percent （10/29） of patients in the LAMN group showed “onion skin”appearance， while no such sign was found in the AMAC group. The masses of 14% （4/29） of patients in the LAMN group and 88% （15/17） in the AMAC group had internal septa. In the LAMN group， 7% （2/29） of patients had adhesion to the surrounding tissue， and in the AMAC group， this percentage was 94% （16/17）.In the LAMN group， 7% （2/29） of the patients showed high enhancement in CEUS， and in the AMAC group，82% （14/17） of the patients showed high enhancement in CEUS， mainly thick-walled nodules， while the masses in the remaining patients showed no enhancement. Peritoneal pseudomyxoma （PMP） was found in 7% （2/29） of patients in the LAMN group and 65% （11/17） in the AMAC group. The number of patients with elevated tumor markers in the AMAC group was higher than that of the LAMN group， and there were statistically significant differences in carcinoembryonic antigen， carbohydrate antigen 199， carbohydrate antigen 125， carbohydrate antigen 242， and neuron-specific enolase between the two groups （P＜0.05）.There were more patients with elevated infection indexes in the AMAC group than in the LAMN group， and there were statistically significant differences in white blood cell count， neutrophils， and C-reactive protein between the two groups （P＜0.05）.
Conclusion
The diagnostic accuracy for LAMNs and AMAC can be significantly improved by ultrasonography and contrast-enhanced ultrasonography combined with serum tumor markers and infection indicators.
To explore the ultrasonic imaging characteristics of pulmonary lesions in multiple microbial pulmonary infections （MMPI） and evaluate the clinical value of ultrasound-guided percutaneous lung biopsy （UGPLB） in these conditions.
Methods
Two hundred and sixty-two patients with suspected MMPI from August 2012 to February 2024 at the Fourth People's Hospital of Nanning were selected. After chest CT and ultrasound examinations， UGPLB was successfully implemented for peripheral lung lesions， and the obtained lung lesion samples were subjected to histopathological examination and pathogen detection. The patients were divided into either an MMPI group or a single pathogen pulmonary infection （SPPI） group according to the confirmed pathogen（s）. The ultrasonic manifestations were compared between the MMPI group and SPPI group using the χ2 test， and the relevant clinical data were comprehensively analyzed.
Results
All lung lesions were successfully obtained by UGPLB for pathological diagnosis and pathogen detection. Among the 262 patients， 210 were finally diagnosed with MMPI， of which the pathogen combination was mainly Mycobacterium tuberculosis + Marneffei basket （59 cases）， followed by Mycobacterium tuberculosis + Rhodococcus equi （44 cases）， Mycobacterium tuberculosis + Cryptococcus（37 cases）， and Mycobacterium tuberculosis + Klebsiella pneumoniae （36 cases）； 52 patients were diagnosed with SPPI， and the main pathogen was Mycobacterium tuberculosis （22 cases）， followed by Marneffei basket（14 cases）. One hundred and sixty-seven cases （79.52%） in the MMPI group and 18 cases （34.62%） in the SPPI group has a mean lung lesion size of ≥50 mm as measured by ultrasound， and there was a significant difference between the two groups （χ2=40.506， P＜0.001）. There were 132 cases （62.86%） in the MMPI group and 11 cases （21.15%） in the SPPI group with mixed solid and liquid echo in the lung lesions， and there was a significant difference between the two groups （χ2=29.240， P＜0.001）. There was no significant difference in the boundary of lung lesions， internal blood flow signal， or complication with pleural effusion between the two groups （P＞0.05）.
Conclusion
The characteristics of chest ultrasound in patients with MMPI are that the volume of lung lesions is large， and most of them showed mixed echo of solid and liquid， but there was no obvious specificity. For patients with clincially highly suspected MMPI， UGPLB is effectively helpful for the precise and differential diagnosis of MMPI.
To investigate the influence of imaging location on uterine artery （UtA）hemodynamic parameters measured by Doppler ultrasound.
Methods
Doppler ultrasonography was used to assess the UtA at different segments （near the first ［UtA-1］， second ［UtA-2］， third ［UtA-3］， and fourth gestational sacs ［UtA-4］ ascending from the cervix）， uterine artery branches （UtB）， and ovarian artery （OA） in pregnant rats.Hemodynamic parameters such as peak systolic velocity （PSV）， ratio of PSV to end-diastolic velocity （S/D），pulsation index （PI）， and resistance index （RI） were obtained， and the difference in hemodynamic parameters between the left and right sides of the same segment was compared using the paired t-test. One-way ANOVA was used to compare the hemodynamic parameters among different segments of the artery， and the LSD-t test was used for pairwise comparisons.
Results
There was no significant difference in the measurements of different segments，branches， and OA of the bilateral uterine arteries （P＞0.05）. Uterine artery parameters differed significantly across segments （P＜0.05）， decreasing gradually. When measured ＞1 site apart， parameters showed significant reductions ［eg， PSV： UtA-2 vs UtA-4 （32.94±11.24） cm/s vs （25.93±13.10） cm/s， t=2.004， P=0.047； S/D： UtA-1 vs UtA-3 （2.73±0.60） vs （2.23±0.51）， t=3.124， P=0.002； PI： UtA-1 vs UtA-3 （1.06±0.21） vs （0.84±0.26），t=2.819， P=0.006； RI： UtA-1 vs UtA-3 （0.61±0.11） vs （0.53±0.12）， t=2.638， P=0.010］. UtB parameters were lower than UtA-1/2/3 parameters （P＜0.05）. OA parameters were significantly higher than those of the UtB（P＜0.05）.
Conclusion
Doppler ultrasound yields varying hemodynamic parameters at different uterine artery segments in pregnant rats. A standardized scanning protocol is needed to improve consistency in uteroplacental circulation studies using pregnant rat models.
To assess the accuracy and feasibility of ultrasound-guided robot-assisted percutaneous puncture.
Methods
Two physicians with different years of experience conducted ultrasound-guided puncture experiments on thyroid nodule phantoms using both the puncture robot-assisted system and manual puncture， each for 10 times. The puncture needle positioning error， directional error， and total operation time were recorded. Additionally， the consistency among physicians with different experience levels when using the puncture robot-assisted system for puncture was assessed.
Results
The robot-assisted group demonstrated higher puncture accuracy than the manual group， but with longer operation times. The average needle tip error in the robot-assisted group versus the manual group was （0.62±0.26） mm vs （1.29±0.38） mm， the average needle axis angle error was （1.04±0.63）° vs （2.01±0.86）°， and the average operation time was （26.45±12.44） s vs （20.58±9.86） s；the differences were statistically significant between the two groups （ t=9.187， P＜0.001； t=3.409， P=0.003；t=-2.289， P=0.034）. Operators with different experiences using the robot-assisted system for puncture showed good consistency in needle tip error and operation time， with intraclass correlation coefficient （95% confidence interval） values of 0.783 （0.126-0.946） and 0.903 （0.610-0.876）， respectively （P＜0.05）.
Conclusion
Compared to manual puncture， the robot-assisted system exhibits higher accuracy and stability in ultrasound-guided thyroid nodule puncture procedures. However， the use of the robot-assisted system increases the operation time.
To analyze and summarize the adverse reactions associated with three ultrasound contrast agents （Optison， Definity， and Lumason）， in order to provide reference information for optimizing clinical practice.
Methods
Adverse event （ADE） reports on Optison， Definity， and Lumason from January 1， 2004 to December 31， 2022 were extracted from the FDA Adverse Event Report System（FAERS）， and the basic characteristics of the reports were obtained. The reporting odds ratio （ROR） method and the UK Medicines and Healthcare Products Regulatory Agency （MHRA） comprehensive standard method were used to detect the adverse drug reaction （ADR） signals at the preferred term （PT） level and the standard MedDRA query （SMQ） level to evaluate the safety of the three ultrasound contrast agents.
Results
The FAERS database contained 1661 ADR reports related to the three ultrasound contrast agents， with 31， 1523，and 107 ADE reports related to Optison， Definity， and Lumason， respectively. Overall， there were more male patients （811） than female patients （693） in ADE reports， the main age group was 45 years and older （994），and Lumason had the highest percentage of fatal case reports （8.41%）. In ADR signal detection， positive signals were detected in 1 PT and 5 SMQs for Optison， in 58 PTs and 10 SMQs for Definity， and in 37 PTs and 10 SMQs for Lumason. In the PT level ADR signal detection， 3 new signals （pre-syncope， cyanosis，and loss of stimulus response） which were not recorded in the label were detected for Definity， and 8 new signals （pallor， pre-syncope， hyperhidrosis， burning sensation， pulmonary edema， heat sensation， pulmonary embolism， and product reconstitution quality problems） were detected for Lumason. The results of ADR detection at the SMQ level suggested that anaphylactic reaction-related diseases and shock disorders were risk characteristics shared by ultrasound contrast agents.
Conclusion
All three ultrasound contrast agents have potential ADR risks， and there are commonalities and differences among their ADR symptoms. Medical personnel should closely monitor patients during ultrasonography and promptly manage ADR that occur to ensure patient safety.
To investigate the status of humanistic literacy and doctor-patient communication in the Ultrasound Department of Peking Union Medical College Hospital， and explore the potential of humanistic literacy education to enhance doctor-patient communication competence.
Methods
In June 2023， an online questionnaire survey was conducted to obtain the scores of humanistic literacy and the self-evaluation scores of doctor-patient communication confidence and communication ability among the medical staff in the Ultrasound Department of Peking Union Medical College Hospital.The t-test and analysis of variance were used to calculate intergroup differences in humanistic literacy scores and in self-evaluation scores of doctor-patient communication confidence and communication ability， to investigate the current status of humanistic literacy and doctor-patient communication among the medical staff.
Results
A total of 92 valid questionnaires were obtained. About 55.4% of medical staff had positive experiences in doctor-patient communication， and 12.0% had experienced negative events. Doctors scored higher on humanistic literacy than medical assistants （10.0±1.2 vs 8.5±1.8， t=4.459， P=0.001）. Medical personnel with a doctoral degree scored higher in humanistic literacy than those with a master， undergraduate，or associate degree or below （10.3±1.1 vs 9.8±1.2 vs 9.0±1.7 vs 8.5±1.7， F=6.117， P=0.001）. The scores of humanistic literacy were higher in medical personnel with senior professional titles than in those with intermediate and junior titles （11.0±1.0 vs 10.2±1.1 vs 9.8±1.2， F=4.904， P=0.010）. Medical personnel who had not experienced negative events in doctor-patient communication had higher humanistic literacy scores than those who had experienced （9.8±1.3 vs 9.2±1.3， t=-2.173， P=0.032）. The self-evaluation scores of doctor-patient communication confidence and communication ability of medical personnel with a doctoral degree were higher than those with a master， undergraduate， or associate degree or below （8.0±1.1 vs 7.2±1.2 vs 7.1±1.2 vs 7.1±1.2， F=3.796， P=0.013）. The self-evaluation scores of doctor-patient communication confidence and communication ability were higher in medical personnel with senior professional titles than in those with intermediate and junior professional titles （8.4±1.2 vs 7.4±1.0 vs 7.3±1.2， F=3.607， P=0.031）.The self-evaluation scores of doctor-patient communication confidence and communication ability were positively correlated with the scores of humanistic literacy （r=0.441， P＜0.001）， educational background（r=0.300， P=0.004）， and professional title （r=0.266， P=0.044）.
Conclusion
Doctor-patient communication education is very important for medical personnel in ultrasound department. Improving medical humanistic literacy and inheriting the spirit of harmony may help improve the doctor-patient communication competence among medical personnel.
