Reem S. Abu-Rustum MD, Kevin Pierre MD, Mackenzie Dyrda BS, Erica Smith MD, Nicolas Abchee BS, Caterina M. Bilardo MD, PhD
Objective
To assess the coronary sinus (CS) presence, size, and CS to atrial ratio (CS/A) in the first trimester (FT) compared with the second trimester (ST).
Methods
In this IRB-approved retrospective study, fetuses with adequate FT cardiac sweeps and normal ST hearts were included. Maternal and fetal characteristics were obtained. CS and atrial diameters were measured by a single sonologist. The CS/A ratio was compared between FT and ST. Linear regression assessed the relationship between biparietal diameter (BPD) and CS and atrial diameters. Statistical significance was set at P < .05.
Results
Among 99 fetuses, the CS was seen in 42/53 (79.2%) in the FT and 14/32 (43.8%) in the ST. No significant associations were found between CS visualization and the factors analyzed. The CS/A ratio was significantly higher in the FT versus ST (0.43 vs 0.25; P < .0001). Combined FT and ST data revealed positive correlations between BPD and both CS (slope = 0.018, P < .0001) and atrial diameters (slope = 0.135, P < .0001), suggesting differential growth rates, with the atrium exhibiting a faster growth rate as BPD increased.
Conclusions
The CS appears prominent in the FT compared with the ST, likely due to differential growth rates between the CS and atrium. Remnants of embryonic structures, differences in myocardial drainage, and hemodynamics may also be contributing factors. Larger prospective studies are needed to confirm these findings and assess the value of the FT CS/A ratio.
摘要评估妊娠头三个月（FT）与妊娠后三个月（ST）相比，冠状窦（CS）的存在、大小及 CS 与心房比（CS/A）：在这项经 IRB 批准的回顾性研究中，纳入了有足够的 FT 心脏扫描和正常 ST 心脏的胎儿。获得了母体和胎儿的特征。由一名超声医师测量CS和心房直径。比较了 FT 和 ST 的 CS/A 比值。线性回归评估了双顶径（BPD）与CS和心房直径之间的关系。统计显著性以 P 为标准：在 99 个胎儿中，42/53（79.2%）的 FT 和 14/32（43.8%）的 ST 均可见 CS。CS 可见度与分析因素之间未发现明显关联。在 FT 中，CS/A 比值明显高于 ST（0.43 vs 0.25；P 结论：与 ST 相比，CS 在 FT 中显得突出，这可能是由于 CS 和心房的生长速度不同。胚胎结构的残留物、心肌引流和血液动力学的差异也可能是诱因。需要更大规模的前瞻性研究来证实这些发现并评估 FT CS/A 比值的价值。
{"title":"Developmental Changes of the Coronary Sinus Between the First and Second Trimesters","authors":"Reem S. Abu-Rustum MD, Kevin Pierre MD, Mackenzie Dyrda BS, Erica Smith MD, Nicolas Abchee BS, Caterina M. Bilardo MD, PhD","doi":"10.1002/jum.16547","DOIUrl":"10.1002/jum.16547","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the coronary sinus (CS) presence, size, and CS to atrial ratio (CS/A) in the first trimester (FT) compared with the second trimester (ST).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this IRB-approved retrospective study, fetuses with adequate FT cardiac sweeps and normal ST hearts were included. Maternal and fetal characteristics were obtained. CS and atrial diameters were measured by a single sonologist. The CS/A ratio was compared between FT and ST. Linear regression assessed the relationship between biparietal diameter (BPD) and CS and atrial diameters. Statistical significance was set at <i>P</i> < .05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 99 fetuses, the CS was seen in 42/53 (79.2%) in the FT and 14/32 (43.8%) in the ST. No significant associations were found between CS visualization and the factors analyzed. The CS/A ratio was significantly higher in the FT versus ST (0.43 vs 0.25; <i>P</i> < .0001). Combined FT and ST data revealed positive correlations between BPD and both CS (slope = 0.018, <i>P</i> < .0001) and atrial diameters (slope = 0.135, <i>P</i> < .0001), suggesting differential growth rates, with the atrium exhibiting a faster growth rate as BPD increased.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CS appears prominent in the FT compared with the ST, likely due to differential growth rates between the CS and atrium. Remnants of embryonic structures, differences in myocardial drainage, and hemodynamics may also be contributing factors. Larger prospective studies are needed to confirm these findings and assess the value of the FT CS/A ratio.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 11","pages":"2163-2168"},"PeriodicalIF":2.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Morgan E. Cooley MD, Rose A. Maxwell PhD, MBA, Rebecca Miller BS, Samantha L. Wiegand MD, David S. Mckenna MD
Objective
Determine if knowledge of a third-trimester ultrasound diagnosis of large for gestational age (LGA) independently increases the risk of cesarean delivery (CD).
Study Design
Historical cohort comparing CD rate among patients diagnosed with an LGA fetus on a clinically indicated ultrasound from January 2017 to July 2021 with those without an LGA diagnosis at 34 weeks or later. LGA was defined as an ultrasound-estimated fetal weight greater than or equal to the 90th percentile for the gestational age. Univariate analysis was performed to identify significant confounding variables and was utilized as covariates for binary regression with CD rate as the primary outcome, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated. Nulliparous term singleton vertex (NTSV) and multiparous CD rates were also compared.
Results
There were 447 patients diagnosed with an LGA fetus and 1971 patients without an LGA diagnosis on third-trimester ultrasound. The positive predictive value of LGA diagnosis was 50.1% and the false positive rate was 10.6%. Patients with a diagnosis of LGA had higher AOR of CD (OR 2.11, 95% CI 1.56-2.83), and higher AOR of NTSV CD (OR 1.88, 95% CI 1.14-3.13) compared with those without an LGA diagnosis. There was no difference in the rates of non-medically indicated CD, multiparous primary CD, and attempted and successful TOLAC.
Conclusion
Our results suggest third-trimester ultrasound diagnosis of LGA independently increases odds of CD, specifically among nulliparous patients, and the potential bias may be one factor contributing to excessive CDs and NTSV CDs.
研究目的：了解第三孕期超声诊断胎龄过大（LGA）是否会增加剖宫产风险：确定知道第三孕期超声诊断为巨大胎儿（LGA）是否会独立增加剖宫产（CD）风险：历史队列：比较2017年1月至2021年7月期间经临床指征超声诊断为LGA胎儿的患者与34周或之后未确诊LGA胎儿的患者的剖宫产率。LGA的定义是超声估计的胎儿体重大于或等于胎龄的第90百分位数。进行单变量分析以确定重要的混杂变量，并将其作为以CD率为主要结果的二元回归的协变量，计算出调整后的几率比（AOR）及95%置信区间（CI）。此外，还比较了无子宫期单胎顶点（NTSV）和多胎CD率：结果：经第三孕期超声检查确诊为 LGA 胎儿的患者有 447 例，未确诊为 LGA 胎儿的患者有 1971 例。LGA诊断的阳性预测值为50.1%，假阳性率为10.6%。与未确诊 LGA 的患者相比，确诊 LGA 的患者 CD 的 AOR 较高（OR 2.11，95% CI 1.56-2.83），NTSV CD 的 AOR 较高（OR 1.88，95% CI 1.14-3.13）。非医学指征的 CD、多胎原发性 CD 以及尝试和成功 TOLAC 的比率没有差异：我们的研究结果表明，第三孕期超声诊断 LGA 会独立增加 CD 的几率，特别是在无子宫患者中，潜在的偏差可能是导致过多 CD 和 NTSV CD 的一个因素。
{"title":"Third-Trimester Ultrasound Diagnosis of Large for Gestational Age and Risk of Cesarean Delivery","authors":"Morgan E. Cooley MD, Rose A. Maxwell PhD, MBA, Rebecca Miller BS, Samantha L. Wiegand MD, David S. Mckenna MD","doi":"10.1002/jum.16539","DOIUrl":"10.1002/jum.16539","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Determine if knowledge of a third-trimester ultrasound diagnosis of large for gestational age (LGA) independently increases the risk of cesarean delivery (CD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Historical cohort comparing CD rate among patients diagnosed with an LGA fetus on a clinically indicated ultrasound from January 2017 to July 2021 with those without an LGA diagnosis at 34 weeks or later. LGA was defined as an ultrasound-estimated fetal weight greater than or equal to the 90th percentile for the gestational age. Univariate analysis was performed to identify significant confounding variables and was utilized as covariates for binary regression with CD rate as the primary outcome, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated. Nulliparous term singleton vertex (NTSV) and multiparous CD rates were also compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 447 patients diagnosed with an LGA fetus and 1971 patients without an LGA diagnosis on third-trimester ultrasound. The positive predictive value of LGA diagnosis was 50.1% and the false positive rate was 10.6%. Patients with a diagnosis of LGA had higher AOR of CD (OR 2.11, 95% CI 1.56-2.83), and higher AOR of NTSV CD (OR 1.88, 95% CI 1.14-3.13) compared with those without an LGA diagnosis. There was no difference in the rates of non-medically indicated CD, multiparous primary CD, and attempted and successful TOLAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest third-trimester ultrasound diagnosis of LGA independently increases odds of CD, specifically among nulliparous patients, and the potential bias may be one factor contributing to excessive CDs and NTSV CDs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 11","pages":"2109-2117"},"PeriodicalIF":2.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jum.16539","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nathan R. Blue MD, MSCI, Amanda A. Allshouse MS, Kimberly A. Moyle MD, MSCI, Keisha Dimick RDMS, Robert M. Silver MD
Objective
Our objective was to determine the feasibility and interobserver reliability of umbilical cord and placental arteriolar flow assessment in low-risk pregnancies near term.
Methods
This was a prospective pilot study in low-risk pregnancies at 36 weeks with anterior placentas. We excluded any with an indication for antenatal testing or delivery before 39 weeks. Each participant underwent two ultrasounds by different examiners, which included arterial and venous velocimetry at three cord sites (fetal, free loop, and placental) in addition to maternal and fetal placental arterioles. The interobserver reliability was quantified using the Pearson correlation coefficient with that of standard clinical parameters serving as a benchmark for interpretation.
Results
Among 53 participants scanned at 356/7–371/7 weeks, the mean examination duration was 20.5 ± 4.2 minutes. Ascertainment success was high for measures at the free loop, placental cord insertion, and fetal placental arterioles (range 90.6%–99.1%) and was lower at the fetal cord insertion and maternal spiral arterioles (range 47.2%–87.7%). Interobserver reliability estimates for free-loop systolic/diastolic and pulsatility index ranged from 0.38 to 0.44. Interobserver reliability for experimental parameters varied by measurement site, and all were poor at the fetal insertion and in placental arterioles. Parameters had significant variation across cord sites (range 4.3%–21.7%).
Conclusion
In our cohort, flow assessments of the free loop, placental insertion, and placental arterioles are feasible, but interrater reliability varies by measurement type and cord site. Future studies are needed to establish feasibility and reliability in nonanterior placentation and to assess clinical relevance.
{"title":"A Pilot Study of Ultrasound Assessment of Umbilical Cord and Placental Vascular Flow for Cord Accident Stillbirth Prevention","authors":"Nathan R. Blue MD, MSCI, Amanda A. Allshouse MS, Kimberly A. Moyle MD, MSCI, Keisha Dimick RDMS, Robert M. Silver MD","doi":"10.1002/jum.16546","DOIUrl":"10.1002/jum.16546","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Our objective was to determine the feasibility and interobserver reliability of umbilical cord and placental arteriolar flow assessment in low-risk pregnancies near term.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective pilot study in low-risk pregnancies at 36 weeks with anterior placentas. We excluded any with an indication for antenatal testing or delivery before 39 weeks. Each participant underwent two ultrasounds by different examiners, which included arterial and venous velocimetry at three cord sites (fetal, free loop, and placental) in addition to maternal and fetal placental arterioles. The interobserver reliability was quantified using the Pearson correlation coefficient with that of standard clinical parameters serving as a benchmark for interpretation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 53 participants scanned at 35<sup>6/7</sup>–37<sup>1/7</sup> weeks, the mean examination duration was 20.5 ± 4.2 minutes. Ascertainment success was high for measures at the free loop, placental cord insertion, and fetal placental arterioles (range 90.6%–99.1%) and was lower at the fetal cord insertion and maternal spiral arterioles (range 47.2%–87.7%). Interobserver reliability estimates for free-loop systolic/diastolic and pulsatility index ranged from 0.38 to 0.44. Interobserver reliability for experimental parameters varied by measurement site, and all were poor at the fetal insertion and in placental arterioles. Parameters had significant variation across cord sites (range 4.3%–21.7%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In our cohort, flow assessments of the free loop, placental insertion, and placental arterioles are feasible, but interrater reliability varies by measurement type and cord site. Future studies are needed to establish feasibility and reliability in nonanterior placentation and to assess clinical relevance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 11","pages":"2153-2162"},"PeriodicalIF":2.1,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jum.16546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vadim Sheiman MD, Aviv Frenkel MD, Noa Glick MD, Josef Tovbin MD, Ortal Neeman MD, Eran Barzilay MD, PhD
Objective
To assess whether, and to what extent, performing triplicate measurements can improve accuracy of estimation of fetal weight (EFW) compared to single measurements.
Methods
This was a prospective study conducted at a single medical center. A total of 100 term parturients with an anticipated delivery within 72 hours were recruited for EFW measurements. All examinations were done with adherence to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines. EFW was calculated using the Hadlock formula. Triplicate measurements from three different images were obtained for each parameter and the averaged values were used for clinical purposes. EFW calculated using average measurements was compared to EFW calculated using the first measurements.
Results
There was a small but significant improvement in EFW when using averaged measurements compared to single measurements (mean improvement 34 ± 105 g, P = .002). Deviance from birthweight in single measurements was significantly higher compared to averaged measurements (median deviance 198 versus 148 g, respectively, P = .005). This difference was more pronounced when assessing the 75th centile (348 versus 282 g, respectively).
Conclusions
Using triplicate measurements instead of single measurements when performing EFW confers a small, but statistically significant, improvement to EFW accuracy. Using triplicate measurements for assessing EFW should be thus considered, especially in cases suspected of growth disorders.
{"title":"Ultrasonic Estimation of Fetal Weight: Are Averaged Triplicate Measurements More Accurate Than Single Measurements?","authors":"Vadim Sheiman MD, Aviv Frenkel MD, Noa Glick MD, Josef Tovbin MD, Ortal Neeman MD, Eran Barzilay MD, PhD","doi":"10.1002/jum.16545","DOIUrl":"10.1002/jum.16545","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess whether, and to what extent, performing triplicate measurements can improve accuracy of estimation of fetal weight (EFW) compared to single measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective study conducted at a single medical center. A total of 100 term parturients with an anticipated delivery within 72 hours were recruited for EFW measurements. All examinations were done with adherence to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines. EFW was calculated using the Hadlock formula. Triplicate measurements from three different images were obtained for each parameter and the averaged values were used for clinical purposes. EFW calculated using average measurements was compared to EFW calculated using the first measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was a small but significant improvement in EFW when using averaged measurements compared to single measurements (mean improvement 34 ± 105 g, <i>P</i> = .002). Deviance from birthweight in single measurements was significantly higher compared to averaged measurements (median deviance 198 versus 148 g, respectively, <i>P</i> = .005). This difference was more pronounced when assessing the 75th centile (348 versus 282 g, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Using triplicate measurements instead of single measurements when performing EFW confers a small, but statistically significant, improvement to EFW accuracy. Using triplicate measurements for assessing EFW should be thus considered, especially in cases suspected of growth disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 11","pages":"2147-2152"},"PeriodicalIF":2.1,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jum.16545","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This systematic review evaluated accuracy of ureteric jet angles on color Doppler sonography in diagnosing vesico-ureteric reflux (VUR) in children, using voiding cystourethrogram as the reference standard. Six databases were searched, yielding 13 eligible studies of an initial 429, 7 with comparable data. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Most studies demonstrated a correlation between increasing jet angle and VUR severity, but reporting and techniques varied, preventing meta-analysis. Ureteric jet angle sonography may have potential as a VUR triaging tool. Further investigations with rigorous methodology are required. Funding support was obtained from Queensland University of Technology. PROSPERO Registration CRD42020159799.
{"title":"Diagnostic Accuracy of Ureteric Jet Angle Measurement Using Color Doppler Ultrasonography in Children With Vesico-Ureteric Reflux","authors":"Cameron Gemmell BBehavSc(Psych), BBus(International), BBusMan(Hons I), Christopher Edwards BAppSc(MedRadTech), MAppSc(Med Ultrasound), PhD, Tristan Reddan BAppSc(MedRadTech), GradCertHlthSc, GradDipAppSc(Med Ultrasound), PhD","doi":"10.1002/jum.16543","DOIUrl":"10.1002/jum.16543","url":null,"abstract":"<p>This systematic review evaluated accuracy of ureteric jet angles on color Doppler sonography in diagnosing vesico-ureteric reflux (VUR) in children, using voiding cystourethrogram as the reference standard. Six databases were searched, yielding 13 eligible studies of an initial 429, 7 with comparable data. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Most studies demonstrated a correlation between increasing jet angle and VUR severity, but reporting and techniques varied, preventing meta-analysis. Ureteric jet angle sonography may have potential as a VUR triaging tool. Further investigations with rigorous methodology are required. Funding support was obtained from Queensland University of Technology. PROSPERO Registration CRD42020159799.</p>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 11","pages":"2015-2025"},"PeriodicalIF":2.1,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jum.16543","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaoli Lv MS, Qing Yang MS, Yunqi Chen MS, Min Ren PhD, Laman He MS
Objectives
A classification system of ovarian ectopic pregnancies (OEP) could aid in their management. This study aimed to investigate the ultrasound classification and preoperative ultrasound diagnosis of OEP.
Methods
This retrospective case series study analyzed the clinical and ultrasound imaging data of 68 pregnant women diagnosed and confirmed with OEP at the Obstetrics and Gynecology Hospital affiliated with Tongji University between January 2015 and March 2023. The study focused on examining the ultrasound characteristics of different types of ovarian pregnancies and the accuracy of preoperative ultrasound diagnoses.
Results
The study included 68 patients with a median age of 30 (22-47) years. There were 43 cases (63.2%) of ruptured OEP and 25 (36.8%) of unruptured OEP. The unruptured cases were subclassified as embryonic sac type (n = 16) and heterogeneous mass type (n = 9). Preoperative ultrasound accurately diagnosed 19 cases (27.9%) of OEP, including 10 (62.50%) of the embryonic sac type, 4 (44.44%) of the heterogeneous mass type, and 5 (11.63%) of the ruptured type. Preoperative ultrasonography showed that embryonic sac type OEP was characterized by an intra-ovarian cystic structure with a distinctive hyperechoic ring and, in some cases (8 out of 16), the presence of embryonic buds and/or yolk sacs. Ruptured OEP was characterized by mixed masses in the pelvic cavity with minimal or significant free pelvic fluid, an unclear boundary between the mass and the ovary, and limited or no vascularity.
Conclusions
Ultrasound may be used to determine the type of OEP preoperatively, with a higher diagnostic yield for the embryonic sac subtype. Preoperative ultrasonographic classification may enhance the preoperative diagnosis of OEP.
{"title":"Ultrasound Classification and Preoperative Ultrasound Diagnosis Analysis of Ovarian Ectopic Pregnancy","authors":"Xiaoli Lv MS, Qing Yang MS, Yunqi Chen MS, Min Ren PhD, Laman He MS","doi":"10.1002/jum.16540","DOIUrl":"10.1002/jum.16540","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>A classification system of ovarian ectopic pregnancies (OEP) could aid in their management. This study aimed to investigate the ultrasound classification and preoperative ultrasound diagnosis of OEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective case series study analyzed the clinical and ultrasound imaging data of 68 pregnant women diagnosed and confirmed with OEP at the Obstetrics and Gynecology Hospital affiliated with Tongji University between January 2015 and March 2023. The study focused on examining the ultrasound characteristics of different types of ovarian pregnancies and the accuracy of preoperative ultrasound diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 68 patients with a median age of 30 (22-47) years. There were 43 cases (63.2%) of ruptured OEP and 25 (36.8%) of unruptured OEP. The unruptured cases were subclassified as embryonic sac type (n = 16) and heterogeneous mass type (n = 9). Preoperative ultrasound accurately diagnosed 19 cases (27.9%) of OEP, including 10 (62.50%) of the embryonic sac type, 4 (44.44%) of the heterogeneous mass type, and 5 (11.63%) of the ruptured type. Preoperative ultrasonography showed that embryonic sac type OEP was characterized by an intra-ovarian cystic structure with a distinctive hyperechoic ring and, in some cases (8 out of 16), the presence of embryonic buds and/or yolk sacs. Ruptured OEP was characterized by mixed masses in the pelvic cavity with minimal or significant free pelvic fluid, an unclear boundary between the mass and the ovary, and limited or no vascularity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ultrasound may be used to determine the type of OEP preoperatively, with a higher diagnostic yield for the embryonic sac subtype. Preoperative ultrasonographic classification may enhance the preoperative diagnosis of OEP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 12","pages":"2247-2256"},"PeriodicalIF":2.1,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the feasibility of intraoperative transurethral contrast-enhanced ultrasound for the assessment of male urethral fistulas.
Methods
Patients in a prospective database who underwent intraoperative two-dimensional ultrasound, transurethral saline-enhanced ultrasound, and contrast-enhanced ultrasound between January 2017 and July 2022 were included. All patients were clinically diagnosed with urethral fistulae (UF) in the outpatient setting based on clinical presentations, traditional two-dimensional ultrasound, and/or other imaging modalities and confirmed during surgical repair. Dynamic videos of the scans were independently analyzed by two experienced ultrasonologists.
Results
Thirty-nine patients with an average age of 51 years were included. The UF were located in the anterior urethra in 22 (56.4%) patients and in the bulbar urethra in 14 (63.6%) patients. UF were located in the posterior urethra in 17 (436%) patients and in the prostatic urethra in 13 (76.5%) patients. Contrast-enhanced ultrasonography revealed UF in all patients. In patients with anterior UF, saline-enhanced ultrasound images did not show a UF in 15 (68.2%, 15/22) patients, 13 (86.7%, 13/15) of whom had fistulae with diameters <3 mm. Saline-enhanced ultrasound images did not reveal posterior UF in 13 (76.5%, 13/17) patients. The fistula diameters in eight (61.5%, 8/13) patients were <3 mm. The duration for contrast-enhanced ultrasonography was approximately 3 minutes. The duration for surgical repair was approximately 2 hours.
Conclusions
Transurethral contrast-enhanced ultrasound is a real-time, noninvasive, and radiation-free method that allows intraoperative imaging and accurate assessment of male UF. Its sensitivity is higher than that of both two-dimensional ultrasound and transurethral saline-enhanced ultrasound. The location, size, and course of the fistulae can be clearly seen due to greater contrast during contrast-enhanced ultrasound.
{"title":"Contrast-Enhanced Ultrasound: A Real-Time, Noninvasive, Radiation-Free Method for Intraoperative Male Urethral Fistula Assessment","authors":"Qijie Lu MD, Wei Liu MBBS, Lei Chen PhD","doi":"10.1002/jum.16525","DOIUrl":"10.1002/jum.16525","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the feasibility of intraoperative transurethral contrast-enhanced ultrasound for the assessment of male urethral fistulas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients in a prospective database who underwent intraoperative two-dimensional ultrasound, transurethral saline-enhanced ultrasound, and contrast-enhanced ultrasound between January 2017 and July 2022 were included. All patients were clinically diagnosed with urethral fistulae (UF) in the outpatient setting based on clinical presentations, traditional two-dimensional ultrasound, and/or other imaging modalities and confirmed during surgical repair. Dynamic videos of the scans were independently analyzed by two experienced ultrasonologists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-nine patients with an average age of 51 years were included. The UF were located in the anterior urethra in 22 (56.4%) patients and in the bulbar urethra in 14 (63.6%) patients. UF were located in the posterior urethra in 17 (436%) patients and in the prostatic urethra in 13 (76.5%) patients. Contrast-enhanced ultrasonography revealed UF in all patients. In patients with anterior UF, saline-enhanced ultrasound images did not show a UF in 15 (68.2%, 15/22) patients, 13 (86.7%, 13/15) of whom had fistulae with diameters <3 mm. Saline-enhanced ultrasound images did not reveal posterior UF in 13 (76.5%, 13/17) patients. The fistula diameters in eight (61.5%, 8/13) patients were <3 mm. The duration for contrast-enhanced ultrasonography was approximately 3 minutes. The duration for surgical repair was approximately 2 hours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Transurethral contrast-enhanced ultrasound is a real-time, noninvasive, and radiation-free method that allows intraoperative imaging and accurate assessment of male UF. Its sensitivity is higher than that of both two-dimensional ultrasound and transurethral saline-enhanced ultrasound. The location, size, and course of the fistulae can be clearly seen due to greater contrast during contrast-enhanced ultrasound.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 10","pages":"1911-1918"},"PeriodicalIF":2.1,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yeliz Guler MD, Ali Karagoz MD, Duygu Inan MD, Mehmet R. Sonsoz MD, Mehmet N. Bilen MD, Ahmet Guler MD, Cevat Kirma MD
Background
The role of speckle tracking in the assessment of right atrial (RA) deformation parameters has not been investigated yet. The purpose of this article is to establish the effects of normal pregnancy on RA mechanical changes obtained by 2-dimensional speckle-tracking echocardiography.
Methodology
A total of 49 healthy pregnant women were included in the study. All participants were followed for each trimester and postpartum period, encompassing standard assessments of both RA and ventricular functions, as well as measurements of RA global peak atrial longitudinal strain (RA-Global-PALS) and RA global peak atrial contraction strain (RA-Global-PACS). Additionally, the RA segments were individually evaluated with respect to strain parameters.
Results
During pregnancy, the increased volume load resulted in elevated RA reservoir function, as indicated by RA-Global-PALS, and increased contraction parameter, as indicated by RA-Global-PACS. These changes were within physiological limits and reversible. Segmental analysis of the right atrium showed similar findings for regional PACS and PALS parameters.
Conclusion
In this study, we established normal RA deformation parameters for healthy pregnancies. These data will aid in discerning various measures of RA phasic function in cardiovascular and systemic conditions among normal pregnant women. Moreover, they may offer insights into potential cardiac pathologies that may arise during the pregnancy.
背景：目前尚未研究斑点追踪技术在评估右心房（RA）变形参数中的作用。本文旨在确定正常妊娠对二维斑点追踪超声心动图获得的右心房力学变化的影响：研究共纳入 49 名健康孕妇。所有参与者在每个孕期和产后都接受了随访，包括 RA 和心室功能的标准评估，以及 RA 全局峰值心房纵向应变（RA-Global-PALS）和 RA 全局峰值心房收缩应变（RA-Global-PACS）的测量。此外，还对 RA 节段的应变参数进行了单独评估：结果：妊娠期间，容积负荷的增加导致 RA 储库功能升高（如 RA-Global-PALS 所示）和收缩参数升高（如 RA-Global-PACS 所示）。这些变化均在生理范围内，并且是可逆的。右心房的分段分析显示，区域 PACS 和 PALS 参数也有类似的结果：在这项研究中，我们确定了健康妊娠的正常 RA 变形参数。这些数据将有助于辨别正常孕妇在心血管和全身状况下 RA 相位功能的各种测量指标。此外，这些数据还有助于了解妊娠期间可能出现的潜在心脏病变。
{"title":"Quantitative Analysis of Right Atrial Functions by 2D-Speckle Tracking Echocardiography During Healthy Pregnancy","authors":"Yeliz Guler MD, Ali Karagoz MD, Duygu Inan MD, Mehmet R. Sonsoz MD, Mehmet N. Bilen MD, Ahmet Guler MD, Cevat Kirma MD","doi":"10.1002/jum.16537","DOIUrl":"10.1002/jum.16537","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of speckle tracking in the assessment of right atrial (RA) deformation parameters has not been investigated yet. The purpose of this article is to establish the effects of normal pregnancy on RA mechanical changes obtained by 2-dimensional speckle-tracking echocardiography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>A total of 49 healthy pregnant women were included in the study. All participants were followed for each trimester and postpartum period, encompassing standard assessments of both RA and ventricular functions, as well as measurements of RA global peak atrial longitudinal strain (RA-Global-PALS) and RA global peak atrial contraction strain (RA-Global-PACS). Additionally, the RA segments were individually evaluated with respect to strain parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During pregnancy, the increased volume load resulted in elevated RA reservoir function, as indicated by RA-Global-PALS, and increased contraction parameter, as indicated by RA-Global-PACS. These changes were within physiological limits and reversible. Segmental analysis of the right atrium showed similar findings for regional PACS and PALS parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this study, we established normal RA deformation parameters for healthy pregnancies. These data will aid in discerning various measures of RA phasic function in cardiovascular and systemic conditions among normal pregnant women. Moreover, they may offer insights into potential cardiac pathologies that may arise during the pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 11","pages":"2087-2093"},"PeriodicalIF":2.1,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate whether shear wave elastography (SWE) can accurately identify interstitial fibrosis and tubular atrophy (IFTA) in chronic renal allograft injury (CRAI) and whether it can differentiate between different grades of IFTA.
Materials and Methods
Prospective observational study on renal transplant recipients who presented with CRAI. Patient selection was done on the basis of clinical presentation, serum creatinine, and eGFR levels. Biopsy and SWE were performed and SWE values were correlated with histopathological findings according to Banff schema. Receiver operating characteristic (ROC) was also analyzed to assess the diagnostic efficacy of SWE.
Results
Sxity-one patients were evaluated. Ten patients had no IFTA, 33 patients had mild IFTA, 16 patients had moderate IFTA, and 2 patients had severe IFTA. Mean parenchymal stiffness values in no IFTA, mild IFTA, moderate IFTA and severe IFTA were 39.86 ± 2.17 kPa (3.64 ± 0.09 m/s), 41.59 ± 3.36 kPa (3.71 ± 0.15 m/s), 47.59 ± 3.34 kPa (3.98 ± 0.14 m/s), and 53.83 ± 1.41 kPa (4.25 ± 0.03 m/s), respectively. SWE values of parenchymal stiffness reached statistical significance to differentiate between mild, moderate, and severe IFTA. ROC analysis revealed cut-off values of 45.09 kPa (3.89 m/s) to differentiate between mild IFTA and moderate IFTA, 52.06 kPa (4.18 m/s) to differentiate between moderate IFTA and severe IFTA with acceptable sensitivity and specificity.
Conclusion
SWE is a non-invasive and cost-effective imaging tool to evaluate the disease status of renal allografts affected by CRAI. Thus, it can be of paramount importance if added to the regular follow-up imaging protocol of renal allograft along with grayscale and Doppler imaging.
{"title":"Role of Shear Wave Elastography for Assessment of Renal-Allograft Fibrosis and its Correlation With Histopathology","authors":"Surojit Ruidas MBBS, MD, Hira Lal MBBS, MD, Raghunandan Prasad MBBS, MD, Srishti Sharma MBBS, MD, Surabhi Agarwal MBBS, MD, Ranvijai Singh MBBS, MD, Narayan Prasad MBBS, MD, DM (Nephrology), Manas Ranjan Patel MBBS, MD, DM (Nephrology), Ravi Shankar Kushwaha MBBS, MD, DM (Nephrology), Manoj Jain MBBS, MD","doi":"10.1002/jum.16532","DOIUrl":"10.1002/jum.16532","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate whether shear wave elastography (SWE) can accurately identify interstitial fibrosis and tubular atrophy (IFTA) in chronic renal allograft injury (CRAI) and whether it can differentiate between different grades of IFTA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Prospective observational study on renal transplant recipients who presented with CRAI. Patient selection was done on the basis of clinical presentation, serum creatinine, and eGFR levels. Biopsy and SWE were performed and SWE values were correlated with histopathological findings according to Banff schema. Receiver operating characteristic (ROC) was also analyzed to assess the diagnostic efficacy of SWE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sxity-one patients were evaluated. Ten patients had no IFTA, 33 patients had mild IFTA, 16 patients had moderate IFTA, and 2 patients had severe IFTA. Mean parenchymal stiffness values in no IFTA, mild IFTA, moderate IFTA and severe IFTA were 39.86 ± 2.17 kPa (3.64 ± 0.09 m/s), 41.59 ± 3.36 kPa (3.71 ± 0.15 m/s), 47.59 ± 3.34 kPa (3.98 ± 0.14 m/s), and 53.83 ± 1.41 kPa (4.25 ± 0.03 m/s), respectively. SWE values of parenchymal stiffness reached statistical significance to differentiate between mild, moderate, and severe IFTA. ROC analysis revealed cut-off values of 45.09 kPa (3.89 m/s) to differentiate between mild IFTA and moderate IFTA, 52.06 kPa (4.18 m/s) to differentiate between moderate IFTA and severe IFTA with acceptable sensitivity and specificity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SWE is a non-invasive and cost-effective imaging tool to evaluate the disease status of renal allografts affected by CRAI. Thus, it can be of paramount importance if added to the regular follow-up imaging protocol of renal allograft along with grayscale and Doppler imaging.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 10","pages":"1979-1992"},"PeriodicalIF":2.1,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manesha Putra MD, Emma Elizabeth Helen Peek BS, Greggory R. Devore MD, John C. Hobbins MD
Objectives
In a cohort of patients with estimated fetal weights (EFWs) <10th centile, we aimed 1) to compare the prevalence of abnormalities of fetal 4-chamber view (4CV) cardiac size, shape, and ventricular contractility in fetal growth restricted (FGR) and small-for-gestational-age (SGA) fetuses and 2) to compare umbilical vein flow (UVF) measurements to standard Doppler surveillance in predicting abnormalities of cardiac function.
Methods
Prospective observational cohort study of fetuses with EFW <10th percentile. Measurements of size and shape used were 4CV transverse width, 4CV cardiac area, 4CV global sphericity index, and right-to-left ventricular mid-chamber width ratio. Variables of contractility used were fractional shortening change at the mid-ventricle chamber, global longitudinal strain, fractional area change, and left ventricular cardiac output. The UVF and standard Doppler surveillance including umbilical artery (UA), middle cerebral artery, and cerebroplacental ratio (CPR) were collected. Control data were from previously published studies.
Results
A total of 95 fetuses with EFWs <10th centile were included in the study. The rates of abnormalities of cardiac size and shape and ventricular contractility were all significantly elevated compared with normally grown control fetuses but similar between FGR and SGA fetuses. In a subset of 76 patients with UVF data, evaluation UVF identified more patients with any abnormality of contractility compared with UA (37.9 vs 17.2%, P = .02).
Conclusions
The addition of UVF doubled the detection rate of ventricular contractility abnormalities. The addition of UVF should be considered in the surveillance of FGR and SGA fetuses to further stratify the severity of hypoxemia and to identify those at greater risk for future cardiovascular dysfunction.
{"title":"Umbilical Vein Flows and Cardiac Size, Shape, and Ventricular Contractility in Fetuses With Estimated Weight Less-Than 10th Centile","authors":"Manesha Putra MD, Emma Elizabeth Helen Peek BS, Greggory R. Devore MD, John C. Hobbins MD","doi":"10.1002/jum.16536","DOIUrl":"10.1002/jum.16536","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>In a cohort of patients with estimated fetal weights (EFWs) <10th centile, we aimed 1) to compare the prevalence of abnormalities of fetal 4-chamber view (4CV) cardiac size, shape, and ventricular contractility in fetal growth restricted (FGR) and small-for-gestational-age (SGA) fetuses and 2) to compare umbilical vein flow (UVF) measurements to standard Doppler surveillance in predicting abnormalities of cardiac function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective observational cohort study of fetuses with EFW <10th percentile. Measurements of size and shape used were 4CV transverse width, 4CV cardiac area, 4CV global sphericity index, and right-to-left ventricular mid-chamber width ratio. Variables of contractility used were fractional shortening change at the mid-ventricle chamber, global longitudinal strain, fractional area change, and left ventricular cardiac output. The UVF and standard Doppler surveillance including umbilical artery (UA), middle cerebral artery, and cerebroplacental ratio (CPR) were collected. Control data were from previously published studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 95 fetuses with EFWs <10th centile were included in the study. The rates of abnormalities of cardiac size and shape and ventricular contractility were all significantly elevated compared with normally grown control fetuses but similar between FGR and SGA fetuses. In a subset of 76 patients with UVF data, evaluation UVF identified more patients with any abnormality of contractility compared with UA (37.9 vs 17.2%, <i>P</i> = .02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The addition of UVF doubled the detection rate of ventricular contractility abnormalities. The addition of UVF should be considered in the surveillance of FGR and SGA fetuses to further stratify the severity of hypoxemia and to identify those at greater risk for future cardiovascular dysfunction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 11","pages":"2069-2084"},"PeriodicalIF":2.1,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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