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    25 October 2021, Volume 20 Issue 05 Previous Issue    Next Issue
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    Original articles
    Diagnostic values of magnetic resonance imaging in mammography detected BI-RADS≥4 category calcifications with negative ultrasound results
    ZHU Naiyi, JIANG Yixin, CHAI Li, CHAI Weimin
    2021, 20 (05):  439-444.  DOI: 10.16150/j.1671-2870.2021.05.003
    Abstract ( 309 )   HTML ( 1 )   PDF (663KB) ( 201 )  

    Objective: To assess the diagnostic value of magnetic resonance imaging (MRI) for diannosing suspicious calcification which were BI-RADS≥4 on mammography (MG) and negative on ultrasound. Methods: A total of 126 suspicious calcification lesions were included in the study. Those calcifications were classified as BI-RADS≥4 category and negative on ultrasound between January 2020 and December 2020, and lesions were examined with breast magnetic resonance imaging (MRI). Performance of MRI for diagnosing suspicious calcification was assessed based on biopsy pathologic results. Results: There was 100 benign lesions (79.37%), and 26 malignant lesions 26(20.63%). Benign calcifications were mostly presented as amorphous calcifications 68%(68/100), while malignant calcifications were mostly presented as coarse heterogeneous calcifications 53.85%(14/26). In malignant calcifications, 61.54% lesions were presented as mass enhancement, and mass enhancement were more common in malignant lesions than in benign lesions (61.54% vs 22.00%,P<0.001). 67.00% benign calcifications had no abnormal enhancement (P<0.001). Persistent time-signal intensity curve (TIC) suggested benign lesions (63.60% vs 11.54%, P<0.001) while wash-out curve suggested malignant lesions (73.08% vs 0%,P<0.001). The detection sensitivity of MG and MG+MRI for ultrasound-negative calcifications were 15.4% and 92.3% (P<0.001), with accuracy of 80.2%, 96.8% (P<0.001), respectively. The negative predictive value for MG and MRI+MG were 81.5% and 98.0% (P<0.001). Conclusions: MRI combined with MG has higher sensitivity, accuracy and negative predictive value than mammography alone in diagnosing suspicious calcifications of ultrasound negative results.

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    Prediction value of first trimester ultrasound parameters for pregnancy outcome
    CAO Yunyun, WANG Guanjie, ZENG Min, WANG Haifeng, NIU Jianmei, ZHOU Leiping
    2021, 20 (05):  445-449.  DOI: 10.16150/j.1671-2870.2021.05.004
    Abstract ( 235 )   HTML ( 4 )   PDF (548KB) ( 85 )  

    Objective: To explore the predictive value of ultrasonographic parameters in the first trimester pregnancy outcomes. Methods: A total of 1 651 pregnancy were enrolled, and ultrasonographic parameters including fetal heart rate(FHR), mean gestation sac diameter(MSD) and crown to rump length (CRL) at or before 7 weeks′ gestational age were measured, and the sonogram obtained at or before 13 weeks′ gestation to determine the embryo survived or demise.It revealed that 1 556 cases were classified into ongoing pregnancy group and 95 cases were into spontaneous abortion group. Results: Before 13 weeks′, the spontaneous abortion rate was 5.85% in the study. Pregnancy loss occurred in all the cases with the FHR slower than or equal to 80 bpm (100%), while in fetal with FHR>90 bpm decreased significantly (2.51%). The survival rate increased with the increase of FHR when FHR≤130 bpm, while the fetal demise rate increased as FHR>130 bpm(2.79%). The spontaneous abortion rate was 57.14% as MSD-CRL≤5 mm. The bigger the MSD-CRL was, the higher the survival rate was. Receiver operating characteristic (ROC) curve analysis demonstrated that AUC of FHR=97 bpm for poor pregnancy outcome was 0.870 (P<0.05), while sensitivity, specificity, PPV and NPV were 81.05%, 99.04%, 83.7% and 98.8% respectively. When MSD-CRL was taken as 11.3 mm, AUC for prediction of spontaneous abortion was 0.780(P<0.05), with sensitivity, specificity, PPV and NPV values were 56.84%, 89.01%, 24.00% and 97.10% respectively. When the combination of FHR and MSD-CRL, the AUC for prediction of spontaneous abortion was 0.922(P<0.05). Conclusions: The spontaneous abortion rate was 5.85% in the study. The cut-off value for FHR and MSD-CRL to predict abortion are 94 bpm and of 11.3 mm, respectively. The lower the fetal heart rate and the smaller MSD-CRL diameter are, the higher the spontaneous abortion rate will occur.

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    The clinical value of intelligent quantitative measurement of cervical elastography in predicting spontaneous preterm birth during second trimester
    HE Biyuan, ZHOU Yuqing, YAO Bingyi, CAO Li, BAO Li
    2021, 20 (05):  450-455.  DOI: 10.16150/j.1671-2870.2021.05.005
    Abstract ( 305 )   HTML ( 3 )   PDF (799KB) ( 54 )  

    Objective: To evaluate the performance of cervical elastographic parameters combined with cervical length(CL) in predicting spontaneous preterm birth(sPTB) during second trimester. Methods: A total of 431 singleton pregnancies who received routine prenatal care in our hospital from 1 Jan 2019 and 31 Dec 2020 were included. Accor-ding to pregnancy outcome, subjects were divided into study group(n=31, preterm birth) and control group(n=400, term birth). CL was measured by transvaginal ultrasound, and the cervical elasticity parameters were obtained by elastography, including elasticity contrast index (ECI), hardness ratio (HR), mean strain at internal ostium (IOS), mean strain at external ostium (EOS), the ratio of IOS to EOS (IOS/EOS ). Differences in above ultrasound parameters between the two groups were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to assess the value of the above ultrasound parameters in predicting sPTB. Results: CL was lower but ECI, IOS,IOS/EOS were higher in the study group than those in the control group. ROC analysis indicated that the AUC of IOS/EOS (0.885 as a cut-off value) for prediction of sPTB was larger than those of any other elastographic parameters, with sensitivity and specificity were 73.8% and specificity of 64.2%, and AUC of CL (23.8 mm as a cut-off ) was 0.717, with sensitivity of 71.4% and 74.2%. The combination of IOS/EOS and CL showed better performance for predicting sPTB, with AUC of 0.771 and sensitivity of 83.3%. Conclusions: Cervical elastography can be used to predict sPTB during second trimester, and showes better predictive performance when combined with CL.

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    Sjögren′s syndrome secondary to cryptococcal meningoencephalitis: a case report and literature review
    LU Hongyu, GU Jun, WANG Jing, CAO Yafeng, SONG Luxi, FAN Jun, CHEN Mei
    2021, 20 (05):  456-461.  DOI: 10.16150/j.1671-2870.2021.05.006
    Abstract ( 167 )   HTML ( 1 )   PDF (759KB) ( 78 )  

    Objective: To investigate a case of cryptococcal meningoencephalitis (CM) secondary to Sjögren′s syndrome (SS), and to analyze the clinical, pathological features, diagnosis and treatment of the diseases combined with literature review. Methods: Clinical data of 1 case of CM secondary to SS patient were collected, and literatures online were reviewed. Results: The main clinical manifestation consisted of headache, fever and intracranial hypertension. CM was confirmed by cerebrospinal fluid ink stain smear, but the patient still died of complication of amphotericin B treatment. Literature review indicated 9%-18% CM may had a history of autoimmune diseases. Headache because of increased cerebrospinal fluid pressure ocuured in 38%-100%. The efficacy of amphotericin B combined with fluorocytosine in recommended treatment was not satisfactory, and mortality was high (5%-42%). Conclusions: The clinical manifestation of CM secondary to autoimmune diseases is not typical, the abnormal increase of cerebrospinal fluid pressure is its characteristic. The efficacy of treatment is not satisfactory, and the mortality rate is high.

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    Value of serum FBLN1 detection in diagnosis and prognosis prediction of colorectal cancer
    ZHANG Hua, LU Wei, YANG Chengyi, XIANG Mingjie
    2021, 20 (05):  462-465.  DOI: 10.16150/j.1671-2870.2021.05.007
    Abstract ( 223 )   HTML ( 2 )   PDF (455KB) ( 59 )  

    Objective: To investigate the performance of serum fibulin-1 (FBLN1) detection in diagnosis and prognosis prediction of colorectal cancer. Methods: A total of 81 patients with colorectal cancer(CRC group), 50 patients with benign colorectal polyps (polyps group) and 50 healthy individuals (healthy group) were enrolled. Serum levels of FBLN1 were detected by enzyme-linked immunosorbent assay(ELISA), CEA was also measured, and difference between groups was analyzed. Results: Similar to serum CEA, serum levels of FBLN1 were significantly higher in patients with colorectal cancer [(12.98±7.82) ng/mL] than in patients with benign colorectal polyps [(7.54±1.23) ng/mL] (P<0.05) and healthy individuals [(6.89±2.03) ng/mL] (P<0.05), respectively. No significant difference were found in FBLN1 level between patients with benign colorectal polyps and healthy individuals. The serum level of FBLN1 in patients with low differentiated CRC[ (22.23±18.51) ng/mL] was higher than that in patients with medium differentiated CRC [(11.65±13.28) ng/mL] (P<0.05) and patients with high differentiated CRC[(9.12±10.17) ng/mL] (P<0.05), respectively. The serum level of FBLN1 in CRC patients with lymph node metastasis[(15.26±6.98) ng/mL] was higher than that in patients with no lymph node metastasis [(8.58±4.27) ng/mL (P<0.05). The detection of FBLN1 for diagnosing CRC had a greater AUC(0.852) than CEA,with sensitivity of 82.7% and specificity of 90.0%. Conclusions: Serum FBLN1 can serve as a biomarker for diagnosis and prognosis prediction of CRC.

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    Bronchiolar adenoma: a clinic pathological analysis of 10 cases and review of literature
    LI Juan, LIU Jingsong, LI Mei, LI Dianwei, ZHU Hong
    2021, 20 (05):  466-470.  DOI: 10.16150/j.1671-2870.2021.05.008
    Abstract ( 333 )   HTML ( 1 )   PDF (1289KB) ( 103 )  

    Objective: To study the clinic pathological characteristics, diagnosis and differential diagnosis of bronchiolar adenoma. Methods: Ten cases of bronchiolar adenoma in Lu′an people′s Hospital were collected from January to December 2020, and their clinical data, imaging results, histopathological features and immunohistochemical phenotype were analyzed with literature reviewed. Results: Of the patients, there were 4 males and 6 females, with age ranging from 49 to 79 years old. Most patients had no obvious clinical symptoms, and were found occasional pulmonary nodules by chest CT examination, with ground glass nodules on CT. All of the lesions were located in the periphery of the lung. Grossly, all of the tumors were well circumscribed, solid, and tan to brown on the cut surface. Six cases were the proximal type, and four case was the distal type. Microscopically, the tumor showed glandular, flat and papillary growth pattern, and a large amount of extracellular mucus could be seen. The lining cells of the cavity margin were mucous cells, ciliated cells, non-ciliated cuboidal cells and Clara cells. There was no atypia and mitosis. Continuous basal cell layer could be seen outside the cavity margin, and some tumors could be free of mucous cells and ciliated cells. Immunohistochemical staining of p40, p63 and CK5/6 showed the continuous basal cell layer. Conclusions: Bronchiolar adenoma is a kind of peripheral lung tumor composed of double-layer cells, the diagnosis requires the existence of a complete basal cell layer, and sometimes it is difficult to make a definite diagnosis. The existence of basal cell layer which is identified by immunological histochemistry (p40、p63 and CK5/6) is the key point for distinguish BA from lung adenocarcinoma.

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    Application of 2D-ultrasonography in prenatal assessment of fetal thymus development
    YANG Tian, JI Xiang, NIU Jianmei, KONG Xiaoxiao, LV Mingli
    2021, 20 (05):  471-474.  DOI: 10.16150/j.1671-2870.2021.05.010
    Abstract ( 219 )   HTML ( 2 )   PDF (601KB) ( 46 )  

    Objective: To investigate the value of prenatal ultrasound measurement of thymus size and to determine whether maternal administration of euthyrox affects fetal thymus development. Methods: A total of 311 healthy pregnant women(18-40 weeks of gestation)(healthy Group) were enrolled,and prenatal ultrasound examination were performed once in each pregnancy in the department of ultrasound of the hospital from January 2018 to January 2021.In addition, 31 pregnant women (14 cases at 28 weeks and 17 cases at 34 weeks) who took euthyrox(euthyrox Group) for hypothyroidism were selected. The morphology, echo and size of fetal thymus were observed and the anteroposterior diameter, transverse diameter, circumference and area of fetal thymus were measured by 2D-ultrasound;The correlation between ultrasonic parameters and gestational age in healthy group and was analyzed. The differences in thymus related parameters between the euthyrox Group and health Group were compared to determine if maternal administration of euthyrox may affect fetal thymus development. Results: The parameters of fetal thymus (the anteroposterior diameter, transverse diameter, circumference and area)in the healthy group were linearly correlated with gestational age. There was no significant difference in parameters of fetal thymus between the euthyrox group and the healthy group during the same period. Conclusions: 2D-ultrasound may serve as an effective approach to assess prenatal thymus development,and maternal administration of euthyrox had no effect on fetal thymus development.

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    Analysis of fall risk factors and establishment of risk identification model in elderly stroke patients in Shanghai community
    LIU Anping, LING Feng, SHI Chao, SUN Jing
    2021, 20 (05):  475-479.  DOI: 10.16150/j.1671-2870.2021.05.011
    Abstract ( 210 )   HTML ( 3 )   PDF (567KB) ( 107 )  

    Objective: To investigate the risk for falling, and fall risk related factors by visiting elderly stroke patients in Shanghai Community Health Service Center. Methods: A total of 230 patients aged from 60 to 90 in the Service Center were randomly selected during 2019 using convenience sampling method. Biochemical indicators were detected,and Morse Fall Risk Assessment Scale was used to assess the falling risk of the subjects. According to the short-form mini-nutritional assessment (MNA-SF method), patients were divided into low-risk and high-risk groups. Multivariate Logistic regression model was used to analyze the falling risk factors, and receiver operator characteristic (ROC) curves was used to evaluate the value of risk factors in predicting falling risk in elderly stroke patients. Results: After baseline analysis, Multivariate Logistic regression analysis showed that MNA-SF (OR=0.338, 95%CI: 0.225-0.508, P<0.001), serum albumin(OR=0.513, 95%CI: 0.396-0.664, P<0.001), hemoglobin (OR=0.908, 95%CI: 0.858-0.961, P=0.001), female(OR=4.407, 95%CI: 1.006-19.311, P=0.049), older age(OR=3.464,95%CI: 1.172-10.235, P=0.025) were risk factors for falling in elderly patients. Among these factors, female,older age (≥80 years old) were the risk factors for falling in elderly stroke patients, besides high score of MNA-SF, elevated level of serum albumin were the protection factors, and elevated hemoglobin was less protective. The area under the curve of ROC curve for the model established with 5 risk factors was 0.925 (P<0.05), which has a good performance for predicting falling in elderly stroke patients. Conclusions: It indicates that female, older age (≥80 years old) are the risk factors for falling, while elevated level of serum albumin,hemogolbin, and good nutrition (MNA-SF≥11) are protective factors for falling in elderly stroke patients. Establishment of risk model will help to identify the patients with high risk of falling, which has practical value.

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    Detection of five coagulation indices in patients with cirrhosis and its clinical significance
    ZHAO Yingmei, NIE Hongming, ZHANG Jue, HUANG Yan
    2021, 20 (05):  480-483.  DOI: 10.16150/j.1671-2870.2021.05.012
    Abstract ( 262 )   HTML ( 5 )   PDF (503KB) ( 164 )  

    Objective: To investigate clinical significance of detections of fibrinogen (FIB), D-dimer (DD), antithrombin Ⅲ(AT-Ⅲ), protein C (PC) and protein S (PS) in plasma of patients with different degrees of cirrhosis. Methods: A total of 418 patients with cirrhosis treated in our hospital from October 2019 to June 2021 were enrolled as the observation group, including 138 patients with cirrhosis at the compensatory stage and 280 patients with cirrhosis at the decompensa-ted stage. Meanwhile, 115 healthy people who underwent physical examination during the same period were served as control group. The activities of FIB, DD, AT-Ⅲ, PC and PS were detected, and the differences in coagulation indictors between the cirrhosis compensatory group, the cirrhosis decompensated group and the normal control group were analyzed. Results: The activities of anticoagulant factors AT-Ⅲ, PC and PS in cirrhosis group were significantly decreased, than those with normal control group (P<0.01), and there were significant differences between compensatory group and decompensated group (P<0.01). There was no significant difference in DD and FIB between compensatory cirrhosis group and healthy control group (P=0.061 and P=0.270), but there was significant difference in DD and FIB between compensatory cirrhosis group and decompensated cirrhosis group (P<0.01). The area under curve (AUC) of receiver operating cha-racteristic (ROC curve) of AT-Ⅲ, PC, PS for distingiushing liver cirrhosis patients from health controls, liver decormpenation and liver compensation were 0.947, 0.952, and 0.935, and 0.786, 0.657 and 0.761. Conclusions: Besides FIB, DD and AT-Ⅲ, PC and PS activity are correlated with the severity of cirrhosis. In the early stage of cirrhosis, FIB and DD levels do not change significantly,but AT-Ⅲ, PC activity and PS activity change significantly. Therefore, dynamic combined detection of FIB, DD, AT-Ⅲ, PC activity and PS activity in patients with cirrhosis is helpful to monitoring development of the disease.

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    Autoimmune gastritis associated diseases: report of 3 cases and literature review
    TAN Yingbing, XIE Lin, WU Yunling, CHEN Ping
    2021, 20 (05):  484-490.  DOI: 10.16150/j.1671-2870.2021.05.009
    Abstract ( 231 )   HTML ( 4 )   PDF (1228KB) ( 152 )  

    Objective: To analyze the clinical characteristics of autoimmune gastritis associated diseases, and review the related literatures so as to provide reference for clinical practice. Methods: Three cases of autoimmune gastritis were diagnosed by endoscopy and serological examination due to gastrointestinal symptoms accompanied with anemia, gastric neuroendocrine tumor or abnormal index of liver function respectively, and the correlation between autoimmune gastritis and associated diseases was explore. Results: Case 1 presented with " nausea accompanied by intermittent vomiting and anemia for 1 month", and serological examination indicated megaloblastic anemia postoperative pathology of gastric hyperplasia lesions showed local high-grade neoplasia tubular adenoma after admission. Case 2 presented with "repeated middle and upper abdominal discomfort for several months". Postoperative pathology of gastric hyperplasia lesions was neuroendocrine tumor (G1 stage) after admission to hospital. Case 3 presented with "abnormal index of liver function", and liver biopsy confirmed the diagnosis of primary biliary cholangitis after admission to hospital. Due to the thin mucosal layer of fundus and submucosal vessel penetration of gastric mucosa atrophy, chronic atrophic gastritis was observed in gastric pathology in all patients. Therefore, all serum tests showed positive results for endogenous factor antibody and parietal cell antibody, and all patients were diagnosed as autoimmune gastritis. Subsequent literature analysis suggested that autoimmune gastritis was associated with the development and progression of megaloblastic anemia, neuroendocrine tumor, primary biliary cholangitis and so on. Conclusions: Three cases reported were treated as megaloblastic anemia or gastric neuroendocrine tumor or abnormal index of liver function on first visit, and subsequently were diagnosed as having autoimmune gastritis. Attention should be paid to autoimmune gastritis associated diseases.

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    Fertility quality of life for female patients undergoing in vitro fertilization-embryo transfer and influencing factors
    NI Ying, TONG Chenye, HUANG Limin, QIAN Wen, ZHA Qinghua, FANG Qiong
    2021, 20 (05):  491-497.  DOI: 10.16150/j.1671-2870.2021.05.013
    Abstract ( 180 )   HTML ( 1 )   PDF (752KB) ( 56 )  

    Objective: To investigate the fertility quality of life (Ferti QoL) of female patients undergoing in vitro fertilization and embryo transfer (IVF-ET), and to explore the related influenced factors. Methods: The random sampling has been conducted to enroll subjects, and questionnaires (General Information, Fertility Quality of Life, Perceived Social Support Scale, Self-Rating Anxiety Scale and Self-rating Depression Scale) were performed in patients undergoing IVF-ET at Reproductive Medicine Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine during December 2018 to June 2019. Results: A total of 236 IVF-ET patients were recruited in the study, and the total score of Ferti QoL was (64.6±13.12). Multiple linear regression analysis indicated that longer years of infertility(β=-4.8769, P<0.001), more financial difficulties (β=-7.2121, P<0.001), male factor-infertility (β=-3.6523, P=0.038), more IVF-EF cycles (β=-6.8252, P<0.001) and heavy depression (β=-0.4413, P<0.001) were independent factors for low FetiQoL. While living in a town (P=0.0186), having high monthly income (P=0.0181) and high degree of family support (P<0.001) were independently positively correlated with FertiQoL. Conclusions: The female undergoing IVF-EF have a significantly lower FertiQoL score, and while residence, monthly income, and social support are significantly associated with FertiQoL.

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