Objective: To investigate the method and application of ultrasound-guided post-mortem lung tissue sampling in cases of COVID-19 Methods: Ultrasound-guided post-mortem lung tissue sampling was performed with 14G biopsy needles in 17 confirmed COVID-19 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from Feb to Mar 2020 ①Ten conventional puncture points were designed according to the anatomy of human lung lobes and the projections on the body surface The 3rd and 6th intercostal spaces in the left midclavicular line were the puncture points for the tissues of the medial areas of the upper and lower lobes of the left lung, and the 3rd, 4th, and 6th intercostal spaces in the right midclavicular line were the puncture points of the lung tissues taken from the medial areas of the upper, middle, and lower lobes of the right lung The 4th and 7th intercostal spaces in the left midaxillary line were the puncture points of the lung tissues from the upper and lower lateral lobes, and the 4th, 5th, and 7th intercostal spaces in the right midaxillary line were the puncture points of the lung tissues from the lateral areas of the upper, middle and lower lobes of the right lung ②According to the sonographic findings of the lung tissues at each puncture point, it was divided into three types: air-containing lung, consolidated lung and compressed lung And the corresponding sampling methods were designed to complete multiple points of the medial and lateral areas of the left and right lung lobes ③The time required for each lung sampling was recorded, and the sizes of the specimens were measured The success rates of all puncture points were compared and the success rates of various type lung tissues were compared Results: ①In 17 COVID-19 death cases, 174 puncture points were selected for bilateral lung tissues, and 288 lung tissue specimens were obtained by puncture ②There were differences in the success rates of the puncture points, and the success rate of the 6th intercostal puncture points on the left and right midclavicular lines were lower than those of the other puncture points(P<0 05) ③There were differences in the success rate of corpse lung sampling with different types of ultrasonographic performance The success rates of gas-containing lung sampling was 74 4%, which was lower than that of consolidation lung (86 8%)and compressed lung(84 1%)(P<0 05) ④The length of the compressed lung specimen was 11 4(10 6, 12 3)mm, which was lower than that of gas-containing lung and consolidation lung[14 6(12 5, 15 2)mm, 13 5(12 5, 15 0)mm] (P<0 05) Conclusions: This study introduces an ultrasound-guided minimally invasive puncture method for cadaver lung tissue sampling, and itmay be a reliable method for collecting lung tissues in COVID-19 cases © 2020 Chinese Medical Association

Objective: To investigate the application of post-mortem tissue sampling under ultrasonography guidance in the autopsy of COVID-19 cases Methods: Ultrasound-guided post-mortem tissue sampling of heart, lungs, liver, kidneys, and spleen were performed in 24 confirmed COVID-19 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from Feb 20 to Mar 28, 2020 Seventeen males and seven females aged 39-91(66 6±10 6) years old were enrolled The total time required for each post-mortem sampling was recorded, and the size of the samples collected from each organ was measured The success rate of ultrasound-guided post-mortem tissue sampling for each organ was calculated Results: Ultrasound images could clearly show the needle path and enabled accurate placement of the needle within the target organs, including heart, lung, liver, kidney, and spleen The total time required for sampling was about 32-54 (39 8±5 7)min The lengths of heart, lung, liver, kidney, and spleen tissues collected by ultrasound-guided sampling were 10(8, 14)mm, 13(12, 15)mm, 14(13, 15)mm, 13(11, 15)mm, 14(13, 15)mm, respectively The success rates of heart, lung, liver, kidney, and spleen tissue sampling under ultrasound guidance were 87 5% (21/24), 91 7%(44/48), 100%(24/24), 89 6%(43/48) and 83 3%(20/24), respectively Conclusions: Post-mortem sampling under ultrasonography guidance may be a rapid and reliable method for collecting of heart, lung, liver, kidney, and spleen tissues in the autopsy of COVID-19 cases © 2020 Chinese Medical Association

Objective To investigate the effect of endometrial thickness(EMT) on the clinical outcome of blastocyst hormone replacement freeze-thawed embryo transfer (HRT-FET) on the first progesterone day, and to analyze the threshold and optimal thickness interval corresponding to ideal clinical pregnancy rate by statistical method. Methods The endometrial preparation protocols of 2 825 blastocyst HRT-FET cycles from January 2013 to December 2016 in Henan Provincial People′s Hospital and the Second Hospital of Hebei Medical University were studied retrospectively. According to EMT on the first progesterone day, they were divided into 5 subgroups: group Q1(EMT: 3.5-7.9 mm), group Q2(EMT: 8.0-8.9 mm), group Q3(EMT: 9.0-9.5 mm), group Q4(EMT: 9.6-10.7 mm), group Q5(EMT: 10.8-21.0 mm). Univariate analysis, classification multivariate Logistic regression analysis, curve fitting and threshold effect analysis were used to investigate the effect of endometrial thickness on clinical outcome of blastocyst HRT-FET. Results Group Q1 was set as the control group in classification multivariate Logistic regression analysis, after adjusting for confounding factors, the clinical pregnancy rate and live birth rate in other groups were higher than the control group. The clinical pregnancy rate and live birth rate in group Q3 and Q4 were significantly increased and the differences were statistically significant(all P<0.05). The cut-off value of the endometrial thickness was 9.6 mm. When endometrial thickness was less than 9.6 mm, with 1 mm increase of endometrial thickness, the clinical pregnancy rate increased by 23%(OR=1.23, 95%CI=1.11-1.36) and the live birth rate increased by 21%(OR=1.21, 95%CI=1.10-1.33). When the endometrial thickness was thicker than the threshold, the clinical pregnancy rate did not increase significantly(OR=0.92, 95%CI=0.84-1.02), and the live birth rate showed a downward trend(OR=0.88, 95%CI=0.81-0.96). Conclusions In the blastocyst HRT-FET cycle, endometrial thickness showes a curvilinear relationship with clinical outcome. The optimal endometrial thickness range for ideal clinical outcome is 9.0-11.0 mm. Key words: Ultrasonography, transvaginal; Freeze-thawed embryo transfer; Endometrial thickness; Clinical pregnancy rate; Live birth rate

Objective To evaluate the impact of runoff score on the patency of femoropopliteal artery (FPA) stent in patients with type 2 diabetes mellitus with ultrasonography. Methods A retrospective review of a database of 127 patients with type 2 diabetes mellitus (127 limbs) undergoing femoropopliteal stents in Xuanwu Hospital from January 2016 to July 2018 was made. Demographic characteristics and possible related risk factors were recorded. The extent of FPA disease and the runoff lesions below the knee (anterior tibial artery, posterior tibial artery, and peroneal artery) were preoperative evaluated and regular followed-up by color Doppler ultrasonography (CDU). Femoropopliteal artery lesions were graded according to the Trans-Atlantic Inter-Society Consensus (TASCII), and the runoff lesions below the knee were scored according to the Society for Vascular Surgery (SVS). The patency and the predictors for in-stent restenosis were assessed using a Kaplan-Meier and Cox proportional hazards model. Results Follow up period ranged from 1 month to 24 months.The total patency rates at the 3, 6, 12, 24 months were 91.5%, 70.9%, 45.7% and 31.7%, respectively. Post-procedural runoff score according to SVS criteria: 1-3 scores in 45 limbs, 3.5-5 scores in 37 limbs, 5.5-7 scores in 34 limbs, 7.5-10 scores in 11 limbs. The median runoff score was 4.Patients were stratified according to runoff scores (score ≤4 and >4 groups), and the difference of the patency rates between the two groups was statistically significant by Kaplan-Meier analysis and Log-rank test (χ2=10.825, P=0.001). The runoff score affected patency significantly on COX analysis (RR=1.155, P=0.006, 95%CI: 1.042-1.281). Conclusions Compromised runoff negatively affects the patency of FPA stent. High post-procedural runoff score is a main risk factor related to loss of patency. CDU is a reliable method for monitoring patients with femoropopliteal stenting. Key words: Ultrasonography; Diabetes; Femoropopliteal artery; Runoff score; Stent

Objective To investigate the echocardiographic characteristics, pathological anatomy and genetic abnormality of congenital absent semilunar valves in first trimester. Methods Eleven cases of congenital absent semilunar valve fetus diagnosed at 11-13+ 6 weeks of gestation in Guangxi Magernity & Child Healthcare Hospital from December 2014 to December 2018 were analyzed. The characteristics of echocardiography and the abnormal microanatomy of cardiac tissue after labor induction was compared. Results The crown-lump length of the 11 fetus was 46-74(62.0±9.2)mm, and nuchal translucency thickness(NT) was 2.4-10.4 (6.4±2.6)mm. The NT of 10 cases were greater than 3.0 mm. Color Doppler flow imaging revealed that biphasic bidirectional flow in the aortic arch and/or pulmonary artery at the 3VT view( to-and-fro ) in those 11 cases, and pansystolic turbulence and pandiastolic reflux spectrum were showed on spectral Doppler. Among them, there were 10 cases of stealing type , including 2 cases of isolate absent aortic valves, 3 cases of absent pulmonary valves and 5 cases of absent both aortic and pulmonary valves; and all the 10 cases had secondary ultrasonic manifestations of fetal heart failure. Chromosome analysis and detection of genes showed that 4 cases with Trisomy 13 syndrome, 3 cases with Trisomy 18 syndrome, 1 case with 22q11.2 deletion, 1 case with 12q24.32q24.33 deletion and 1 case was normal. Pathological anatomy revealed enlarged heart in 8 cases, isolate absent aortic valves in 2 cases (1 case complicated with pulmonary atresia, absence of ductus arteriosus and thymus), absent pulmonary valves in 3 cases, absent both aortic and pulmonary valves in 3 cases, relics of semilunar valves in 3 cases. And 2 cases of absent pulmonary valves and 3 cases of absent both aortic and pulmonary valves with short and thick ductus arteriosus. Only 1 case was congenital absent semilunar valve in non-stealing type without secondary ultrasonic manifestations of fetal heart failure. Chromosome analysis and detection of genes showed 22q11.2 deletion, and there were relics of semilunar valves in the pathological anatomy. It also combined with tetralogy of Fallot and absence of ductus arteriosus. Conclusions In first trimester, congenital absent semilunar valves are more common as stealing type . The echocardiographic features of congenital absent semilunar valves are the in-out sign of aorta arch and/or pulmonary artery and biphasic spectrum in spectral Doppler. Trisomy 13 syndrome and trisomy 18 syndrome significantly increased the risk of congenital absent semilunar valves in stealing type in first trimester. Key words: Echocardiography; Congenital absentsemilunar valve; First trimester; Pathologic diagnosis

Objective To investigate the value of contrast-enhanced ultrasound(CEUS) in differential diagnosis of complex renal cysts and clear renal cell carcinoma with cystic change(CRCCC). Methods The ultrasonographic datas of 82 lesions in 82 patients with complicated renal cysts or CRCCC confirmed by pathology were analyzed. The characteristics of conventional ultrasound and CEUS were observed and evaluated. The lesions were graded according to Bosniak classification criteria. Results Pathological examination showed that 36 cases were complicated renal cysts and 46 cases were CRCCC. Routine ultrasound showed there were 9 cases (25.0%) with cystic masses and 27 cases (75.0%) with solid and cystic masses in complex renal cysts, of which 14 cases (38.9%) could detect color flow signals. In CRCCC, 2 cases (4.3%) were with cystic masses and 44 cases (95.7%) were with solid and cystic masses, of which 33 cases (75.0%) could detect color flow signals. CEUS showed that only 18 cases (50.0%) of the complex renal cysts showed enhancement of cystic wall or septum, with equal or low enhancement at the peak, 9 cases (50.0%) accompanied by decrease of renal cortex, 35 cases (97.2%) had thin and regular cystic wall, no enhancement of cystic wall in all lesions, and 33 cases (91.7%) had septal thickness less than 1 mm. Forty-five cases (97.8%) of CRCCC showed enhancement of cystic wall or septum, 40 cases (88.9%) showed equal or high enhancement at peak, 30 cases (66.7%) were faster than the decrease of renal cortex, 37 cases (80.4%) showed uneven thickness of cystic wall, 24 cases (52.2%) showed enhancement of cystic wall nodules, and 28 cases (60.9%) showed uneven thickness of septum. After CEUS, 33 cases (91.7%) of complex renal cysts were classified as grade Ⅰ and Ⅱ, while 42 cases (91.3%) of CRCCC were classified as grade Ⅲ and Ⅳ. Conclusions The CEUS manifestations of complex renal cysts are different from those of CRCCC. The application of Bosniak criteria in CEUS is helpful for the differential diagnosis of complex renal cysts and CRCCC. Key words: Contrast-enhanced ultrasound; Complex renal cysts; Clear renal cell carcinoma with cystic change; Differential diagnosis

Objective To explore the characteristics of gallstone-like echo in fetal gallbladder and its changes with gestational age, and following up its prognosis as well as the relationship with bilirubin after birth so as to provide more information for prenatal consultation about neonatal jaundice related diseases. Methods A total of 82 fetuses from January 2014 to December 2017 at Women′s Hospital of Zhejiang University School of Medicine, who had prenatal ultrasound diagnosis and follow-up results with gallstone-like echo in fetal gallbladder, were included in this study. The characteristics of gallstone-like echo in fetal gallbladder were summarized, its change with gestational age, and its association with the status of pregnant mother were analyzed. Bilirubin and the prognosis of the gallstone-like echo were followed up after birth. Results Four different types of prenatal ultrasound characteristics of gallstone-like echo in fetal gallbladder were observed: sediment-like type(n=13), full of hyperechoic type (n=19), multiple hyperechoic type (n=42), and single or scattered hyperechoic type(n=8). Of the total 82 cases, 2 fetus were induced abortion. In the 80 normal-born fetuses, the number of gallstone-like echo were reduced in 9 cases during pregnancy, the gallstone-like echo disappeared in uterus in 8 cases. During the follow up, the gallstone-like echoes disappeared at 3 days, 42 days, 1 year and 2 years after birth in the rest 72 cases, respectively. In the 80 fetuses, 20 cases of neonates with hyperbilirubinemia after birth (4 males and 16 females) including 4 cases of ABO hemolytic, 2 cases of neonatal sepsis.No abnormalities occurred in the remaining 60 neonates during the follow-up period. Conclusions Gallstone-like echo in fetus is a self-limiting disease that occurs in late pregnancy.Some neonates develop hyperbilirubinemia after birth with good prognosis. After phototherapy, the jaundice index decreased to the normal standard and the serum bilirubin content decreased. Key words: Ultrasonography, prenatal; Fetus; Gallbladder; Gallstone-like echo

Objective To investigate the differential performance of ultrasound between infantile fibrosarcoma(IFS) and soft tissue hemangioma. Methods The retrospective study was conducted from January 2012 to January 2019 in Beijing Children′s Hospital, Capital Medical University. A total of 16 patients with IFS were consecutively collected as IFS group, and 26 consecutive patients with soft tissue hemangioma (hemangioma group) were selected for comparison according to the tumor size of IFS. All the final diagnosis got confirmed by pathological analysis. The ultrasonographic features of IFS and hemangioma were compared and analyzed, and after weighting on the basis of the dominance ration (OR), the ultrasonic features with diagnostic value were used to establish the prediction equation. Then, the differential performance of every feature and the prediction equation was evaluated via the ROC analysis. Results There were differences in the lesion echo, margin and blood flow characteristics between IFS group and hemangioma group (P=0.013, 0.002, 0.005), the area under the ROC (AUC) of applying every ultrasonic feature with diagnostic value for differentiation were 0.695, 0.740, and 0.700, respectively. Benefiting from the employment of the prediction equation, the AUC was improved to 0.887 with a sensitivity of 81.3% and a specificity of 96.2%, which were better than the diagnosis by any single feature (P=0.017, 0.035, 0.003). Conclusions Ultrasound can be utilized to discriminate infantile fibrosarcoma from soft tissue hemangioma. The use of prediction equation can further improve the differential performance with higher clinical value. Key words: Ultrasonography; Infantile fibrosarcoma; Hemangioma; Children

Objective To compare the diagnostic efficacies of contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis of liver nodules ≤2.0 cm in patients with cirrhosis, and to explore the clinical values of combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI in the diagnosis of early hepatocellular carcinoma (HCC). Methods One hundred and thirteen nodules with diameters lower than 2.0 cm in 98 patients from February to December 2016 in Tianjin Third Central Hospital were included in this retrospective study. The enhancement patterns of nodules in CEUS and EOB-MRI were analyzed. The reference standard was pathological diagnosis or substantial lesion growth at a follow-up of at least 6 months. The efficiencies of CEUS and EOB-MRI in the diagnosis of liver lesions with a diameter lower than 2.0 cm were compared. A new diagnostic strategy, which combines the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was presented to diagnose the early HCC in this study. Results The area under the ROC curve of CEUS and EOB-MRI were 0.858 and 0.814(P>0.05), the sensitivity were 79.1%, 81.4%, specificity were 92.6%, 81.5% and diagnostic accuracy were 82.3% and 81.4%, respectively. By combination of CEUS and EOB-MRI, the area under the ROC curve was 0.831, without difference from CEUS, EOB-MRI (0.831 vs 0.858, 0.814; all P>0.05); its sensitivity was 66.3%, specificity was 100% and diagnostic accuracy was 74.3%. The area under the ROC curve of the new diagnostic strategy, combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was 0.934, which was larger than that of CEUS, EOB-MRI and the combination of CEUS and EOB-MRI(0.934 vs 0.858, 0.814, 0.831; all P<0.05). The sensitivity, specificity and diagnostic accuracy of new strategy were 94.2%, 92.6% and 93.8%, respectively. Conclusions The new diagnostic strategy based on the arterial phase of CEUS and hepatobiliary phase of EOB-MRI improves the sensitivity and accuracy in detecting small lesions, which can be used as a complementary diagnostic enhancement pattern for lesions with an atypical enhancement pattern in CEUS or EOB-MRI. Key words: Contrast-enhanced ultrasonography; Gadoxetic acid-enhanced magnetic resonance imaging; Micro hepatocellular carcinoma; Diagnosis

Objective To explore the feasibility of real-time three-dimensional ultrasound imaging in quantifying left and right atrial diastolic maximal volume (LAVmax, RAVmax) and evaluating cardiac diastolic function in fetuses with cardiac disease in second and later trimesters. Methods One hundred and forty-four fetuses with abnormal heart morphology at 16-34 weeks of gestational age were included and divided into 3 groups according to the influence of pathological changes on atrial volume: group A with symmetrical left and right atrial volume, group B with decreased left atrial volume and increased right atrial volume and group C with increased left atrial volume and decreased right atrial volume, and the fetus were also divided into 2 groups according to the law of fetal development: the middle pregnancy group (16-27+ 6 weeks) and the late pregnancy group (28-34+ 6 weeks). Using the Xplane mode of volume probe, the maximal atrial volume was calculated automatically by tracing method and three-path line method. The correlation between the two methods in quantitative LAVmax was validated by paired sample t test and Pearson correlation analysis. The correlation between LAVmax, RAVmax and gestational age were analyzed by curve fitting. The volumes of bilateral chambers and the average weekly growth rates of E peak, A peak and E/A value of mitral and tricuspid orifices were calculated and compared. Results There was no significant statistical difference between the maximal volume of the left atrium obtained by the tracing method and the three-diameter line method (P>0.05), and there was high correlation between the two methods in the comparison of the maximal volume of the left atrium (r=0.90, 0.88, 0.85; all P<0.01). The data of group A, B and C showed that LAVmax and RAVmax could increase with the increase of gestational weeks in a certain period of abnormal state, and had a good correlation with them(LAVmax: r=0.78, 0.74, 0.78, all P<0.005; RAVmax: r=0.79, 0.77, 0.78, all P<0.005). The average weekly growth rate of RAVmax showed an advantage in group A, B and C. Especially in group C with reduced right atrium, the growth rate of right atrium was 8.15%, which was higher than that of group B with decreased left atrium by 5.06%. The weekly growth rates of E peak and E/A in tricuspid orifice were also higher than those in mitral orifice. The E peak and E/A values of tricuspid orifice in group C were 4.05% and 0.60%, respectively, higher than those in group B, which were 2.58% and 0.02%. Peak A showed an increase in growth rate in group B and group C with decreased atria, peak A values in group B and group C increased by 4.01% and 2.19%, respectively. Conclusions The right ventricular dominance of fetal heart can still be reflected in certain stages of disease, and the atrial active systolic may play a regulatory role in the filling of cardiac blood flow. Real-time three-dimensional ultrasound imaging could be used to quantify the atrial volume of fetuses with abnormal heart morphology in second and later trimesters and to preliminary assess atrial function combined with the changes of atrioventricular valve orifice hemodynamics. Real-time three-dimensional ultrasound imaging technology has obvious advantages of simple, safe, non-invasive, simultaneous and high repeatability in measuring fetal atrial volume. Key words: Ultrasonography, real-time, three-dimensional; Xplane imaging technology; Fetal heart; Atrial volume; E peak; A peak