Semimetal to semiconductor transition and polymer electrolyte gate modulation in single-crystalline bismuth nanowires

A semimetal to semiconductor transition in low-dimensional Bi nanowires is theoretically predicted based on the quantum confinement effect, which results in the enhancement of the thermoelectric performance. However, this transition has rarely been observed in the transport properties of gate modulation because of there being too few charge carriers induced by a typical electric field effect. In this paper, we report on our observations of the on-off state in a Bi nanowire using a polyethylene oxide/LiClO₄ electrolyte gate, which produces a much larger effect than a back-gate. The carrier density of the surface state was found to be consistent with previously reported results. The intrinsic properties of the Bi nanowires, as obtained by temperature- and diameter-dependent gate modulations, are also discussed.

The Nature of Metastable AA' Graphite: Low Dimensional Nano- and Single-Crystalline Forms

Over the history of carbon, it is generally acknowledged that Bernal AB stacking of the sp² carbon layers is the unique crystalline form of graphite. The universal graphite structure is synthesized at 2,600~3,000 °C and exhibits a micro-polycrystalline feature. In this paper, we provide evidence for a metastable form of graphite with an AA' structure. The non-Bernal AA' allotrope of graphite is synthesized by the thermal- and plasma-treatment of graphene nanopowders at ~1,500 °C. The formation of AA' bilayer graphene nuclei facilitates the preferred texture growth and results in single-crystal AA' graphite in the form of nanoribbons (1D) or microplates (2D) of a few nm in thickness. Kinetically controlled AA' graphite exhibits unique nano- and single-crystalline feature and shows quasi-linear behavior near the K-point of the electronic band structure resulting in anomalous optical and acoustic phonon behavior.

Compact ECEI system with in-vessel reflective optics for WEST

An electron cyclotron emission imaging (ECEI) diagnostic system for WEST (W Environment for Steady state Tokamak) is under development to study the MHD instabilities affected by tungsten impurities. The system will provide 2-D T_e fluctuation images (width × height = ∼18 cm × ∼ 34 cm at low field side and ∼13 cm × ∼ 39 cm at high field side) from a poloidal cross section with high spatial (≤1.7 cm) and temporal (≤2 μs) resolutions. While the key concept and electronic structure are similar to that of prior ECEI systems on other tokamak devices such as KSTAR, DIII-D, or ASDEX-U, part of the imaging optics have to be placed inside the vacuum vessel in order to resolve issues on limited installation space and longer beam path to the detector position. The in-vessel optics consisting of two large curvature-radius mirrors are expected to withstand the extreme heating on long-pulse operation scenario (∼1000 s). The out-vessel optical housing is constructed as compact as possible to remove easily from the installation site in case of necessity. Commissioning of the system is scheduled on the second experimental WEST campaign end of 2017.

Ion gyroscale fluctuation measurement with microwave imaging reflectometer on KSTAR

Ion gyroscale turbulent fluctuations with the poloidal wavenumber k_θ ∼ 3 cm^-1 have been measured in the core region of the neutral beam (NB) injected low confinement (L-mode) plasmas on Korea superconducting tokamak advanced research. The turbulence poloidal wavenumbers are deduced from the frequencies and poloidal rotation velocities in the laboratory frame, measured by the multichannel microwave imaging reflectometer. Linear and nonlinear gyrokinetic simulations also predict the unstable modes with the normalized wavenumber k_θρ_s ∼ 0.4, consistent with the measurement. Comparison of the measured frequencies with the intrinsic mode frequencies from the linear simulations indicates that the measured ones are primarily due to the E × B flow velocity in the NB-injected fast rotating plasmas.

New compact and efficient local oscillator optic system for the KSTAR electron cyclotron emission imaging system

Electron cyclotron emission imaging (ECEI) diagnostic on Korean Superconducting Tokamak Advanced Research utilizes quasi-optical heterodyne-detection method to measure 2D (vertical and radial) T_e fluctuations from two toroidally separated poloidal cross section of the plasma. A cylindrical lens local oscillator (LO) optics with optical path length (OPL) 2-2.5 m has been used in the current ECEI system to couple the LO source to the 24 vertically aligned array of ECE detectors. For efficient and compact LO optics employing the Powell lens is proposed so that the OPL of the LO source is significantly reduced from ∼2.0 m to 0.4 m with new optics. The coupling efficiency of the LO source is expected to be improved especially at the edge channels. Results from the optical simulation together with the laboratory test of the prototype optics will be discussed in this paper.

Penetrating foreign body in the masticator space with injury to the internal maxillary artery: a surgical challenge

INTRODUCTION Foreign bodies (FBs) in the masticator space (MS) are a unique problem because of the difficulty of accessing this deep compartment within the head and neck. In addition, MS contents include critical structures such as the internal maxillary artery (IMA) and mandibular nerve. CASE HISTORY A 39-year-old tradesman was involved in a construction accident whereby a metallic projectile from a machinery drill penetrated his left cheek. Computed tomography revealed a metallic object of dimension 1.9 ×1.2 cm within the MS, with concomitant fracture of left maxillary anterior and lateral walls. Surgery was indicated in view of constant pain and swelling. The FB was removed through the cheek laceration with the aid of an X-ray image intensifier. Persistent significant bleeding was observed within the wound cavity after FB removal that could not be arrested despite attempts at haemostasis with adrenaline packing and oxidised cellulose polymers. Urgent selective left external carotid angiography showed breach of a distal branch of the left internal maxillary artery with contrast extravasation. Embolisation of this branch was undertaken successfully with a liquid agent. CONCLUSIONS This is the first time a FB within the MS with injury to the internal maxillary artery has been described.

Solar optics-based active panel for solar energy storage and disinfection of greywater

Smart city and innovative building strategies are becoming increasingly more necessary because advancing a sustainable building system is regarded as a promising solution to overcome the depleting water and energy. However, current sustainable building systems mainly focus on energy saving and miss a holistic integration of water regeneration and energy generation. Here, we present a theoretical study of a solar optics-based active panel (SOAP) that enables both solar energy storage and photothermal disinfection of greywater simultaneously. Solar collector efficiency of energy storage and disinfection rate of greywater have been investigated. Due to the light focusing by microlens, the solar collector efficiency is enhanced from 25% to 65%, compared to that without the microlens. The simulation of greywater sterilization shows that 100% disinfection can be accomplished by our SOAP for different types of bacteria including Escherichia coli. Numerical simulation reveals that our SOAP as a lab-on-a-wall system can resolve the water and energy problem in future sustainable building systems.

Diagnostic accuracy of ultrasonography and magnetic resonance imaging for the detection of fetal anomalies: a blinded case-control study

OBJECTIVES

To compare the accuracy of two-dimensional ultrasound (2D-US), three-dimensional ultrasound (3D-US) and magnetic resonance imaging (MRI) for the diagnosis of congenital anomalies without prior knowledge of indications and previous imaging findings.

METHODS

This was a prospective, blinded case-control study comprising women with a singleton pregnancy with fetal congenital abnormalities identified on clinical ultrasound and those with an uncomplicated pregnancy. All women volunteered to undergo 2D-US, 3D-US and MRI, which were performed at one institution. Different examiners at a collaborating institution performed image interpretation. Sensitivity and specificity of the three imaging methods were calculated for individual anomalies, based on postnatal imaging and/or autopsy as the definitive diagnosis. Diagnostic confidence was graded on a four-point Likert scale.

RESULTS

A total of 157 singleton pregnancies were enrolled, however nine cases were excluded owing to incomplete outcome, resulting in 148 fetuses (58 cases and 90 controls) included in the final analysis. Among cases, 13 (22.4%) had central nervous system (CNS) anomalies, 40 (69.0%) had non-CNS anomalies and five (8.6%) had both CNS and non-CNS anomalies. The main findings were: (1) MRI was more sensitive than 3D-US for diagnosing CNS anomalies (MRI, 88.9% (16/18) vs 3D-US, 66.7% (12/18) vs 2D-US, 72.2% (13/18); McNemar's test for MRI vs 3D-US: P = 0.046); (2) MRI provided additional information affecting prognosis and/or counseling in 22.2% (4/18) of fetuses with CNS anomalies; (3) 2D-US, 3D-US and MRI had similar sensitivity for diagnosing non-CNS anomalies; (4) specificity for all anomalies was highest for 3D-US (MRI, 85.6% (77/90) vs 3D-US, 94.4% (85/90) vs 2D-US, 92.2% (83/90); McNemar's test for MRI vs 3D-US: P = 0.03); and (5) the confidence of MRI for ruling out certain CNS abnormalities (usually questionable for cortical dysplasias or hemorrhage) that were not confirmed after delivery was lower than it was for 2D-US and 3D-US.

CONCLUSIONS

MRI was more sensitive than ultrasonography and provided additional information that changed prognosis, counseling or management in 22.2% of fetuses with CNS anomalies. False-positive diagnoses for subtle CNS findings were higher with MRI than with ultrasonography. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Audit feedback on reading performance of screening mammograms: An international comparison

Objective

Providing feedback to mammography radiologists and facilities may improve interpretive performance. We conducted a web-based survey to investigate how and why such feedback is undertaken and used in mammographic screening programmes.

Methods

The survey was sent to representatives in 30 International Cancer Screening Network member countries where mammographic screening is offered.

Results

Seventeen programmes in 14 countries responded to the survey. Audit feedback was aimed at readers in 14 programmes, and facilities in 12 programmes. Monitoring quality assurance was the most common purpose of audit feedback. Screening volume, recall rate, and rate of screen-detected cancers were typically reported performance measures. Audit reports were commonly provided annually, but more frequently when target guidelines were not reached.

Conclusion

The purpose, target audience, performance measures included, form and frequency of the audit feedback varied amongst mammographic screening programmes. These variations may provide a basis for those developing and improving such programmes.

Design of a collective scattering system for small scale turbulence study in Korea Superconducting Tokamak Advanced Research

The design characteristics of a multi-channel collective (or coherent) scattering system for small scale turbulence study in Korea Superconducting Tokamak Advanced Research (KSTAR), which is planned to be installed in 2017, are given in this paper. A few critical issues are discussed in depth such as the Faraday and Cotton-Mouton effects on the beam polarization, radial spatial resolution, probe beam frequency, polarization, and power. A proper and feasible optics with the 300 GHz probe beam, which was designed based on these issues, provides a simultaneous measurement of electron density fluctuations at four discrete poloidal wavenumbers up to 24 cm(-1). The upper limit corresponds to the normalized wavenumber kθρe of ∼0.15 in nominal KSTAR plasmas. To detect the scattered beam power and extract phase information, a quadrature detection system consisting of four-channel antenna/detector array and electronics will be employed.

Inertial focusing in non-rectangular cross-section microchannels and manipulation of accessible focusing positions

Inertial focusing in microfluidic channels has been extensively studied experimentally and theoretically, which has led to various applications including microfluidic separation and enrichment of cells. Inertial lift forces are strongly dependent on the flow velocity profile and the channel cross-sectional shape. However, the channel cross-sections studied have been limited to circles and rectangles. We studied inertial focusing in non-rectangular cross-section channels to manipulate the flow profile and thus the inertial focusing of microparticles. The location and number of focusing positions are analyzed with varying cross-sectional shapes and Reynolds number. We found that the broken symmetry of non-equilateral triangular channels leads to the shifting of focusing positions with varying Reynolds number. Non-rectangular channels have unique mapping of the focusing positions and the corresponding basins of attraction. By connecting channels with different cross-sectional shapes, we were able to manipulate the accessible focusing positions and achieve focusing of microparticles to a single stream with ∼99% purity.

Hollow Nanobarrels of α-Fe2O3 on Reduced Graphene Oxide as High-Performance Anode for Lithium-Ion Batteries

Alpha-phase iron oxide nanoparticles (α-NPs), α-iron oxide hollow nanobarrels (α-HNBs), and α-HNBs on reduced graphene oxide (α-HNBs/RGO) for Li-ion batteries (LIBs) were synthesized by a time-efficient microwave method to improve the low electrical conductivity of iron oxide and exploit the porous structure of RGO, which prevents the volume expansion of α-Fe2O3 during the insertion/extraction. On the other hand, α-HNBs (∼200 nm in diameter, ∼360 nm in length) provide a short diffusion path for Li ions and accommodate the strain generated by the volume change. The α-HNBs/RGO hybrid structure was synthesized by a one-step microwave-assisted hydrothermal method to bond α-HNBs with RGO. The as-prepared α-HNBs/RGO electrode exhibited a superior reversible capacity of 1279 mA h g(-1) at 0.5 C after the first cycle; such a capacity was nearly recovered after numerous cycles (2nd to 100th cycle, 95%). The long-term cyclability of α-HNBs/RGO shows 478 mA h g(-1) after 1000 cycles. Moreover, the α-HNBs/RGO electrode shows a high rate capacity of 403 mA h g(-1) even at 10 C. The α-HNBs/RGO exhibited a better electrochemical performance that could be attributed to the absence of nanoparticle agglomeration and RGO restacking, which provided a buffer effect against the volume expansion, promoted electrical conductivity and high structural integrity.

Rapid extraction of uranium ions from seawater using novel porous polymeric adsorbents

Nanoporous polymeric networks, are firstly exploited for uranium capture from seawater. Amidoxime PIM-1 is capable of uptake 95% of uranium in 24 h, and the U extraction efficiency is to be intact throughout three cycles of sorbent regeneration.

Post calibration of the two-dimensional electron cyclotron emission imaging instrument with electron temperature characteristics of the magnetohydrodynamic instabilities

The electron cyclotron emission imaging (ECEI) instrument is widely used to study the local electron temperature (Te) fluctuations by measuring the ECE intensity IECE ∝ Te in tokamak plasmas. The ECEI measurement is often processed in a normalized fluctuation quantity against the time averaged value due to complication in absolute calibration. In this paper, the ECEI channels are relatively calibrated using the flat Te assumption of the sawtooth crash or the tearing mode island and a proper extrapolation. The 2-D relatively calibrated electron temperature (Te,rel) images are reconstructed and the displacement amplitude of the magnetohydrodynamic modes can be measured for the accurate quantitative growth analysis.

Clinical Markers Associated with Metabolic Syndrome Among Military Aviators

BACKGROUND

Due to the recent increase of metabolic syndrome (MetS) in the Korean population, this study was performed to investigate the prevalence of MetS among Republic of Korea (ROK) Air Force military aviators and its relationship with clinical markers.

METHODS

A cross-sectional study was performed among 911 aviators who filled out the lifestyle questionnaire and underwent medical examinations at the ROK Air Force Aerospace Medical Center. Clinical markers of aviators with MetS were investigated and odds ratios were calculated.

RESULTS

Among the 911 aviators, 90 (9.9%) were found to have MetS and the prevalence of subcomponents were: 31.7% elevated blood pressure, 25.3% elevated waist circumference, 19.0% impaired glucose tolerance, 16.6% elevated triglycerides, 7.9% reduced high density lipoprotein (HDL) cholesterol. Among aviators, a significant statistical association was found between the diagnosis of MetS with the highest quartile of uric acid, white blood cell (WBC) count, and alanine transaminase (ALT) level. Adjusted odds ratio of MetS was 8.88 (3.16 ∼24.99) if all three clinical markers were at highest quartile range.

DISCUSSION

Despite the relatively low prevalence of MetS in ROK Air Force aviators, further preventive measures are required as the prevalence is expected to increase in the future. Aviators with high levels of WBC count, uric acid, and ALT should be examined for MetS. Further comprehensive cohort study is required to link the elevation of clinical markers and development of MetS.

Eosinophilic Granulomatosis with Polyangiitis preceding allergic bronchopulmonary aspergillosis

A 61-year-old Chinese man with long-standing, stable Eosinophilic Granulomatosis with Polyangiitis (EGPA) and asthma, presented with acute hypoxemia and declining obstructive pulmonary function. Elevated serum IgE levels, positive Aspergillus fumigatus specific IgE and CT findings of central bronchiectasis with small airway mucoid impaction confirmed new development of Allergic Bronchopulmonary Aspergillosis (ABPA). The maintenance therapy for EGPA, azathioprine, was discontinued. Prednisolone 0.5 mg/kg/day and Itraconazole improved his symptoms and IgE levels. To our knowledge, ABPA occurring in a patient with EGPA has not been reported. Differentiation of EGPA with asthmatic flare vs ABPA vs asthma with aspergillus hypersensitivity is discussed. Heightened Th2 immunity where eosinophils play a central role may link these conditions.

Quantification of liver herniation in fetuses with isolated congenital diaphragmatic hernia using two-dimensional ultrasonography

OBJECTIVES

To describe a method of quantifying the amount of liver herniation in fetuses with isolated congenital diaphragmatic hernia (CDH) using two-dimensional ultrasonography and to correlate this finding with neonatal outcome.

METHODS

Ultrasound images obtained from 77 consecutive fetuses that presented with isolated CDH between January 2004 and July 2012 were reviewed. Liver herniation and thoracic area were measured in a cross-sectional plane of the fetal chest at the level of the four-chamber view of the heart (the same section as is used to measure the lung area-to-head circumference ratio) and the ultrasound-derived liver-to-thoracic area ratio (US-LiTR) was calculated by dividing the liver herniation area by the thoracic area. Receiver-operating characteristics (ROC) curve analysis was used to evaluate the performance of US-LiTR in predicting neonatal outcome (survival to 6 months after delivery and need for extracorporeal membrane oxygenation (ECMO)). In addition, the US-LiTR was compared with the magnetic resonance imaging (MRI)-derived volume ratio (MRI-LiTR) and percentage of liver herniation (MRI-%LH).

RESULTS

The overall neonatal mortality in the 77 cases with isolated CDH was 20.8% (16/77). ECMO was needed in 35.5% (27/76) of the newborns, with a survival rate of 52%. The US-LiTR was associated statistically with mortality (P < 0.01) and with the need for ECMO (P < 0.01). Good correlations were observed between US-LiTR and MRI-LiTR (r = 0.87; P < 0.001) and between US-LiTR and MRI-%LH (r = 0.90; P < 0.001). Based on ROC curve analysis, all three parameters had similar accuracy in predicting mortality (US-LiTR: area under the ROC curve (AUC), 0.78 (95% CI, 0.65-0.92), P < 0.01; MRI-LiTR: AUC, 0.77 (95% CI, 0.63-0.90), P < 0.01; MRI-%LH: AUC, 0.79 (95% CI, 0.65-0.92), P < 0.01, respectively) as well as the need for ECMO (US-LiTR: AUC, 0.72 (95% CI, 0.60-0.84), P < 0.01; MRI-LiTR: AUC, 0.73 (95% CI, 0.60-0.88), P < 0.01; MRI-%LH: AUC, 0.77 (95% CI, 0.64-0.89), P < 0.01, respectively).

CONCLUSIONS

Two-dimensional ultrasound measurement of the amount of liver herniation in fetuses with isolated CDH is feasible and demonstrates a predictive accuracy for neonatal outcome similar to that of MRI.

An array of virtual Frisch-grid CdZnTe detectors and a front-end application-specific integrated circuit for large-area position-sensitive gamma-ray cameras

We developed a robust and low-cost array of virtual Frisch-grid CdZnTe detectors coupled to a front-end readout application-specific integrated circuit (ASIC) for spectroscopy and imaging of gamma rays. The array operates as a self-reliant detector module. It is comprised of 36 close-packed 6 × 6 × 15 mm(3) detectors grouped into 3 × 3 sub-arrays of 2 × 2 detectors with the common cathodes. The front-end analog ASIC accommodates up to 36 anode and 9 cathode inputs. Several detector modules can be integrated into a single- or multi-layer unit operating as a Compton or a coded-aperture camera. We present the results from testing two fully assembled modules and readout electronics. The further enhancement of the arrays' performance and reduction of their cost are possible by using position-sensitive virtual Frisch-grid detectors, which allow for accurate corrections of the response of material non-uniformities caused by crystal defects.

Features and Outcomes of 899 Patients With Drug-Induced Liver Injury: The DILIN Prospective Study

BACKGROUND & AIMS

The Drug-Induced Liver Injury Network is conducting a prospective study of patients with DILI in the United States. We present characteristics and subgroup analyses from the first 1257 patients enrolled in the study.

METHODS

In an observational longitudinal study, we began collecting data on eligible individuals with suspected DILI in 2004, following them for 6 months or longer. Subjects were evaluated systematically for other etiologies, causes, and severity of DILI.

RESULTS

Among 1257 enrolled subjects with suspected DILI, the causality was assessed in 1091 patients, and 899 were considered to have definite, highly likely, or probable DILI. Ten percent of patients died or underwent liver transplantation, and 17% had chronic liver injury. In the 89 patients (10%) with pre-existing liver disease, DILI appeared to be more severe than in those without (difference not statistically significant; P = .09) and mortality was significantly higher (16% vs 5.2%; P < .001). Azithromycin was the implicated agent in a higher proportion of patients with pre-existing liver disease compared with those without liver disease (6.7% vs 1.5%; P = .006). Forty-one cases with latency ≤7 days were caused predominantly by antimicrobial agents (71%). Two most common causes for 60 DILI cases with latency >365 days were nitrofurantoin (25%) or minocycline (17%). There were no differences in outcomes of patients with short vs long latency of DILI. Compared with individuals younger than 65 years, individuals 65 years or older (n = 149) were more likely to have cholestatic injury, although mortality and rate of liver transplantation did not differ. Nine patients (1%) had concomitant severe skin reactions; implicated agents were lamotrigine, azithromycin, carbamazepine, moxifloxacin, cephalexin, diclofenac, and nitrofurantoin. Four of these patients died.

CONCLUSIONS

Mortality from DILI is significantly higher in individuals with pre-existing liver disease or concomitant severe skin reactions compared with patients without. Additional studies are needed to confirm the association between azithromycin and increased DILI in patients with chronic liver disease. Older age and short or long latencies are not associated with DILI mortality.

On growth measurements of abdominal aortic aneurysms using maximally inscribed spheres

The maximum diameter, total volume of the abdominal aorta, and its growth rate are usually regarded as key factors for making a decision on the therapeutic operation time for an abdominal aortic aneurysm (AAA) patient. There is, however, a debate on what is the best standard method to measure the diameter. Currently, two dominant methods for measuring the maximum diameter are used. One is measured on the planes perpendicular to the aneurism's central line (orthogonal diameter) and the other one is measured on the axial planes (axial diameter). In this paper, another method called 'inscribed-spherical diameter' is proposed to measure the diameter. The main idea is to find the diameter of the largest sphere that fits within the aorta. An algorithm is employed to establish a centerline for the AAA geometries obtained from a set of longitudinal scans obtained from South Korea. This centerline, besides being the base of the inscribed spherical method, is used for the determination of orthogonal and axial diameter. The growth rate parameters are calculated in different diameters and the total volume and the correlations between them are studied. Furthermore, an exponential growth pattern is sought for the maximum diameters over time to examine a nonlinear growth pattern of AAA expansion both globally and locally. The results present the similarities and discrepancies of these three methods. We report the shortcomings and the advantages of each method and its performance in the quantification of expansion rates. While the orthogonal diameter measurement has an ability of capturing a realistic diameter, it fluctuated. On the other hand, the inscribed sphere diameter method tends to underestimate the diameter measurement but the growth rate can be bounded in a narrow region for aiding prediction capability. Moreover, expansion rate parameters derived from this measurement exhibit good correlation with each other and with growth rate of volume. In conclusion, although the orthogonal method remains the main method of measuring the diameter of an abdominal aorta, employing the idea of maximally inscribed spheres provides both a tool for generation of the centerline, and an additional parameter for quantification of aneurysmal growth rates.

Cell population data in neonates: differences by age group and associations with perinatal factors

INTRODUCTION

Cell population data (CPD) describe physical parameters of white blood cell subpopulations and are reported to be of some value in the diagnosis of sepsis in neonates. Before using the CPD for diagnosing sepsis, the baseline features of the CPD distribution in healthy neonates should be clarified. The aim of this study was to compare the CPD distributions of healthy neonates and other age groups and to identify perinatal factors that are associated with changes in the CPD distribution of healthy neonates.

METHODS

The CPD distribution of 69 samples from term neonates was compared with adolescents and adults. The CPD distribution of 163 samples from healthy neonates was analyzed in association with perinatal factors, including gestational age, chronologic age, birthweight, delivery mode, premature rupture of membranes, diabetes, and pregnancy-induced hypertension.

RESULTS

The CPD distribution for term neonates was significantly different from those in adolescents and adults. The mean lymphocyte volume showed a negative correlation with gestational age at birth (r = -0.305; P < 0.01). The mean neutrophil volume was smaller in the cesarean section group than in the normal delivery group. The small for gestational age (SGA) group had smaller mean neutrophil volume and mean monocyte volume than the appropriate for gestational age group.

CONCLUSION

The CPD distribution of healthy neonates differed from those of adolescents or adults, and the differences were associated with gestational age, delivery mode, and being SGA.

Longitudinal assessment of lung area measurements by two-dimensional ultrasound in fetuses with isolated left-sided congenital diaphragmatic hernia

OBJECTIVE

To evaluate lung growth in healthy fetuses and those with congenital diaphragmatic hernia (CDH) using two-dimensional (2D) ultrasound.

METHODS

Fetal right lung measurements obtained by 2D ultrasound between 19 and 37 weeks' gestation were evaluated longitudinally in 66 healthy fetuses and 52 fetuses with isolated left-sided CDH. Right lung areas were determined by the 'tracing' and 'longest-diameters' methods and, subsequently, lung area-to-head circumference ratios (LHRs) were calculated. Functions fitted to these size parameters with respect to gestational age were evaluated for three sets of group-wise comparisons: (1) healthy vs CDH fetuses; (2) different degrees of severity of CDH; and (3) CDH fetuses that survived vs those that died by 6 months postpartum.

RESULTS

There was a significantly slower increase in right lung areas and LHRs with advancing gestational age in CDH fetuses than in healthy individuals (P < 0.05). Compared to those with milder forms of CDH, lung areas and LHRs of fetuses with more severe forms displayed a smaller increase (P < 0.05) and LHRs of fetuses with severe CDH did not increase during pregnancy (P > 0.05). Individuals who died postpartum did not show any increase in LHR (P > 0.05) throughout gestation.

CONCLUSIONS

The right lung area and LHR, calculated using either the longest-diameters or tracing method, display reduced growth rates during gestation in cases of isolated left-sided CDH as compared with healthy fetuses. The growth curve characteristics of fetal lung areas and LHRs may be useful for predicting neonatal mortality.