Objective To describe the diagnostic approach and clinical outcomes of fetal intraabdominal extralobar pulmonary sequestration (IEPS).Methods Three cases of IEPS were diagnosed prenatally by ultrasound in our center.The data of these 3 cases and 43 cases in prior studies from 1986 to 2016 were retrospectively reviewed.The prenatal sonographic features,treatment,and outcomes were collected.Results The gestational age of diagnosis IEPS was (24.5±5.9)weeks,the male-to-female ratio was 3-4∶1,78.3% (36/46) of IEPS masses located on the left side,47.8% (22/46) of lesions were homogenous and hyperechoic,8.7% (4/46) of cases associated anomalies,78.3% (36/46) of patients were preformed resection and postoperative recovery and subsequent course were uncomplicated.Feeding arteries were detected in 15.2% (7/46) cases and confirmed by surgery or autopsy.Conclusions Prenatal ultrasound has the diagnostic accuracy of IEPS.Feeding arteries noted on color Doppler are strongly indicators of IEPS.Postsurgical outcomes are favorable.

[Objective]This study was designed to investigate the effects of 5-aminoimidasole-4-carboxamide ribonucleoside (AICAR)on activity of transcription factor Forkhead O 3a(FOXO3a)and expression of ubiquitin ligase muscle atrophy F-box (MAFbx),and to explore the role of adenosine monophosphate-activated protein kinase(AMPK)on proteolysis pathways in eardiomyocytes.[Methods]The effect of AICAR on activation of AMPK was observed.Cultured neonatal rat cardiomyocytes was treated with AICAR in different concentration.Cultured cardiomyocytes were then divided into three groups:control group,AICAR group,AICAR+Compound C group.Effects of AMPK activation on phosphorylation of FOXO3a and expression of MAFbx in cardiomyocytes were detected using Western blot.[Results]①Compared with control group,activity of AMPK in cultured cardiomyocytes was increased after treatment with 0.25 mmol/L or 0.5 mmol/L AICAR for 6 h(P＜0.05),and the activity of AMPK was further enhanced after treatment with 1.0 mmol/L or 2.0 mmol/L AICAR for 6 h(P＜0.01).②Activation of AMPK by AICAR significantly increased the transcriptional activity of FOXO3a(P＜0.01),and enhanced MAFbx protein expression in cardiomyocytes when comparing with control group(P＜0.01),however,specific AMPK antagonist Compound C markedly reversed these effects induced by AICAR.[Conclusion]AMPK may regulate cardiomyocytes proteolysis by activation of FOXO3a transcription factor,and up-regulation of MAFbx protein expression.

AIM: To study the effects of metformin on the pressure overload-induced cardiac hypertrophy in rats. METHODS: Transverse aortic constriction (TAC) model of rat was made through laparotomy. One week after TAC surgery, the rats were randomly divided into 5 groups (n=8 in each group) and were administered with the corresponding drugs orally every day for 8 weeks: sham group (sham surgery, administered with 2 mL distilled water);TAC group (TAC rats, administered with 2 mL distilled water);metformin(MET) group (TAC rats, administered with MET at dose of 300 mg·kg~(-1)·d~(-1));MN group [TAC rats, administered with MET at dose of 300 mg·kg~(-1)·d~(-1) plus NOS inhibitor, NG-nitro-L-arginine methyl ester (L-NAME) 50 mg·kg~(-1)·d~(-1)] and L-NAME group (TAC rats, administered with L-NAME at dose of 50 mg·kg~(-1)·d~(-1)). After treated for 8 weeks, the echocardiography, hemodynamics, the ratio of heart weight to body weight (HW/BW) and histological examination of the heart were performed. The levels of myocardial AMP-activated protein kinase subunit α (AMPKα), p-AMPKα~(Thr172), endothelial nitric oxide synthase (eNOS) and p-eNOS~(Ser1177) were detected by Western blotting. Plasma and myocardial nitric oxide (NO) were detected biochemically. RESULTS: After 8 weeks treatment, the wall thickness of left ventricle, the heart weight/body weight ratio (HW/BW), and the left ventricular myocardial perivascular fibrosis and myocardial interstitial fibrosis of the animals in TAC group were significantly increased as compared to those in sham rats. Treatment with MET for 8 weeks significantly attenuated left ventricular hypertrophy and improved cardiac function in TAC rats. These effects of MET were mostly abolished by L-NAME. Molecular biology and biochemical testing revealed that the levels of left ventricular myocardial p-AMPKα~(Thr172) and p-eNOS~(Ser1177), as well as the levels of myocardial and serum NO were significantly increased in MET group. CONCLUSION: Long-term MET treatment significantly inhibits the cardiac hypertrophy and the myocardial fibrosis and improves the cardiac functions in pressure-overload rats. The anti-hypertrophic effects of MET may be mediated via activation of AMPK-eNOS signaling pathway.

Objective To investigate the regional cerebral blood flow perfusion in fetuses with congenital heart disease (CHD)by three-dimensional power Doppler ultrasound (3D PD).Methods The vascular index (VI),flow index (FI)and vascular/flow index (VFI)in the main arterial territories [middle cerebral artery (MCA ),anterior cerebral artery (ACA ) and posterior cerebral artery (PCA )] were prospectively compared in 1 12 fetuses with CHD and 1 12 normal fetuses using 3D PD.Correlations between the 3D PD indices and neurodevelopment scores were assessed.Results Compared with the controls,the VI,FI and VFI of the three main arteries were significantly increased in fetuses with hypoplastic left heart syndrome (HLHS)and left sided obstructive lesions (LSOL)(P < 0.001 ).The mean psychomotor development index (PDI)and mental development index (MDI)scores were significantly lower than normal (P <0.001).ACA VI and ACA VFI were positively correlated with PDI (r =0.377,P =0.01 5 and r =0.389,P = 0.012,respectively)but were not correlated with MDI.Conclusions Cerebral blood flow perfusion in three main arteries was significantly increased in fetuses with HLHS/LSOL,and blood flow perfusion in ACA area was significantly increased in fetuses with TGA.ACA-VI,ACA-FI had association with neurodevelopment scores.3D PD ultrasound might help to identify cases of brain vasodilatation earlier and inform parental counseling.

Objective To analyze the reliability and reproducibility of three different classification systems of Tile,Young Burgess and AO in pelvic fracture.Methods One hundred cases of pelvic fractures conforming to the inclusion standard and with intact imaging data were selected and classified according to these 3 classification methods by the orthopedic surgeons.The retyping was performed at 8 weeks after disorganizing the order.Then reliability and reproducibility analysis was performed by using the Kappa values and typing consistency.Results The reliability Kappa values during the two periods before and after the Tile classification were 0.743 and 0.745 respectively,and the reproducibility Kappa value was 0.771;the reliability Kappa values during the two periods before and after the Young-Burgess classification were 0.587 and 0.590 respectively,and the reproducibility Kappa value was 0.691;the reliability of Kappa values during the two periods before and after the OA classification were 0.402 and 0.406 respectively,and the reproducibility Kappa value was 0.498.Conclusion the Tile classification has better reliability and reproducibility than the other two classifications in pelvic fracture,which is easy to master and apply.

BACKGROUND: Recent study showed that osteocalcin may elevate Insulin secretion and sensitivity, prevent the fat accumulation, play a role in the metablism of glucose and lipid. Undercarboxylated osteocalcin works as the main role. OBJECTIVE: To investigate the effect of different concentrations of glucose on osteoblast undercarboxylated osteocalcin. METHODS: The rib trabeculae were resected and broken, trypsinizated and washed completely by PBS. Bone surface and non-adhesive floating cells in cleaning fluid were observed with inverted microscope. Rib trabeculae was washed by DMEM culture medium once, and cultured in culture bottle. The culture liquid was replaced by new one once a week. The osteoblast was moved from the scledte a week later. The cells were fused monolayer and could be subcultured 4 to 6 weeks later. The active second or third generation cells were inoculated to 6-pore plate forming 5 groups. Osteoblast were stimulated by 5.6 mmol/L., 7.6 mmol/L, 9.6 mmol/L, 12.6 mmol/L, 20.6 mmol/L glucose medium respectively after the 80% cells were fused, the vitamin K_2 was added into the culture liquid until the concentration of it to be 10~(-5) mol/L. Supernatant was collected after half hour culturing, the undercarboxylated osteocalcin level were detected with RIA test kit, and corrected it as the total the undercarboxylated osteccalcin, calculated the carboxylated incomplete osteocalcin rate. RESULTS AND CONCLUSION: The rate of ostecblast carboxylated incomplete osteocalcin was different under different concentration glucose. The rate of 7.6 mmol/L, 9.6 mmol/L, 20.6 mmol/L concentration glucose groups were higher than that of 5.6 mmol/L glucose group [(0.27±0.02)%, (0.29±0.04)%, (0.12±0.02)%, P < 0.05]. It is indicated that osteoblast could sense the change of glucose concentration by regulating the secretion of the undercarboxylated osteocalcin between the concentration of 5.6mmol/L to 9.6mmol/L, while the carboxylated incomplete osteocalcin decreased as the concentration of glucose increased.

Objective:To develop Z-scores for the aortic arch in normal fetuses as a reference for fetuses with suspected coarctation of aorta(CoA).Methods:The aortic arch inner diameters of 610 normal fetuses and 59 CoA fetuses from May 2010 to March 2015 in the Second Xiangya Hospital of Central South University were measured at the long axis of the aortic arch view. Gestational age(GA), femur length(FL) as the independent variable, the aortic arch inner diameters as the dependent variable, Z-scores were created relating the aortic arch inner diameters to the GA and FL. Z-score=[ln(measured diameter)-ln(predicted diameter)]/root MSE. Z-scores of the CoA fetuses were calculated with the above regression, and compared with the Z-scores of the control group.Results:A simple linear regression model was the best description of the data in each case and correlations between FL and the aortic arch inner diameters were excellent ( P<0.001). There was no significant difference in Z-scores calculated with FL or GA as independent variables ( P>0.05). Z-scores of the control group was between -2 and + 2, Z-scores of the CoA group was significantly lower and below -2( P<0.001). Conclusions:Z-scores of fetal aortic arch are sensitive indicators of fetal coarctation, and are of clinical importance for the diagnosis and follow-up study of CoA.

OBJECTIVE: To evaluate the echocardiographic diagnosis for ventricular non-compaction cardiomyopathy (NCCM) in foetus and to analyze the pathologic features of NCCM.
 METHODS: A total of 9 patients with fetal NCCM were examined by prenatal echocardiography from 2004 to 2013, which was compared with postnatal echocardiography or autopsy to analyze the fetal characteristic of myocardial ultrastructure.
 RESULTS: The results of echocardiography displayed an excessive muscle trabecular meshwork and muscle trabecular crypt, and the ventricular myocardium and non-compaction/compaction ratio was ≥2.0. Among the 9 fetuses of NCCM, 6 fetuses were involved in left ventricle, 2 in both left and right ventricles and 1 in right ventricle. Two fetuses were confirmed by postnatal echocardiography, the remaining 7 patients were chosen to terminate their pregnancies, which were confirmed by autopsy later. Muscle biopsies revealed the abnormal myocardial mitochondria, sarcomeres and myocardial fibrosis.
 CONCLUSION It is feasible to accurately diagnose NCCM by prenatal echocardiography. Fetal NCCM most often involves the left ventricle, but it can involve the right ventricle or both, too. The myocardial ultrastructure of fetal NCCM possesses certain unique characteristics, such as the low maturation of the mitochondria, sarcomeres and myocardial fibers.
Cardiomyopathies ; diagnosis ; Echocardiography ; Fetus ; Heart Ventricles ; pathology ; Humans ; Myocardium ; pathology