Objective To evaluate the pregnancy outcomes and prognosis of fetuses with different levels of ventriculomegaly.Methods Fetuses with ventriculomegaly subjected to the multidisciplinary consultation in the Obstetrics and Gynecology Hospital of Fudan University between January 2004 and December 2013 were included in this study.The fetuses were divided into three groups according to the width of the lateral ventricles on ultrasound examination as follows:mild ventriculomegaly (Mild Group,≥ 10 -＜12 mm,151 cases),moderate ventriculomegaly (Moderate Group,≥ 12-＜15 mm,56 cases) and severe ventriculomegaly (Severe Group,≥ 15 mm,34 cases).All cases were followed up with additional ultrasound scans during pregnancy and follow up was continued until the children were almost nine years old.Chi square test,Fisher's exact test and Bonferroni method were used to analyze the data.Results Two hundred and forty one fetuses were followed up.Ninety-one cases were terminated,and 150 were born (105 cases in Mild Group,30 cases in Moderate Group,and 15 cases in Severe Group).During ultrasound follow up of the 150 cases,the lateral ventricle width regressed in 42 cases (28.0％) and remained stable in 108 cases (72.0％).In the regressed group,the ventricle width in 31 cases in the Mild Group regressed to normal and a hearing abnormality was noted in one case after birth.In the Moderate Group,the lateral ventricle width in nine cases regressed to normal,one case had mild ventriculomegaly,and none of these cases showed abnormalities after birth.One case in the Severe Group showed no abnormalities,while the width of the lateral ventricles decreased to 14.0 and 16.0 mm.With regard to the outcomes of lateral ventricle width with or without regression,one of 42 cases in the regressed group had a significant abnormality,while 19 of 108 cases in the stable group [eleven cases (14.9％,11/74) in Mild Group,two (10.9％,2/20) in Moderate Group,and six (6/14) in Severe Group] showed significant abnormalities.Statistically significant differences were found between the two groups [2.4％(1/42) vs 17.6％(19/108),x2=4.940,P=0.026].When the outcomes of the three groups were compared,12 of 105 cases in the Mild Group (11.4％),two of 30 cases in the Moderate Group (6.7％),and 6 of 15 cases in the Severe Group (6/15) had significant abnormalities.Statistically significant differences were found between the three groups (x2=6.908,P=0.032).Statistical significance was observed in the Moderate Group and Severe Group (x2=4.929,P=0.026),while the Mild Group had a more favorable prognosis than the Severe Group (x2=5.266,P=0.022).Chromosomal examinations were carried out in 57 cases and the incidence of chromosomal abnormalities was 8.8％(5/57) [7.0％ (3/43),1/8 and 1/6 in the three groups,respectively].Infection screening was performed in 29 cases and one case was found to be positive for rubella virus-IgM,two cases were positive for cytomegalovirus-IgM,and one case was positive for toxoplasma gondii-IgM.Conclusions Pregnancy outcomes and the prognosis of fetal ventriculomegaly are associated with the degree and progression of ventricular dilatation.

Objective To observe the effects of hedysari polysaccharide (HPS) on myocardial fibrosis and the expression of MMP-2/TIMP-2 in model mice of diabetic cardiomyopathy; To discuss the mechanism of action of prevention and treatment of myocardial fibrosis in diabetes.Methods Sixty mice were randomly divided into model group, rosiglitazone group and HPS high-, mediume- and low-dose groups. The normal group was 12 non-transgenic male BKS.Cg-Dock7m+/+Leprdb/JNjumice with the same age. Each group was given relevant medicine for gavage, for 8 weeks. Blood glucose of mice before and after medication 2, 4, 6, and 8 weeks was detected. The levels of MMP-2, MMP-2 and MMP-9 in myocardium were measured by Masson staining. The protein expressions of MMP-2 and TIMP-1 in myocardium were detected by Western blot.Results Compared with the model group, the blood glucose of HPS (high- and medium dose) groups and rosiglitazone group decreased significantly. Masson staining showed that the green fibers in the model group significantly increased and rosiglitazone group and HPS high-dose group decreased compared with the model group. Western blot showed that the expressions of MMP-2 in model group and MMP-2/TIMP-2 ratio were declined significantly, while the expression of MMP-2 was increased and TIMP-2 was decreased significantly, and the ratio of MMP-2/TIMP-2 increased in rosiglitazone group and HPS high- and medium-dose group.Conclusion HPS may reduce the degree of myocardial fibrosis in model mice with diabetic cardiomyopathy. The therapeutic effect of HPS may be to relieve myocardial fibrosis in model mice by increasing the ratio of MMP-2/TIMP-2.

Objective To explore the efficacy of transurethral resection of bladder neck(female)and urinary sphincter(male)to treat neurogenic urinary dysfunction. Methods Forty-one patients(28 women and 13 men)with neurogenic urinary dysfunction(dysuria)were retrospectively analyzed.All patients had sacral neurological damage.The mean patient age was 27(12-43)years.All patients had urinary retention and ureter dilation.Twenty-nine patients had renal function damage.Residual urine volume was 151-700 ml(mean 420 m1).MFR was 4-14 ml/s.After local anesthesia,bladder neck(female)was incised at 5,6,7 o'clock to the circle fiber.Urinary sphincter(male) was cut off at 11,1 o'clock and was dilated using sound(F24-F27).The catheterization time was 1-2 weeks. Results All 41 patients were followed up,from 2 months to 252 months,average 85 months.Thirty-six patients(88%)were completely recovered with no residual urine,no dilation of ureter and pelvis,no renal function damage.of these 36 cases,surgery was carried out once for 1 patient,twice for 20 and 3 times for 15.Five patients(12%)were not improved. Conclusion Transurethral resection of bladder neck(female)and urinary sphincter(reale)to treat neurogenic urinary dysfunction could be an effective method.

The rapidly aging population has attracted extensive attention to the health of elderly people .The elderly are a vulnerable group in society .Their adverse physical and mental health not only affects their own well-be-ing but also brings a heavy burden on families and society .Numerous studies have found that health inequality of the elderly is a problem throughout the world, and differences in gender, age, marital status, socioeconomic status, and social capital among the elderly are all contributing factors .This paper summarizes these factors through a literature review.We suggest that cross-sectional and longitudinal data should be combined and suitable indicators and mathe -matical models to Chinese conditions should be established in order to analyze the mechanisms of various factors and their effects on health inequality and serve as a reference for promoting the overall health of the elderly .

Down syndrome is caused by partial or complete triplication of genes located on chromosome 21. Its incidence increases dramatically with the age of women. Hypotheses proposed for this have included abnormal homologous recombination, defective spindle assembly, biological aging, reduction of cohesion complexes, endocrine disorders, oocyte selection model, and single nucleotide polymorphisms of genes that maintain chromosome stability, etc. A literature review is provided here.
Aging ; genetics ; Chromosomes, Human, Pair 21 ; genetics ; Down Syndrome ; genetics ; Female ; Humans ; Maternal Age ; Oocytes ; metabolism ; Polymorphism, Single Nucleotide ; genetics

Objective To evaluate the intra-and inter-rater reliability of MyotonPRO for Achilles tendon properties measured. Methods Twenty healthy subjects were recruited to measure Achilles tendon properties using a novel hand-held Myoton-PRO device by two testers, one of the testers re-tested five days later. The reliability was assessed using in-tra-class correlation coefficient (ICC) and Bland-Altman analysis, and minimum detectable changes (MDC) was calculated. The Achilles tendon properties of the dominant or non-dominant leg was compared. The correlation between body mass and Achilles tendon properties was examined. Results The intra-rater reliabilities of Achilles tendon properties were ICCleft=0.884 and ICCright=0.904; the inter-rater reli-abilities were ICCleft=0.883 and ICCright=0.945. The MDC was 36.64 N/m. Bland-Altman plots showed good agreement. There was no significant difference in Achilles tendon properties between dominant and non-domi-nant legs (t<1.236, P>0.05). The body mass positively correlated with Achilles tendon properties (r>0.477, P<0.05). Conclusion The intra-and inter-rater reliabilities of MyotonPRO were good in measuring Achilles tendon properties in healthy subjects. No significant difference was found between dominant and non-dominant legs. The body mass positively correlated with Achilles tendon properties in healthy subjects.

Objective To explore the effect of hedysarum polybotrys polysacchcaide (HPS)on myocar-dial fibrosis of db /db mice with diabetic cardiomyopathy (DCM)by taking TGF-β1 /Smads signaling pathway as the index.Methods Altogether 60 six-week-old male db /db mice were randomly divided in-to five groups:HPS high-,mid-,low-dose group,rosiglitazone group and model group,additional 12 non transgenic db /m male mice with the same background were assigned into the normal group.The mice ex-cept for those of the normal group were intragatrically administered (i.g.)corresponding medicines for consecutive 8 weeks.Before treatment and every two weeks during the period of i.g.drugs,the body weight and blood glucose were detected.At the end of Week 8,HE staining was used to observe the pathological changes of left ventricular myocardial fibers,Masson staining was used to observe the degree of left ventricular myocardial collagen fibrosis,and Western blot,RT-PCR were used to measure the pro-tein and mRNA expressions of TGF-β1 and Smad2,Smad3 in cardiac muscle tissue.Results Eight weeks after treatment,the blood glucose of rats in HPS high-,mid-dose group,and rosiglitazone group decreased significantly compared with model group (P <0.05).The sections of HE staining showed that the model rats’myocardial cells structure became unclear and some of them were swollen and deformed obviously,even the nucleus disappeared.The sections of Masson staining showed that bright green colla-gen fibers were heaped up between myocardial cells and around blood vessels of the model rats.The pro-tein and mRNA expressions of TGF-β1 ,Smad2 and Smad3 had no significant difference between model group and HPS low-dose group (P >0.05),but the other groups decreased significantly compared with the model group (P <0.05),especially the HPS high-dose group or rosiglitazone group was superior to mid-dose group (P <0.05).Conclusion The effect of HPS against myocardial fibrosis in db /db mice with DCMto slow down the progression of DCMwas proved,and its potential mechanism may be related to inhibitation of TGF-β1 /Smads signaling pathway.

In clinical practice,methotrexate exhibits individual difference in drug efficacy and adverse reactions.Genetic variation is one of the most important influence factors.The article reviewed latest researches of methotrexate in metabolism,transport,and targets to discover the relationship between gene polymorphisms on pharmacogenomics and methotrexate so as to provide references for clinical individualized treatment.

Objective: To assess the impact of viable myocardium in left ventricular aneurysm (LVA) and ventricular arrhythmia on prognosis of LVA patients.
Methods: A total of one hundred and sixty LVA patients who received99Tcm-MIBI SPECT and18F-FDG PET were enrolled, including 139 male and 21 female with the mean age of (58 ± 10) years.There were 42 (26.3%) patients combining ventricular arrhythmia. LVEDV, LVESV and LVEF were detected. Semi-quantitative analysis of myocardium perfusion imaging was conducted, viable myocardium in aneurysm was deifned as the perfusion-metabolism mismatch score (MMS) ≥ 2.0. According to myocardium viability, the patients were divided into 2 groups: No viability group,n=97 and With viability group,n=63;based on ventricular arrhythmia, the patients were divided into another 4 groups: Group①, viability-, ventricular arrhythmia-, n=68, Group②, viability-, ventricular arrhythmias+,n=29, Group③, viability+, ventricular arrhythmias-,n=50 and Group④, viability+,ventricular arrhythmias+,n=13. The average follow-up time was (50 ± 7) months, the end point was cardiac death. The survival curve was obtained by Kaplan-Meier method and survival rates were compared by Log-rank analysis.
Results: The mean LVEF in 160 patients was (34 ± 11) %, cardiac death occurred in 19 (11.9%) patients. Long-term survival rates in Groups①,② and③ were 94.1%, 89.7% and 86.0%, respectively,P>0.05; while in Group④, the survival rate was 61.5%, which was lower than the other 3 groups,P=0.004. Multivariate Cox regression analysis showed that female (HR=5.101, 95% CI 1.853-14.044, P=0.002), GPET-ESV (HR=1.009, 95% CI 1.002-1.015,P=0.013), interaction between MMS and ventricular arrhythmia (HR=1.368, 95%CI 1.113-1.681,P=0.003) were independent risk factors for cardiac death;while surgical treatment (HR=0.199, 95% CI 0.054-0.742,P=0.016) could decrease the risk of cardiac death.
Conclusion: Patients with viable aneurysm and ventricular arrhythmia had poor long-term prognosis; while early and active treatment is needed for them (surgery with anti-arrhythmic therapy).

Acute myocardial ischemia is the most common cause of sudden cardiac death.The diagnosis of early myocardial ischemia is a hot point in forensic medicine,which is also an early and important part for a prevention against myocardial infarction.This paper conducts a comprehensive discussion of the structure,function,clinical value and forensic medicine application prospect of ischemia modified albumin (IMA) and heart-type fatty acid binding protein (H-FABP),aiming to determine whether the two proteins can be used as biochemical detection indicators of early myocardial ischemia for the diagnosis of sudden cardiac death in forensic medicine.