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Objective To study the prenatal diagnosis and clinical significance of fetal hyperechogenic kidneys.Methods Thirty one cases with fetal hyperechogenic kidneys were prenatally diagnosed with ultrasound.Autopsy was conducted and histological examination of the kidney was performed when pregnancy was terminated.A close follow-up was given for cases continuing pregnancy.Umbilical cord blood was collected for fetal chromosome analysis after delivery.Results(1)6 fetuses were complicated with other organ abnormalities,3 fetuses had abnormal chromosome,and 2 cases had a family history.(2) 12 cases chose to terminate pregnancy,10 of whom were oligohydromnios.Causes for fetal hyperechogenic kidneys were infantile polycystic kidney disease(IPKD,10 cases),adult polycystic kidney disease (APKD,1 case),polycystic kidney dysplasia(PKD,1 case)after postmortem histological examination. (3)Nineteen cases continued pregnancy,2 neonates with oligohydramnios died during neonatal period,both of them were IPKD;3 cases that were IPKD,IPKD and KPD respectively died 3 months,8 months and 1 year after birth,respectively;one case presented with hypertension symptom 26 months after birth,which was diagnosed as IPKD.The other 13 cases had no clinical manifestation and a close following-up is being undertaken for them at present.Conclusions(1)Fetal hyperechogenic kidneys could be caused by IPKD, APKD,or PKD,and are sometimes a normal variant.(2)Aminotic fluid volume is a key factor for prognosis;a suggestion for termination would be given to cases with fetal hyperechogenic kidneys and oligohydromnios.(3)For cases with fetal hyperechogenic kidneys,a complete and careful ultrasonography should be given to both parents and fetus,and fetal chromosomal analysis is suggested prenatally.

Objective To investigate the effect of high expression of functional IDO trom donor DCs on transplantation rejection in mice heterotopic cardiac transplantation.Method Adenovirus vector containing IDO gene was used to infect donor (C57BL/6) DCs to obtain IDO+ DCs.Mouse heterotopic cardiac transplantation models were established (C57BL/6-BALB/c) and the following groups were set up:control group,DCs injection group and IDO+ DCs injection group.Survival time of the donor heart in all groups was observed.Meanwhile,donor hearts were harvested at 7 th day post-transplantation for different examinations,including pathological examination,mRNA expression of IDO by real-time PCR,and IDO protein expression by Western blotting.Peripheral blood of recipients was also harvested for T lymphocyte apoptosis rate examination by FACS.Result Cardiac allograft median survival time in control group,DCs injection group and IDO+ DCs injection group was 7,7.5,and 17.5 days respectively.IDO+ DCs treatment significantly prolonged the survival time of donor hearts (P＜0.01).Pathological grading was significantly decreased (P＜0.01).The CD3+ T lymphocyte apoptosis rate in peripheral blood of recipients in IDO+ DCs injection group was (46.50 + 5.02)％,significantly higher than the other two groups (P＜0.01).Both IDO mRNA and protein expression showed significant increase (P＜0.01).Conclusion The preoperative medication with IDO+ DCs injection to the recipients could induce T lymphocyte apoptosis and significantly suppress the rejection in mice heterotopic cardiac homotransplantation.

Objective To evaluate the effectiveness and safety of 25G illumination aided scleral buckling surgery for treatment of rhegrmatogenous retinal detachment (RRD).Methods This is a retrospective case control study.Fifty-seven RRD patients (57 eyes) were enrolled in this study.There were 35 males (35 eyes) and 22 females (22 eyes).The patients were randomly divided into ophthalmoscope group (29 patients,29 eyes) and illumination group (28 patients,28 eyes).There was no differences in the data of gender,age,onset time,logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity(BCVA) and information of retinal tears between the two groups (P＞0.050).The patients in the ophthalmoscope group received operation of conventional scleral buckling with binocular indirect ophthalmoscope.The patients in the illumination group received scleral buckling surgery with the aid of intraocular illumination and noncontact wide-angle viewing system.The follow-up was ranged from 6 to 12 months.The BCVA,intraocular pressure,fundus examination and complications were observed and recorded.Results The difference of operation time between two groups was significant (t=2.124,P=0.031).In the ophthalmoscope group,26 eyes (89.7％) achieved retinal reattachment,3 eyes (10.3％) failed in retinal reattachment.In the illumination group,26 eyes (92.8％) achieved retinal reattachment,2 eyes (7.2％) failed in retinal reattachment.There was no difference of retinal reattachment rate (P=I.000).Five eyes failed in retinal reattachment,3 eyes received sclera buckling surgery,2 eyes received vitrectomy with silicone oil tamponade.The final reattachment ratios were both 100％.BCVA increased in both groups compared with pre-surgery BCVA (t=4.529,5.108;P＜0.001).The difference of BCVA between two groups was not significant (t=0.559,P=0.458).There was no significant difference of intraocular pressure and complications before and after surgery in both two groups (t=-1.386,-1.437;P=0.163,0.149).The difference of intraocular pressure between two groups was not significant (t=0.277,P=0.730).Subretinal hemorrhage occurred in 1 eye in the ophthalmoscope group.There was no iatrogenic retinal break,choroidal hemorrhage and endophthalmitis in the two groups.Conclusion 25G intraocular illumination aided buckling surgery for treatment of RRD is fast,safe and effective.

Objective To evaluate the effect of ultrasound-guided interscalene brachial plexus block and nerve stimulator on operation around shoulder joints. Methods Sixty cases of patients scheduled for operation around shouler joints were randomly divided into group A and B , with 30 cases in each group. Patients in group A underwent interscalend brachial plexus block guided by nerve stimulator with 0.5% ropivacaine and those in group B interscalend brachial plexus block guided by ultrasound and nerve stimulator with 0.5% ropivacaine 30 mL. The number of puncture, the effect of anesthesia and complication of anesthesia in both groups were recorded. Results The number of puncture of group B was less than that of group A (P﹤0.05) while the effect of anesthesia and the duration of anesthesia of group B were similar to those of group A (P﹥0.05). There was no serious complications in two groups. Conclusion With definite anesthesia effect and less pain , ultrasound-guided interscalene brachial plexus block and nerve stimulator is simple and safe for operation around shouler joints.

Objective To investigate the effect of human umbilical cord mesenchymal stem cells (hUC-MSCs) on macrophage polarization under hypoxia. Methods hUC-MSCs were obtained by explants adherent culture and cultured under normoxia (21% O2) and hypoxia (5% O2). The multi-directional differentiation of hUC-MSCs was observed by osteogenic and adipogenic differentiation induction. Live/death staining was performed to detect the cell viability, and ELISA was executed to detect the protein content in supernatant of hUC-MSCs. Transwell chamber was employed to co-culture the hUC-MSCs cultured under normoxia and hypoxia and macrophage (THP-1) stimulated by lipopolysaccharide (IPS), then the polarization of THP-1 was detected by immunofluorescence, and the secretions of inflammatory factor and anti-inflammatory factor of THP-1 were detected by ELISA. Results hUC-MSCs cultured under hypoxia showed the ability of osteogenic and adipogenic multi-directional differentiation. Live/death staining showed the high cell viability of hUC-MSCs cultured under normoxia and hypoxia. The expression levels of prostaglandin E2 (PGE2) and indoleamine 2,3-dioxygenase (IDO) were significantly higher in the hUC-MSCs cultured under hypoxia than in those cultured under normoxia. hUCMSCs cultured under hypoxia promoted the polarization of THP-1 to M2, obviously reduced the expression of TNF-α and IL-1β, and increased the expression of IL-10 significantly. Conclusion hUC-MSCs cultured under hypoxia may promote the polarization of THP-1 to M2 and improve the viability of anti-inflammatory.

?AlM: To observe the expression of Acin1 ( apoptotic chromatin condensation inducer 1 ) in congenital cataract mouse retina during development and investigate the differences of retinal apoptosis and the connection of lens and retina development between congenital cataract mouse and normal mouse.
?METHODS: There were congenital cataract mice ( 10 female and 5 male) and normal C57BL/6 mice (10 female and 5 male) . One male and two female mice were fed in the same cage randomly. The young mice were divided into two groups: congenital cataract group and normal control group. Five young mice were treated each group on 1, 5, 9, 14, 17, 21, 26, 60d. The left eyes were fixed with 4% neutral formalin to detect AClN1 protein by immunohistochemistry and retinas from right eyes were used to detect the mRNA expression of Acin1.
?RESULTS: Acin1 had sustained expression in each group. AClN1 protein gradually expressed from the ganglion cell layer, inner nuclear layer to the outer nuclear layer following retinal development. lt mainly expressed on ganglion cell layer and inner nuclear layer, but not neuroblastoma layer. AClN1 protein positive cells on P1 ~ P14d increased in normal control group, P17d reduced, after P21d positive cells of each layers decreased. The overall trend was similar in congenital cataract group with normal control group, P1 ~ P14d positive cells count was lower than normal control group, P17-P21d positive cells were flat and higher than the normal control group. Compared with the same day of the two groups, the differences except for P17, P26, P60d were significant (P<0. 05). The overall difference was statistically significant in congenital cataract group ( Fcataract=295. 07, P<0. 01);in addition to P1 and P5, P17 and P21, the differences were statistically significant ( P< 0. 05 ) compared with each other in congenital cataract group. The overall difference was statistically significant in control group (Fnormal=214. 21, P<0. 01); in addition to P1 and P5d, the difference was statistically significant ( P<0. 05) compared with each other in control group. The expression of P17d in congenital cataract group was lower compared with that of P14d in control group, the difference was statistically significant (P<0. 05). Acin1 mRNA trends of two groups were similar with AClN1 protein. Compared with the same day of the two groups, the difference was significant except for P17, P21, P60d (P<0. 05 ) . The overall difference was statistically significant in each other of the two groups ( Fcataract=522. 29, P<0. 01;Fnormal=472. 05, P<0. 01). The difference was statistically significant compared with each day in control group ( P<0. 05). Compared with all the rest of days except for P21 and P26d, the difference was statistically significant in congenital cataract group (P<0. 05).
?CONCLUSlON: Acin1 exist differential expression of time and space in mouse retina during development, congenital cataract crystal developmental disorder may affect the expression of Acin1 and retinal cell apoptosis and development.

Objective To evaluate the value of captopril challenge test (CCT) in the diagnosis of primary aldosteronism (PA).Methods A total of 674 patients [(45.0±13.7) years, men 341, women 333] admitted to Peking Union Medical College Hospital from 2000 to 2015 were analyzed.Among them, 222 subjects were with essential hypertension (EH), 28 were with pheochromocytoma (PHEO), 246 were with idiopathic hyperaldosteronism (IHA) and 178 were with aldosterone producing adenoma (APA).All patients received CCT.24 h urine sodium was measured in partial patients.Plasma renin activity (PRA), aldosterone (ALD) were detected.Results Compared with EH [PRA: before 0.5(0.2,0.9) μg·L-1·h-1, after 0.8(0.4,1.5) μg·L-1·h-1;ALD: before (393±122) pmol/L, after (360±97) pmol/L] and PHEO [PRA: before 0.3(0.1,0.9) μg·L-1·h-1, after 0.4(0.1,1.6) μg·L-1·h-1;ALD: before (396±108) pmol/L, after (374±114) pmol/L], lower levels of PRA and higher levels of ALD before and after CCT were observed in PA patients [PRA: before 0.1 (0.1,0.2) μg·L-1·h-1, after 0.1 (0.1,0.2) μg·L-1·h-1;ALD: before (468±216) pmol/L;after (457±199) pmol/L].After CCT, the suppression rate of ALD [2.8% (-8.8%,15.4%) vs 6.6% (-4.3%, 17.6%)] and increasing rate of PRA [0(0,50%) vs 50%(0, 200%)] in PA patients were lower than those in EH patients.The ALD/PRA ratio (ARR) were higher in PA than that in EH or PHEO patients.In the EH subjects, ALD levels of seated posture were higher than those of recumbent posture both before and after receiving captopril, but with no changes in ARR after CCT.No significant differences in ALD and ARR (before and after receiving captopril) were observed between seated and recumbent position in the PA group.The ARR after CCT tended to decrease in EH subjects with elevated urine-sodium compared with those with normal urine-sodium.No changes could be viewed in ALD and PRA levels between normal urine-sodium and elevated urine-sodium groups among APA, IHA and EH patients either before or after CCT.Among patients with APA, the ALD levels before CCT and the ARR after CCT were lower in the patients with AngiotensionⅡ(AngⅡ) reactive than those without.A ROC curve analysis suggested that the optimal cutoff value was 46.2 (ALD unit:ng/dl;PRA unit:μg·L-1·h-1) for ARR after challenge in diagnosing PA, with the sensitivity of 88.7% and specificity of 84.8%.Conclusions ARR after 25 mg captopril had high sensitivity and specificity in diagnosis of PA with the cutoff of 46.2.Seated CCT could replace recumbent CCT as a more confirmatory test.The PRA increasing rate should be taken into consideration when diagnosis of PA.