[Chronic kidney disease in community: Current state for screening and management].

OBJECTIVE: To understand the current state and problem of screening and management of chronic kidney disease (CKD) in the community, and to explore the improving strategies. METHODS: We established a community-CKD integrated data science platform based on medical information from 79 community health centers, in Xicheng District, Beijing. Patients who referred to 79 community health centers from 21 June 2015 to 20 November 2021 were retrospectively included in this study using the CKD data platform. The monitoring of the indicator of kidney injury, risk factor control, medicine use and device configuration in community were assessed in the study. RESULTS: In the study, 70.6% of the population were identified with high risk of CKD in the total 374 498 individuals who referred to the community health centers. Hypertension (62.3%), coronary heart disease (43.3%) and diabetes (30.4%) were the most common risk factors in high-risk CKD population. Only 17.2% of the patients with high risk of CKD were screened for kidney injury including at least one serum creatine (Scr) or albuminuria test, among which 10 992 (24.2%) individuals were defined as CKD. 22.7% (11 338/49 908) of the total patients with kidney screening in community were defined as CKD, of whom, 42.6% and 46.1% were identified by estimated glomerular filtration rate (eGFR) < 60 mL/(min·1.73 m2) and abnormalities of urinary proteins, respectively. The overall CKD detection rate in the community was 5.2% (19 299/374 498), and the miss-diagnosis rate of CKD was 38.1%. Of the 79 community health centers, 13 (16.5%) were equipped with ACR testing device, and eGFR was reported directly in 66 (83.5%) centers. Altogether 60.3% and 99.7% of the community CKD patients achieved glucose control and blood pressure control, respectively, and 59.3% of the CKD patients who had proteinuria was treated with renin-angiotensin-aldosterone system (RAAS) inhibitors. CONCLUSION: High-risk CKD population account for a substantial proportion of patients who refer to the community. Early screening, prevention and management of CKD in the community are of great importance to improve the prognosis and decrease the burden of CKD. It's essential to establish a screening and monitoring system, strengthen standardized management and clinician training for improving the ability of CKD management in the community.

[Magnetic resonance imaging analysis on the effect of marathon on the dynamic changes of morphological characteristics of patellar tendon in amateur marathon runners after half marathon].

Objective: To explore the dynamic changes of morphological characteristics of patellar tendon (PT) in amateur athletes after a half-marathon using magnetic resonance imaging. Methods: A total of 19 male amateur marathon runners with 38 knee joints,aged from 26 to 53(41.5±7.9) years, running for 3 to 18 years, with a weekly running volume of 30-90 km and a monthly running volume of 100-300 km were enrolled and underwent 1.5T MRI scan before the half-marathon, within 3 hours after running and 3 days after running. Ten healthy male volunteers with 20 knee joints, who had never participated in marathon and exercised (including but not limited to running) per week for less than 150 minutes were recruited as the control group, aged from 26 to 54 (39.4±9.1) years. Firstly, the PT signal was qualitatively assessed on fat-suppressed proton density-weighted imaging (fs-PDWI) sequence to observe the presence of patellar tendinitis. Then, the length, proximal, middle and distal cross-sectional area (CSA), and volume of PT were measured using the post-processing tool ITK-SNAP, and the data were standardized. The independent sample t-test was used for comparing. One-way repeated measures analysis of variance was used to analyze the morphological changes of PT before and after half-marathon running. Results: The incidence of asymptomatic patellar tendinitis in amateur marathon runners was 26.3% (5/19). No significant MR signal changes of PT were observed in all runners after running. The proximal CSA in runners group was larger than that in controls [(4.20±0.62) mm2/kg3/4 vs (3.63±0.57) mm2/kg3/4, P<0.05], and there was no significant difference in length, medium and distal CSA and volume(all P>0.05). The length, proximal and distal CSA and volume of PT in runners group increased at 3 h after running [(47.35±3.22) mm vs (46.83±3.35) mm; (102.52±13.03) mm2 vs (98.98±13.14) mm2; (108.67±15.72) mm2 vs (100.27±14.37) mm2; (4 020.36±514.38) mm3 vs (3 826.57±499.23) mm3, all P<0.05]. There was no significant difference between before running and 3 days after running(all P>0.05). The middle CSA were not significantly different among different periods(all P>0.05). Conclusion: Marathon has effect on the normal PT morphology in male amateur marathon runners, showing an increase in proximal CSA. A half-marathon will cause reversible changes in PT length, regional CSA and volume.

[Diffusion tensor imaging in quantitative evaluation on thigh muscle of male amateur marathon runners after running a half marathon].

Objective: To investigate the effect of half marathon on thigh muscle in male amateur marathon runners by diffusion tensor imaging (DTI). Methods: A total of 17 male amateur marathon runners aged from 27 to 57 (43.7±2.8) years were recruited from May to August 2020 in Hangzhou, Zhejiang Province. MRI examination of bilateral thigh muscles were performed before and 3 h, 3 d and 7 d after a half marathon. The fractional anisotropy (FA) values was obtained by DTI sequence. The FA values of rectus femoris, intermedius femoris, medial femoris, lateral femoris, biceps femoris longus, semitendinosus, semimembranosus, adductor magnus and adductor longus were measured on the horizontal axis of bilateral thigh muscles. Friedman M test was used to compare the changes of FA values of each muscle at each time point before and after running, and pairwise comparison of FA values of statistically significant muscles at 3 h, 3 d and 7 d after running was performed. Results: The overall FA value of thigh muscle group [M (Q1, Q3)] at 3 h after running was decreased compared to before running [0.24 (0.20, 0.28) to 0.25 (0.21, 0.29), P<0.001], and there was no significant difference between baseline values at 3 d and 7 d after running (all P>0.05). FA values of vastus intermedius, vastus medialis, semimembranosus and adductor magnus at 3 h after running were lower than those before running [(0.19 (0.18, 0.22) vs 0.21 (0.19, 0.24), 0.19 (0.17, 0.20) vs 0.21 (0.18, 0.23), 0.26 (0.24), 0.29) vs 0.27 (0.15, 0.30) and 0.20 (0.19, 0.22) vs 0.21 (0.20, 0.23), both P<0.05], and there was no statistical significance between 3 d and 7 d after running and those before running (all P>0.05). FA value of vastus lateralis muscle at 3 h after running decreased compared with that before running, but the difference was not statistically significant (P>0.05). FA value began to increase at 7 d after running, and the difference was statistically significant [0.24 (0.21, 0.27) vs 0.23 (0.19, 0.25), P = 0.002]. FA value of rectus femoris muscle at 3 h after running decreased compared with that before running, but the difference was not statistically significant (P>0.05), and began to increase at 3 d after running and the difference was statistically significant [0.29 (0.26, 0.34) vs 0.26 (0.23, 0.29), P=0.006]. FA value of adductor longus muscle increased at 3 h after running, but the difference was not statistically significant (P>0.05). FA value continued to increase at 3 d and 7 d after running, and the difference was statistically significant [0.23 (0.21, 0.25) vs 0.22 (0.19, 0.24), 0.23 (0.21, 0.26) vs 0.22 (0.19, 0.24), all P<0.05]. Conclusions: The change of FA value of thigh muscle after half marathon is reversible. At 3 h after half marathon, FA values of femoris intermedius, femoris medialis, semimembranosus muscle and adductor magnus muscle of amateur marathon runners decreased most obviously, which may be the dominant muscle group during running.

[Molecular pathological diagnosis of twin pregnancy with complicated genetical characteristics].

Objective: To investigate the molecular pathological diagnostic strategy of twin pregnancy(TP) with complex genetic characteristics, using p57 immunohistochemistry and short tandem repeat (STR) genotyping. Methods: Ten cases of TP with suspected hydatidiform mole(HM) according to pathological morphology were collected in Peking University Third Hospital from 2015 to 2019, and were subject to p57 immunohistochemistry, STR genotyping and follow-up. Results: The age of ten patients ranged 23 to 36 years, with an average of 29.5 years. Seven patients accepted assisted reproductive techniques in this conception. Three patients with "divergent" p57 staining pattern were diagnosed as TP with complete HM by STR, in which one had a persistent trophoblastic disease. The villi of five patients were consistently positive for p57, but the genotyping result was polyploid and suspicious as TP. Four of them showed excessive paternal alleles at more than 40% of the loci, suggesting that concomitant partial moles could not be excluded. One patient was diagnosed as TP without HM according to the maternal allelic predominance at all loci in villi. Two patients with p57 "divergent" and "discordant" staining villi were genotyped as TP with mosaic conception. Conclusions: The correct identification of p57 staining pattern and accurate interpretation of STR genotyping results are important in diagnosing TP. It may assist pathologists in making a definite or likely diagnosis of TP with complex genetic features to fulfill clinical triage strategies and contribute to formulate a reasonable follow-up approach.

[Application of molecular analysis in differential diagnosis of ovarian adult granulosa cell tumors].

Objective: To investigate the application value of molecular detection in the differential diagnosis of ovarian adult granulosa cell tumors (AGCT) by analyzing FOXL2, AKT1 and DICER1 mutations in these tumors. Methods: A total of 48 cases of ovarian sex cord-stromal tumor (SCST) were selected from July 2012 to June 2019 in Beijing Obstetrics and Gynecology Hospital, including 21 adult granulosa cell tumors (AGCT), 15 fibromas/fibrothecomas, 8 Sertoli-Leydig cell tumors (SLCT) and 4 other types of ovarian SCST. Genomic DNA was extracted from the formalin-fixed paraffin-embedded tissue sections. Polymerase chain reaction amplification for FOXL2, AKT1 and DICER1 genes was performed, followed by sequencing using capillary electrophoresis. Fisher exact test was used to compare the prevalence difference of FOXL2, AKT1 and DICER1 mutations among the groups. P<0.05 was considered significant. Results: Eighteen of the 21 (85.7%) AGCT harbored FOXL2 mutation. Compared with other SCST (13.0%, 3 of 23; including fibromas/fibrothecomas and SLCT), FOXL2 mutation was significantly higher in AGCT (P<0.001). In addition, FOXL2 mutation was also detected in one fibrothecoma, two SLCT and two gynandroblastomas. DICER1 mutation was identified in four of eight SLCT, and these cases were moderately to poorly differentiated. FOXL2 mutation was found in one SLCT with DICER1 mutation. There was no DICER1 mutation in other ovarian SCST. No AKT1 mutation was detected in all the patients. Conclusions: FOXL2 mutation is a highly specific biomarker for adult AGCT and may be helpful to resolve problematic cases. Diagnosis should also be taken into consideration of the clinical and histological features as FOXL2 mutation is also found in other SCST. The detection of DICER1 mutation is helpful for the differential diagnosis of ovarian SLCT. Synchronous DICER1 and FOXL2 mutation in the SLCT has been observed, and its significance needs to be further studied.

[Thoughts and practice on the treatment of severe and critical new coronavirus pneumonia].

Severe and critical coronavirus pneumonia 2019 (COVID-19) often occurs in elder patients with multiple comorbidities, and severe hypoxemia events constitute a key factor for the deterioration of some cases. The critical type of COVID-19 could progress into acute respiratory distress syndrome and multi-organ dysfunction, which are the major causes of death. Early non-invasive ventilation (NIV) treatment of possible pathophysiological abnormalities is helpful to improve prognosis. Close monitoring of oxygenation, reducing patients' oxygen consumption, active psychological intervention, and rapid handling of severe hypoxemia events are the key factors for successful NIV treatment. In addition, active adjuvant therapies such as correcting coagulation dysfunction, providing proper nutritional support, accurate volume control, and safe individualized blood glucose monitoring are of great significance.

[Clinicopathological features of ovarian Brenner tumors].

Objective: To investigate the clinicopathological characteristics and diagnosis of ovarian Brenner tumors. Methods: Forty-seven cases of ovarian Brenner tumors were enrolled from January 2012 to May 2018 at Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Clinical data, imaging examination, histopathological characteristics and immunohistochemical phenotype were analyzed. Results: The age of the patients ranged from 30-73 years and the mean age was 55 years. Thirty-nine patients (83.0%) were postmenopausal. Forty cases (85.1%) of the Brenner tumors were benign, five (10.6%) borderline and two (4.3%) malignant. Usual tumor markers of ovarian carcinoma, including CA199 and CA125 were normal or mild elevated in the 47 cases. Imaging before surgery was not specific to Brenner tumors. Microscopically, benign Brenner tumors were composed of nests of bland, transitional-type cells within a fibromatous stroma. In our 5 cases of borderline Brenner tumors, mildly atypical transitional-type cells were projected into the cyst lumens and lack of stromal invasion. In 2 cases of malignant Brenner tumors, different degrees of nuclear atypial transitional-type cells exhibited stromal invasion. Immunohistochemical stains for CK7, GATA3, p63 and CK5/6 were positive in all cases. Ki-67 was less than 5% in Brenner tumors, and up to 20%-30% in malignant Brenner tumors. Conclusion: Brenner tumors are mostly seen in postmenopausal patients and are usually benign. Imaging examination and usual ovarian tumor markers do not provide diagnostic value. Diagnosis and classification of Brenner tumors depend on histopathological evaluation.

[Clinical study of a new wearable device for rehabilitation after total knee arthroplasty].

Objective: To evaluate the effect of promoting knee joint rehabilitation after total knee arthroplasty (TKA) with a rehabilitation training instrument NEO-GAIT. Methods: Sixty patients who received TKA from January 2017 to July 2017 in the Third Hospital of Hebei Medical University were randomly assigned to receive rehabilitation training with continuous passive motion (CPM) or NEO-GAIT with random number (30 cases in CPM group, included 8 males and 22 females; 30 cases in NEO-GAIT group, included 6 males and 24 females). The visual analogue scale (VAS) evaluation of pain, the postoperative range of motion (ROM) of the knee at the 5th and 10th day, and the Hospital for Special Surgery Knee-rating Score (HSS) at 1-month and 3-month follow-up were recorded. The data were compared between the two groups with paired t test. Results: All the patients were followed-up for more than 3 months. The mean VAS in CPM group and NEO-GAIT group on the 5th day was 2.4±1.1, 2.8±1.3, respectively; and it was 2.1±1.1, 2.5±1.2 respectively on the 10th day after the operation (t=-1.618, -1.505, both P>0.05). There was no significant difference in ROM on the 5th day after operation between the 2 groups (84°±12° vs 85°±12°, t=-0.377, P>0.05); however, it was remarkably higher in the NEO-GAIT group (95°±11°) than that in CPM group (88°±8°) on the 10th day after the operation (t=-3.002, P<0.05). The HSS score at 1-month follow-up in CPM group was 72±9, and it was 84±10 in NEO-GAIT group (t=-5.358, P<0.05); but it was comparative between the two groups at the 3-month follow-up (87±5 vs 89±5, t=-1.575, P>0.05). Conclusion: NEO-GAIT plays a more active and effective role in promoting postoperative rehabilitation after TKA than CPM.

[KRAS mutations analysis in mucinous epithelial lesions of the endometrium].

Objective: To investigate the frequency of KRAS mutation in mucinous epithelial lesions of the endometrium, and analyze the correlation between KRAS mutation and the clinicopathologic features. Methods: The cohort included forty-three cases of mucinous epithelial lesions of the endometrium selected from July 2015 to October 2017 from Beijing Obstetrics and Gynecology Hospital, and 22 control cases. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue sections. Polymerase chain reaction amplification for KRAS exons 2 and 3 was performed, followed by sequencing using capillary electrophoresis. The Fisher exact test was used to compare the prevalence of KRAS mutation among the different groups. Results: The patients'age ranged from 33 to 77 years [mean (55.12±9.34) years, median 55 years]. None of the eight cases of endometrial hyperplasia with mucinous differentiation without atypia showed KRAS mutation. The frequency of KRAS mutations was 1/10 in endometrial atypical hyperplasia, 1/12 in endometrioid carcinoma, 4/11 in endometrial atypical hyperplasia with mucinous differentiation (EAHMD), 6/15 in endometrioid carcinoma with mucinous differentiation (ECMD) and 8/9 in mucinous carcinoma (MC), respectively. The differences were statistically significant between MC versus EC (P<0.01) and MC versus ECMD (P<0.05). Conclusion: The high frequency of KRAS mutation in EAHMD, ECMD and MC indicates that KRAS mutational activation is implicated in the pathogenesis of endometrial mucinous carcinoma.

[Clinical application of STR genotyping diagnosis for hydatidiform mole and nonmolar gestation].

Objective: To investigate the value of short tandem repeat (STR) genotyping in the diagnostic workup of molar and non-molar gestations with correlation of histological characteristics. Methods: Six hundred and fifty-six cases were selected based on clinically suspected hydropic abortion and/or molar pregnancy from July 2015 to September 2017 at Beijing Obstetrics and Gynecology Hospital. DNA was extracted from dissected chorionic villi and paired maternal endometrial FFPE tissue samples by Simplex OUP™ FFPE DNA Tissue Kit. STR genotyping was performed by PowerPlex 16 HS system. Results: DNA genotyping was informative in 649 of 656 cases, leading to identification of 215 hydatidiform mole gestations and 434 non-molar gestations. Most of non-molar gestations (375 cases, 86.4%) were diploid hydropic abortion. Various trisomy syndromes were found (53 cases, 12.2%), including trisomy 2, 3, 4, 7, 8, 13, 16 and 21. Only 2(0.5%) digynic triploid gestations were detected. Moreover, 4 cases (0.9%) of uniparental disomies (homologous or heterologous) were found. There were 196 cases with histologic diagnostic suspicious of hydatidiform moles were accurate sub-classified. Among them, 59 cases hydatidiform moles were under-diagnosed as diploid hydropic abortions, and 28 cases diploid hydropic abortions were over-diagnosed as hydatidiform moles.Compared with partial moles(PHM), there were no specific histomorphological features between the various types of non-molar gestations and partial moles for definitive diagnostic separation. There was no significant difference in the expression of p57(kip2) among PHM, trisomy and diploid hydropic abortions group (P=0.247). Conclusions: STR genotyping can distinguish non-molar gestations from early hydatidiform moles, and efficiently avoid misdiagnosis based only on histological evaluation. Therefore, using STR genotyping, not only can the overdiagnosis of non-molar pregnancy be avoided, but also individualized management can be offered to patients including monitoring of serum hCG.

Stable color-tunable Ca3Y(GaO)3(BO3)4:Bi3+/Tb3+/Eu3+ phosphors for application in n-UV-pumped wLEDs.

For further development of light sources, white light-emitting diodes (wLEDs) have attracted widespread attention as promising next-generation light sources fabricated via the combination of phosphors and LED chips. However, latent defects, such as chemical/thermal instability, low color rendering index (CRI) and high correlated color temperature (CCT), of current mainstream wLEDs seriously hinder their further large-scale implementation. Herein, in order to overcome these limitations, single-phase color-tunable gaudefroyite (Ca3Y(GaO)3(BO3)4 (CYGB)) tridoped with Bi3+/Tb3+/Eu3+ ions was synthesized for the first time and detailed characterisation was performed via high-temperature solid-state reaction and structural/spectral analyses, respectively. Radius difference percentage calculations and Rietveld refinements indicate that dopants occupy both Y3+ and Ca2+ sites but preferably the Y3+ site over the Ca2+ site due to the same valence state. Through subtly regulating the (co)doping contents and skillfully utilizing the energy transfer (ET) strategy from the allowed transition of blue light-emitting Bi to the forbidden transition of green/red light-emitting Tb/Eu, the color hue (including white light) of highly efficient PL can be easily tuned according to the need. Meanwhile, composition/content-optimized white light-emitting CYGB:2%Bi/10%Tb/12%Eu also shows splendid chemical/thermal stability. Finally, as a proof-of-concept experiment, the CYGB:2%Bi/10%Tb/12%Eu phosphor-converted wLED (pc-wLED) was fabricated and encapsulated via the up-to-date remote 'capping' method, which imparted attractive performances. Altogether, the stable CYGB:Bi/Tb/Eu phosphor is a promising candidate for application in lighting/display fields.

Structure and luminescence properties of single-component melilite Sr2MgSi2O7:Ce/Tb/Sm for n-UV wLEDs.

Phosphor-converted white light-emitting diodes (pc-wLEDs) have attracted attention in the field of solid-state lighting. Selection and study of suitable single-phase phosphor and packaging modes are currently the main research hotspots. Herein, color-tunable photoluminescence (PL) and thermally stable tri-doped Melitite Sr2MgSi2O7:Ce/Tb/Sm are systematically studied via structural and static/dynamic spectral analyses. All dopants could only be accommodated in the Sr site due to similar ionic radii. Previous studies have concluded that green and red PL could be obtained from singly doped Tb and Sm phosphors with excellent reproduction, and color tunable PL can be achieved from Ce/Tb co-doped phosphors. The forbidden 4f-4f transitions of Tb/Sm cause low efficiency and Ce/Tb co-doping cannot achieve white light emissions. Alternatively, co-doping allowed 5d-4f transition sensitizer with emissions in the UV-blue region (i.e., Ce), color-tunable PL (including the white light); high efficiency of Sr2MgSi2O7:Ce/Tb/Sm could be achieved via energy transfer (ET) from Ce → Tb → Sm. The impossibly direct ET from Ce → Sm is associated with the side metal-metal charge transfer (MMCT) effect. Due to chemically nonequivalent substitutions, two positive Ce(Tb,Sm)Sr and one negative V''Sr were created to maintain the whole charge balance. To reduce the defects and allow more dopants to enter into the Sr site, Na+ was added as a charge balancer to enhance PL efficiency. Furthermore, an alkaline-earth-metal-ions blending strategy via partial replacement of Sr with Ba was investigated to regulate PL owing to the change in crystal field splitting. PL blue-shifted by Ba-co-doping, which could increase the degree of overlapping and enhance ET efficiency. As a proof-of-concept experiment, the pc-wLED fabricated via a combination of the optimal Sr(Ba)2MgSi2O7:Ce/Tb/Sm/Na and an n-UV LED chip based on a remote 'capping' packaging mode shows excellent performances, indicating its strong potential application in the field of solid-state lighting.

The characteristics and risk factors of the postoperative nausea and vomiting in female patients undergoing laparoscopic sleeve gastrectomy and laparoscopic gynecological surgeries: a propensity score matching analysis.

OBJECTIVE: The aim of this study was to compare the prevalence of postoperative nausea and vomiting (PONV) in matched patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic gynecological surgeries (LGS) and investigate the main cause of the high occurrence of PONV in bariatric surgeries. PATIENTS AND METHODS: Medical records of female patients with a body mass index (BMI) greater than 30 kg/m2 undergoing LSG or LGS from January 1, 2016 to September 1, 2020 were reviewed for PONV episodes in the first postoperative 48 hours. A 1:1 propensity score matching (PSM) method was performed between cases subject to the two types of surgery, and PONV rates were compared. RESULTS: A total of 278 patients met the inclusion criteria (LSG = 101, LGS = 177), and 74 matched subjects were selected from each group after PSM. An increased occurrence of PONV was noted in female patients with LSG compared with those undergoing LGS (66.2% vs. 23.0%; p<0.001). PONV severity was significantly worse in the LSG (p<0.001), and more frequent use of rescue antiemetics was detected in the LSG group compared with the LGS group (51.4% vs. 17.6%; p<0.001). The time of the first use of rescue drugs was much earlier in the LGS group (p = 0.034). CONCLUSIONS: Female patients undergoing LSG are at increased risk of PONV compared with those with LGS, indicating a critical role of procedure-related alterations of gastric physiology in the high occurrence of PONV after bariatric surgery.

Ultrasound-targeted microbubble destruction enhances AAV-mediated gene transfection in human RPE cells in vitro and rat retina in vivo.

This study was conducted to investigate the efficacy and safety of ultrasound (US)-targeted microbubble (MB) destruction (UTMD)-mediated rAAV2-CMV-EGFP transfection to cultured human retinal pigment epithelium (RPE) cells in vitro and to the rat retina in vivo. In the in vitro study, cultured human RPE cells were exposed to US under different conditions with or without MBs. Furthermore, the effect of UTMD on rAAV2-CMV-EGFP itself and on cells was evaluated. In the in vivo study, gene transfer was examined by injecting rAAV2-CMV-EGFP into the subretinal space of rats with or without MBs and then exposed to US. We investigated enhanced green fluorescent protein (EGFP) expression in vivo by stereomicroscopy and performed quantitative analysis using Axiovision 3.1 software. Hematoxylin and eosin staining and frozen sections were used to observe tissue damage and location of the EGFP gene expression. In the in vitro study, the transfection efficiency of rAAV2-CMV-EGFP under optimal UTMD was significantly higher than that of the control group (P=0.000). Furthermore, there was almost no cytotoxicity to the cells and to rAAV2-CMV-EGFP itself. In the in vivo study, UTMD could be used safely to enhance and accelerate the transgene expression of the retina. Fluorescence expression was mainly located in the retinal layer. UTMD is a promising method for gene delivery to the retina.

The safety of obstetric ultrasonography: concern for the fetus.

It has been estimated that more than half of all pregnant women in the United States undergo diagnostic ultrasound during their pregnancies. In light of this, the question of safety is of fundamental importance. Nondiagnostic ultrasound has been shown to produce biologic effects by thermal and cavitational activities. However, diagnostic ultrasound uses much lower intensities, and no evidence exists to suggest that it is associated with adverse effects. Numerous studies have examined the biologic effects of diagnostic ultrasound in insects, plants, cell suspensions, and even small mammals. The data from these experiments are confusing when attempting to relate these findings to the human. Epidemiologic data in humans, used to evaluate the potential adverse effects of exposure to diagnostic ultrasound, have revealed no ill effects from such exposure. Current data indicate that there are no confirmed biologic effects on patients and their fetuses from the use of diagnostic ultrasound and that the benefits to patients exposed to prudent use of diagnostic ultrasound outweigh the risks, if any. This review discusses the available information on the safety of obstetric ultrasonography.

Ultrarapid detection of sex chromosomes with the use of fluorescence in situ hybridization with direct label DNA probes in single human blastomeres, spermatozoa, amniocytes, and lymphocytes.

OBJECTIVE: To assess the ultrarapid fluorescence in situ hybridization (FISH) procedure with a 1-minute hybridization time for gender determination. DESIGN: Fluorescence in situ hybridization with direct label fluorescence DNA probes for chromosomes X and Y were tested with the use of different hybridization times and different cell types. SETTING: Hospital-based IVF program. INTERVENTION(S): The efficiency of the FISH procedure with different hybridization times was compared with the use of male lymphocytes. The same FISH procedure, but with only 1-minute hybridization, was carried out in human blastomeres, spermatozoa, uncultured amniocytes, male lymphocytes, and female lymphocytes. MAIN OUTCOME MEASURE(S): Percentages of nuclei with positive signals. RESULT(S): The percentages of nuclei with positive signals in lymphocytes with hybridization times of 1, 3, 4, 10, 30, and 45 minutes were 97%, 97%, 98%, 98%, 98%, and 98%, respectively. The percentages of nuclei with positive signals after FISH with a 1-minute hybridization time in single blastomeres, spermatozoa, amniocytes, male lymphocytes, and female lymphocytes were 94%, 96%, 96%, 98%, and 97%, respectively. CONCLUSION(S): Chromosomes X and Y of human blastomeres. spermatozoa, uncultured amniocytes, and lymphocytes can be detected rapidly with the use of this ultrarapid FISH procedure with a 1-minute hybridization time.

Potential use of repeated fluorescence in situ hybridization in the same human blastomeres for preimplantation genetic diagnosis.

OBJECTIVE: To assess the feasibility of repeated fluorescence in situ hybridization (FISH) procedures in the same nucleus of a human blastomere. DESIGN: Three consecutive FISH procedures were performed in the same human blastomere by using direct label fluorescence CEP and WCP probes (Vysis). SETTING: Hospital-based private IVF program. PATIENT(S): Twenty-eight infertile couples who underwent conventional IVF in our center. INTERVENTION(S): Embryos from oocytes with three pronuclei after in vitro insemination were used in this study. MAIN OUTCOME MEASURE(S): The rates of nuclear loss, present signals, and absent signal were examined. RESULT(S): In group 1, the rates of presence of signals were 94% after the first FISH, 92% after the second FISH, and 88% after the third FISH. In group 2, the rates of presence of signals were 96% after the first FISH, 93% after the second FISH, and 87% after the third FISH. There was no statistically significant difference in the rates of nuclear loss, present signals, and absent signal between three consecutive FISH procedures and between CEP and WCP probes. CONCLUSION(S): Six or more chromosomes of a single blastomere may be examined with use of this repeated FISH procedure, which may be important for preimplantation genetic diagnosis.

Cryopreservation of a small number of fresh human testicular spermatozoa and testicular spermatozoa cultured in vitro for 3 days in an empty zona pellucida.

It is known that the motility of human testicular sperm can be improved when they are cultured in vitro for a few days. The purpose of this study was to determine whether it is better to freeze human testicular spermatozoa on the day of biopsy (fresh) or after they were cultured for 3 days. A modified, single-sperm freezing technique was used in this study. The study consisted of two parts: (1) ejaculated spermatozoa were used to examine the influence of different concentrations of glycerol and synthetic serum substitute (SSS) on the survival rate after cryopreservation, and (2) the survival rates between cryopreserved fresh testicular spermatozoa (Group 1) and testicular spermatozoa that were cultured for 3 days before freezing (Group 2) were compared. Empty zonae pellucidae were obtained from mouse eggs. Five to 10 motile spermatozoa were selected and injected into an empty zona pellucida. For freezing, the zona pellucida with spermatozoa was transferred into a HEPES-buffered human tubal fluid containing different concentrations of glycerol and kept at room temperature for 10 to 15 minutes, and then loaded into a 0.25-ml-plastic straw. The straws were exposed to liquid nitrogen vapor for 2 hours and then plunged into liquid nitrogen. For thawing, the straws were taken out of liquid nitrogen and placed into a 37 degrees C waterbath for 25 to 30 seconds. There was no statistically significant difference in survival rates between 3% and 10% SSS with different glycerol concentrations. There was no statistically significant difference in the survival rates of spermatozoa between Group 1 and Group 2 after cryopreservation. It appears that in vitro culture of testicular spermatozoa before freezing does not increase survival rate.

Assessment of carbohydrate tolerance in pregnancy.

A review is given of the various methods of assessing carbohydrate tolerance in pregnancy. Oral glucose tolerance screening and diagnostic tests have been in use for more than 25 years. They are easily administered, relatively inexpensive, and present reasonable sensitivity; therefore, they continue to be used quite extensively. However, lack of reproducibility of the results and side effects such as nausea, vomiting, and headache have led to the use of alternate methods including glucose polymer (Polycose) and standard breakfast meals. These methods have been reported to present satisfactory results in clinical practice. Glycosylated hemoglobin (HbA1c) and fructosamine assays are also alternate forms of testing carbohydrate metabolism HbA1c measurement have been proven insensitive as a screening test for gestational diabetes, while their use as an index of overall glucose control remains valuable. The role of fructosamine in the assessment of carbohydrate intolerance remains controversial with conflicting claims made by various investigators regarding its sensitivity in detecting gestational diabetes and its response to alterations in glycemic control. In this review, the relative advantages and disadvantages of each glucose tolerance test are discussed and recommendations are given regarding their utility in pregnancy.