[Prenatal diagnosis and prognosis of fetal nephrohydrosis].

OBJECTIVE: To explore the clinical significance of prenatal ultrasonic diagnosis of fetal nephrohydrosis and its prognosis. METHODS: Prenatal ultrasonography was performed on 9526 women at more than 20 weeks gestation, and 162 women whose anteroposterior diameter of the renal pelvis was > or = 8 mm were included in this study. The grade of fetal nephrohydrosis was classified according to Grignon grading method. The changes in fetal nephrohydrosis were observed regularly until delivery. RESULTS: (1) The incidence of fetal encephalic fluid and Grignon grade: there were 162 fetuses with fetal nephrohydrosis among 9526 fetuses, with an incidence of 1.7%. The numbers of fetuses with Grades 1 to 5 were 71, 59, 7, 3 and 22, respectively. (2) The distribution in gestational weeks of fetal nephrohydrosis: generally, fetal nephrohydrosis was first diagnosed at (33 +/- 5) weeks, and the maximum degree of nephrohydrosis was observed at (36 +/- 3) weeks. One hundred and ten fetuses with nephrohydrosis recovered during the process of gestation, at about (37 +/- 4) weeks. (3) Poor terminations of pregnancy: there were 40 (25%) fetuses with poor terminations among totally 162 cases. Among these 40 fetuses, 3 (27%) were first diagnosed at 20 to 24 weeks within 11 fetuses, 6 (24%) were first diagnosed at 25 to 28 weeks within 20 fetuses, 14 (26%) were first diagnosed at 29 to 32 weeks within 53 fetuses, 11 (23%) were first diagnosed at 33 to 36 weeks within 48 fetuses, and 6 (20%) were first diagnosed at 37 to 40 weeks within 30 fetuses. The results demonstrate that high grade of fetal nephrohydrosis according to Grignon grading method indicates a poorer prognosis of the fetus. (4) Follow-up results: there were 122 (75%, 122/162) live and healthy neonates in total, including 110 neonates whose nephrohydrosis recovered prior to birth and 12 neonates whose nephrohydrosis recovered within 1 week after birth. These neonates all developed well without any urinary sequela within the first 2 years. There were also 20 (12%, 20/162) hydronephrotic neonates who were still diagnosed as nephrohydrosis within 1 week after birth, including 11 fetuses graded below Grignon grade 3, whose nephrohydrosis recovered 3 to 12 months after birth and who developed well without any urinary symptoms. CONCLUSIONS: The study demonstrates that hydronephrotic fetuses who are diagnosed at earlier gestational weeks and with higher grading have poorer prognosis. The Grignon grading method can be used in the prenatal evaluation of fetal nephrohydrosis to predict the prognosis of the fetus.

Distributions of angiogenesis and lymphangiogenesis in gastrointestinal intramucosal tumors.

BACKGROUND: Although angiogenesis and lymphangiogenesis in gastrointestinal cancers has been investigated in many studies, their distribution characteristics in gastrointestinal intramucosal tumors have not been well addressed. METHODS: We evaluated the blood microvessel density (BMVD) and lymphatic microvessel density (LMVD) by immunostaining with monoclonal antibodies of CD34 and D2-40 in 37 patients with stomach intramucosal carcinoma and 28 patients with colorectal intramucosal neoplasia. Microvessels with endothelial cells labeled by CD34 but not by D2-40 were recognized as blood microvessels; and microvessels with endothelial cells labeled by both CD34 and D2-40 were recognized as lymphatic vessels. Furthermore, the relationships between expression of vascular endothelial growth factor (VEGF), VEGF-C, and BMVD, LMVD were investigated as well. RESULTS: The LMVD was significantly higher in peritumoral tissues than in corresponding normal tissues in gastrointestinal intramucosal tumors (20.87 versus 14.56, P = 0.003). However, there was no significant difference in the BMVD between peritumoral tissues and corresponding normal tissues (P = 0.166). The BMVD in peritumoral tissues was higher in patients with lymph node metastases than in patients without lymph nodes metastases (P = 0.047). Our results did not show significant association between VEGF, VEGF-C and BMVD, LMVD. CONCLUSIONS: Our results suggested that the increase of lymphangiogenesis seems superior to the increase of angiogenesis in gastrointestinal intramucosal tumors.

[The effects of GABAergic neurotransmitters and GABAA receptors on the auditory afferent pathway in the brainstem analyzed by optical recording].

AIM: To explore the influence of GABAergic neurotransmitters and GABAA receptors on the auditory afferent impulses recorded in the brainstem evoked by electro-stimulation. METHODS: Brainstem slices were prepared using ddy/ddy mice of postnatal 0-5th days. The brainstem slices were stained with a voltage-sensitive dye(NK3041). The cut end of the vestibulocochlear nerve (nVIIIth) connected with slices was stimulated by a tungsten electrode, a 16 x 16 pixels silicon photodiode array apparatus was used to record the optical mapping from auditory brainstem slices. The data were analyzed by ARGUS-50/PDA software. RESULTS: The spatial-temporal patterns of the excitatory propagation from the vestibulocochlear nerve (nVIIIth) to cochlear nucleus and vestibular nucleus were displayed with multiple-sites optical recording. The optical signal coming from one pixel consisted of a fast spike-like response and a following slow response. Inhibitory neurotransmitter GABA decreased the fast spike-like response and following slow response of evoked optical signals, while an antagonist BMI against GABAA receptors increased the both responses. CONCLUSION: A 16 x 16 pixel silicon photodiode array apparatus can be used to record multiple-sites optical mapping evoked by electro-stimulation to the cut end of the vestibulocochlear nerve. The every optical signal consists of both presynaptic and postsynaptic elements. Inhibitory neurotransmitter GABA and an antagonist BMI of GABAA receptors can modulate the excitatory propagation of evoked optical signals.

[Ultrasonic diagnosis and prognosis of fetal multicystic kidney dysplasia].

OBJECTIVE: To explore the diagnosis, clinical course and prognosis of fetal multicystic kidney dysplasia (MCDK). METHODS: 24 858 pregnant women detected by prenatal ultrasound, here were 41 cases with fetal multicystic kidney dysplasia, these fetuses were diagnosed at average 29.8 weeks of gestation, Carried on an observation to fetuses with multicystic kidney dysplasia and postnatal follow-up study. RESULTS: T17 cases were induced abortion. Of 13 infants, 1 case involute, 3 cases decrease, 9 cases no change. CONCLUSION: Prenatal ultrasonography can actual diagnosis for fetal multicystic kidney dysplasia, the key of management of multicystic kidney dysplasia is assessment of fetal prognosis, the natural history of unilateral MCDK is usually benign, the affected kidneys tend to show involution after birth. But bilateral MCDK often associated with impairement of renal function, abnormal chromosome or other anomalies, which indicates a poor prognosis.

[Clinical study on fetal encephalic fluid].

OBJECTIVE: To discuss the clinical significance of fetal encephalic accumulated fluid revealed by prenatal ultrasonography. METHODS: Prenatal ultrasonography was performed on 8426 women at more than 20 weeks' gestation. Totally 150 women with fetal encephalic accumulated fluid more than 5 mm were included in this study. The changes of fetal encephalic accumulated fluid and the associated anomalies were observed regularly every 2 weeks until delivery. The live infants were followed up regularly. RESULTS: The incidence of fetal encephalic fluid was 1.8%, including 72 cases with fluid in the fetal anterior or posterior cornu of unilateral ventricle, 46 cases with accumulated fluid in fetal posterior fossa, 32 cases with fluid in more than 2 sites. Generally, the accumulated fluid in fetal encephalus was first diagnosed at 17 - 40 gestational weeks, with a median of (26 +/- 5) weeks. Most of them were found between 29 - 32 gestational weeks (63 cases, 42.0%), and the maximum amount of accumulated fluid was also found between 29 - 32 weeks (70 cases, 46.7%). Spontaneous regression of intracranial fluid could be seen in 111 fetuses (74.0%). The period of fluid regression ranged from 29 to 40 weeks of gestation, of which the average gestational week was (36 +/- 2) weeks. Additionally, the most frequent period of regression was in the first two thirds of the three trimesters of pregnancy. The incidence of defected infants was 3.8%, 10.2% and 67.4%, respectively, when the amount of accumulated fluid was less than 10 mm, 10 - 14 mm and more than 15 mm. And the accumulated fluid in more than 2 sites was also a risk factor of defected fetuses, with an incidence of 60.0%. CONCLUSIONS: Most cases could be diagnosed between 29 - 32 gestational weeks, and the maximum amount of accumulated fluid is also observed in this period. The more fluid in fetal encephalus, the more sites the fluid distributed in, the more defected fetuses or infants would be observed. So in cases of more than 15 mm of fluid, or accumulated fluid in more than 2 sites, anomalies should be observed extremely carefully.

[Expression of osteopontin mRNA and its clinical significance in gastric cancer].

OBJECTIVE: To investigate the expression of osteopontin mRNA and its correlation with clinicopathologic features of gastric cancer and elucidate its role in tumor invasion and distant metastasis. METHODS: The expression of OPN mRNA was detected by semi-quantitive RT-PCR. The relationship between the relative content of OPN mRNA and clinicopathologic features of gastric cancer was analyzed. RESULTS: In 66 cancer tissue samples, a 330 bp band was detected in 50 cases, the positive rate of OPN mRNA expression was 75.8% (50/66). The expression in all 20 cases of normal gastric mucosa was negative. The expression was associated with the depth of tumor invasion, diameter, lymph node metastasis and but had no correlation with differentiation grades. The 66 patients were followed up for 10 approximately 27 months (mean 16 months). The OPN mRNA expression positive group (50 cases) had recurrence in 15 patients and the negative group (16 cases) had only 1 case with recurrence (P = 0.05); 10 patients died in OPN mRNA expression positive group but no patient died in OPN staining negative group (P = 0.05). CONCLUSION: OPN mRNA is over-expressed in gastric cancer. It reflects the progression of disease and association with poor prognosis of gastric cancer. OPN may play an important role in the process of distant metastasis in gastric cancer.

Optical mapping of neural responses and their gamma-aminobutyric acid-ergic inhibitory effects in the auditory brainstem of early postnatal mice.

gamma-Aminobutyric acid (GABA)ergic neurons play important tropic and modulatory roles in the auditory pathway, especially in the early stage between postnatal Days 0 and 5. The effects of GABA and GABAa receptor antagonist were observed in this experimental study. Numerous histological and electrophysiological studies have been performed on the contribution of GABA to the auditory pathway; however, the spatio-temporal patterns of excitatory propagation and the relationships between GABA receptor and excitatory propagation have yet to be reported. Using an optical recording technique and a voltage-sensitive dye, the spatio-temporal patterns of excitatory propagation were observed in the auditory brainstem slices of early postnatal mice. A bath containing 50 microM GABA was applied, which largely inhibited the excitatory activities along the vestibulocochlear pathway. Bicuculline methiodide (BMI), a competitive antagonist against GABAa receptor, partially reversed the effects of GABA on the optical signals. Bath application of BMI alone helped to facilitate the depolarization course and its effect was apparent as an enlargement of the depolarized region from the cochlear nucleus and vestibular nucleus to some adjacent brainstem nuclei, as well as enhancing the amplitude of changes in the optical signals. The experimental results seem to suggest that GABAa receptors are widely distributed in an early postnatal auditory brainstem. GABA exhibited a greater modulating effect in the adjacent brainstem nuclei, which are involved in complex information processes, than that observed in the modulating primary auditory pathway. In the present experiment, significant GABAergic contributions to the optical recordings in the auditory brainstem were observed.

Diagnostic value of endoscopic ultrasonography for gastrointestinal leiomyoma.

AIM: To investigate the clinical pathologic features of gastrointestinal leiomyoma and the diagnostic value of endoscopic ultrasonography (EUS) on gastrointestinal leiomyoma. METHODS: A total of 106 patients with gastrointestinal leiomyoma diagnosed with EUS were studied. The location, size and layer origin of gastric and esophageal leiomyomas were analyzed and compared. The histological diagnosis of the resected specimens by endoscopy or surgery in some patients was compared with their results of EUS. RESULTS: The majority of esophageal leiomyomas were located in the middle and lower part of the esophagus and their size was smaller than 1.0 cm, and 62.1 % of esophageal leiomyomas originated from the muscularis mucosae. Most of the gastric leiomyomas were located in the body and fundus of the stomach with a size of 1-2 cm. Almost all gastric leiomyomas (94.2 %) originated from the muscularis propria. The postoperative histological results of 54 patients treated by endoscopic resection or surgical excision were completely consistent with the preoperative diagnosis of EUS, and the diagnostic specificity of EUS to gastrointestinal leiomyoma was 94.7 %. CONCLUSION: The size and layer origin of esophageal leiomyomas are different from that of gastric leiomyomas. Being safe and accurate, EUS is the best method not only for gastrointestinal leiomyoma diagnosis but also for the follow-up of patients.

Endoscopic retrograde cholangiopancreatography in evaluation of choledochal dilatation in patients with obstructive jaundice.

OBJECTIVE: To determine the causes of choledochal dilatation in patients with obstructive jaundice. METHODS: One hundred and sixty-four patients with obstructive jaundice were investigated by endoscopic retrograde cholangiopancreatography(ERCP), and patients with choledochal dilatation (group I, n=110) were compared with those without choledochal dilatation (group II, n=54). RESULTS: The causes of common bile duct dilatation were choledocholith, juxtapapillary duodenal diverticula and congenital dilatation of the common bile duct. The distal common bile duct and its surroundings were abnormal in 104 (94.55%) of the 110 patients and in 13 (24.08%) of the 54 patients (P<0.01). Juxtapapillary duodenal diverticulum accounted for 24.55% in group I, and only in 9.26% in group II (P<0.05). Post-cholecystectomy patients were 13.64% in group I, and only 5.56% in group II. CONCLUSIONS: The abnormalities of the distal common bile duct and its surroundings can usually be detected as underlying causes of common bile duct dilatation. ERCP is necessary before cholecystectomy, since it is considered the "gold standard" for the diagnosis of distal common bile duct abnormalities.