For evaluation of lung hypoplasia in congenital diaphragmatic hernia rCDHl, we measured lung-thorax transverse area ratio rLT ratio), which was defined as the area of bilateral lung profiles divided by the profile area of thorax ai the level of the four-chamber view of the heart, using fetal ultrasonography. LT ratio in cases with CDH was lower than that in the control group and related well to the postnatal respiratory condition. Measurement of LT ratio using fetal ultrasonography may be useful in predicting the degree of lung hypoplasia in fetuses with CDH. Indexing Words: Congenital diaphragmatic hernia · Fetal diagnosis · Fetal ultrasonography · Fetal surgery · Lung hypoplasia · Antenatal evaluation A newborn infant with a congenital diaphragmatic hernia (CDHl often suffers from severe res-Piratory failure after birth. The causes of respiratory failure are thought to be lung hypoplasia due to compression by herniated viscera before birth and the associated persistent fetal circulation. 1 Due to the recent development of fetal ultrasonographic diagnosis, early operation has been performed after cesarean section. However, the prognosis of fetuses with CDH is still poor in spite of maximum treatment with conventional respiratory and pharmacological methods. 2 In cases with severe hypoplastic lung, high-frequency oscillatory ventilation (HFOVl, extracorporeal membrane oxygenation iECMOl, and fetal surgery may be recommended.:! To decide whether these treatments are indicated, the severity of lung hypoplasia should be properly evaluated. While Polyhydramnios has been reported to be predicrom the ''tive of poor outcome in cases with CDH, 2 no study has assessed the ultrasonographic evaluation of lung hypoplasia.For evaluation of lung hypoplasia in CDH, lung-thorax transverse area ratio (LT ratio) was measured using fetal ultrasonography in normal control fetuses and 8 cases with CDH. PATIENTS AND METHODSFetal examination was made by using a dynamic image ultrasound scanner, the Hitachi EUB 25-M (linear probe, 3.5 MHzl and YHP 77020 (sector probe, 3.5 MHz). The section chosen for determining the LT ratio was a transverse section of the chest, which included four chambers of the heart and two ribs on both sides of the same level. The image obtained enddiastole of the heart, which was visualized by slow-motion replay of the recorded videotape used for measurement. Figure 1 shows ultrasonograms of a control fetus and a case with CDH. The area of the thorax, bounded by the inner border of bilateral ribs, the posterior edge of sternum, and the center of the vertebra, was measured by using digigrammer Casio BX-1. The area of the lungs was 705

The use of novel tobacco- and nicotine-containing vapor products that do not combust tobacco leaves is on the rise worldwide. The emissions of these products typically contain lower numbers and levels of potentially harmful chemicals compared with conventional cigarette smoke. These vapor products may therefore elicit fewer adverse biological effects. We compared the effects of emissions from different types of such products, i.e., our proprietary novel tobacco vapor product (NTV), a commercially available heat-not-burn tobacco product (HnB), and e-cigarette (E-CIG), and a combustible cigarette in a human bronchial epithelial cell line. The aqueous extract (AqE) of the test product was prepared by bubbling the produced aerosol into medium. Cells were exposed to the AqEs of test products, and then glutathione oxidation, Nrf2 activation, and secretion of IL-8 and GM-CSF were examined. We found that all endpoints were similarly perturbed by exposure to each AqE, but the effective dose ranges were different between cigarette smoke and the tobacco- and nicotine-containing vapors. These results demonstrate that the employed assays detect differences between product exposures, and thus may be useful to understand the relative potential biological effects of tobacco- and nicotine-containing products.

Epidermal growth factor (EGF) is present in biliary, pancreatic, and Brunner's gland secretions. The aim of the present study was to assess the effects of EGF on lipid-induced mucosal injury. The proximal jejunum of anesthetized rats was cannulated for perfusion of the lumen with emulsified oleic acid (40 mM oleic acid in 20 mM sodium taurocholate; pH 6.0). Mucosal epithelial integrity was monitored by measuring the blood-to-lumen clearance of 51Cr-labeled EDTA. Perfusion of the lumen with emulsified lipid increased EDTA clearance. Addition of EGF (0.5 ng/ml) to the lipid emulsion ameliorated the lipid-induced increase in EDTA clearance. Perfusion of the lumen with EGF alone stimulated mucus secretion from goblet cells. This effect of EGF was abolished by atropine. In addition, in atropinized animals there was 1) an exaggeration of the lipid-induced injury and 2) a loss of the protective effect of EGF. Our findings provide evidence supporting the hypothesis that EGF provides protection against lipid-induced mucosal injury, in part, by stimulating mucus production.