Usually,invasive prenatal diagnosis of birth defects is necessary for pregnant women with advanced age .The classic technology is evaluation of fetal chromosome karyotype which is performed by cytogenetic analysis of amniotic fluid fetal exfoliated cells through amniocentesis in the second trimester .For some pregnant women who were unfit or refused to accept invasive prenatal diagnosis ,the application of new technology makes assessment of risk of fetal abnormalities more accurate .When screening is used to assess risk of fetal abnormalities , the women should be told that the screening technologies cannot substitute for invasive diagnosis testing of fetal exfoliated cells , the reason of older pregnancy and both advantages and limitations of the prenatal diagnosis and screening technologies should be considered , and the risks of invasive prenatal diagnosis and risk of missed diagnosis of abnormal fetal in selection of prenatal diagnosis strategy for pregnant women with advanced age should be compared .

Objective To compare the effect of laparoscopic thymectomy on immune function and inflammatory factors in patients with myasthenia gravis.Methods 80 patients with myasthenia gravis treated by thymectomy were selected,and they were divided into observation group and control group according to the random number method,each group in 40cases.The observation group was treated with video assisted thoracoscopic surgery,the control group was treated by thoracotomy.All the patients were followed up for outpatient visits in 3 months.The incidences of myasthenia gravis crisis in the two groups were compared and the ratio postoperative humoral immunoglobulin levels and inflammation related factor changes were observed.Results The operation time of the observation group [(118.6±11.3)min] was shorter than (138.5±13.8)min of the control group (t=7.056,P<0.05).The amount of bleeding of the observation group [(96.6±3.8)mL] was less than (125.5±5.6)mL of the control group (t=27.008,P<0.05).The hospitalization time of the observation group [(7.2±0.3)d] was shorter than (10.8±1.1)d of the control group (t=19.969,P<0.05).The incidence rate of myasthenia gravis crisis in the observation group was significantly lower than that in the control group (1 patient vs 9 cases,x2=5.600,P=0.018).The levels of IgM,IgG and IgA in the observation group were (1.65±0.03)mg/L,(9.55±0.12)mg/L,(3.99±0.20)mg/L respectively, which were higher than (1.31±0.02)mg/L,(8.82±0.10)mg/L,(1.81±0.13)mg/L in the control group(t=59.640,29.557,57.800,all P<0.05).The IL-6,TNF-α,IL-1,hs-CRP levels in the observation group were (34.5±6.1)ng/mL,(12±0.2)ng/mL,(0.60±0.1)g/mL,(10.3±1.0)mg/L respectively, which were lower than (153±14.1)ng/mL,(18.1±0.5)ng/mL,(0.92±0.2)g/mL,(31.3±2.0)mg/L in the control group (t=48.784,71.641,9.051,59.397,all P<0.05).Conclusion Laparoscopic thymectomy for myasthenia gravis has short operative time and less bleeding.It has little effect on the humoral immune function of the patients and can significantly reduce the inflammatory response and promote the recovery of the patients.

Objective To explore the application value of laparoscopic surgery in type 2 diabetes patients with acute cholecystitis.Methods 50 type 2 diabetic patients with acute cholecystitis were chosen as the research objects,the patients were divided into the observation group and control group according to the method of treatment, 25 cases in each group.Strict control of blood glucose levels in patients before operation,the observation group treated by laparoscopy,the control group were treated with conventional open surgery.Recorded the operation time and hemor-rhage,postoperative abdominal drainage,anal exhaust time,patient ambulation time and hospitalization time and other indicators.The patients were followed up to record the postoperative infection,occurrence of complications such as postoperative inflammation.Results There was no statistically significant differences between the two groups in oper-ation time(t =1.02,P >0.05).In the observation group,the intraoperative blood loss was (41.2 ±8.3)mL,postop-erative drainage volume was (107.5 ±16.4)mL,which were significantly lower than those in the control group,and the anal exhaust time was (1.7 ±0.3)d,total hospitalization time was (7.1 ±1.7)d,which were significantly shorter than those of the control group,the differences were statistically significant(t =3.43,3.78,3.43,4.21,all P <0.05).The observation group the complications included wound infection 1 cases,the complication rate was 4.0%, while in the control group,the complications included bile leakage,reflux esophagitis,incision infection,fat liquefac-tion,pulmonary infection and incisional hernia,the overall complication rate was 24.0%,there was statistically signifi-cant difference in the complication rate between the two groups(χ2 =4.54,P <0.05).Conclusion The laparoscopic surgery in the treatment of type 2 diabetic patients with acute cholecystitis has exact effect,and the patients recovery time is short,the complication rate is low.

Objective To investigate the effect and necessity of hysteroscopy combined with laparoscopy in the diagnosis and treatment of refractory polycystic ovarian syndrome complicated with infertility.Methods 80 cases of patients with polycystic ovary syndrome (PCOS)combined with infertility were randomly divided into two groups with 40 cases in each group.The testing group used hysteroscopy combined with laparoscopy in diagnosis and treatment while the laparoscopy was only used in the control group.The changes of ovary,ovarian follicles and serum hormone level of the two groups which before and after operation were compared,and the data of postoperative normal ovulation rate,pregnancy rate and abortion rate of the two groups were recorded.Results The follicle number and ovarian volume of the testing group were significantly decreased than that before treatment,and were significantly lower than that of the control group,with statistical difference (t =3.82,3.80,3.74,3.75,all P <0.05).The serum T,LH and LH/FSH of the testing group were significantly decreased than the data before surgery,and were significantly lower compared to the control group with statistical difference (t =9.32,4.06,3.80,all P <0.05).The normal ovulation rate,pregnancy rate and abortion rate of the testing group were significantly higher compared to the control group (90.0%,62.5% and 7.5% vs.72.5%,50% and 15%)χ2 =4.02,4.10,3.90,all P <0.05).Conclusion Hyste-roscopy combined with laparoscopy has an obvious curative effect in the diagnosis and treatment of polycystic ovary syndrome combined with infertility,which can effectively improve ovulation rate and pregnancy rate and reduce the abortion rate,is worthy of clinical application.

Most children with Hirschsprung's disease (HD) have a satisfactory outcome after a pull-through operation.However,a small group of patients develop severe postoperative complications,and a reoperation may be necessary.The most common and serious complications after definitive surgery are as follows:anastomotic stricture,a twist of the pull-through segment,retained aganglionosis,HD-associated enterocolitis,anastomotic leak,and fistulae.Using a well-defined treatment algorithm based on the clinical status as well as precise diagnostic workup can end the long suffering of patients with postoperative complications.Pull-through surgery can be safely performed with favorable outcomes after thorough history-taking,meticulous clinical examination,a thoughtful planning,adherence to basic surgical principles and under skillful hands.

Objective To evaluate clinical efficacy of Yishen-Bushui-Tongluo decoction in the treatment of multiple sclerosis (multiplesclerosis, MS).Methods 60 patients met the inclusion criteria of MS were recruited into a compound group and a control group, with 30 patients in each. The control group was treated with conventional western medicine, while the compound group was treated withYishen-Bushui-Tongluo decoction on the basis of the control group. Both groups were treated for continuous 3 months, the clinical efficacy, symptoms, signs, expanded disability scale (expanded disability status scale, EDSS) scores, as well as adverse reactions and hormone-year recurrence rate were compared between the two groups.Results After the treatment, the total effective rate was 93.3% (28/30) in the compound group and 73.3% in the control group (22/30), showing statistically difference (χ2=4.320,P=0.038). After treatment, the clinical symptom score (5.1 ± 2.7vs. 7.0 ± 3.1,t=2.532), neurological signs score (5.1 ± 1.6vs. 6.3 ± 1.7, t=2.815), EDSS score (3.4 ± 1.5 vs.4.8 ± 1.5,t=3.615) in the compound group were significantly lower than the control group (P<0.01 or P<0.05); the follow-up period of 1 year showed the recurrence times in the compound group was lesser than the control group (0.31 ± 0.17vs.0.89 ± 0.36;t=7.980,P=0.000).ConclusionsYishen-Bushui-Tongluo decoction combining conventional western therapy can significantly improve the clinical symptoms of MS patients, relieve nervous system damage mitigation, reduce relapse frequency, and reduce the adverse effects of hormones.

The liver is a crucial organ involved in immune and metabolic processes.In multiple organ dysfunction syndrome secondary to sepsis, liver is one of the target organs.Sepsis-associated liver injury worsens the prognosis and mortality.MicroRNAs are single-stranded,non-coding RNAs.MicroRNAs modulate gene expression post-transcriptionally by binding themselves to complementary sites of target genes and degradation proteins.MicroRNAs affect sepsis pathogenesis at multiple levels through regulating signaling pathways and inflammation factors in immune reaction, as well as functions of immune cells.Among microRNAs involved in sepsis pathogenesis,microRNA-155 is critical in sepsis associated liver injury and it is sketchily described in this review.

Prenatal diagnosis is vitally important to control birth defects.The mature application of detecting biochemical markers in maternal serum and cytogenetic karyotype analysis of amniotic fluid cells , villi cells and umbilical cord blood cells , as well as the development of fluorescence in situ hybridization , nucleic acid amplification , gene sequencing , chips and other molecular biological techniques , have significantly improved the standards of prenatal diagnosis.The application of high-throughput sequencing , a non-invasive detection technique , ushers the development of prenatal diagnostic techniques into a new stage.In the face of a growing number of and constantly updated test items , it is necessary to assess the advantages and limitations of various prenatal diagnostic techniques , so as to realize scientific selection and combination, and utilize the techniques to their fullest potential.

Along with improvements in the embedding materials, continual innovation of the applied technique, and further understanding of therapeutic mechanism, the application scope of negative pressure wound therapy (NPWT) becomes broader, clinical experience in its use becomes more abundant. This issue of the journal highlights 5 papers to introduce the experience and knowledge regarding NPWT technique of the authors.
Humans ; Negative-Pressure Wound Therapy ; Wound Healing

Objective To explore the effect and safety of compression and distraction technique by external fixation without grafting in treatment of noninfectious nonunion of tubular fractures.Methods 43 patients were randomly divided into 2 groups by visiting sequence with random number,odd into the observation group,even into the control group.The observation group(22 cases) adopted the external fixation retractor pressure treatment,the control group(21 cases) was given extemal fixation combined with locking plate treatment.The efficacy of two groups was compared.Results 43 patients were followed up for 6 ～ 15 months,average 7.5 months.The bone healing time was 3 ～ 14 months,average 5.1 months.43 patients were all healed.The total effective rate of the observation group was 81.8％,which was significandy higher than 66.7％ in the control group (Z =9.654,P =0.001).There were no significant differences in adverse reactions and complications between the two groups (x2 =0.068,P =0.795).Conclusion The compression and distraction technique by external fixation in the treatment of noninfectious nonunion of tubular fractures has obvious curative effect,it can be widely used in clinical practice.