Objective To calculate the incidence of chromosomal abnormalities at second trimester in women who were 35 or older at their expected date of birth.Methods The amniocentesis and karyotyping results in Peking Union Medical College Hospital from January 1st,2001 to June 30th,2011 were retrospectively analyzed.The only indication for amniocentesis in these group of woman was advanced maternal age.A total of 6584 cases Were included in this study and were divided into two groups according to maternal age,ie.35-39 and ≥40 year old group.The incidences of fetal 47,+ 21,47,+ 18 and sex aneuploidies were calculated and compared between two groups by Chi-square test.Results Altogether,121 cases were diagnosed to be abnormal chromosome,and the overall incidence was 18.38‰ (121/6584).The abnormal karyotypes included 111 cases of aneuploidies (mosaicism included) and 10 cases of structural abnormalities.The aneuploidies included 59 cases of 47,+21 (8.96‰,59/6584),25 cases of 47,+18 (3.80‰,25/6584),2 cases of 47,+13 (0.30‰,2/6584) and 25 cases of sex aneuploidies (3.80‰,25/6584).Fetal 47,+21 was the most frequent chromosomal abnormality,accounting for 53.15％ (59/111) of all aneuploidies.The incidence of fetal 47,+21 was significantly higher in ≥40 year-old group than that of 35-39 year old group[13.99‰(16/1144) vs 7.90‰(43/5440),x2=3.937,P=0.047].There were no statistical differences of the incidences of fetal 47,+ 18 and sex aneuploidies between the two groups.Conclusions The main fetal chromosomal abnormalities in women aged 35 and older are the aneuploidies of chromosome 21,18,13 and sex chromosomes.The incidence of fetal 47,+21 is significantly increased in the women aged 40 years and older.So prenatal screening should be provided first to women at 35-39 years of age and amniocentesis should be the first choice of prenatal diagnosis for women over 40 years old.

Description of the practice, significance and principles of networking operation for primary medical institutions in Shenzhen, and an introduction to the strategy and implementation assurance. The paper covered the following features of such operation: establishment and upgrading of the primary patients movement system; establishment of the tiered health service system; establishment of the consultation and referral system based on networking operation; establishment of multi-institution practice system for physicians within the network; establishment of medical resources sharing system within the network; support for joint research programs; experiment in effective medical insurance payment and health service price support system; diversity and loose structure of institutions within the network

Objective:The regulatory effects of ethyl acetate extract of Herba Eclipta EAEE on immune function were studied.Methods: The experimental immunosuppressive models were induced by injection of Cyclophosphamide or hydrocortisonc.Results: The index of thymus gland spleen in immunosuppressive mice was increased significantly. when large and small dose of EAEEP were given. EAEE remarkably enhanced the delayed type hypersensitivity in immunosuppressive mice. Conclusions: EAEE possesses notable immunomodulatory action on immune system in mice.

Objective To evaluate the residual risk (i.e.failure risk in detecting aneuploidies abnormalities except for chromosome 13,18,21,X and Y) of cytogenetic abnormalities using interphase fluorescence in situ hybridization (FISH) for the second-trimester amniocytes.Methods The results of interphase FISH and conventional karyotyping of 2 837 consecutive amniotic fluid specimens were analyzed retrospectively.Probes for chromosomes 13,18,21,X and Y were used.The detection rate and residual risk for interphase FISH were calculated for the following three major clinical indications for prenatal diagnosis (advanced maternal age,abnormal maternal serum screening indicating an increased risk for trisomy 18 or trisomy 21,and ultrasound abnormalities).Results Consecutive interphase FISH and karyotyping of second-trimester amniocytes for prenatal diagnosis were performed from January 1,2010 to July 31,2013.Among the 2 837 cases,85 (3.0％) cases with abnormal karyotypes were found,including 73 cases of aneuploidies involving chromosome 13,18,21,X and Y,which were considered detectable by interphase FISH; 12 cases of chromosomal anomalies,other than aneuploidies of chromosome 13,18,21,X and Y,were diagnosed after karyotyping and were not detected by interphase FISH,including six cases of balanced rearrangements,five cases of imbalanced rearrangements,and one case of pseudomosaic of trisomy 20.Of these 12 chromosomal anomalies,three cases of imbalanced rearrangements involving chromosome 21 showed positive FISH results,and the other nine cases showed negative FISH results among which four case of hereditary balanced rearrangemerts and two cases of novel balanced rearrangements.The total detection rate for interphase FISH was 89.4％ (76/85),the misdiagnosis rate of chromosome abnormalities was 14.1％(12/85),and the residual risk was 0.43％ (12/2 761) following interphase FISH of the second-trimester amniocytes.Conclusions Interphase FISH is a useful adjunct to conventional karyotyping,but should not be regarded as a replacement for karyotyping as too many structural chromosomal abnormalities will be missed.Providing patients with a detection rate and residual risk during counselling may help them understand the advantages and limitations of interphase FISH in their prenatal diagnostic evaluation.

Objective To evaluate the detection rates of colorectal polyps and cancer in the elderly and characterize the pathological features of the colorectal neoplasm in DongLi District in Tianjin.Method Totally,46 743 subjects aged 60-74 were recruited from the national colorectal cancer screening program,including subjects registered from November 2012 to April 2013 in DongLi District in Tianjin.Each subject completed a questionnaire and a fecal occult blood test.Colonoscopies were conducted in 434 subjects with high risk for colorectal cancer.Results Among all the subjects,2 880 were at high risk for colorectal cancer which accounts for 6.16％ (2 880/46 743) of the total subjects.Among the subjects who underwent the colonoscopy,165 (men:105,women:60) were colorectal polyps accounting for 5.73％ (165/2 880)in the total risk,with 51 subjects (1.77％) advanced neoplasms and 4 subjects (0.14％) cancer.The detection rates of colorectal polyps is 0.35％ (165/46 743),and colorectal cancer is 8.6/105(4/46 743).More polyps were found on the left colon compared with the right.More tubular adenoma was found compared with the other pathological types.Most of the polyps were smaller than 0.5 cm.Colorectal polyps and advanced neoplasms were more frequent in men than women [45.45％ (105/231) vs 29.56％ (60/203),16.02％ (37/231) vs 6.90％ (14/203),all P ＜ 0.01].Multiple polyps (P ＜ 0.05) and polyps with diameter larger than 1.0 cm (P ＜ 0.01) were more often in men than in women.Men tended to have more colorectal polyps in right colon and higher detection rate for moderate or sever atypical hyperplasia than women(all P ＜ 0.05).Conclusion There is a higher incidence of colorectal polyps in the elderly.It is important to establish the national sequential colorectal cancer screening program for the early diagnoses of colorectal polyps and cancer in the elderly.

Objective To evaluate the impact of sequence on the quality of bowel preparation in patients with anesthesia for same-day sequential bidirectional endoscopy and propose the optimal procedural sequence.Methods Single center blinded randomized observational study.Sixty-five patients were randomized to either the gastroscopy-first group or the colonoscopy-first group.Bowel cleanliness according to Boston bowel preparation scale (BBPS) scores were evaluated,also done the propofol dosage,caecal intubation time,procedure duration and complications.Results The BBPS score of entire colon showed no difference (6.72 ± 1.34 vs.6.89 ± 1.50,P =0.638),but the BBPS of ileal-cecum portion was higher in the colonoscopy-first group (1.21 ±0.54 vs.1.55 ±0.73,P =0.035).The total procedure time,propofol dosage and complications were similar between the two groups.Conclusion The bowel cleanliness of ileal-cecum portion in colonoscopy-first group is better than that of gastroscopy-first group during sequential bidirectional endoscopy in patients with propofol sedation.We propose colonoscopy first in patients with suspicious ileal-cecum lesion.

Objective To explore the reaction time and attention bias characteristics of patients with first-episode depressive disorder.MethodsTotally 32 patients with first-episode depressive disorder (MD group) and 24 non-depression control participants(NC group) matched with MD group on age,gender and education level were enrolled in the study.The clinical symptoms were assessed by Beck Depression Inventory(BDI).All participants completed a dot-probe task to assess attentional preference for facial stimuli with varying valence (happy,sad and neutral facial expressions).ResultsThe reaction times(RTs) of MD group was longer than that of NC group in the dot-probe task ((468.6±87.7)ms,(451.7±82.5)ms,P<0.01).The four-way ANOVA revealed a significant main effect of prime duration,indicating overall shorter RTs on primes with longer duration ((476.9±88.4)ms vs (456.2±82.7)ms vs (447.7±83.9)ms,P<0.01).Compared with NC group,the scores of attention bias for sad faces were decreased in MD group ((7.43±26.4)ms vs (-4.97±19.5)ms,P<0.05).With the longer duration of presentation,the score of attention maintenance of emotional facies for MD group were increased (happy faces: (-11.0±4.8)ms,(2.2±6.9)ms,(6.1±8.5)ms;angry faces:(-1.6±7.5)ms,(6.5±8.6)ms,(14.9±6.7)ms).The adherence score of attention to happy faces were decreased ((1.8±5.6)ms,(-8.2±6.7)ms,(-8.7±7.1)ms),while the score of adherence score towards sad faces were increased ((-7.6±7.2)ms,(-2.6±8.5)ms,(1.5±6.2)ms) with increasing prime duration.ConclusionPatients with first-episode depressive disorder have slower response to emotional faces and associated with attentional bias for sad faces.With the increasing prime duration,it is more and more obvious to attentional bias in the two aspects of allocation and adherence.

Objective To evaluate the outcome of reoperation(after I stage anterior/posterior operation)for thoracolumbar fractures combined with kyphosis and spinal cord injury. Methods A retrospective study was done on the medical records of 12 patients who underwent two-stage decompression with kyphosis and neurologic deficit due to single-stage approach(anterior or posterior) operation of thoracolumbar fractures combined with spinal cord injury between January 2005 and April 2009.There were 9 males and 3 females,at mean age of 34.6 years(range,19-57 years).According to the Denis classification,there were five patients with burst fractures,five with compression fractures and two with fracture dislocation.All the patients had couns medullaris injury.Of all the patients,five underwent one stage anterior approach surgery and the others underwent posterior approach operation.All the patients had vailous degrees of neurological symptoms.The patients treated with one stage anterior surgery were treated with two stage posterior surgery and the patients treated with one stage posterior surgery were treated with the two stage anterior operation.The mean interval from one stage operation to two stage decompression was 13.4 months(range,12-18 months).The radiologic,neurologic and functional outcomes were assessed through observation of the Cobb angle,Frankel spinal cord injury grading and Japanese Orthopaedic Association Scores(JOA). Results AIl the patients were followed up for mean 25 months (12-48months),which showed primary healing of the incisions in all the patients.The average anterior and posterior heisht of the vertebrae wers corrected from preoperative 42.6%and 70.5%to postoperative 92.5%and 95.7%and to 87.3%and 92.2%at the final follow-up respectively.Neurologic status was improved at least one Frankel grade in the patients who had preoperative incomplete paraplegia.The Cobb angle was corrected from preoperative 36.3°to postoperative 5.8°and to 5.9°at the final follow-up(P<0.05).No patient had any notable loss of correction between discharge and final follow-up.According to JOA coring,the results were excellent in nine patients,good in two and fair in one,with excellence rate of 92%. Conclusions Two stage decompression for epiconus and cauda equina syndrome resulted from one stage approach(anterior or posterior)operation of thoracolumbar fractures combined with spinal cord injury call attain satisfactory correction of the kyphosis and nerve decompression as well as various degrees of nerve function recovery.

Objective Mesenteric panniculitis is an idiopathic , uncommon disease involving the adipose tissue of mesentery .The etiology , diagnosis and treatment are still unnoticed .We thus reported a case series to improve the understanding of this rare disorder .Methods We retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation , diagnosis, treatment and prognosis.Results We found a male predominance (M∶F 3∶1) with the median age of 58 years old at diagnosis.The most common symptom was abdominal pain (9/12), followed by abdominal distension (3/12) and weight loss (3/12).Physical examination was unremarkable in the majority of patients (8/12).C reactive protein (9/12) and erythrocyte sedimentation rate (10/12) were normal in majority of patients.CT findings were of much diagnostic value .All patients had small intestinal mesentery involvement and multi-nodular appearance with increased fat density .Pseudo-capsule sign ( 8/12 ) and fat halo sign (6/12) were common.Pathological diagnosis was obtained in 4 cases showing fat tissue inflammation with local necrosis and fibrosis .Six cases all received prednisone , 2 with combined cyclophosphamide , 1 with azathioprine, 1 with tripterygium wilfordii .Short-term clinical response was achieved in all cases , but two patients relapsed .Conclusions Mesenteric panniculitis occurs predominantly in middle-aged and elderly . Abdominal pain is the leading symptom .Inflammatory markers are often normal while computed tomography is the most important diagnostic tool .Surgery combined with cortical steroid and immunosuppressant agents is effective.

Objeetive To evaluate the performance characteristics of the second trimester double test for the detection of fetal Down's syndrome(DS)in women of advanced maternal age(AMA).Methods We undertook a prospective nation-wide multi-centered study and chose alpha-fetoprotein(AFP))and free β-subunit of human chorionic gonadotrophin(free β-hCG)as the serum markers.Between May 2004 and September 2006,12 centers participated in the collection and analysis of maternal serum AFP and free β-hCG.Patients with an iuereaged risk of DS(≥1/270)wero offered generic sunniocentesis.Follow up of the outcome of all pregnancies was obtained.Patients were divided into two groups,the AMA group and the non-AMA group and the screening efficiency Was evaluated in beth groups.Results A total of 66 132 singleton pregnancies were included in the study.and there were 36 10(5.46%)AMA women.The median maternal age of AMA women was 36.8years(35-47 years).At a cut-off of 1/270,in the AMA group,the number of positive cases screened was 727 and 22 cases of fetal DS were detected:the number of negative cases screened was 2883,and no fetal DS was found.In the non-AMA group,the number of positive cases screened was 4743 and 69 cases of fetal DS were detected:the number of negative cases screened was 57 779,and 6 cases of fetal DS were diagnosed postnatally.In AMA group,the detection rate(DR),false positive rate(FPR)and odds of being affected given a positive result(OAPR)were 100%,19.7%and 3.0%respectively.In the non-AMA group,the DR,FPR and OAPR were 92.0%.7.5%and 1.5%respectively.Conclusion The double-marker test using AFP and free β-hCG is an effective screen strategy for second-trimester detection of Down syndrome in AMA women.