Objective To discuss the diagnosis and management options of fetal nuchal cystic hygroma(NCH). Methods Ten cases of fetal nuchal cystic hygroma from Mar 1996 to Mar 2003 were retrospectively analyzed. The sonographic images, fetal karyotype examination after amniocentesis, TORCH results and pathology were reviewed. Results The sonogram detected a large cystic mass around the posterior of the neck. The smallest one was 5.3 cm?4.8 cm?4.0 cm in size and the biggest 12.6 cm?6.6 cm?4.0 cm. The nuchal ligament could be seen inside the mass. Four cases complicated with pleural effusions and 4 with pleural effusions, ascites and skin edema. One case was deliveried in full term and the other 9 cases were induced (including 4 fetal death). Seven cases were examined for TORCH of amniotic fluid among which only one TOX PCR positive. The karyotype examination was performed in 6 cases. The results were 45XO(3 cases), 45XO/46XX (60:40) and 45XX,-21,-22,+t(21;22). The only alive baby is 46XX. Conclusions Ultrasound and invasive amniocentesis to detect the fetal karyotype have an important role in early diagnosis and management of nuchal cystic hygroma. Nuchal cystic hygromas are associated with Turner’s syndrome and other chromosomal abnormalities.

OBJECTIVE: To observe the effect and explore the mechanism of Huannao Yicong capsule in treating senile patients with mild cognitive impairment (MCI). METHODS: The investigational drugs were packed by blind method. A randomized, double-blind and controlled trial was conducted on ninety senile patients with MCI. Other forty-five senile healthy persons were recruited to the healthy control group. The ninety senile patients were randomly divided into the Huannao Yicong capsule-treated group (45 patients administered with three Huannao Yicong capsules and two aniracetam capsule analogues) and aniracetam-treated group (45 patients treated with two aniracetam capsules and three Huannao Yicong capsule analogues). Patients in the two groups were treated three times daily for 16 weeks. Memory, traditional Chinese medicine syndrome, cerebral blood flow, free radicals and inflammatory mediators, such as superoxide dismutase (SOD), malondialdehyde (MDA), acetylcholinesterase (AchE), interleukin-1alpha (IL-1alpha) and interleukin-6 (IL-6) were determined before and after the treatment. Blood lipids, including triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), apolipoprotein A-1 (ApoA-1) and apolipoprotein B-100 (ApoB-100), were detected before and after the treatment. The safety indexes, such as routine tests of blood and urine, hepatic and renal function tests and electrocardiogram (ECG) were taken before and after the treatment. RESULTS: Index score of clinical memory scale in senile healthy people was significantly higher than that in MCI patients before treatment (P<0.01), and the content of AchE, IL-1alpha and IL-6 was obviously lower (P<0.01, P<0.05), the activity of SOD was higher (P<0.05). No significant difference was found in direction memory of clinical memory scale between the two treatment groups. Other index scores of clinical memory scale and traditional Chinese medicine syndrome in patients of Huannao Yicong capsule-treated group were significantly improved as compared with those of the aniracetam-treated group (P<0.05, P<0.01). The blood flow parameters of anterior cerebral artery, posterior cerebral artery and resistant index in patients of Huannao Yicong capsule-treated group were increased significantly (P<0.01, P<0.05). Huannao Yicong capsule could significantly increase the activity of serum SOD and decrease the content of AchE, IL-1alpha and IL-6 (P<0.01, P<0.05), better than aniracetam. Furthermore, Huannao Yicong capsule could significantly improve the blood lipid, such as the level of TG, LDL-C, HDL-C, ApoA-1 and ApoB-100 (P<0.01, P<0.05), and better than aniracetam (P<0.01, P<0.05). No significant changes were found after treatment in safety indexes, such as routine tests of blood and urine, hepatic and renal function tests and ECG. CONCLUSION: Huannao Yicong capsule has better therapeutic effect than aniracetam capsule in treating senile mild cognitive impairment.

OBJECTIVEIt aims to study potential genotoxicity of almond skins.

METHODSA bacterial reverse mutation assay was performed on S. typhimurium strains TA97, TA98, TA100, TA102, and TA1535 in the absence or presence of S-9 mixture at a dose range of 312.5 to 5 000 μg/plate. A micronucleus test and a mammalian bone marrow chromosome aberration tests were performed in Swiss Albino (CD-1) mice at doses of 625, 1 250, and 2 500 mg/kg bw used.

RESULTSAlmond skins exerted no mutagenic activity in various bacterial strains of Salmonella typhimurium in either the absence or the presence of metabolic activation at all doses tested. Various doses of almond skins did not affect the proportions of immature to total erythrocytes, the number of micronuclei in the immature erythrocytes, or the number of structural and numerical chromosomal aberrations of Swiss albino mice.

CONCLUSIONAlmond skins are not genotoxic under the conditions of the in vitro bacterial reverse mutation assay and two in vivo tests - micronucleus test and mammalian bone marrow chromosome aberration test, which supports the safety of almond skins for dietary consumption.

Animals ; Bone Marrow Cells ; drug effects ; Chromosome Aberrations ; chemically induced ; Female ; Male ; Mice ; Micronucleus Tests ; Plant Extracts ; chemistry ; toxicity ; Prunus ; chemistry ; Salmonella typhimurium ; drug effects ; Seeds ; chemistry

Objective:To investigate the mid-term clinical efficacy and imaging changes of Waveflex semi-rigid internal fixation system combined with posterior lumbar interbody fusion (PLIF) in the treatment of double segmental lumbar degenerative diseases.Methods:The data of 51 patients with lumbar degenerative diseases who underwent surgery from September 2014 to September 2015 were retrospectively analyzed, including 29 males and 22 females, aged 65.5±5.6 years (range 58-73 years). Preoperative intervertebral space degeneration grade by University of California at Los Angeles (UCLA) and Pfirrmann intervertebral disc degeneration grade were recorded. 23 cases of primary responsible segments were treated with decompression, fixation and fusion, and adjacent secondary responsible or degenerative segments were treated with Waveflex semi-rigid internal fixation (combined group); 28 cases of double segments were treated with decompression, fixation and fusion (fusion group). Disc height index (DHI) and intervertebral foramina height (IFH) of the semi-rigid fixation segments, DHI and IFH of the upper adjacent intervertebral space, and horizontal displacement of the upper adjacent vertebral body (HD) were measured on lateral X-ray films of lumbar spine; In the fusion group, DHI and IFH adjacent to the upper vertebral space and HD adjacent to the upper vertebral body were measured. The efficacy was evaluated by short-form McGill Pain Questionnaire (SF-MPQ) and Oswestry disability index (ODI).Results:51 cases were followed up for 5.4±0.3 years (range 5.2-6.3 years). The low back and leg pain and function in the combined group and fusion group were significantly improved compared with those before operation. SF-MPQ and ODI at 3 months, 1 year, 5 years after operation were significantly different from those before operation ( P<0.05). In the combined group, the DHI of semi-rigid internal fixation segments before operation and 3 months, 1 year, 5 years after operation were 37.8%±7.6%, 37.9%±7.4%, 36.5%±6.9% and 36.0%±7.1% respectively ( P>0.05); The IFH of semi-rigid internal fixation segments before operation and 3 months, 1 year, 5 years after operation were 21.5±2.8, 21.4±2.8, 20.4±2.7, 19.4±2.4 mm respectively ( P<0.05); The DHI of the upper segment adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 37.1%±9.3%, 36.8%±9.1%, 35.2%±9.1%, 33.9%±8.8% respectively ( P>0.05); The IFH of the upper segment adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 21.9±3.0, 21.4±3.0, 20.4±2.9, 19.5±2.7 mm, respectively ( P<0.05). The HD of upper vertebral body adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 2.2±0.7, 2.3±0.5, 2.5±0.5, 2.8±0.5 mm respectively ( P<0.05). At the last follow-up, one case of semi-rigid titanium rod fracture, one case of screw loosening at semi-rigid internal fixation segment, three cases with unsatisfied numbness relief, and 2 cases of facet joint spontaneous fusion at semi-rigid fixation segment occurred in the combined group. Conclusion:Waveflex semi-rigid internal fixation can protect the degenerative lumbar intervertebral disc, and delay the degeneration of semi-rigid internal fixation segment and adjacent upper segment after interbody fusion, but long-term follow-up and study are needed.

Objective:To assess the current practice in perioperative nutritional managament of patients undergoing pancreatoduodenectomy from 64 level A tertiary hospitals in China, and investigate nutritional managament strategies.Methods:The cross-sectional survey was conducted. From March 31 st to April 13 th, electronic questionnaires of perioperative nutritional management of patients undergoing pancreatoduodenectomy were sent to the members of Youth Club of Chinese Pancreatic Surgery Association and some pancreatic surgeons from other level A tertiary hospitals in China. The questionnaires were issued by online Wechat platform. Observation indicators: (1) general data; (2) preoperative nutritional management; (3) intraoperative nutritional management; (4) postoperative nutritional management; (5) comparison of nutritional management among medical centers with different surgical amount. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Results:(1) General data: a total of 96 questionnaires from 64 level A tertiary hospitals in 35 cities of 22 provinces were retrieved. There were 94 males and 2 females, aged (42±7) years, with a range from 29 to 59 years. (2) Preoperative nutritional management. ① Preoperative nutritional evaluation and screening: 62.5%(60/96) of surgeons evaluated preoperative nutritional status for patients. For preoperative screening, 41.7%(40/96) of surgeons performed nutritional screening in every patient, and 54.2%(52/96) performed nutritional screening when considering nutritional support. For screening tools, Nutritional Risk Screening 2002 was used in 66.7%(64/96) of surgeons. For selection of non-tool evaluation parameters, 97.9%(94/96) chose two or more indicators for comprehensive evaluation, 92.7%(89/96) chose Albumin as the evaluation parameter. ② Preoperative nutritional support: there were 13.5%(13/96) of surgeons conducting nutritional support regularly. For preoperative nutritional support methods, nutritional support based on diet was conducted by 94.8%(91/96) of surgeons. For timing of perioperative nutritional support, 43.8%(42/96) of surgeons determined the time according to the surgical time. Based on the theory of enhanced recovery after surgery, 24.0%(23/96)of surgeons routinely gave liquid diet or carbohydrate load at the preoperative 2 hours. (3) Intraoperative nutritional management. ① Intraoperative jejunostomy management: 8.3%(8/96) of surgeons performed routine jejunostomy. ② Intraoperative nutrition line management: the nasojejunal tube was placed intraoperatively by 30.2%(29/96), and the nasogastric tube was placed intraoperatively by 78.1%(75/96). Of the above surgeons, 38.7%(29/75) determined the time to nasogastric tube removal based on gastric volume, and 32.0%(24/75) removed the nasogastric tube after flatus in patients. (4) Postoperative nutritional management. ① Postoperative nutritional support methods: 84.4%(81/96) of surgeons gave nutritional support, in which 56.8%(46/81) mainly gave the parenteral nutrition and transition to diet. Total parenteral nutrition at the postoperative first day or complementary parenteral nutrition was the first choice in 78.1%(75/96) of surgeons, oral feeding at postoperative 7 days was the first choice in 86.5%(83/96) of surgeons. ② Postoperative nutritional management for complications: 63.5%(61/96) of surgeons chose enteral nutritional support through percutaneous endoscopic gastrojejunostomy, nasogastric tube or nasojejunal tube for grade B or C pancreatic fistula, 72.9%(70/96) chose enteral nutritional support through percutaneous endoscopic gastrojejunostomy or nasojejunal tube for delayed gastric emptying. (5) Comparison of nutritional management among medical centers with different surgical amount: of the 96 surgeons, surgeons in medical centers with surgical amount >100 cases a year had the nasogastric tube placement rate of 66.7%(32/48), and surgeons in medical centers with surgical amount ≤100 cases a year had the nasogastric tube placement rate of 89.6%(43/48), showing a significant difference between the two groups ( χ2=7.375, P<0.05). Conclusions:There is no uniform standards for indications, routes, or timing of perioperative nutritional management of patients undergoing pancreatoduodenectomy among surgeons from level A tertiary hospitals in China. In patients undergoing pancreatoduodenectomy, the theories and practice of perioperative nutritional management and enhanced recovery after surgery are diverse, which urgently require prospective study with nutritional management strategy as intervention and expert consensus on perioperative nutritional managament in pancreatic surgery accorded with clinical practice in China.