C677T mutation in methylenetetrahydrofolate reductase gene and neural tube defects: Should Japanese women undergo gene screening before pregnancy?

We analyzed the role of maternal C677T mutation in methylenetetrahydrofolate reductase (MTHFR) gene on spina bifida development in newborns. A total of 115 mothers who had given birth to a spina bifida child (SB mothers) gave 10 mL of blood together with written informed consent. The genotype distribution of C677T mutation was assessed and compared with that of the 4517 control individuals. The prevalence of the homozygous genotype (TT) among SB mothers was not significantly different from that among the controls (odds ratio [OR] = 0.65; 95% confidence interval [CI] = 0.31–1.25; P = 0.182), suggesting that MTHFR 677TT genotype in Japan is not associated with spina bifida development in newborns. The T allele frequency was not increased in SB mothers (34.8%) as compared to that of the control individuals (38.2%). Further, the internationally reported association between the two groups was found to be similar in all 15 countries studied except the Netherlands, where the TT genotype was found to be a genetic risk factor for spina bifida. For the prevention of affected pregnancy every woman planning to conceive has to take folic acid supplements 400 μg a day and the government is asked to take action in implementing food fortification with folic acid in the near future. In conclusion, it is not necessary for Japanese women to undergo genetic screening C677T mutation of the MTHFR gene as a predictive marker for spina bifida prior to pregnancy, because the TT genotype is not a risk factor for having an affected infant.     

Comparison of fluid leakage from four different cuffed pediatric endotracheal tubes using a pediatric airway simulation model

This study used an airway model to compare the ability of a pediatric endotracheal tube with a taper‐shaped cuff to prevent microaspiration relative to endotracheal tubes with conventional cuffs. Four different types of 5.0‐mm inner diameter cuffed pediatric endotracheal tubes (taper‐shaped cuff [Taper], high‐volume low‐pressure [Hi‐Lo], middle‐volume low‐pressure [Intermediate], and low‐volume low‐profile [Lo‐Pro]) were fixed within vertically placed acrylic tubes. The cuffs were maintained at 10, 20, or 30 cmH₂O pressure and 3 mL of simulated stomach contents was added to the top of the cuffs. The volume of leakage around the cuffs after 5 min and 4 h was measured. After 5 min, the volume of leakage was significantly lower with the Taper than with the Hi‐Lo, Intermediate, or Lo‐Pro at all pressure settings. After 4 h, leakage was significantly lower with the Taper than with the other three tubes regardless of initial cuff pressure (P < 0.05).     

A study on kinetic frictional properties in Begg/KB orthodontic appliances at posterior sites

In Begg and KB techniques, the kinetic frictional force generated between their characteristic orthodontic appliances at posterior sites and the orthodontic wire affects the efficiency of tooth movement. We compared the kinetic frictional force between the recent orthodontic appliances for posterior sites: the by-pass loop-KB buccal tube system (loop-KB tube system) and the conventional by-pass clamp-round buccal tube system (clamp-round tube system), and elucidated the frictional properties of the loop-KB tube system. We used 016"/018" round wires (016/018 round) and 022" × 016" ribbon wire (022 ribbon) with anchorage bend/curve applied. The results obtained were as follows:

可视软镜下导引型气管导管在颈椎手术中经口气管插管的效果北大核心CSCD

目的观察和比较可视软镜下导引型气管导管和加强型气管导管在颈椎手术患者中应用的效果。方法选择择期全身麻醉颈椎手术患者86例,男51例,女35例,年龄34~64岁,BMI 19~24 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为三组:斜面不朝向患者头端组(NTH组,n=28)、斜面朝向患者头端组(TH组,n=29)和导引型气管导管组(GT组,n=29)。NTH组和TH组患者采用加强型气管导管,NTH组导管斜面朝向患者头端,TH组导管斜面不朝向患者头端,GT组患者采用无斜面的导引型气管导管。记录气管插管时间、置管时间、置管次数、插管过程中低氧血症例数和置管难度分级;记录首次置管成功例数和低氧血症发生率;记录术后吞咽困难、咽喉疼痛和声音嘶哑发生情况。结果TH组和GT组插管时间、置管时间明显短于NTH组(P<0.05),置管次数明显少于NTH组(P<0.05),首次置管成功率明显高于NTH组(P<0.05),置管难度明显低于NTH组(P<0.05),吞咽困难、咽喉疼痛、声音嘶哑发生率明显低于NTH组(P<0.05)。GT组置管难度明显低于TH组(P<0.05)。三组低氧血症发生率差异无统计学意义。结论可视软镜引导下颈椎手术患者经口气管插管,采用气管导管斜面朝向患者头端和导引型气管导管,置管更快速、高效,术后并发症发生率低。使用导引型气管导管置管操作更简单、难度更低。     

经肛减压导管置入处理结直肠癌并急性梗阻的临床观察

目的 探讨内镜辅助下经肛门置入减压导管在低位结直肠癌并急性肠梗阻中的应用及疗效观察。方法 13例急性结直肠癌性梗阻患者在结肠镜辅助下,经肛门置入肠梗阻减压导,灌洗、引流等保守治疗7~10天后行一期根治手术。结果 13例患者均成功置入减压导管;术后患者腹痛、腹胀明显缓解,腹胀呕吐症状消失;置管后第3天,腹围由92.7±5.7 cm减小到81.2±4.8 cm;腹腔内压力由21.00±1.5 cmH₂O减至12.2±0.8 cmH₂O;减压导管引流量从782.3±72.1 mL下降至33.8±15.3 mL;梗阻近端肠管最大横径由5.4±0.6 cm缩小至2±0.3 cm（均P<0.001）。所有患者均接受一期结肠癌根治手术,术后未发生吻合口漏、伤口、腹腔感染等并发症。结论 对于低位结直肠癌伴发急性肠梗阻,经肛门置管减压不仅可显著缓解梗阻症状同时有利于改善患者全身状况并进行充分的术前准备,为一期根治性手术赢得时机;具有有效、安全、经济、创伤小等优势。     

手术治疗儿童硬脊膜囊末端囊肿样膨出的疗效

目的观察手术治疗儿童硬脊膜囊末端囊肿样膨出的疗效。方法2015年1月至2021年1月苏州大学附属儿童医院神经外科采用手术治疗11例儿童硬脊膜囊末端囊肿样膨出患者,其中8例行终丝离断+椎管内囊肿切除+硬脊膜囊末端缺损修补术,2例仅行终丝切断手术,1例行终丝离断+囊壁部分切除+囊腔脂肪填塞术。回顾性观察患儿术后的临床及影像学改善情况。结果11例患儿术后无一例发生感染及脑脊液漏等并发症。术后随访3个月至5年4个月(中位数为3年6个月),无一例患儿出现新发神经功能缺损症状;4例术前出现症状的患儿术后3例原有症状明显改善。术后3~6个月复查MRI,所有患儿均可见终丝离断;行硬膜囊远端瘘口修补的8例患儿,术后MRI显示骶管囊肿基本消失;行终丝离断+囊壁部分切除+囊腔脂肪填塞术的1例患儿,术后MRI显示囊肿为填塞脂肪组织代替。3例术前出现脊髓远端和终丝中央管极度扩张的患儿,术后MRI显示扩张明显改善。结论采用手术治疗儿童硬脊膜囊末端囊肿样膨出,手术安全;可改善患儿的临床症状和影像学情况。     

盐酸奥布卡因凝胶在经鼻肠梗阻导管置入术中的应用价值

目的探讨肠梗阻病人行经鼻肠梗阻导管置入术中应用盐酸奥布卡因凝胶的价值。方法将60例拟行经鼻肠梗阻导管置入术的肠梗阻病人按随机数字量表法分为研究组和对照组,每组各30例,研究组病人术前应用盐酸奥布卡因凝胶10 ml(30 mg)进行鼻腔麻醉及导管前端润滑,对照组病人术前于鼻腔及导管前端涂抹石蜡油进行润滑,比较两组病人的一次性置管成功率、置管时间及术后并发症发生率,并采用视觉模拟评分法(visual analogue scale,VAS)进行评分。结果研究组病人的一次性置管成功率为96.7%(29/30),对照组病人的一次性置管成功率为70.0%(21/30),差异有统计学意义(P<0.05)。与对照组比较,研究组病人置管所用时间明显减少,术中疼痛VAS评分降低,差异均有统计学意义(均P<0.05)。两组病人均未出现穿孔、出血等并发症。结论盐酸奥布卡因凝胶在肠梗阻病人行经鼻肠梗阻导管置入术中应用,提高了一次性置管成功率,减少置管所用时间,明显地减轻了病人术中的疼痛不适,未见并发症,效果满意。