Multifetal pregnancies with monochorionicity are more complicated, for which pregnancy monitoring and intrauterine intervention are of great importance. For dichorionic triamniotic triplets with MC twin, multifetal pregnancy reduction measures included cardiac injection of potassium chloride at 11 to 14 weeks of gestation for reduction to monochorionic singleton, and radiofrequency ablation after 16 weeks of gestation to preserve the dichorionic diamniotic twins. Moreover no significant difference was observed in the pregnancy outcomes between the two methods. Fetalscopic laser surgery can significantly improve the perinatal prognosis of multiple pregnancies complicated by twin-to-twin transfusion syndrome. Umbilical occlusion and transection can be used for the reduction of triplets containing monochorionic monoamniotic twins to avoid fetal death caused by entanglement of the umbilical cord. Cardiac injection of potassium chloride is appropriate for reducing the two fetuses in the same chorionic sac for trichorionic quadruamniotic pregnancy. Selective fetal reduction is applicable for MC triplets or quadruplets pregnancy, however, relevant studies are all with a small sample size, which requires full consultation and individualized treatment.

ObjectiveTo investigate the psychological and behavioral intervention on the rehabilitation of patients with chronic fatigue syndrome.MethodsIn this prospective,single blind study,71 outpatients diagnosed with chronic fatigue syndrome according to the criteria of the U.S.Centers for Disease Control were recruited and were divided randomly into two groups by coin method,one group for systematic psychological and behavioral intervention (31 cases) and the other group (the control group) for antidepressant drug treatment only (40 cases).Chronic Fatigue Assessment Scale ( FAI ) was used to estimate patients＇ clinical efficacy.ResultsEach factor score of FAI in psychological and behavioral intervention group was significantly improved after treatment ( S (3.20± 1.72) ;SS(4.01 ± 1.32) ; PC(4.95 ± 1.82) ;RTR / S(6.02 ± 1.59) ) (P＜0.01).Three factor scores of FAI in the control group were improved(P ＜ 0.01 ),but one factor score of this group was not significantly improved (S ( 5.39 ± 1.33 ) ) (P ＞ 0.05 ),Total improvement was not clear (P ＞ 0.05 ).Research group of significant efficiency,the total effective rate was significantly higher than that of control group.Compliance results showed,psychological behavior intervention group follow-up without falling off,the control group had 8 cases to fall off.Psychological and behavior intervention treatment efficacy and disease course,＜ 12 months in patients with good effect.ConclusionBoth of psychological and behavioral interventions and antidepressant medication are effective therapies for patients with chronic fatigue syndrome,the former is slightly better.

Objective:To observe the curative effects of the combined application of domperidone, pantoprazole and hydrotalcite tablets in the treatment of bile reflux gastritis ( BRG) and explore the underlying mechanism. Methods:Totally 80 patients with BRG were randomly divided into the treatment group and the control group with 40 cases in each. The treatment group was received panto-prazole, hydrotalcite tablets and domperidone, and the control group was treated by hydrotalcite tablets and domperidone. The efficacy was observed in both groups after 4 weeks. Results:The effective rate of symptom relief in the treatment group and the control group was respectively 92. 5% and 62. 5% (P<0. 05). After the 4 week treatment, the gastritis healing rate in the treatment group was higher than that in the control group (P<0. 05). The improvement of gastric mucosal hyperemia, edema and erosion in the treatment group was better than that in the control group with significant difference (P<0. 05). Cholic acid in gastric juice and gastric acid se-cretion were significantly reduced in both groups after the treatment, while the reduction of gastric acid secretion in the treatment group was more notable than that in the control (P<0. 05). Conclusion:Pantoprazole can be used to control BRG, and the combination of the three drugs shows better efficacy in the treatment of BRG.

Objective To evaluate the clinical effect of Liyanjiedu decoction for the prophylaxis and treatment of acute radiotherapy-induced oral mucositis of nasopharyngeal carcinoma(NPC)and the influence to the effect of the radiotherapy to NPC.Methods A total of 96 patients with NPC were randomly divided into treatment group and control group,48 cases for each group.The two groups were given radical radiotherapy.The treatment group was given Liyanjiedu decoction for buccal.The control group were given western medicine for mouthwash.The course of two groups was all from the beginning of radiotherapy to the end of it.Results The occurring time of radiotherapy-induced mucositis in treatment group and control group were(21?4.2)d and(16?3.6)d,and radiotherapeutic dose were(40.252?11.758)Gy and(29.625? 11.632)Gy,with significant difference between the tow groups(P

Objective To evaluate the effect of esophagogastric intramural implantation anastomosis after esophagectomy. Methods One thousand and two hundred thirty-six patients with esophageal and cardial cancers were treated by esophagogastric intramural implantation anastomosis after esophagectomy. The mucosal layer, the esophageal and gastric muscular layers were on three different levels after the anastomosis. Results Among 1236 patients, 842 cases were esophageal cancer,and 394 cases were cardial cancer.The anastomoses were performed in different levels including 15 cases below the pharynx, 193 cases on neck,634 case above the aortic arch and 394 cases below the aortic arch. One of the patients died 24 hours after the operation due to myocardial ischemia, and two of them died of respiratory failure. Anastomotic leakage, stenosis and refluxing esophagitis did not appear in this series. Conclusions Esophagogastric intramural implantation anastomosis can decrease the incidence of anastomotic leakage, stenosis and refluxing esophagitis after esophagectomy.

Objective To study the relationship between micro-vessel density(MVD), proliferating cell nuclear antigen(PCNA) expression and clinicopathological characteristics in cervix squamous cell carcinoma. Methods PCNA and CD 34 expression in 32 cervix squamous cell carcinomas were examined by SP immunohistochemical staining. MVD and proliferation index (PI) were calculated. Results PI and MVD were significantly correlated with the differentiatial degree and FIGO stage of cervix squamous cell carcinomas, and in the low differential cancers with high FIGO stage were obviously higher than those in the high differential cancers with low FIGO stage. In addition, PI and MVD in the cancers with lymph node metastasis were significantly higher than those in the cancers without one (P

Objective To evaluate the efficacy of different duration of low-carbohydrate diet (LCD) intervention on glycosylated hemoglobin (HbA1c) in type 2 diabetes mellitus (T2DM) patients. Methods Randomized controlled trials (RCTs) of LCD intervention in T2DM patients were collected in the databases such as MEDLINE, PubMed, OVID, China National Knowledge Infrastructure, China Scientific Journal Database by VIP, Wanfang database, et al.Data were analyzed by RevMan 5.3 version. Results Eight RCTs were included. The results of Meta-analysis indicated that the effects of lowering HbA1c by LCD intervention for three (Z=2.28, P<0.05) and six months (Z=14.99, P<0.01) were better than other diabetes diets, but there was no significant statistical difference between one (Z=0.65, P=0.51) and two years (Z=1.62, P=0.10). Conclusions Hypoglycemic effect of short-term LCD was better than other diabetes diets, but long-term effect was similar between them. LCD was a therapeutic diet suitable for T2DM patients.

Objective To explore the diagnostic value of 18F-FDG PET/CT in the inflammatory bowel diseases (IBD).Methods The clinicopathological data of 75 patients(46 males,29 females;average age 38 years) with IBD confirmed by colonoscopy from March 2010 to March 2014 were reviewed retrospectively.Among the 75 patients,30 were with ulcerative colitis(UC) and 45 were with Crohn's disease (CD).All underwent whole-body 18F-FDG PET/CT imaging.Enteroscope and CRP examination were performed within 1 week before or after PET/CT imaging.The results of 18F-FDG PET/CT were compared with those of located CT and enteroscope (x2,t tests).Linear correlation analysis was used to analyze the relationship between CRP and the SUVmax of lesions presented in IBD.Results (1) 18 F-FDG PET/CT accurately detected 65 patients with IBD,while located CT diagnosed 55 patients with IBD.The diagnostic sensitivities were significantly different:86.7％ (65/75) vs 73.3％ (55/75),x2 =4.167,P＜0.05.(2) Among 65 patients with positive results in 18F-FDG PET/CT,lesions were consistent with those detected by endoscopy in 33 (33/75,44.0％)patients.Results of the 2 methods in 24 patients (24/75,32.0％)were not completely same,those in 8 patients (8/75,10.7％)were totally different.18F-FDG PET/CT detected 145 lesions,while enteroscope only detected 119 lesions.Diffuse high FDG uptake was shown in intestinal wall in 40 of 65 patients,and mild mucosa injury was showed by enteroscope in 18 patients (45.0％,18/40).(3)Fortyeight of 65 patients detected by PET/CT were proven clinically to be in active stage,and the rest were in stable stage.The SUVmax of active stage group (8.31±4.21) was significantly higher than that of the chronic stage group (6.36±3.15;t =2.033,P＜0.05).There was a linear correlation between CRP and SUVmax of patients in active stage(r=0.453,P＜0.01).Conclusions 18F-FDG PET/CT is helpful to assess the activity of IBD and may serve as a supplementary diagnosing tool to detect the lesions under the epithelium of bowel,which are often false-negative by enteroscope.

Objective To provide ideal endometriosis animal models for research new treatment methods. Methods 64 Sexual mature without pregnant SD rats who has regular oestrous cycle were underwent operation that autologous endometrium were transplanted to peritoneum and subcutaneous with lancet gently cut tissue of where to transplant in the rut, and compared the model of peritoneum and subcutaneous after 4 weeks.Results The general success rate of autologous endometrium transplantation in rat estrus was 93.3%,and the peritoneum transplantation success rate was 51.7%, subcutaneous was 88.3%, the difference of the two place transplantation has statistical significance. Compare the two parts of volume of endometriosis,there was no statistically significant difference.Conclusion Using the lancet to establish the endometriosis model has a high success rate, and subcutaneous model is better than peritoneum.

Objective To investigate and evaluate the pregnancy outcomes and fetal loss after fetal reduction of triplets to twins or singleton pregnancy. Methods 282 cases of triplets who received multi-fetal pregnancy reduction (MFPR) at Shandong Provincial Hospital affiliated to Shandong University were recruited from Sep 2001 to Mar 2014. According to the remaining fetal number after MFPR, 231 cases were opted to reduce to twins (twins group) while 51 cases were opted to singleton pregnancy (singleton group).The indication of the former group was fetal abnormalities under ultrasound or on patients′ demand; while the indication for the later group included dichorionic triamniotic (DCTA) triplets or patients′ aspiration. Potassium chloride was injected into the targeted fetal heart until cardiac standstill was obtained. The pregnancy outcomes, gestational age at delivery, birth weight of newborns of the two groups were recorded. Successful pregnancy was defined as take-home at least one baby. Results (1)The overall rate of successful pregnancy was 91.5%(258/282).There were 413 neonates in the twins group, including 4 neonatal deaths and 409 live babies, with the successful rate of 90.5%(209/231). There were 49 neonates in the singleton group, including 2 cases of fetal loss. Thus the successful rate was 96.1%(49/51). There was no difference of successful pregnancy rate between the two groups(P>0.05).(2)The mean gestational age at operation for the twins group and singleton group were(16.5±3.5)weeks and (14.2±2.0) weeks, respectively. Each group was divided into three periods,11-13+6 weeks, 14-16+6 weeks and≥17 weeks.In the twins group, the cases in each time period were129(55.8%,129/231), 50(21.6%,50/231)and 52(22.5%,52/231), respectively. While in the singleton group, the cases in each time period were 27(53%,27/51), 16(31%, 16/51)and 8(16%,8/51).There was no difference between the two groups at each time period(P>0.05). (3)The fetal loss rate in the twins group were 7%(9/129), 12%(6/50), 10%(5/52) at each time period, respectively. While for the singleton group they were 4%(1/27), 0(0/16)and 1/8, respectively. There was no significant difference between the two groups at each time period(P>0.05).(4)The mean birth weight of the twins group was lower than the singleton group [(2 555±447) g vs (3 084±550) g, respectively, P<0.05].The rates of low birth weight infants(<2 499 g)in the twins group and the singleton group were 45.5%(188/413)and 8%(4/49), respectively(P<0.05).The rate of very low birth weight infants(≤1 499 g) was 3.9%(16/413)in the twins group compared with 0(0/49)in the singleton group(P>0.05).(5)The gestational age at delivery of the twins group was earlier than the singleton group [(36.2 ± 2.4) weeks vs(38.3 ± 2.2)weeks, respectively,P<0.05]. The labor rate of the two groups was significantly different for both 34-36+6 weeks and≥37 weeks(P<0.05).The full-term delivery rate in the twins group was 47.6%(110/231), and was 88.2%(45/51)in the singleton group(P<0.05). The fetal loss rate before 28 weeks did not differ between the two groups[8.7%(20/231)vs 3.9%(2/51), P>0.05].Conclusions Reduction to one fetus led to significantly better outcome than two fetuses, with no significant difference in fetal loss rate. It is better to advise patients with triplets reduce to singleton pregnancy.