Objective To investigate the operative indication,timing,method,selective standards of fetieided fetus and the number of reduced fetuses of selective multifetal pregnancy reduction in second trimester,and the pregnancy outcome of multifetal pregnancy by this operation.Methods Trans-abdominal selective multifetal pregnancy reductions in 37 cases of multiple pregnancy (twins 6 cases,triplets 21cases, quadruplets 8 cases,and quintuplets 2 cases) during 12~(+1) -25 weeks were performed under ultrasound guidance.The fetus to be reduced was injected potassium chloride (KC1) intraeardiacally until the fetal heartbeat stopped gradually.Totally 46 fetuses were reduced.Periodic prenatal examination and monitoring of coagulation function were carried out after the procedure.The pregnancy complications and pregnancy outcome of all cases were recorded.Results (1) The successful ratio of reduction was 100% (46/46 fetuses) and the successful pregnancy ratio was 88.9% (24/27).(2) Among all the 37 cases,fifteen deliveried after 36 weeks,seven deliveried in 32-36 weeks,three deliveried in 28-32 weeks,two aborted after feticide,and ten cases were in pregnancy at the time of this study.The mean gestational age of all was (34.9?4.1) weeks,and the delivery ratio after 28 weeks was 92.6% (25/27).(3) The mean birth weight of singletons was (3014?640) g,and of twins was (2557?573) g.The neonates of three triplets all died except for in one case two fetuses were alive.(4) Except in two cases after reducing one fetus of monoamniotie twins,another one died within 24 hours,the remaining fetuses were all alive.(5) Pre- eclampsia occurred in three cases.None of the cases had blood coagulation disturbances.Conclusion (1) Selective muhifetal pregnancy reduction in second trimester can feticide the abnormal fetus objectively or reduce the fetal number effectively.It is a safe procedure to decrease the complications of multifetal pregnancy and increase the birth weight.(2) ff the intention is reducing the fetal number,we choose the fetus who lies in the fundus uteri and reduce the muhifetal pregnancy to twins.(3) It is advised to aviod performing the procedure during vaginal bleeding.We reduce fetus after vaginal bleeding stops for one or more weeks.(4) Selective second-trimester multifetal pregnancy reduction will not result in the disturbance of blood coagulation and the death of remaining fetus.The incidence of pre-eclampsia is decreased after muhifetal pregnancy reduction.

INTRODUCTIONMinimally invasive surgery (MIS) is increasingly used in the treatment of lumbar stenosis. However, it is still not clear if the employment of minimally invasive surgical techniques can achieve superior clinical outcomes compared to standard open laminectomy.

MATERIALS AND METHODSAn extensive literature review regarding the clinical outcome, safety, and efficiency of MIS and standard open surgery (OS) in the treatment of lumbar stenosis was conducted on Medline, Cochrane, EMBASE, and Google Scholar databases up to 19 August 2016.

RESULTSSixteen studies that enrolled a total of 1580 patients with surgically-indicated lumbar stenosis were identified; 793 patients underwent MIS and 787 patients underwent conventional OS. No significant difference was found in the improvement of Oswestry Disability Index (ODI) (P = 0.718) and operation time (P = 0.322) between patients from different treatment groups. MIS was associated with better visual analogue scale (VAS) for back pain (P = 0.01), shorter length of hospital stay (P <0.001), and lower blood loss (P <0.001).

CONCLUSIONOur findings indicate that both MIS and standard OS can effectively manage patients with lumbar stenosis and lead to comparable clinical outcomes. Further studies are necessary to evaluate MIS with different types of conventional surgery for lumbar stenosis.

Objective To assess the clinical effect of Percutaneous transforaminal endoscopic spinal surgery for central lumbar spinal stenosis.Methods Total 92 patients (44 males and 48 females with average age of 68.6± 12.4 years) with central lumbar spinal stenosis were enrolled in our study during February 2012 and July 2016.All patients were treated with Percutaneous transforaminal endoscopic spinal surgery.Clinical and Radiographic evaluation were investigated on 1 week,3 months,6 months,12 months postoperatively and final follow-up.Visual analogue scale (VAS) for low back pain and leg pain,Oswestry disability index(ODI) for low back pain were used to evaluate the clinical efficacy of surgery.Pre and postoperative Dural sac cross sectional area(DSCA) was measured.And the correlation between changes of DSCA and clinical efficacy was analyzed.Results The operation time was 45-1 15 min.The mean operation time was 75±15 min.the mean blood loss was 15±5 ml (range 8-50 ml).All patients were followed for 12-46 months (24.5±5.3 months).VAS for low back pain,VAS for leg pain,and OD1 were significantly improved from 6.75± 1.28,7.79± 1.15 and 39.82％ ±5.06％ preoperatively to 2.21± 1.08,2.16± 1.14 and 9.82％ ±3.69％ at the latest follow-up.Dural sac cross sectional area significantly increased from 55.35±12.18 mm2 preoperatively to (102.36±15.38) mm2 at the latest follow-up.Correlation coefficient with DSCA change was-0.480 for ODI change,-0.612 for VAS(low back pain) change,-0.637 for VAS (leg pain)(P ＜ 0.05);obvious positive correlation existed between the change of DSCA and patient's clinical efficacy.It showed that the change of DSCA was positively correlated with the patient's clinical efficacy.The clinical results were excellent in 56 cases.good in 29,fair in 4,and poor in 3 based on the MacNab criteria.92.39％ demonstrated a good-to-excellent outcome.One case occurred cauterizing syndrome,3 cases of recurrence,and 2 cases of Dural tear.There was no severe vascular or nerve injury.Conclusion Percutaneous transforaminal endoscopic spinal surgery provides a new minimally invasive treatment for central lumbar spinal stenosis.It is safe and effective.It is found that the change of DSCA is positively correlated with the clinical efficacy of surgery.

OBJECTIVE: To investigate the incidence of neonatal asphyxia and possible contributing factors for the development of severe asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture, China. METHODS: A total of 16 hospitals in Hubei Enshi Tujia and Miao Autonomous Prefecture were selected as research centers. A retrospective analysis was performed for the clinical data of 22 294 live births in these 16 hospitals from January to December, 2016 to investigate the incidence rate of neonatal asphyxia and possible contributing factors for the development of severe asphyxia. RESULTS: Of the 22 294 neonates born alive, 733 (3.29%) were diagnosed with neonatal asphyxia, among whom 627 had mild asphyxia and 106 had severe asphyxia. The neonates with low maternal education level, maternal anemia during pregnancy, chorioamnionitis, abnormal amniotic fluid, abnormal umbilical cord, placenta previa, placental abruption, Tujia Minority, preterm birth, and low birth weight had a higher incidence of severe asphyxia (P<0.05). CONCLUSIONS The incidence rate of neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture is higher. Low maternal education level, maternal anemia during pregnancy, chorioamnionitis, abnormal amniotic fluid, abnormal umbilical cord, placenta previa, placental abruption, Tujia Minority, preterm birth, and low birth weight may be related to the development of severe neonatal asphyxia.
Asphyxia Neonatorum ; epidemiology ; China ; Humans ; Incidence ; Infant, Newborn ; Retrospective Studies

OBJECTIVETo investigate the expression level of WT1 gene in bone marrow of patients with acute myeloid leukemia (AML) and its relationship with prognosis.

METHODSThe copy numbers of WT1 and internal reference gene in bone marrow samples from 75 newly diagnosed AML patients were detected by using real-time quantitative PCR. The gene WT1 expression level was determined by the ratio of the copy numbers of WT1 to reference gene. And the clinical characteristics, the complete remission (CR) rate after induction chemotherapy, 2-year overall survival (OS) rate and event-free survival (EFS) rate were calculated and analysed.

RESULTSThe expression level of WT1 did not significantly correlate with common clinical parameters such as age, sex, molecular abnormality, FAB classification and risk stratification. The CR rate in the high WT1 expression group before treatment was 65.4%, which was lower than that of 93.9% in the low expression group (χ2=8.25, P<0.01). The 2-year overall survival rate and event-free survival rate of the two groups were statistically significantly different (P<0.05), and the OS and EFS rates in high WT1 expression group were lower than those in low expression group. After the induction chamotheropy for about 1, 3 month and 6 months, the 2-year OS rate significantly increased in patients with decrease of WT1 gene expression level by one log or more (P<0.05).

CONCLUSIONThe expression level of WT1 gene in bone marrow may be an effective marker to evaluate therapy efficacy and prognosis for AML patients (non APL).

Bone Marrow ; metabolism ; Disease-Free Survival ; Genes, Wilms Tumor ; Humans ; Induction Chemotherapy ; Leukemia, Myeloid, Acute ; diagnosis ; genetics ; Prognosis ; Real-Time Polymerase Chain Reaction ; Remission Induction ; Survival Rate ; WT1 Proteins ; genetics ; metabolism

BackgroundFacing the increasing prevalence of gestational diabetes mellitus (GDM), this study aimed to evaluate the management of GDM and its association with adverse pregnancy outcomes.

MethodsThe data of 996 inpatients with GDM who terminated pregnancies in our hospital from January 2011 to December 2015 were collected. Treatments during pregnancy and the last hospital admission before delivery were analyzed. Pregnancy outcomes of the GDM patients were compared with 996 nondiabetic subjects matched by delivery year and gestational age. The association between fasting plasma glucose (FPG) and adverse pregnancy outcomes was examined by logistic regression analyses.

ResultsThe average prevalence of GDM over the 5 years was 4.4% (1330/30,191). Within the GDM patients, 42.8% (426/996) received dietary intervention, whereas 19.1% (190/996) received insulin treatment. Adverse outcomes were more likely to occur in patients with unsatisfactory control of blood glucose such as respiratory distress syndrome (RDS, χ = 13.373, P < 0.01). Elevated FPG was identified as an independent risk factor for premature birth (odds ratio [OR] = 1.460, P < 0.001), neonatal care unit admission (OR = 1.284, P < 0.001), RDS (OR = 1.322, P = 0.001), and stillbirth (OR = 1.427, P < 0.001).

ConclusionsManagement of GDM in the real world of clinical practice was unsatisfactory, which might have contributed to adverse pregnancy outcomes.

Blood Glucose ; analysis ; Diabetes, Gestational ; blood ; Female ; Humans ; Pregnancy ; Pregnancy Complications ; blood ; Pregnancy Outcome ; Retrospective Studies ; Risk Factors