After the development history, knowledge system and main characteristics of Introduction to medical in-formatics textbooks in China were described, the problems in the textbooks used at present were analyzed, and sug-gestions were put forward for their improvement.

Objective To investigate the clinical outcome and placental characteristics of spontaneous twin anemia-polycythemia sequence (sTAPS). Methods Twelve cases with sTAPS delivered in Peking University Third Hospital from May 2013 to August 2016. The data of ultrasound characteristics, gestational age at delivery, and 1 minute Apgar score were analyzed,retrospectively. Placental superficial vascular anastomoses, placental territory discordance and the ratio of umbilical cords insertion distance to the longest placental diameter were also analyzed. Results (1) Only 1 case of sTAPS was diagnosed prenatally, the others were diagnosed postnatally because the fetal middle cerebral artery(MCA) doppler was not measured regularly. Five cases were complicated with selective intrauterine growth restriction (sIUGR). The median gestational age at delivery was 32.8 weeks(31-37 weeks). The pregnancies were terminated because 3 cases were sIUGR typeⅠ, 1 case was sIUGR type Ⅱ, 1 case was sIUGR type Ⅲ, 2 cases were fetal distress, 2 cases were severe pre-eclampsia, 2 cases were premature rupture of membrane, 1 case was fetal hydrops with abnormal doppler waveforms of ductus venouses. (2) When 5 sIUGR cases were excluded, there was no difference between the twins in birth weight [1797 g(940-2620 g),1648 g(980-2500 g);P=0.688]. The hemoglobin (Hb) level in all donor was significantly lower than recipient(P=0.000)and the inter-twin Hb difference was 147.6 g/L (84.0-216.0 g/L). While the reticulocyte percentage in donor was significantly higher than recipient (P=0.013) and reticulocyte percentage ratio was 3.60 (1.04-7.50). Five donor newborns had neonatal asphyxia, including 1 severe asphyxia, while no asphyxia happened in the recipient twins. (3) Arterio-arterial (A-A) anastomoses, veno-venous (V-V) anastomoses, arterio-venous (A-V) anastomoses were found in 3, 1 and 11 placentas, respectively. The total number of anastomoses was 2 (1-5) and the total diameter was 1.1 mm (0.4-2.1 mm), including 0 (0-1) A-A anastomoses with 0.2 mm (0.0-0.9 mm) in diameter and 2 (0-5) A-V anastomoses with 0.7 mm (0.0-2.1 mm) in diameter. The placental territory discordance was 0.17 (0.02-0.40) and the ratio of umbilical cords insertion to the longest placental diameter was 0.82 (0.34-0.99). Conclusions The pathogenesis of sTAPS might result from slow and chronic blood transfusion from donor to recipient through a few minuscule vascular anastomoses in the placenta. In all monochorionic twins, especially sIUGR cases, MCA doppler should be monitored closely in the second and third trimester, in order to diagnose and manage sTAPS in time.

Objective To evaluate the efficacy of fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in treatment of twin-twin transfusion syndrome (TTTS) and to investigate the incidence of TTTS complicated with selective intrauterine growth restriction (sIUGR) for better understanding the effects of sIUGR as a complication of TTTS on pregnancy outcomes. Methods A retrospective study was performed on 116 gravidas who were diagnosed with TTTS of Quintero stage Ⅰ - Ⅳ in Peking University Third Hospital from September 2008 to September 2014. Among them, 44 cases received FLOC therapy. The incidences of sIUGR in each Quintero stage of TTTS were analyzed. Pregnancy outcomes of those 44 cases treated with FLOC were observed and the differences among four stage groups were analyzed. Chi-square or Fisher exact test was performed for statistical analysis. Results (1) The survival rates of both twins from stage Ⅰ to Ⅳ groups were 4/7, 10/14, 5/19 and 3/4, respectively, with statistically significant difference (χ2=7.840, P=0.038), but that in stage Ⅲ group was lower than in stage Ⅱ group without significant difference (P'=0.008). Differences in the total fetal survival rate among the four groups were statistically significant [8/14, 75% (21/28), 32% (12/38) and 6/8, χ2=14.016, P=0.002]. The total fetal survival rate in stage Ⅲ group was significantly lower than that in stageⅡ group (P'<0.008). In patients with stage Ⅲ TTTS, those complicated with sIUGR, after receiving FLOC therapy, showed a lower total fetal survival rate than those without sIUGR [21% (6/28) vs 6/10, P<0.05]. (2) Among the 116 TTTS patients, there were 63 cases (54%) with sIUGR complication. Patients with sIUGR complication in TTTS stages Ⅰ to Ⅳ groups accounted for 40% (14/35), 48% (11/23), 78% (28/36) and 46% (10/22), respectively, and the differences were significant (χ2=11.963,P=0.007). The incidence of sIUGR in stage Ⅲ group was greater than that in stage Ⅰ group (χ2=10.482, P'=0.002), and those in both stage Ⅲ and Ⅱ groups were higher than in stage Ⅰgroup without significant difference. Conclusions TTTS patients in stage Ⅲ have lower survival rate of both twins and total fetal survival rates after FLOC therapy, which may be related to a higher incidence of concurrent sIUGR.

This study was aimed to observe effects ofDendrobium ofifcinaleKimura et Migo on cardiac function and changes of blood vessel in rabbits with coronary heart disease (CHD).Thirty clean grade healthy rabbits were randomly divided into 5 groups, which were the control group, model group,Dendrobium low-dose (DLD), middle-dose (DMD), and high-dose (DHD) group, with 6 rabbits in each group. Constrictor ring was implanted in the left coronary artery to establish CHD model in the model group, DLD, DMD and DHD groups. Intragastric administration of Dendrobium decoction at the dose of 10, 20, and 40 g·kg-1 was given to rabbits in the DLD, DMD and DHD groups once a day for 21 consecutive days, respectively. The same volume of normal saline was given to the control group and the model group. Detections were made on levels of IL-8, TNF-α, VCAM-1, ICAM-1, the expression of actin, changes of LVSP, LVEDP,±dp/dtmax, BPs, BPd and morphologic changes of blood vessel. The results showed that compared with the control group, levels of IL-8, TNF-α, VCAM-1, ICAM-1 and the expression of actin increased or significantly increased in the model group with statistical significance (P< 0.05, orP< 0.01); LVEDP increased significantly (P< 0.01). However, LVSP,±dp/dtmax and BPs reduced (P< 0.05, orP< 0.01). The blood vessel wall became thicker. Compared with the model group, IL-8, TNF-α, VCAM-1, ICAM-1 and the expression of actin in the DMD and DHD group reduced or significantly reduced with statistical significance (P< 0.05, orP< 0.01); LVEDP reduced significantly in the DMD and DHD group with statistical significance (P< 0.01). While, LVSP,±dp/dtmax and BPs increased or significantly increased with statistical significance (P< 0.05, orP< 0.01). The thickening of blood vessel wall was inhibited. It was concluded thatDendrobium ofifcinale Kimura et Migo can improve cardiac function, which may take effect by improving and inhibiting pathologic changes of blood vessel and alleviating vessel injury.

A method of complete acid hydrolysis combined with high performance anion exchange chromatography and pulsed amperometric detection was developed for the monosaccharide composition analysis of arabinoxylan from the seeds of Plantago asiatica L. The parameters including hydrolysis methods, acid types, acid concentration, hydrolysis temperature, hydrolysis time and placement time, which would affect the hydrolysis process, were optimized. The results showed that it would have a better hydrolysis effect for polysaccharide from the seeds of Plantago asiatica L. with 2 mol/L H2 SO4 in an atmospheric oil bath at 120℃for 2 hours. However, the placement time for diluted solution of the hydrolyzed polysaccharide should be less than 6 hours. The polysaccharide was mainly composed of Arabinose (8. 89%) and Xylose (41. 52%) and Galacturonic acid (0. 73%). Glcuronic acid (3. 44%) was detected simultaneously, and there were also trace amounts of Galatose and Glucose. The results were reproducible. Other arabinoxylans from Panicummiliaceum L. shell, Avena sativa L. bran and Hordeum vulgare L. were taken for monosaccharide compositions analysis under the optimal hydrolysis conditions and the analysis results were good. This study would provide a good reference for monosaccharides composition analysis of arabinoxylans from various sources.

Objective To investigate the risk factors for preeclampsia (PE) in pregnancies complicated with chronic aplastic anemia ( CAA ) by analyzing the obstetric management and pregnancy outcome.Methods Retrospectively review the clinical data including the obstetric management,the laboratory findings and the pregnancy outcome of 41 pregnant women complicated with CAA,all of whom were hospitalized in Peking University People's Hospital from May 2002 to February 2011.Multiple logistic regression was used to explore the risk factors associated with PE.Results ( 1 ) Twenty-eight patients were diagnosed before conception while 13 were diagnosed during gestation.Eleven patients including all the 7 who were categorized as severe CAA presented with mild bleeding in the third trimester.( 2 ) The medians of white blood cell counts,hemoglobin concentrations and platelet counts were 5.0 × 109/L,66.0 g/L and 12.0 × 109/L respectively.(3) The obstetric management consisted of strict assessment, intensive surveillance and follow-up,appropriate supportive measures,timely recognition of complications,and delivery when necessary.Twenty-one patients received supportive transfusions.Ten patients developed PE,all of whom were diagnosed as severe PE( SPE).Twelve patients suffered postpartum hemorrhage,and 3 of them had blood loss more than 1000 mL All were conservatively treated in success.(4) The median gestational age of delivery was 37 weeks.Sixteen cases delivered before 37 weeks and 5 delivered before 34 weeks.Two patients developed SPE at 29 weeks and 30 weeks respectively,and both of the neonates died for severe asphyxia.The birth weight of the live neonates ranged from 1500 to 3660 g.(5) The postpartum follow-up period ranged from 6 months to 7 years.Thirty-three patients got improvement without dependence on transfusions.Four achieved no remission and still needed intermittent transfusions.Four were lost in followup.(6) Significant differences were found in the bleeding tendency,the platelet counts and the delivery weeks when comparing the patients developing PE and those without PE.No differences were found with regard to the age,the gestational age of first visit,the percentage of patients diagnosed before conception,the percentage of severe CAA,the choice of treatment,the white blood cell counts and the hemoglobin level.The Multiple logistic regression showed that the platelet count less than 10 × 109/L was an independent risk factor for CAA patients developing PE (P =0.006).Conclusions Most pregnancies complicated with CAA could achieve good maternal and fetal outcome, when intensive prenatal care and supportive management are provided SPE is the most common complication.The platelet count less than 10 × 109/L is perhaps an independent risk factor for CAA patients developing PE.

Objective: To grasp the research dynamics and development trend of the thermal environment of campus buildings in China, so as to lay the foundation for in depth research and provide a reference basis. Methods: Based on 479 documents in CNKI from 2000 to 2020, the documents were visualized and analyzed by keywords, including co occurrence, clustering, outbreak and author cooperation network in CiteSpace. Results: In the past 20 years, the research on thermal environment of campus buildings in China had gone through a period of formation development growth, and was at a high growth stage now. The word frequency of "thermal comfort, thermal environment, indoor thermal environment, natural ventilation" was greater than 50, which was a high frequency keyword. The highest outbreak rate of "green campus" was 3.75, and "university library, university building, microclimate and green building" was in the outbreak period. And LIU Jiaping, LIU Zehua, WANG Hongguang and others were highly productive authors and have formed cooperative network groups with their own cores, but the cooperation among the network groups was less to be strengthened. Conclusion The research dynamics of the thermal environment of campus buildings is closely related to the policy development in China, and the research on "green campus, campus energy saving optimization, and university buildings" based on human thermal comfort theory is a hot topic of continuous attention.

Objective:To investigate the effect of placental vascular distribution on residual anastomoses (RA) after fetoscopic laser occlusion of chorioangiopagous ressels (FLOC) for twin to twin transfusion syndrome (TTTS).Methods:A total of 57 cases of TTTS after laser surgery were retrospectively analyzed from April 2014 to April 2019 in Peking University Third Hospital. The patients were divided into RA group (24 cases) and non-RA group (33 cases) according to whether RA occurred in the placenta after laser surgery. The clinical characteristics, perioperative conditions, pregnancy outcomes and placental structure characteristics of the two groups were compared. Multivariate logistic regression was used to analyze the risk factors of placental vascular distribution for RA. The RA group was further divided into non-remission group and remission group, and the placental characteristics and pregnancy outcome of the two groups were compared.Results:(1)General clinical characteristics: the age, application of assisted reproductive technology, incidence of gestational hypertension, gestational diabetes mellitus, preoperative maximum amniotic fluid depth of the donor and recipient twins, Quintero stage and placental position of TTTS patients in the two groups were compared respectively, and there were no statistically significant differences (all P>0.05).The gestational age of patients received FLOC in the RA group was significantly higher than the non-RA group [(23.0±2.4) vs (21.9±2.7) weeks, P=0.033].(2) Perioperative conditions and pregnancy outcomes: the delivery gestational age of the RA group was significantly lower than that of the non-RA group (median:31.8 vs 34.4 weeks, P=0.002);The newborn birth weight in the RA group was significantly lower than that in the non-RA group [(1 648±597) and (2 013±481) g, P=0.003].The birthweight difference in the RA group was significantly higher than that in the non-RA group (median:0.30 vs 0.11, P=0.005). (3) The placental structure and the risk factors influencing RA happened: the differences in the proportion of four types of placental vascular distribution in the RA group and non-RA group were different significantly ( χ2 =10.214, P=0.012), with a detail of parallel type 29% (7/24) and 3% (1/33), staggered type 58% (14/24) and 76% (25/33), hybrid 8% (2/24) and 21% (7/33), monoamniotic membrane type 4% (1/24) and 0 respectively. Multivariate logistic regression analysis showed that parallel placental vascular distribution was an independent risk factor for RA after FLOC ( OR=24.5, 95% CI 1.7-336.2, P=0.017). (4) Placental characteristics and pregnancy outcomes in the remission and non-remission groups of the RA group: the incidence of three kinds of anastomoses, the total number, total diameter and proportion of RA, and the placental territory discordance ratio were compared between the two groups, and there were no statistical significances ( P>0.05);The birth weight difference ratio in the non-remission group was higher than that in the remission group (median:0.41 vs 0.28, P=0.036). Conclusion:The parallel type of placental vascular distribution may be an independent risk factor for RA in TTTS after laser surgery.

BACKGROUND:With the emergence of more sophisticated imaging instruments in recent years, orthopedic preoperative examination becomes more clear and accurate. With the help of three-dimensional reconstruction technology, it is bound to improve the accuracy of pedicle screw placement. OBJECTIVE:To investigate the accuracy and safety of digital three-dimensional reconstruction technique in the placement of thoracolumbar pedicle screw. METHODS:200 cases of pedicle screw fixation were col ected and randomly divided into two groups. One group was treated with traditional anatomical landmarks combined with intraoperative fluoroscopic fixation of pedicle screws. Assisted thoracic pedicle screws were implanted with digital three-dimensional reconstruction technique. Preparation time, the amount of bleeding, accuracy of pedicle screw placement, and neurovascular injury of pedicle were recorded by comparing the preoperative and postoperative spine digital models of the pre-and post-virtual spine. RESULTS AND CONCLUSION:(1) The accuracy rate of pedicle screw placement was 85%and 99%in the nail-hand nail group and the auxiliary nail group respectively, and the success rate of one-time placement was 80%and 95%;the excel ent and good rates of placement were 86%and 96%, respectively (P>0.05). (2) The preparation time of nail channel was (5.87±1.34) minutes and the volume of blood loss during nailing was (10.08±7.58) mL in the nail-hand nailing group. The preparation time of nail channel was (3.91±2.28) minutes and the volume of blood loss during nailing was (18.31±8.56) mL in the auxiliary nail group. There was significant difference between the two groups (P<0.05). (3) Nerve injury occurred in six cases, and vascular injury in eight cases in the nail-hand nailing group. Nerve injury occurred in 0 case, and vascular injury in one case in the auxiliary nail group. There were significant differences in nerve and vascular injuries between the two groups (P<0.05). (4) These results confirm that the accuracy and safety of digital three-dimensional reconstruction technique in the treatment of thoracolumbar pedicle screw placement are high.

Objective To investigate the factors affecting Fly-Thru (FT) and the best reconstruction conditions in a bile duct model.Methods The bile duct model was made with corn powder and rubber pipes.FT data of bile duct in vitro were acquired with a 3-dimensional probe of Toshiba Aplio 500,and the data were reconstructed offline in Fly-Thru workstation.Two US doctors assessed the FT images in three degrees.Results The images were divided into good,moderate and poor groups with corresponding score 3,2,1.Of 162 images,72 were rated as grade 1,57 as grade 2 and 33 as grade 3.According to x2 analysis,the diameter,scanning way,and Filter were brought into multinomial regression,then the scanning way was found to be correlated to FT images quality as well as filter (likelihood ratio =87.598,294.290,x2 =9.492,313.722,respectively,P ＜0.01).Best images of FT can be acquired by transverse scanning,reconstructing in Filter =3,gain =5(0,dynamic range (DR) =50 and threshold ranging 40-90.Conclusions Best FT images in the model could be achieved by scanning in short-axis,and reconstructing the data in Filter =3,gain =50,DR =5(0 and threshold ranging 40-90,which would be basic information for advanced clinic study.