Objective To investigate the perinatal outcomes of twin-twin transfusion syndrome (TTTS)and the management.Methods During Nov 1, 2002 to Sep 30, 2005, 24 cases of TTTS in Beijing Obstetrics and Gynecology Hospital were analyzed.The outcomes of them were compared with the pregnancy without TTTS in all twins and in monozygotic twins.The outcomes of the blood-supplying fetus and the blood-recepter were compared.Results 6.8%cases had TTTS in all twins.The group of TTTS had more maternal,fetal and neonatal complications than twins pregnancy without TTTS :polyhydramnios [37.5%(9/24)vs 2.1%(7/328),P＜0.01],gestational hypertension[20.8%(5/24)vs 7.0%(23/328),P=0.043],premature labor[66.7%(16/24)vs 36.3%(119/328),P=0.003],perinatal dead fetus in uterus[18.8%(6/32)vs 1.1%(7/540),P＜0.01],neonatal asphyxia[73.1%(19/26)vs 3.0%(19/632),P＜0.01],the proportion of NICU[88.5%(23/26)vs 23.4%(148/632),P＜0.01],neonatal death [15.4%(4/26)vs 1.7%(11/632),P=0.002 ]and the rate of perinatal mortality [31.2%(0/32)vs 2.8%(18/632)].Compared with the monozygotic twins without TTTS,in TTTS group there were more complications of the mother,the fetus and the neonates:gestational hypertension[20.8%(5/24)vs 9.9%(14/142),P=0.224],premature labor[66.7%(16/24)vs 49.3%(70/142),P=0.115 ],perinatal dead fetus in uterus [ 18.8%(6/32)vs 0.7%(2/282),P＜0.01 ],neonatal asphyxia [73.1%(19/26)vs3.9%(11/280),P＜0.01 ],the proportion of NICU[88.5%(23/26)vs 29.3%(82/280),P＜0.01],neonatal death[15.4%(4/26) vs 2.1%(6/280),P:0.006]and the rate of perinatal mortality[31.3%(10/32) vs 3.2%(8/282)].The perinatal outcomes were better in those cases that the grades of TTTS were below 3 in the first diagnosis.Conclusions We should try to diagnose and treat TTTS as early as possible because the outcome is poor.

Objective To investigate the effect of perinatal care on the reduction of the maternal and perinatal mortality. Methods The perinatal care and the relationship between the maternal and perinatal mortality during 1980 to 1997 were analysed. The factors that related to the morality were studied. Results The maternal mortality rate was significantly decreased from 31.7/10~5 live births in 1960 to 16.1/10~5 live births in 1992～1997. The main cause of maternal deaths in 1960' was obstetrical factors, but in 1997 it was pregnancy complications. The perinatal mortality rate was 21.2‰ in 1980～1981 ,and was 10.9‰ in 1992～1997. The factors related to the maternal and perinatal mortality including the perinatal care, high risk pregnancy,and birth weight were analysed, the specific mortality rate of each factor was calculated. Conclutions The two mortalities can be used to evaluate the result of perinatal care,and are important feedback information for making health care policy. Pernatal care play an important role in the reduction of maternal and perinatal mortality.

Objective To analyze the clinical features and diagnostic experiences of retroperitoneal neuroendocrine carcinoma (NEC).Methods Clinical data of primary retroperitoneal NEC from January 2000 to January 2012 were retrospectively collected and analyzed.Results Five candidates were included 4 male and 1 female.The median age was 53 years old.3 cases initially suffered from abdominal pain and radiative back pain,2 cases were confirmed by normal physical check.The CT scan and B type ultrasound were performed among all patients,1 case was diagnosed as pancreas head neoplasm,1 case pancreas insulinoma,which was closely associated with other tissues and the intervational therapy was performed twice preoperatively.All 5 cases were selected surgery as the main treatment,2 cases performed radical tumor resection,3 cases received bypass operation.2 cases were 3 years survival.Conclusion Retroperitoneal NEC is a rare carcinoma,characterized by seriously invasion and high malignant degree.Surgery still remains the mainstay of selections,early diagnosis can significantly improve NEC patients’ overall survival rate.But the early diagnosis rate of this rare kind of patients still need to be improved.

0.05). The fungus-carrier rate of newborn skin was 16.67% (8/48) in VVC group and 37.71% (23/61) in fungus-carrier group (P0.05; in the 48 cases who had received treatment during pregnancy, there was no neonatal diseases; in the 61 cases who did not receive any treatment, the morbidity of neonatal umbilical inflammation, diaper dermatitis and thrush were 4.92% , 19.67% and 3.28%, respectively. Conclusions Vertical transmission of VVC is possible during pregnancy. Those pregnant women with VVC have a higher neonatal morbidity.

Objective To observe the effect of acupuncture analgesia on delivery and observe the result of analgesia in mother and infant.Methods Totally 324 primiparae were randomized into four groups:Electro-acupuncture group,82 cases,transcutaneous electrical nerve stimulation(TENS)group,82 cases,control group,81 cases,and spinal-epidural analgesia group,79 cases.The VAS scores of pain,degree of satisfaction of analgesia,outcome of delivery and changes of endorphin concentration were observed during the delivery and after.Results Compared with the TENS group and control group,viewing from the VAS scores of 30~120 minutes after analgesia,the effect in the electro-acupuncture group was better,but not as good as that in the spinal-epidural analgesia group,the difference was significant(P

Objective To analyze the perinatal outcomes of those women experienced hypoglycemia during 75 g oral glucose tolerance test(OGTT).Methods A retrospective study was conducted in 774.pregnant women who underwent OGTT and delivered in our institution from January 2005 to January 2006.The distribution of glucose levels of the fasting,1 h,2 h and 3 h of the OGTT was analyzed.Plasma glucose level below the 5th percentile and above the 1h percentile was defined as hypoglycemia and those below the 1th percentile as exceeding hypoglycemia.Perinatal outcomes including birth weight,birth height,obstetric complications,the incidence of small for gestational age (SGA)were compared between women with hypoglycemia or exceeding hypoglycemia. Results The birth weight in exceeding hypoglycemia group of fasting glucose was significantly lower than that of the others [(2817±764)g vs(3439±487)g,t=3.344,P＜0.01]and the incidence of SGA in this group was also higher(3/7 vs 3.4%,x2=22.78,P＜0.01);the proportion of babies with birth weight＜3000 g in the same group was higher than the others(5/7 vs 14.73%,P＜0.01).The newhorns height was significantly shorter in the hypoglycemia group at 2 h than the normal glycemic group [(49.03±1.68)cm vs(49.48±1.65)cm,P＜0.05].Conclusions The plasma glucose 1evel is associated with the newborns'birth weight and height.Women with hypoglycemia during OGTT are more likely to have babies with lower birth weight and height.

Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in radical resection of hepatocellular carcinoma (HCC).Methods The propensity score matching (PSM) and retrospective cohort study were conducted.The clinicopathological data of 116 patients with HCC who were admitted to the Fuzhou General Hospital of Nanjing Command of PLA from June 2014 to January 2016 were collected.Fifty-eight patients using pre-,intra-and post-operative ERAS managements were allocated into the ERAS group and 58 using traditional perioperative managements were allocated into the control group.Observation indicators:(1) operation situations;(2) postoperative recovery:postoperative recovery time of bowel sound,time to initial anal exsufflation,time of drainage-tube removal,levels of alanine transaminase (ALT),total bilirubin (TBil),C-reactive protein (CRP) at 1,3 and 7 days postoperatively,postoperative complications (vomiting,abdominal distension,wound infection,intra-abdominal infection and pulmonary infection),duration of postoperative hospital stay,hospital expenses and satisfaction degree of patients;(3) follow-up situation.Followup using outpatient examination and telephone interview was performed to detect survival of patients up to March 2016.Measurement data with normal distribution were described as x±s.The comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).The comparison between groups was analyzed using the paried rank sum test.Repeated measurement data were evaluated by the repeated measures ANOVA.Results (1) Operation situations:all the patients underwent successful operations,without perioperative death.(2) Postoperative recovery:postoperative recovery time of bowel sound,time to initial anal exsufflation,time of drainage-tube removal,levels of ALT,TBil and CRP at 1,3 and 7 days postoperatively,duration of postoperative hospital stay,hospital expenses and satisfaction degree of patients were (49±10)hours,(60±10)hours,(3.3±0.7)days,(379±99)U/L,(222±65)U/L,(98±16)U/L,(20.4±4.7)μmol/L,(15.5±2.1)μmol/L,(13.4±1.8)μmol/L,(49±10)mg/L,(124±21)mg/L,(30± 5)mg/L,(9.7±0.9)days,(4.1±0.6) ×104 yuan,8.6±0.9 in the ERAS group and (53±5)hours,(64±7)hours,(6.2±1.6)days,(445± 114)U/L,(278±79) U/L,(116± 25) U/L,(18.6± 3.5) μmol/L,(17.0±2.7) μmol/L,(14.2±1.9)μmol/L,(53±11)mg/L,(135±35)mg/L,(34±6)mg/L,(10.0± 1.0) days,(4.3±0.5)x104 yuan,8.2±1.0 in the control group,respectively,with statistically significant differences between the 2 groups (t=2.537,2.479,2.065,F=20.075,14.357,13.460,t=2.060,2.197,2.370,P＜0.05).Number of patients with postoperative vomiting,abdominal distension,wound infection,intra-abdominal infection and pulmonary infection were 5,3,2,1,1 in the ERAS group and 6,6,7,5,3 in the control group,respectively,with no statistically significant difference between the 2 groups (x2=0.100,1.084,3.011,0.206,0.618,P＞ 0.05).(3) Follow-up situation:all the 116 patients were followed up for 1-20 months,with a median time of 11 months.During the follow-up,2 patients in the ERAS group died (1 dying of tumor recurrence and 1 dying of respiratory failure) and 3 in the control group died (1 dying of multiple organs metastasis,1 dying of lung metastasis of HCC and 1 dying of myocardial infarction).Conclusion ERAS in the perioperative management after radical resection of HCC is safe and effective,and it can quickly improve postoperative recovery of patients.

BACKGROUND:There are few clinical control ed trials about the clinical effects in patients with pertrochanteric femur fractures after treatment with short or long proximal femoral nail antirotation.
OBJECTIVE:To compare the clinical outcomes in patients with AO/ASIF-A1/2 pertrochanteric femur fractures after treatment with short or long proximal femoral nail antirotation.
METHODS:A total of 98 patients with AO/ASIF-A1/2 pertrochanteric femur fractures were treated by proximal femoral nail antirotation. They were divided into two groups according to the type of proximal femoral nail antirotation:short nail group (n=50) and long nail group (n=48). The operative time, blood loss, and hospital stay were recorded in both groups. In fol ow-up, fracture healing time, imaging and clinical complications were evaluated. In the final fol ow-up, Harris hip score was used to evaluate functional recovery.
RESULTS AND CONCLUSION:Compared with the short nail group, operative time was shorter and blood loss was less in the long nail group (P<0.05). No significant difference in hospital stay was detected between the short nail and long nail groups (P>0.05). Average fol ow-up periods were respectively (15.8±6.4) months and (16.2±5.7) months in the long nail and short nail groups.“Cutting-out”or infection occurred in five patients in the long nail group and three in the short nail group. Besides above-mentioned patients, the remaining patients in the two groups achieved fracture healing. No significant difference in average fracture healing time was detected between groups (P=0.588). In the final fol ow-up, no significant difference in Harris hip score was detectable in the two groups (P=0.204). The incidence rates of total postoperative complications in the long and short nail groups were 31.2%and 16.0%, respectively (P=0.075). Results suggested that no differences in the union and complication rates between the two groups were identified, suggesting that long nails offer no advantage compared with short nails for stabilizing AO/ASIF-A1/A2 pertrochanteric femur fractures.

AIM: Previous studies paid more attention to the effect of fibroblast immigration in normal surrounding tissue or blood on wound healing. This study explored the morphological character of fibroblasts after heat injury to support the new operation of autogenous epidermis overlapping denatured dermis. METHODS: The experiment was performed at the State Key Laboratory of Trauma, Burn and Combined Injury in the Third Military Medical University of Chinese PLA from April 2006 to April 2007. The dermal fibroblast from the infant prepuce disposed after surgery was cultured in vitro, and divided into 2 groups. In normal group, the dermal fibroblasts were put in water bath at 37 ℃ for 30 seconds; the cells in experimental group were stimulated at different temperatures (50, 51, 52, and 53 ℃) for different time (30, 60, 90, and 180 seconds). Cell survival was detected by MTT; morphology of injured cells were observed under inverted microscope and transmission electron microscope at 3 hours, 1, 2, 3, 4, 5, and 7 days; cell cycle was detected by flow cytometry. RESULTS: At different temperatures and different time, there were significant differences in the survival rate of fibroblast between the experimental groups and normal group (P

Objective To observe the effects of phlorohlucinol on cervical dilatation. Methods Totaling 250 normal parturients were randomized into four study groups (50 in each group) and control group (n=50). Phloroglucinol was given in the study groups(group1,2,3 and 4)at the dose of 40 mg to the cervix and/or 160 mg and 200 mg intravenously during the latent phase. The control group (group1) received only atropine (0.5 mg) intravenously. Results The overall speed of cervical dilatation in the study group was (2.82?1.82) cm/h and (1.78?1.01) cm/h in the control group. The mean time of the first stage of labor was (14.23?1.11) h and (17.71?2.23) h in the study and control group, respectively (P