Objective To evaluate the effectiveness and safety of invasive procedures of prenatal diagnosis for twin gestations through analysing the results and outcomes of twins.Methods Invasive prenatal diagnostic procedures guided by ultrasound were introduced to 164 twin pregnancies with various indications,including 111 amniocentesis,and 53 cordocentesis.The results of prenatal diagnosis,complications and outcomes of these twins were analyzed with Chi-square test or Fisher's exact test.Results (1) Chromosome was examined in 261 fetuses and 6.13% (16/261)had abnormal karyotypes.(2) Comparing amniocentesis with cordocentesis,the fetal loss rate within two weeks after the procedure were 0.00% (0/191) and 3.85% (3/78),respectively (P=0.024).The total fetal loss rate and preterm delivery rates in amniocentesis and cordocentesis group were 3.87% (6/155) and 5.45% (3/55),51.22% (42/82)and 38.71% (12/31),respectively (P=0.235and 0.618).(3) Selective feticide was performed on 18 cases after prenatal diagnosis.Fifteen cases had survival neonates,two cases suffered from spontaneous abortion,and two cases had preterm labor with neonatal death.Conclusions (1) Invasive prenatal diagnostic procedures are effective and feasible in twins.Amniocentesis is a relative safer and simpler alternative to cordocentesis,which demanding higher skill and carrying higher fetal loss rate.(2) Mid-trimester selective feticide after prenatal diagnosis appears safety.Before the procedure,the chorionicity and fetal condition should be considered,in order to choose suitable feticide procedures.

Objective To assess feasibility and advantages of the improved endoscopic resection of duodenal major papillary.Methods A total of 56 cases were collected in Drum Tower Hospital from October 2007 to December 2012, which were diagnosed as duodenal major papillary adenoma or carcinoma in situ, where tumor didn't extend to the biliary or pancreatic duct by the endoscopic ultrasonography, intraductal ultrasonography or histology of biopsy specimens.The diameters of these adenoma ranged from 0.3 cm to 5.0 cm.Twenty-four lesions were resected by routine endoscopic method and 32 lesions were removed by modified endoscopic method.All patients underwent ERCP and biliary and/or pancreatic stents were placed.Results En bloc resection rate was significantly higher in modified group(87.5％ ,28/32) than that in routine group (60.9％, 14/23, P ＜ 0.05).There were no significant differences in complete resection rates (93.8％ ,30/32 VS 87.0％, 20/23;P ＞0.05), or in the amount and difficulty of pancreaticobiliary stenting(P ＞ 0.05)between modified group and routine group.Short-term complication occurrence in modified group was lower than that of the routine group(15.6％ ,5/32 VS 41.6％, 10/24, P ＜ 0.05), but long-term complication occurrence showed no significant difference.There was no significant difference in recurrence rate between two groups[7.1％ (2/28) VS 15.0％ (3/20) ,P ＞0.05].Conclusion Endoscopic resection of duodenal major papillary adenoma with a modified method shows more therapeutic effect.

Objective To study the effects of fluid loading during fluid resuscitation on hemodynamics and cerebral perfusion(CPP)under different levels of intra-abdominal pressure(IAP).Methods Forty swine were employed in the study.Hypovolemia was made by blood withdrawal of 30% of estimated blood volume from each animal through the carotid artery line.All swine were randomized(random number) into four groups, namely IAPL0, IAPL15, IAPL25 and IAPL35.Then N2 gas was used to inflate in the abdomen slowly for elevating the IAP to 0,15, 25 and 35 mmHg.Fluid loading were performed with 500 mL hydroxyethyl starch within 30 minutes.Hemodynamic variables were evaluated by PiCCO.Heart rate (HR),mean arterial pressure(MAP), central venous pressure(CVP), cardiac output(CO), global end-diastolic volume index(GEDVI) and stroke volume index(SVI)were measured 30 minutes before fluid loading and 30 minutes after fluid loading.After placement of intracranial pressure optical fiber probe in the ventricle connected to intracranial pressure monitor for continuous monitoring of ICP changes, cerebral perfusion pressure (CPP) could be calculated.Results (1)HR decrease, MAP increased, SVI, CI and GEDVI significantly increased after fluid loading in all four groups (IAPL0,IAPL15,IAPL25 and IAPL35)(P<0.05),and there were not significant changes in CVP and EVLWI(P>0.05).SVRI decreased significantly in group IAPL15,IAPL25 and IAPL35 respectively(P<0.05).(2) ICP increased significantly in group IAPL15, IAPL25 and IAPL35(P<0.05), and CPP increased significantly in group IAPL25 and IAPL35(P<0.05) while CPP only slightly increased in group IAPL15(P>0.05).Conclusion When combined with intra-abdominal hypertension,fluid loading could improve the circulation of swine due to increase in CO and improve CPP.

Objective To investigate the efficacy of pancreatic duct stent in preventing post-ERCP pancreatitis (PEP) of difficult bile duct cannulation.Methods A total of 120 patients who underwent difficult bile duct cannulation during routine ERCP were randomized to receive pancreatic duct stent placement (S group) or not (NS group),and the incidence of PEP,hyperamylasemia and scores of abdominal pain were analyzed.Results There were 15 cases of hyperamylasemia and 5 cases of PEP occurred in S group,but no severe PEP was observed.The score of abdominal pain was (3.82 ± 1.48) in S group.There were 18cases of hyperamylasemia and 14 cases of PEP occurred,including 2 severe PEP in NS group.The score of abdominal pain was (7.48 ± 1.93) in NS group.There was no significant difference in the incidence of hyperamylasemia between the two groups (P ＞ 0.05).The incidence of PEP,severe PEP and the scores of abdominal pain were lower in the S group (P ＜ 0.05).Conclusion Placement of pancreatic duct stent can reduce the PEP rate of difficult bile duct cannulation and relieve the abdominal pain.

Objective To investigate the risk factors of post-ERCP pancreatitis( PEP). Methods Data of 4,234 patients who underwent ERCP in Nanjing Drum Tower Hospital were retrospectively analysed. Information of patients and operations,including age,gender,operation history,major disease history,labora-tory examination before operation,abdominal ultrasound,CT,MRCP,detailed ERCP operation process,com-plications and treatment were carefully recorded. Then Chi-square test was used for univariate analysis,and stepwise multivariate Logistic regression for variate analysis. Linear correlations between risk factors were de-tected. Results There were totally 226 PEPs,with 5. 3% incidence rate. Univariate analysis showed that the female(χ2 =9. 715,P=0. 002),young( <60 years)(χ2 =6. 108,P=0. 013),chronic pancreatitis(χ2 =14. 703,P=0. 001),initial ERCP(χ2 =14. 899,P=0. 000),hypertension(χ2 =4. 489,P=0. 034),nor-mal bilirubin levels before operation(χ2 =19. 159,P =0. 000 ),difficult cannulation(χ2 =45. 824,P =0. 000),pancreatic guide wire(χ2 =30. 223,P=0. 000),papillary pre cut(χ2 =45. 928,P=0. 000),pan-creatography(χ2 =20. 170,P=0. 000)may be risk factors for PEP. Non conditional Logistic regression analy-sis showed that female(OR=1. 449,P=0. 011),initial ERCP(OR=1. 745,P=0. 003),normal bilirubin levels before operation(OR=1. 917,P=0. 000),difficult cannulation(OR=3. 317,P=0. 000)and pancre-atography(OR=1. 823,P=0. 004)were independent risk factors for PEP. Linear correlation analysis sugges-ted that pancreatic duct guide wire and papillary precut were related to the difficult cannulation,and the corre-lation coefficients were -0. 788 and -0. 699. Conclusion Female,young(<60 years),chronic pancreati-tis,initial ERCP,hypertension,normal bilirubin levels,difficult cannulation,pancreatic duct guide wire,pa-pillary precut,pancreatography may induce PEP. Female,normal bilirubin levels before operation,initial ER-CP,difficult cannulation and pancreatography are independent risk factors for PEP,while pancreatic duct guide wire,papillary precut are not,as they were linear correlated to difficult cannulation.

Objective To evaluate the validity of stroke volume variation (SVV) for predicting fluid responsiveness in different grades of intra-abdominal pressure (IAP).Methods Forty pigs were involved in the study.Hypovolemia was made by blood withdraw of 30% of estimated blood volume from each animal via carotid artery.All the pigs were randomized into four groups namly 0 mm Hg (L0), 15 mm Hg (L15), 25 mm Hg (L25) and 35 mm Hg (L35).Nitrogen was inflated slowly till IAP to 0, 15, 25 and 35 mm Hg.Fluid loading was performed with 500 ml hydroxyethyl starch within 30 minutes.Hemodynamic parameters were evaluated by the thermodilution technique of pulse induced continuous cardiac output (PiCCO).SVV and stroke volume (SV) were measured before and after fluid loading.Results In groups L0 and L15, SVV was positive correlated with changes in SV (r=0.888, 0.942, respectively, P<0.05).In groups L25 and L35, there were poor correlations between SVV and changes in SV(r=0.068,-0.114, respectively).Conclusion When IAP was slightly increased up to 15 mm Hg, SVV remains an effectiveness index to predict fluid responsiveness index, however it failed to assess fluid responsiveness effectively when IAP is further raised up to 25 mm Hg or more.

Objective To assess the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for children with pancreaticobiliary diseases. Methods Data of children under 14 years old who have underwent ERCP in Nanjing Drum Tower Hospital between September 2007 and August 2016 were reviewed for completion, complications and therapeutic methods. Results A total of 41 children underwent 68 ERCP, including 6(8. 8%) diagnostic and 62(91. 2%) therapeutic procedures. All procedures were performed under deep sedation. Cannulation failed in only 1 child with anomalous junction of pancreaticobiliary duct. The procedure success rate was 98. 5%( 67/68 ) . There were 8 adverse events, including 7 mild post?ERCP pancreatitis and 1 fever. Incidence of adverse event was 11. 8%( 8/68) . There was no such severe adverse event as bleeding, perforation, death, or other anesthesia related adverse event. Thirty?two children ( 78. 0%) had follow?up, ranging from 2 month to 6 years. Children followed lived well with no long?term adverse event. Conclusion ERCP is an effective and safe procedure for the diagnosis and treatment of pancreaticobiliary diseases in children.

Objective:To study the effects of new antiepileptic drugs (AEDs), including Topiramate (TPM), Oxcarbazepine(OXC), Lamotrigine(LTG), and Levetiracetam (LEV) monotherapy on bone metabolism in children with epilepsy aged 4-12.Method:s One hundred and sixty children with epilepsy who were diagnosed for the first time at Shanxi Children′s Hospital from July 2016 to June 2017 were selected and given oral TPM (40 cases), OXC (40 cases), LTG (40 cases) and LEV (40 cases) respectively according to the type of seizure.The changes of bone mineral density (BMD) and bone metabolism indexes including serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), osteocalcin (OC), parathyroid hormone (PTH), 25 hydroxyvitamin D [25-(OH)D] before treatment and at 3, 6 and 12 months after treatment were observed.Result:s (1) Bone metabolism indicators and BMD had no significant difference among groups before treatment (all P>0.05). (2) After 6 and 12 months of treatment in OXC group, Ca was lower than before treatment[2.38(0.08) mmol/L vs.2.47(0.17) mmol/L, 2.44(0.10) mmol/L vs.2.47(0.17) mmol/L], PTH was higher than before treatment[37.64(17.52) ng/L vs.34.23(20.53) ng/L, 40.74(16.15) ng/L vs.34.23(20.53) ng/L]; Ca in TPM group decreased after 6 and 12 months of treatment[2.40(0.11) mmol/L vs.2.42(0.10) mmol/L, 2.41(0.09) mmol/L vs.2.42(0.10) mmol/L], and the differences were statistically significant(all P<0.05). (3) After 6 and 12 months of treatment, Ca in the OXC group was lower than that in the LEV group[2.38(0.08) mmol/L vs.2.44(0.10) mmol/L, 2.44(0.10) mmol/L vs.2.44(0.12) mmol/L] and LTG group[2.38(0.08) mmol/L vs.2.44(0.13) mmol/L, 2.44(0.10) mmol/L vs.2.42(0.13) mmol/L], and PTH in the OXC group was higher than that in the LEV group[37.64(17.52) ng/L vs.36.52(20.71) ng/L, 40.74(16.15) ng/L vs.31.89(14.84) ng/L] and LTG group[37.64(17.52) ng/L vs.39.39(24.03) ng/L, 40.74(16.15) ng/L vs.33.01(12.20) ng/L], Ca in TPM group after 12 months of treatment was lower than that in the LEV group[2.41(0.09) mmol/L vs.2.44(0.12) mmol/L] and LTG group[2.41(0.09) mmol/L vs.2.42(0.13) mmol/L], and the differences were statistically significant(all P<0.05). Conclusions:In the new AEDs, LEV and OXC have no significant effect on bone metabolism.TPM may affect bone metabolism by reducing Ca in children with epilepsy, and OXC may cause the decrease of Ca and the increase of PTH, thereby leading to increased bone turnover in children with epilepsy.

Objective To investigate the effect of nursing interventions on type 2 diabetic ( T2DM ) patients after laparoscopic gastric bypass surgery treatment. Methods Eighty patients with T2DM cases of laparoscopic gastric bypass surgery in accordance with balloting were divided into control group and observation group, each of 40 cases, which were treated with routine care and personalized care respectively, the indicators (including BMI, FPG, 2 h postprandial blood glucose, HbA1c and fasting C-peptide), SAS and SDS scores, postoperative recovery time indicators were compared before and after treatment. Results BMI, FPG, 2 h postprandial blood glucose, HbA1c and fasting C-peptide levels were statistically significant differences between two groups before and after nursing ( P<0 . 05 ) , and these indicators were statistically significant difference between two groups after treatment ( P<0 . 05 ); SAS and SDS scores were statistically significant differences in two groups before and after nursing (P<0.05), and post-treatment observation group was significantly lower than the above rates in the control group after treatment ( P<0 . 05 ); First ambulation time, exhaust time and wound stitches first time of observation group were significantly lower than the control group, the difference was significant ( P<0 . 05 ) . Conclusion Nursing intervention targeted patient care of laparoscopic gastric bypass surgery in the treatment of T2DM is significant effect, it is worth to the promotion and application in clinical practice.

Objective:To investigate the effects of levetiracetam on bone metabolism and thyroid hormone levels in children with epilepsy.Methods:A total of 20 children with epilepsy first diagnosed in our hospital from July 2016 to June 2017 were selected as the treatment group, the other 20 children who received physical examination in the same period were selected as the control group.The treatment group was given oral LEV monotherapy for 12 months.The changes of bone metabolism indexes[blood calcium, blood phosphorus, alkaline phosphatase activities, osteocalcin, parathyroid hormone, 25-(OH)D], bone mineral density(BMD)and serum thyroid hormone(triiodothyronine, tetraiodothyronine, free triiodothyronine, free thyroxine, thyroid stimulating hormone) in the control group and the treatment group were detected before, 6 and 12 months after medication.Results:(1)There were no statistically significant differences in bone metabolism indexes and BMD between the control group and the treatment group before medication( P>0.05). The differences showed no statistically significant in bone metabolism indexes and BMD among different time points of treatment group( P>0.05). (2)There were no significant differences in thyroid hormone levels between the control group and the treatment group before medication( P>0.05). There were no significant differences in thyroid hormone levels among different time points of treatment group ( P>0.05). Conclusion:Levetiracetam has no significant effects on bone metabolism and thyroid hormone level in epileptic children.