Objective To compare the outcomes of selective feticide by umbilical cord ligation (UCL),bipolar cord coagulation (BCC) and radiofrequency ablation (RFA) in the treatment of complicated monochorionic twins.Methods We retrospectively analyzed all cases of complicated monochorionic twin pregnancies treated at Peking University Third Hospital from August 2008 to December 2014.The indications for surgery included severe twin-to-twin transfusion syndrome (TTTS),selective intrauterine growth restriction (sIUGR) (type Ⅱ and Ⅲ),twin reversed arterial perfusion sequence (TRAP) or discordant anomaly.One-way ANOVA,LSD t test,Mann-Whitney U test,Chi-square or Fisher's exact test were used for statistical analysis.Results (1) A total of 68 patients chose selective feticide by different techniques,including fetoscopic UCL (n=18,UCL group) and ultrasound-guided RFA (n=46,RFA group).The other four patients treated by bipolar cord coagulation (BCC) were excluded.The maternal age,proportion of assisted reproductive technology,indications,gestational age and mean birth weight all showed no differences between the two groups (P＞0.05).One case of anterior placenta was found in UCL group,fewer than in the RFA group (27 cases,36.9％)(x2=4.853).No fetal loss occurred within two weeks in UCL group,but there were seven cases (seven cases,15.2％) of earlier fetal loss in RFA group (x2=4.952).The median operation time was (63.2±22.5) min in UCL group,and longer than in the RFA group (33.3 ± 11.4) min (t=5.165),all P＜0.05.(2) The gestational age of TTTS and TRAP patients for feticide was older than patients with sIUGR and discordant anomaly [(22.7± 3.0),(22.8±3.2),(20.3 ± 2.5) and (20.4± 3.6) weeks,respectively,F=2.957,P=0.040].Fetal loss rate within two weeks in patients with discordant anomaly was higher than in other groups (4/11 vs 1/10,0/23 and 1/15,P＜0.05).The survival rate,gestational age at delivery and mean birth weight showed no significant differences among the four groups.(3)Compared with feticided fetuses at the upper uterine cavity,the fetal loss rate was higher,and the operation time,gestational age at delivery,birth weight and neonatal survival rate were lower than those performed at the lower uterine cavity,but the difference was not significant.Conclusions RFA provides similar outcomes of selective feticide in complicated monochorionic twins compared with UCL,while RFA is easier to operate.

Objective To evaluate the placental characteristics in monochorionic (MC) twin pregnancy with selective fetal growth restriction (sFGR). Methods Fifty-five placentas from women with MC twin pregnancy were included, who had terminated pregnancy in the Peking University Third Hospital between June 1, 2013 and June 1, 2014, including 23 cases with sFGR and 32 uncomplicated cases as control group. We perfused the placentas within 24 h after delivery, and pigment of four different colors was used to perfuse the umbilical arteries and veins of both twins and determine the types of vascular anastomosis. Umbilical cord insertion, placental territory discordance (PTD, the territory difference between two placentas/the bigger one), and the type, number and diameter of placental superficial vascular anastomosis were analyzed using two independent samples t-test, nonparametric test,χ2 test or Fisher's exact test. Results The PTD was 0.60(0.10-0.80) vs 0.22(0.00-0.90) in sFGR group and control group (Z=-3.913) respectively, and the proportion of placenta with uneven share was 91.3%(21/23) vs 50.0%(16/32) (Fisher's exact test), which were significantly higher in sFGR group (both P < 0.01). The proportion of non-central cord insertion was 82.6% (19/23), 13.0% (3/23) and 40.6% (26/64), respectively, in smaller fetus of sFGR, bigger fetus of sFGR and control group, which was significantly higher in smaller fetus of sFGR than in the other two groups (Fisher's exact test, both P < 0.01). The proportion of arterioarterial (AA), arteriovenous (AV) and venovenous (VV) anastomosis in sFGR group and control group was 78.3%(18/23) vs 75.0%(24/32), 82.6%(19/23) vs 71.9%(23/32), and 17.4%(4/23) vs 15.6%(5/32);there were no significant differences between two groups (Fisher's exact test,all P>0.05). The number of AA, AV and VV anastomosis in sFGR group and control group was 1.0 (0.0-2.0) vs 1.0 (0.0-4.0), 3.0 (0.0-10.0) vs 2.0 (0.0-5.0), and 0.0 (0.0-1.0) vs 0.0 (0.0-3.0) (Z=-0.256, -0.142 and -0.123);the total diameter of AA, AV and VV anastomosis was 2.7 (0.0-7.0) vs 2.2 (0.0-9.7), 4.0 (0.0-13.7) vs 3.4 (0.0-11.5), and 0.0 (0.0-7.9) vs 0.0 (0.0-7.1) mm (Z=-0.070, -0.087 and -0.087);there were no significant differences between two groups (all P>0.05). The total number of all anastomosis was 3.5 (0.0-10.0) vs 3.5 (0.0-6.0) (Z= - 0.567); the total diameter of all anastomosis was 6.9 (0.0-22.4) vs 5.9 (0.0-17.1) mm (Z= - 0.556); there were no significant differences between two groups (all P>0.05). Conclusions Placental sharing discordance and non-central cord insertion may be the risk factors for MC pregnancies complicated with sFGR.

Objective To observe the effect of acupuncture on cerebral palsy children. Methods90 children with cerebral palsy were divided into the observation group (acupuncture and comprehensive rehabilitation) and control group (comprehensive rehabilitation). They were assessed with Gross Motor Function Measure and the Gesell Development Schedules before and 3 months after treatment. ResultsThe total effective rate was 95% in observation group, and 80% in the control group (P<0.01). The score of gross motor function and Gesell adaptive development quotient improved more in the observation group than in the control group (P<0.01). ConclusionAcupuncture is efficacious on functional recovery in children with cerebral palsy

The authors reviewed the research and development of tissue engineered meniscus from three points (cell seeds, scaffolds, cell factors) and point out current questions and investigative direction in the future.

0.05).In terms of toxicity,Aleucocytosis,phlebitis and constipation were more common in NP group while thrombocytopenia and skin rash were more common in GP group(P

Objective:To observe slit expression on the model of DMBA induced cheek pouch caricnoma in hamsters in various stages, so as to elucidate the relationship between slit expression and angiogenesis.Methods:Carcinogenesis model (HBPCa) was established in 60 hamsters by topical application of 5 g/L DMBA in left buccal pouch three times per week for 14 weeks.Slit expression, vascular endothelial growth factor (VEGF) and von Willebrand factor (v-WF) were examined by immunohistochemical staining,microvascular dense(MVD) was measured 6-16 weeks respectively after application of DMBA.Results:Carcinoma was developed in all the hamsters.Slit,VEGF and v-WF expression and MVD were all increased with the development of carcinoma(P

Optic nerve is composed by the axonal of retinal ganglion cells,there are no Schwann cells around it,and optic nerve belongs to the central nervous,so it cannot regenerate when injuried. In 1985 So and Aguayo have made a success in peripheral nerve retinal transplant,which completely changes the concept that optic nerve injury cannot regenarate. Currently nerve injury recovry has following several methods: use of neurotrophic factor,such as nerve growth factor,ciliary neurotrophic factor and brain-derived neurotrophic factor,etc. These factors could promote the regeneration and repair of retinal ganglion cells; treatment of gene correction and gene regulation,by changing the expression of host gene,reduce the effect due to the disease,slow the progress of the disease course or provide protection against the disease; neural stem cell transplantatin and tissue-engineered Schwann cell transplantion. But these treatments are still at the stage of animal experiment,how timely and effctively reduce the apoptosis and increase the survival rate of ganglion cells,even further promote nerve regeneration and recovery,there is still not a perfect method so far.

Objective To evaluate the effect on maternal blood dilution of fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in treating twin to twin transfusion syndrome(TTTS). Methods The clinical data of 71 cases of TTTS who had FLOC in Peking University Third Hospital were reviewed. Fluid intake, blood pressure, heart rate, red blood cell count, hemoglobin and hematocrit in perioperative 24 hours were analyzed. Results (1)According to the Quintero staging, 9 cases were stageⅠ, 24 were stageⅡ,28 were stageⅢand 10 cases were stageⅣ.(2)The average operation time of FLOC was (64.0±16.3) minutes. One case had placental abruption after the procedure;one had placental vessel rupture and 6 women refused to take blood counting. These 8 cases were excluded and 63 cases were included in the study. (3) The perioperative bleeding volume was 3 (1, 5) ml, and the volume of fluid intake, urine, amniotic fluid drainage and net fluid intake in the perioperative 24 hours was 2 050 ml(1 530 ml, 3 700 ml), 2 300 ml (1 100 ml, 3 500 ml), 1 900 ml (1 400 ml, 2 700 ml) and -1 760 ml (-100 ml,-3 350 ml), respectively. There was no significant difference between maternal blood pressure or heart rate preoperatively and postoperatively.(4)The maternal red blood cell count [(3.47±0.36)×1012/L versus (3.01± 0.37) × 1012/L, P=0.000], hemoglobin [(107.8 ± 12.1) g/L versus (95.1 ± 11.2) g/L, P=0.000] and hematocrit [0.313(0.238, 0.387) versus 0.276(0.213, 0.800), P=0.000] decreased significantly 24 hours after FLOC.(5) The postoperative hematocrit decreased more in the group which the amniotic fluid drainage volume was 2 000- 3 000 ml than that in the group which the amniotic fluid drainage volume was 1 000-1 999 ml. Conclusions The blood dilution can not be ignored after the FLOC in TTTS patients. The more the amniodrainage volume during the FLOC, the more the maternal blood dilution would be. It might result from amniodrainage during the FLOC, improved maternal-placenta circulation and tocolytics used after FLOC. More attention should be take about maternal cardiac function and complications related with anemia after FLOC.

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.