ObjectiveTo investigate the differences in pregnancy outcomes between dichorionic diamniotic （DCDA） twin pregnancies conceived via assisted reproductive technology （ART） and those from spontaneous conception， in order to provide evidence for the perinatal management of ART-conceived DCDA twins. MethodsA retrospective analysis was conducted on the clinical data of 549 DCDA twin parturients. Based on the mode of conception， they were divided into ART group （423 cases） and spontaneous conception group （126 cases）. The baseline characteristics， pregnancy complications and neonatal outcomes were compared between the two groups. ResultsRegarding baseline characteristics， the ART group had higher maternal age， number of previous abortions， proportions of primiparas， proportions of advanced maternal age and greater 24-hour postpartum blood loss， but lower parity and proportion of scarred uterus compared to the spontaneous conception group （P<0.05）. For pregnancy complications， the ART group exhibited higher incidences of hypertensive disorders of pregnancy， placental adhesion， postpartum hemorrhage and a higher application rate of uterine artery ascending branch ligation （P<0.05）. There were no statistically significant differences in neonatal-related indicators between the two groups. After adjusting for confounding factors such as age， number of abortions and parities， ART remained an independent risk factor for hypertensive disorders of pregnancy， placental adhesion and postpartum hemorrhage （P<0.05）， while it did not increase the risk of adverse neonatal outcomes. Further subgroup analysis by gestational age showed that in the late preterm subgroup， the risk of ART-related pregnancy complications remained elevated （P<0.05）. Additionally， neonatal outcomes showed no significant difference between the two groups in both the late preterm and term subgroups. ConclusionART increases the risk of hypertensive disorders of pregnancy， placental adhesion and postpartum hemorrhage in DCDA twin parturients. Clinically， enhanced monitoring of blood pressure during pregnancy and blood loss during delivery and postpartum， along with targeted prevention and management of these complications， are crucial for improving pregnancy outcomes.

Objective To discuss the experience of open heart operation on beating in complex and severe congenital heart diseases. Method This kind of operation was put to use in 48 cases of the heart diseases in order to observe the effect of myocardial protection, prevention from air embolism,exposure of the operative field, and cardiopulmonary bypass. Results Operation field exposure was clear enough to finish the manipulation. One cases was eventiful postoperatively and died(2.08%). Conclusion Open heart operation on beating with slight hypothermia might have much feasibility in the part of complicated and severe congenital heart diseases.

Objective To summarize the clinical experience of video-assisted thoracoscopic surgery (VATS) for thoracic diseases. Methods Clinical data of 207 patients receiving VATS form October 1997 to March 2004 were retrospectively analyzed. Among them, there were 155 cases of spontaneous pneumothorax treated by pulmonary bubble ligation or resection, 30 cases of spontaneous or traumatic hemopneumothorax treated by urgent exploration, 14 cases of pulmonary benign diseases undergoing pulmonary wedge resection and biopsy, and 8 cases of mediastinal tumor resection. Results Surgical procedures were completed thoracoscopically in 190 patients and were accomplished under thoracoscope with an additional mini-thoracotomy in 12 patients, while conversions to open surgery were required in 5 patients. The time of surgical procedures was 20~180 min (mean, 56 min). The postoperative hospital stay was 5~52 d (mean, 9 d). Postoperative complications occurred in 17 cases (8.2%, 17/207), including 9 cases of persistent air leakage, 6 cases of re-expansion pulmonary edema, and 2 cases of infection of thoracic cavity. Spontaneous pneumothorax reoccurred in 2 patients 3~4 months postoperatively. Conclusions VATS offers more advantages over traditional thoracotomy for the treatment of spontaneous pneumothorax pulmonary bubble, traumatic hemopneumothorax and selected chest benign diseases. The combination with mini-thoracotomy under certain circumstance may contribute to assuring the safety of this procedure.

Objective: To study the effect and mechanism of delayed preconditioning induced by adenosine A 1 receptor. Methods: Male Wistar rats in group A, C,D,K were preconditioned with CCPA, normal salt, Pyrrolidin diethyldi thiocarbamate(DDTC), DDTC +CCPA, respectively. The hearts were isolated and perfused with H-K buffer solution on the Langendorff apparatus 24 hours later,the isolate heart was perfused modified St.Thomas solution for 180 minutes at 4℃, and then reperfused with the H-K buffer for 60 minutes at 37℃. Results:The left ventricular function (+dp/dt max ,%) and myocardial ATP level in group A were better than those of C, D, K groups (P