Rupi Sanjie Xiaotong Plaster in Treating Breast Hyperplasia of Liver Stagnation and Phlegm Coagulation Pattern

Objective:To observe the clinical efcacy and safety of external application of Rupi Sanjie Xiaotong Plaster(乳癖散结消痛膏,RPSJXTP)in treating breast hyperplasia of liver stagnation and phlegm coagulation pattern.Methods:Totally 72 female patients with breast hyperplasia of liver stagnation and phlegm coagulation pattern admitted to the First Hospital Affiliated to Henan University of Chinese Medicine were enrolled by ran-domized,single-blind,placebo-controlled research method,and were divided into the treatment group(36 ca-ses)and the control group(36 cases)according to computer random number method.The treatment group were given RPSJXTP,while the control group were gi ven placebo plaster.The course of treatment in both groups was 8 weeks.The breast pain score,breast color ultrasound score,lump score,depression score,and Chinese medicine syndrome score were compared between the two groups at different times.The levels of estra-diol(E_(2)),progesterone(P)and pituitary prolactin(PRL)were detected and the adverse reactions of two groups were observed during the treatment of both groups.Results:Before treatment,there was no significant difference in total breast pain score,breast color ultrasound score,lump score,depression score and levels of serum P,E_(2)and PRL between the two groups(P>0.05);compared with previous treatment,the total breast pain score,breast color ultrasound score,lump score,and depression score significantly decreased in the treat-ment group(P<0.05),and the total breast pain score and depression score of the control group significantly declined(P<0.05);compared with control group,the total breast pain score,breast color ultrasound score,lump score,and depression score significantly decreased after treatment in the treatment group(P<0.05).The improvement rate of Chinese medicine syndromes and the clinical efective rate in the treatment group were higher than those in the control group(P<0.05).There were no serious systemie adverse reactions during the treatment in both groups.Local pruritus occurred in 3 cases in the treatment group and 1 case in the control group.Conclusion:RPSJXTP is effective in treating breast hyperplasia of liver stagnation and phlegm coagula-tion pattern.It can effectively relieve the breast pain which will not recur after stopping of drug use,which can reduce the color ultrasound score,lump score,and depression score of the patients and improve Chinese medi-cine syndromes without serious adverse reactions.

Fetal reduction by bipolar cord coagulation in managing complicated monochorionic multiple pregnancies： preliminary experience in China

Background Monochorionic multiple pregnancies （MMPs） are associated with higher rates of perinatal morbidity and mortality caused by interfetal vascular anastomoses in the monochorionic placenta, which can lead to fetal health interactions. In some circumstances, selective feticide of the affected fetus is necessary to save the healthy co-twin. We evaluated the effects and safety of our initial experiences using bipolar cord coagulation for the management of complicated MMPs. Methods Using ultrasound-guided bipolar cord coagulation, we performed selective feticide on 14 complicated MMPs （5 with twin-twin transfusion syndrome, 4 with acardia, 3 with discordant structural anomalies, and 2 with severe selective intrauterine growth restriction）. One patient with monochorionic triplets received the procedure twice to terminate 2 affected fetuses for different JndJcatJons. Data regarding the operations, complications and neonatal outcomes were analyzed. Results Cord occlusions were successfully performed in 13/14 （93%） cases. The failure happened in an acardiac fetus and the pregnancy was terminated by induction. The included cases delivered at a mean gestational age of 35.4 weeks with a perinatal survival rate of 11/13 （85%）. Three operation-related complications occurred （21%）, including membrane rupture of the terminated sac （1 case）, preterm labor at 28 weeks gestation （1 case）, and chorioamniotic membrane separation （1 case）. Amnioinfusion was indicated in 11 procedures to expand the target sacs for entering the trocar and obtaining sufficient working space. However, in all 4 cases of acardia, the acardiac sacs showed extreme oligohydramnios and could not be well expanded by infusion; thus, the trocar had to be inserted from the sac of the preserved co-twin. Conclusions The application of bipolar cord coagulation in complicated MMPs is safe and improves the prognosis. Amnioinfusion is useful in helping to expand the target sac when the working space is limited.