Objective To compare the efficacy of Letrozol ( LE) regimen for ovulation induction in elderly and younger patients with polycystic ovary syndrome (PCOS).Methods A total of 67 ovulation induction cycle by LE regimen in patients elderly than 35 years old or younger than 28 years old with PCOS were studied .The endometrial thickness,morphology,number of dominant follicles,ovulation on the day of injection HCG and pregnancy outcome were recorded.Results The endometrial thickness were significantly different between the two groups [(7.9 ±1.7) mm vs (9.4 ±3.2)mm,t=2.648,P<0.05],but the endometrial morphology of AB type ,the number of dominant follicles and ovulation,pregnancy rate were indifferent [71.9% vs 77.8%,(1.5 ±1.5) vs (1.4 ±1.2),(1.3 ± 0.8) vs (1.4 ±1.2),37.5%vs 27.8%,t=2.456,1.995,1.758,1.525,all P>0.05].Conclusion LE regimen for ovulation induction is effective for PCOS patients of all ages ,although the elderly patients with endometrial thick-ness is less than that in younger ones .The number of dominant follicles ,endometrial morphology and ovulation is no different,don′t reduce pregnancy rates .

Objective To investigate the operative techniques of microsurgery treatment of M1 segment of middle cerebral artery (MCA) aneurysms via pterional approach in 132 cases.Methods Retrospectively analyzed the clinical manifestation,angiograms,and surgical operation data of 132 patients with M1 segment of MCA aneurysms who underwent microsurgery through pterional approach.Results Preoperative digital subtraction angiography (DSA) was conducted in 121 cases to identify the size,shape,orientation and relationship with blood vessels around the MCA aneurysms.The other 11 cases underwent emergency operation.Among the 132 cases,72 patients were discharged in good condition according to Glasgow Outcome Scale; 41 patients were in poor condition; 19 cases were dead or in predying state.Postoperative CT showed that49 cases occurred new infarction and 7 cases developed hydrocephalus or enlargement of ventricles.Ventriculoperitoneal shunt was conducted in 2 cases.Intraoperation rupture and bleeding of aneurysms occurred in 17 cases.Conclusion The aneurysms in M1 segment of the middle cerebral artery are mostly located in the bifurcation of M1 segment.Most branches and perforating arteries stem from middle cerebral artery trunk.Patients with Hunt-hess grade Ⅰ-Ⅲ MCA aneurysms or with Hunt-hess grade Ⅳ,Ⅴ should be treated with microsurgery as soon as possible.Inside Sylvian fissure approach is the most frequently adopted in microsurgery via pterional approach.It is key for the success of the operation to preoperatively understand the anatomy surrounding the aneurysms,have good microsurgical skills and employ correct methods of preventing and managing of rupture of aneurysm.It can relieve the secondary cerebral vasospasm to clear up hematocele in the cisterns or to wash the cisterns or use adhesive wound dressing on blood vessels during operation using papaverine.

Objective To investigate the effects of ISO-1, a selective MIF tautomerase activity inhibitor, on liver metastasis in a BALB/c mouse model of colonic cancer. Methods Micmporous migration assay was used to determine the effect of ISO-1 on the invasion abilities of CT26 cells. Orthotopic transplantation of fresh colonic tumor fragments into the hernial sac of cecum was used in a BALB/c mouse model of eolorectal cancer. Thirty mouse models were divided into three groups and treated respectively with ISO-1 (0. 2 ml, 20 mg/kg), 5% DMSO and NS ( normal sodium) twice a week, iutraperitoneally. After 4 weeks, mice were sacrificed and the whole livers were made into serial slices to detect the occurrence of liver metastasis. Serum MIF tautomerase activities were measured using L-dopachrome methyl ester, ELISA was used to test serum VEGF concentrations. Immunohistochemical staining of CD31 was used for comparing microvascular density (MVD) of tumor tissues. Results 100 μmol/L ISO-1 treatment for 24 hours significantly reduced the average number of the cells penetrating polycarbonates, ( 151 ± 19 ) vs. ( 178 ± 9 ), P<0. 01. Serum MIF tautomerase activities were significantly inhibited after ISO-1 treatment (51% vs. 81%, P <0. 01 ). Compared with DMSO and NS treatment, ISO-1 decreased the occurrence of liver metastasis ( 10% ,60% and 70% ,respectively;x2 = 8. 30, P < 0. 05 ). Also ISO-1 decreased serum VEGF levels ( 15 ± 7 ) pg/ml, ( 63 ± 11 ) pg/ml and ( 67 ± 8 ) pg/ml, respectively; P < 0. 01 and the MVD of tumor tissues (17±4) ,(36±7) and( 38±5) ,respectively; P<0. 01. Conclusion In vitro ISO-1 inhibits the invasion ability of CT26 cells. In vivo ISO-1 reduces the occurrence of liver metastasis, possibly by a mechanism of inhibiting MIF tautomerase activities, down-regulating the expression of VEGF and reducing MVD.

Objective To investigate the effects of rapamycin on the expression of glioma patients tumor helicase RECQ1.Methods 50 glioma patients admitted to the department of neurosurgery in second hospital of hebei medical university were selected and randomly divided into 2 groups,25 patients in control group,were treated with routine admission surgical treatment;25 cases in the experimental group,firstly were given rapamycin capsule 1 mg,1 times/day orally,took 14 days in a row,and had surgical treatment after stopping drug a week.Glioma tissue samples were taken during the operation,mRNA and protein expression of tumor helicase RECQ1 were detected by reverse transcriptase polymerase chain reaction(RT-PCR)and Western blot.Results Glioma tumor helicase RECQ1 mRNA expression in the control group increased more significantly than experimental group,the optical density value in control group was(1.657 ±0.748),while the experimental group optical density value was(1.059 ±0.894),and the difference was statistically significant(P<0.05 );all organizations had the expression of tumor helicase RECQ1 protein,but gliomas tumor helicase RECQ1 protein expression in the experimental group patients(0.952 ±0.021)was significantly lower than that in the control group(1.211 ±0.024),and the difference was statistically significant(P<0.05).Conclusion Rapamycin capsule could reduce the expression of mRNA helicase RECQ1,inhibit DNA glial tumor cells of brain replication,effectively kill cancer cells,control the the progress of brain glioma,and improve prognosis,worth clinical promotion.

Testicular/paratesticular mucinous cystadenoma is a rare type of ovarian epithelial tumor. This paper reported a patient with enlarged left testicle , and CT showed a multifocal cystic mass in left testis. Radical left testis orchiectomy was performed, and the pathology showed testicular borderline mucinous cystadenoma. The patient was followed up for 3 years and no recurrence and metastasis was observed.

A case is presented involving a patient with a history of pelvic fracture who experienced progressive difficulty in urination following the removal of a urethral catheter. Attempt to retain the catheter was unsuccessful, leading to an ultrasound-guided suprapubic puncture cystostomy. Subsequently, the patient developed persistent abdominal pain, distension, nausea, and vomiting. Analysis of turbid greyish-yellow thin purulent fluid obtained during abdominal paracentesis indicated the presence of peritonitis. Urgent surgical exploration revealed that the diversion tube had passed through the abdominal cavity and into the bladder. The entire abdominal cavity was filled with yellowish-thin purulent fluid. Intraoperatively, the patient presented with worsening hypotension, tachycardia, oliguria, and decreased skin temperature, suggestive of septic shock resulting from peritonitis. Prompt management, including antimicrobial therapy, hemodynamic support, and fluid resuscitation, successfully controlled the infectious symptoms, leading to complete recovery. In clinical practice, the emphasis is often placed on assessing injuries to intra-abdominal organs, whereas awareness and understanding of peritoneal injuries remain limited. As a result, postoperative peritonitis is frequently attributed solely to intra-abdominal organ damage, overlooking the potentially grave consequences of pure peritoneal injury. Therefore, it is imperative to enhance our recognition and knowledge regarding peritoneal injuries, enabling timely diagnosis and treatment to prevent the occurrence of complications.

Objective:To compare the outcomes of combined lingual mucosal graft with buccal mucosal graft urethroplasty and combined lingual mucosal graft with ADM (acellular dermal matrix) urethroplasty for the treatment of repair failed hypospadias.Methods:From February 2017 to February 2019, 26 patients with failed hypospadias repairs were treated with combined lingual mucosal graft with buccal mucosal graft urethroplasty (14 cases in Group A), and combined lingual mucosal graft with ADM urethroplasty (12 cases in Group B). The mean age of Group A was (29.5±1.2) years (range 18.0-41.0 years), and (26.5±0.8) years (range 20.0-38.0 years) in Group B. The previous operation times was mean (3.6±0.7)(range 2-5 times) and (4.6±0.8)(range 3-5 times) in Group A and Group B respectively. Operation method: All patients were nasally intubated, the remaining curvature was corrected, the fibrous tissue or scar was removed, and the defected urethra was measured. In Group A, the lingual mucosa was spread and fixed to the corpora cavernosa over the midline as the urethral plate, the buccal mucosa was covered the lingual mucosa as ventral urethra, both the mucosa lateral edges was sutured. In Group B, the lingual mucosa was harvested and fixed to the corpora cavernosa the same as in Group A, the ADM was made appropriate length and width, covered and sutured with the lingual mucosa. The lingual mucosa was harvested mean (5.0±0.2)cm(range 4-6cm)long, mean (1.2±0.2)cm (range 1.0-1.5cm)wide and mean (5.0±0.2)cm(range 5-6cm)long, mean (1.2±0.2)cm (range 1.0-1.5cm)wide in Group A and Group B respectively( P<0.05). In Group A, the buccal mucosa was harvested mean (4.1±0.2)cm(range 3.5-5.5cm)long, mean (1.2±0.2)cm wide. Criteria for successful repair of hypospadias were set as: ①The appearance of the penis is nearly normal; ②The penis curvature was corrected; ③Urethra orifice in normal position; ④Urine flow line is normal. The outcomes of the two groups were analyzed and compared, statistical analysis was done using SPSS 18.0 software. Results:The mean follow-up time was (16.3±1.6)(8-24) months. The age, number of preoperative surgeries, number of previous oral mucous membranes, and length of urethral defects were no statistically significant differences between the two groups in A and B( P>0.05). The length of oral mucosa was harvested during the operation between group A and Group B were statistically significant differences( P<0.05). The incidence of oral complications in group A and B: Oral pain 7/14, 1/12; The feeling of tension in mouth 8/14, 1/12; The numbness in the oral 8/14, 1/12, A and Group B were statistically significant differences( P<0.05). The incidence of urethral complications in group A and Group B: the urethra fistula 1/14, 4/12; the urethral stricture 2/14, 6/12, there were statistically significant differences between the two groups ( P<0.05). Penile curvature 2/14, 1/12, ( P>0.05). The success rate was 12/14 and 5/12 in Group A and B respectively, with statistical difference( P<0.05). Conclusions:Combined lingual mucosal graft with buccal mucosal graft urethroplasty could be a good choice for repeated failed hypospadias repairs. Combined lingual mucosal graft with ADM urethroplasty has many complications and less success, should be performed in caution.

Urinary tract infection (UTI) is one of the most common infectious diseases. It has the characteristics of high recurrence rate and prolonged course. At present, the problem of antibiotic resistance is becoming more and more serious, the incidence of adverse reactions is high, and the disadvantages of long-term administration appear, which brings severe challenges to the treatment of recurrent urinary tract infection. The prevention and treatment of UTI recurrence has become the focus of research. Recurrent urinary tract infection is related to the immune regulation mechanism of the body. Administration of immune regulation can provide new ideas for prevention and treatment. The vaccine based on immune regulation to prevent rUTI has made some progress. It can not only reduce the frequency of recurrences, but also decrease related symptoms. At the same time, the vaccine has good tolerance, high safety and good application prospect. This paper aims to summarize the progress of immune regulation and immune vaccines in vivo and clinical research.

Objective: To clarify the situation of the detection of upper gastrointestinal cancer and precancerous lesions in the Feicheng city and discuss the possible influencing factors. Methods: A cluster sampling method was used to determine the participants. A unified questionnaire was used to investigate the basic information including history of alcohol intake, smoking and chinese tea, as well as other eating habits, medical history of digestive tract and cancer. Endoscopy was used to to screen the patients with upper gastrointestinal cancer and precancerous lesions. Influential factors were explored by non-conditional logistic regression model. Results: 911 of 7 291participants were positive, and the total detection rate was 12.49%. The total positive detection rate of male and female was 17.94% and 8.71%, respectively (P<0.001). Multivariate logistic regression analysis showed that the sex (OR=0.527, 95%CI: 0.440-0.631), age (OR=2.037, 95%CI: 1.849-2.245), smoking (OR=1.240, 95%CI: 1.014-1.516) and alcohol consumption (OR=1.232, 95%CI: 1.012-1.500) , meat and protein intake (OR=0.794, 95%CI: 0.638-0.987) and drink tea (OR=1.233, 95%CI: 1.056-1.440) may be influencing factors of the total detection rate of upper gastrointestinal cancer and precancerosis. Conclusions In Feicheng city, intake of meat and protein is the protective factor of the upper gastrointestinal cancer and precancerous lesions. Men, aged, smoking, drinking and tea will increase the risk of upper gastrointestinal cancer and precancerous lesions.