Thirty-three anovulatory, infertile patients under clomiphene (CC) treatment were studied. Out of the 33 patients with 83 treatment cycles, 32 cases with 64 cycles presented ovulatory responses. Only 12 patients (37.5%) conceived.Through ovarian function monitoring by BBT, cervical score (GS), reproductive hormonal assays and serial ultra-sonography, it was found that of 64 cycles which presented ovulatory responses, only 37 cycles (51.8%) showed actual ovu-lation; follicles in 27 cycles (42.2%) were unruptured but luteinized (LUF). The incidence of reoccurrence of LUF in repeated CG treatment cycles was 83.3%. There was no evidence that CG adversely affected the CS after 5-day treatment. And luteal function was normal in the above ovulatory cycles. We consider LUF to be an important cause in the failure to achieve pregnancy.Through investigation of some related parameters, including reproductive hormone assay, the key points of successful induction of ovulation and mechanisms causing LUF were analysed.

Transplantation is regarded as the only therapeutic choice for end-stage organ failure,however,rejection restricted its efficacy after transplantation.MSCs exhibit several desirable characteristics,which may advocate their use in organ transplantation.This includes the capacity to suppress alloreactive and autoimmune T-cell responses,and pro mote a cytokine environment which is likely to be graft protective.This review describes the recent research of MSCs used in organ transplant.

Post-traumatic osteomyelitis is painful and challenging disease.High success rate of antimicrobial therapy in most cases has not been achieved in skeleton due to its physiological and anatomical characteristics.The key to successful management is early diagnosis and treatment.Different types of post-traumatic osteomyelitis require different medication and different surgical therapeutic strategies.Post-traumatic osteomyelitis is associated with avascular necrosis of bone and formation of sequestrum(dead bone).Surgical debridement is necessary in addition to antibiotic therapy.Generally,multidisciplinary techniques are required,including orthopaedic surgery,plastic surgery,as well as vascular surgery,especially for complex cases with soft-tissue defect.

Objective To introduce our experience of treating Pilon fractures with an articulated and spanning external fixator. Methods From February 2002 to June 2004, 19 patients with high energy Pilon fractures (21 sides) were treated with a T- shaped unilateral articulated and spanning external fixator in our department. The fixators were placed medial1y across the ankle joint, and the fixation of fracture was enhanced by a combined use of limited internal fixation. The main causes of injury were traffic accidents and high altitude falling. The distal 2 pins were inserted into the talus and the tuberosity of calcaneus so that the subtalar joint was treated as an axis during ankle movement. At approximately postoperative 2 or 3 weeks, the articular hinge was released and the patient began ankle exercises. The clinical outcomes and complications were investigated and the postoperative X- ray examinations of the ankle were also evaluated. Results 19 patients were followed up for a mean period of 13 months. No infection of wound or pin site, no neurovascular complication or no nonunion was found. According to Baird & Jackson ankle joint scoring system, their functional evaluation of the ankle scored from 72 to 98 (averaging 92). Clinical results were excellent in 4, good in 12, fair in 3 and poor in 2. Reduction of the articular surface was anatomic in 16, fair in 3 and poor in 2 according to Burwell & Charnley classification. Conclusions External fixation with an articulated and spanning fixator combined with limited internal fixation is a satisfying technique to treat Pilon fractures. This technique can restore anatomical articular surface, allow early ankle joint motion, effectively decrease complications of both wound and bone healing, and prevent ankle joint stiffness after fixation.

Objective To investigate the effects of metformin on serum testosterone (T)levels and ovulation in hyperinsulinemic women Methods Twenty nine patients with hyperinsulinemic anovulation were treated with metformin for 12 weeks Among them 19 had history of clomiphene(CC) treatment with 11 cases failure CC was given again after one month of metformin treatment Serum T, luteinizing hormone,follicle stimulating hormone, insulin(Ins) levels were measured after 4 weeks of treatment Basic body temprature was also observed Results Serum T and Ins levels declined significantly after 4 weeks of metformin treatment [(2 7?1 6) nmol/L Vs (1 9?1 0) nmol/L, (49 2?34 1) mU/L Vs (25 3?23 9) mU/L, P

Objective To investigate the clinical presentation, hormonal profile and metabolic abnormalities in subgroups of women with PCOS and explore a reasonable classification for PCOS. Methods A cross-sectional study of 192 women with PCOS (14-38 years of age) was performed. The patients were divided into 3 groups of A, B and C according to the revised 2003 consensus on diagnostic criteria and also divided into 2 groups according to body mass index(BMI) : group A(n=110), long term anovulation, clinical and biochemical evidence of high androgen level, ovary enlargement with its size larger than 10 ml or number of small follicles of 2-9 mm ≥12 under ultrasound with exclusion of other diseases caused by high androgen;group B(n=46), long term anovulation, clinical and biochemical evidence of high androgen level;group C(n=36), long term anovulation, ovary enlargement with its size larger than 10 ml or number of small follicles of 2-9 mm ≥12 under ultrasound with exclusion of other disease caused by high androgen; obesity PCOS group (OB-PCOS,n=70),BMI≥25(kg/m~2); no obesity PCOS group (NOB-PCOS,n=122), BMI

Objective To determine the hemolytic activity of products of sphingomyelinase hemolysin encoding genes of Leptospira interrogaas, and the transcriptional level alterations in the infected host cells. Methods By using genomic DNAs of pathogenic L. interrogans serovar serogroup Icterohaemorrhagiae serovar Lai strain Lai and serogroup Pomona serovar Pomona strain Luo, and non-pathogenic L. biflexa serogroup Sama-ranga serovar Patoc strain Patoc Ⅰ as templates, PCRs were performed to amplify entire sph1-sph4 genes. The amplified products were sequenced after T-A cloning. Prokaryotic expression systems of sph1-sph4 genes were re-spectively constructed, and the expressions of target recombinant proteins rSph1-rSph4 were examined by SDS-PAGE. Ni-NTA affinity chromatographic column was used to extract the expressed rSph1-rSph4. Hemolytic ac-tivities of rSph1-rSph4 on sheep blood agar plate were identified. Transcription alterations of sphl-sph4 genes in L. interrogans strain Lai after infected J774A. 1 cells were measured by real-time fluorescence quantitative RT-PCR. Results From genomic DNAs of both L. interrogans strain Lai and Luo, but not from that of L. biflexa strain Patoc Ⅰ , the target fragments of sph1-sph4 genes could be amplified. All the cloned sph1-sph4 genes had 100% nucleotide sequence identities compared to the corresponding reported sequences. The constructed pro-karyotic expression systems were able to efficiently express the target recombinant proteins rSph1-rSph4, respec-tively. All the rSph1-rSph4 had hemolytic activities, and among the four products rSph2 displayed the strongest hemolytic activity. After L. interrogaas strain Lai infecting J774A. 1 cells, the transcriptional levels of sph1-sph4 genes were remarkably up-regulated, especially for mRNA levels of sph2 and sph4 genes. Conclusion sph1- sph4 genes exist only in pathogenic L. interrogans species, and their products have hemolytic activity. The up-regulation of sph1-sph4 gene transcriptional levels in L. interrogans strain Lai after infected cells implies that the sphingomyelinase hemolysins may play important roles in the process of L. interrogans infection in hosts.

Objective To evaluate the effect of metformin in treating adolescent polycysfic ovary syndrome (PCOS).Methods Group A [ the metformin and medroxyprogesterone acetate (MPA) group ] was made of 135 adolescents with PCOS taking metformin,and MPA if no menstruation came,while group B ( the control group) consisted of 45 patients taking MPA every two months.Endocrinologic profiles and ovulation were evaluated before and after six months treatment.Results ( 1 ) All patients suffered from anovulation before treatment.( 2 ) Ovulation failure was successfully improved in 74.81％ ( 101/135 )of patients in group A after 6 months,which was significantly higher than that before treatment.In group B,no case recovered ovulation.(3) In group A,fasting serum insulin,homeostasis model assay for insulin resistance ( HOMA-IR),total testosterone,LH were significantly decreased.(4) The retrieval of ovulation was negatively correlated with fasting insulin and HOMA-IR ( both P＜0.05 ). Conclusions ( 1 ) Metformin effectively improves ovulation function and reproductive endocrine parameters in adolescent girls withPCOS.(2) Recovery of ovulation is associated with the decrease of serum insulin.

Objective To analyze the occurrence of insulin resistance ( IR ) and abnormal glucose metabolism in adolescent polycystic ovary syndrome (PCOS). Methods PCOS group included 141 patients aged 15-19 years old, who were diagnosed as PCOS according to criteria by reference to the European Society of Reproduction and Embryology/American Society for Reproductive Medicine proposed in 2003, at Rotterdam; and 266 age-matched female students,with regular menstrual cycles and no family history of diabetes, were enrolled in control group. Fasting insulin(FINS),fasting plasma glucose(FPC) ,and homeostasis model assessment for insulin resistance ( HOMA-IR) were measured in control group. 73% percentile value of control group was set as physical upper limits of FINS and HOMA-IR. PCOS patients were divided into obese ( OB-PCOS) and non-obese (NOB-PCOS) groups, and oral glucose tolerance test(OGTT) were performed. Results According to 75% percentile value of control group,the physical upper limits of FINS and HOMA-IR were 13.13 mIU/ L and 2.69, respectively. FINS and HOMA-IR values in PCOS group were higher than those in control group [ (17.68±16. 13 vs 10.40±5. 33)mIU/L,2. 64±2.01 vs 2. 01 ±1. 61,both P<0.01]. FINS and HOMA-IR values in OB-PCOS group were higher than those in the NOB-PCOS group [ (22.04± 18.01 vs 13.06± 12. 60) mIU/L,4. 62±3. 87 vs 2.38±2.26,both P<0.01]. In PCOS group,FINS of 75 cases(53.19% )and HOMA-IR of 67 patients(47.52% ) exceeded the physical upper limits. In 79 OB-PCOS patients, FINS of 56 cases (70. 89% ) and HOMA-IR of 52 patients (65.82% ) exceeded the physical upper limits while in 62 NOB-PCOS patients there were 19(30.65% ) and 15 (24. 19% )patients. In PCOS group,2(1.42% ) patients were diagnosed diabetes mellitus,and both FINS and HOMA-IR of these two cases increased. Meanwhile, 12 cases(8.51% ) were impaired glucose tolerance(ICT) ,of whom 11 patients FINS and HOMA-IR increased. Conclusion Pathological IR is prevalent in adolescent PCOS, more severe and popular in obese-PCOS, a part of them with abnormal glucose metabolism.

Objective To investigate clinicopathological features of scalp angiosarcoma, and to analyze the relationship of tumor stage and treatment with prognosis. Methods Clinical and follow-up data were collected from 16 patients with non-metastatic primary scalp angiosarcoma treated in the Department of Plastic and Reconstructive Surgery of Zhongda Hospital, Southeast University from September 2002 to June 2013. According to the seventh edition American Joint Committee on Cancer (AJCC)TNM staging system for soft tissue sarcomas (2010), staging of scalp angiosarcoma was performed for the 16 patients. Statistical analysis was carried out by the Kaplan-Meier method for survival rates and by the Log-rank test for survival curve. The Cox regression model was used for multivariate regression analysis. Results Of the 16 patients, 4 had stageⅠangiosarcoma, 4 stage Ⅱangiosarcoma, and 8 stage Ⅲ angiosarcoma. The tumor usually began as ecchymosis-like lesions on the head or face in early stage, and progressed into dark red infiltrative plaques, nodules and ulcers which easily ruptured and bled in later stage. Histopathological examination showed generalized vascular proliferation and infiltration with high histological morphological diversity. Cytologic atypia was commonly seen. The median time to recurrence was 15 months, and local recurrence occurred in 7 patients. The median time to metastasis was 20.5 months, and distant metastasis was observed in 8 cases, including 4 cases of pulmonary metastasis, 2 lymph node metastasis, 1 liver metastasis and 1 bone metastasis. The survival time was 33.0 ± 4.4 months (median, 32 months)in 4 patients with stage Ⅰangiosarcoma, 24.0 ± 7.9 months(median, 15 months)in 4 patients with stage Ⅱangiosarcoma, and 23.9 ± 3.9 months (median, 24 months)in 8 patients with stage Ⅲ angiosarcoma. Additionally, the survival time was 23.4 ± 5.2 months(median, 21 months), 24.4 ± 5.7 months(median, 24 months)and 35.8 ± 9.7 months(median, 26 months) in 5 patients receiving surgical treatment alone, 7 patients receiving surgical treatment and radiotherapy, and 4 patients receiving surgical treatment, radiotherapy and immunotherapy, respectively. Conclusions Surgical treatment combined with radiotherapy and immunotherapy may serve as the first-choice treatment for scalp angiosarcoma. Tumor size and treatment regimens are main factors influencing prognosis of scalp angiosarcoma.