Objective To investigate the efficacy of metholrexate combined with rmifepristone and laparoscopic surgery for treating ectopic pregnancy.Methods 85 patient with ectopic pregnancy were selected.41 cases treated with methotrexate and mifeprisione were considered as the control group,while 44 cases with laparoscopic surgery were considered as the observalion group on the voluntary basis.The clinical efficacy,serum β-HCG value and recovery time after 7d were compared between the two groups.Results After the treatment,the cure rate in the observation group was 100％ which was significantly higher than 90％ of the control group ( P ＜ 0.05 ),the serum β-HCG value of the observation group was lower and the restoration normal time was shorter than the control group ( P ＜0.05).Conclusions Laparoscopic surgery and conservative treatment of methotrexate combined with mifepristone are effective in the treatment of ectopic pregnancy.However,the clinical efficacy of the laparoscopic surgery is better and it has rapid recovery time,and it can completely cure the patients.

Objective To assess the curative effect and safety of endoscopic therapy at duodenum elevated lesions. Methods We retrospectively studied the clinical data including general data, the procedure of performance, the lesions pathological characters, complications and recurrence after the treatment of patients who underwent endoscopic treatment. Results 111 patients of 112 patients were treated by endoscopic treatment successfully, 1 case was treated by surgery. 49 lesions were treated by electrocoagulation, 36 lesions were treated by polypectomy or endoscopic mucosal resection (EMR), 27 by endoscopic submucosal dissection (ESD). Complication rate was 16.96%(19/112), 1 case of active bleeding was treated by surgery in hemostasis difficulty. 6 cases of perforation, 2 cases of delayed bleeding, 2 cases of transient increase in amylase level and 1 case of delayed perforation. All the patients were successfully performed. Post-operation follow-up period was 1~12 months. Conclusion Endoscopic treatment holds advantages of minimally invasive, quick recovery, low cost, and less risk which may be play an important role in duodenal elevated lesions.

Objective·To investigate and compare the curative effect of rubber ring and dental floss combined with hemoclipping assisted endoscopic submucosal dissection(ESD) on gastrointestinal tumors.Methods·A total of 54 patients with gastrointestinal tumors were collected.Twenty-seven patients in rubber ring group accepted ESD assisted by rubber ring with hemoclipping,and the other 27 patients in dental floss group accepted ESD assisted by dental floss.with hemoclipping.Duration of the operation,installation time of the traction device,detachment frequency of hemoclipping,injury of mucosa,one-time complete resection rate,and complication rate were analyzed as key indicators.Results·The detachment frequency of hemoclipping in rubber ring group was significantly less than that in dental floss group (t=4.418,P＜0.05).There was no injury of mucosa in rubber ring group,while,three patients had mucosa injury in dental floss group.There was no statistically significant difference on duration of operation,installation time of traction device,one-time complete resection rate,and complication rate between two groups.After 2 ～ 12 months of follow-up,the wound healed well in all patients in rubber ring group.No evidence of tumor recurrence was noted.Conclusion·Compared with dental floss,rubber ring combined with hemoclipping is superior in assisted ESD,especially in the right half colon.It is an effective assist device with little trauma and adjustable direction.

OBJECTIVE:To investigate the effect of different processing methods on 4 kinds of flavonoids contents in salt-pro-cessed Cuscuta chinensis. METHODS:Salt-processed C. chinensis piece was processed with different baking temperature (70 ℃, 100℃,130℃,160℃,190℃and 210℃),baking time(10 min,15 min,30 min,45 min,60 min and 75 min)and moisten-ing time(0.5 h,1 h,2 h,4 h and 6 h). HPLC was adopted for contents determination of hyperoside,rutin,quercetin and kaemp-ferol:the column was Synergi 4u Hydro-Rp 80A with mobile phase of methanol- 0.1% phosphoric acid (gradient elution) at a flow rate of 1.0 ml/min,the detection wavelength was 360 nm,and column temperature was 35 ℃. RESULTS:The linear range was 0.416-12.48 μg for hyperoside (r=0.999 9),0.14-4.2 μg for rutin (r=0.999 9),0.185-5.55 μg for quercetin (r=0.999 9) and 0.078-2.34 μg (r=0.999 8);RSDs of precision,stability and reproducibility tests were lower than 3%;recoveries were 95.55%-99.74%(RSD=2.12%,n=6),95.96%-101.42%(RSD=2.01%,n=6),95.76%-102.75%(RSD=2.77%,n=6), 99.42%-104.93%(RSD=2.02%,n=6). The flavonoids in salt-processed C. chinensis showed highest contents when baking tem-perature was 160℃,baking time was 60 min and moistening time was 2 h. CONCLUSIONS:Different processing methods have certain effects on flavonoids contents in salt-processed C. chinensis.

Objective To summarize the prevalence,risk factors,and characteristics of testicular adrenal rest tumors(TART) in children and adolescent males with congenital adrenal hyperplasia(CAH) due to 21-hydroxylase deficiency (21-OHD).Methods During past 4 years,there were 44 males with CAH caused by 21-OHD undergone testicular ultrasound scan in our clinic.We have diagnosed 13 cases of TART and summarized the characterizations.Results The prevalence of TART in our group was 29.5％ with 11 cases of salt wasters and 2 cases of simple virilizers.The median age of TART diagnosis was 10.2 years.The median follow-up period of TART was 3.0 years.History of poor control of CAH was found in every case before diagnosis of TART.The doses of hydrocortisone were increased in 5 cases of TART who refused operations or had small TART,resulting in tumor regression in two of those five patients.Testis-sparing surgeries were performed in 8 patients with symptoms relieved; 7 of those eight patients presented elevated FSH and LH after operations.Conclusions Prevalence of TART in our CAH children and adolescent males was 29.5％.Testicular ultrasound was useful in TART screening.TART should be considered when a CAH patient with poor control,especially in post-pubertal one.Delayed management of TART may lead to impaired testicular function.Increased doses of glucocorticoid may be effective in TART of small size.Testis-sparing surgery should be also considered if necessary.

Third-grade class A hospitals undertake three tasks-medical service,scientific research and teaching.scientific research is the motivation for third-grade class A hospitals' continuous development and also an important symbol of their medical and academic level.On the purpose of evaluating overall scientific level of such hospitals this thesis analyze the scientific projects and the outcomes of 34 hospitals by using the method of literature research and questionnaire,extracting advantages for scientific research,seeking their problems and coming up with corresponding strategy.have analyzed the achievements we acquired as well as the problems still existing.According to the reality of Fujian Province,some suggestions are coming up with so as to improve the scientific research.

Objective To observe the final adult height of 20 boys with idiopathic central precocious puberty (ICPP) treated with slow-releasing gonadotropin-releasing hormone analogue(GnRHa).Methods Twenty boys with ICPP were treated with GnRHa for( 20.0 ± 6.1 ) months.At the beginning of therapy,mean chronological age and bone age was( 11.4 ± 1.0 ) years and ( 13.0 ± 0.4 ) years,respectively,GnRHa was discontinued when the boys reached the chronological age and bone age of( 13.2 ± 1.1 ) years and ( 13.7 ± 0.6 ) years,respectively.After the end of treatment,all the boys had been followed up for( 3.3 ± 1.5 ) years and had achieved adult height.Comparisons were made among their predicted adult height ( PAH ),final adult height ( FAH ),and target height ( THt ).The long-term outcome of final adult height in boys with ICPP was investigated after GnRHa treatment.Results All the boys reached target height range.Final height was similar to the target height [ ( 169.8 ± 5.8 vs 167.8 ± 4.6 ) cm,P＞0.05 ].The height gain,defined as the difference between predicted adult height at the start of treatment using the height SDS for bone age and actual adult height was( 3.62 ± 3.57 ) cm with the residual growth capacity of ( 11.82 ±3.99)cm,PAH significantly improved after GnRHa treatment compared with before treatment [ ( 169.0 ± 5.0 vs166.2 ± 4.2 ) cm,P＜0.01 ].There were no differences among PAH,FAH,and THt.Conclusion GnRHa treatment improves final height within the range of target height in boys with central precocious puberty.

Forty girls with Turner's syndrome (TS),aged (12.6 ± 1.9) years,were treated with daily subcutaneous injection of recombinant human growth hormone (rhGH,1.0 ～ 1.1 IU · kg-1 · w-1) and oral stanozolol (0.02 ～ 0.04 mg · kg-1 · d-1) for 1 ～ 5 years.Growth velocity (GV),height standard deviation score (SDS) by reference of healthy Chinese girls (HtSDSNor) and height SDS by reference of untreated Chinese TS girls (HtSDSTs)were evaluated regularly.Of the forty girls studied,thirteen had discontinued the treatment after a mean duration of (2.9 ± 1.2)years when GV was less than 2 cm/year or when patients were satisfied with the achieved height.Final adult height (FAH) or near-final height,which was defined as the most recent available height after discontinuation of treatment,and the height gained in the thirteen girls were evaluated.Estrogen therapy was started at the age of(16.0 ± 1.1) years.HtSDSNor increased from-4.2 ± 1.0 to-3.4 ± 1.0 in the first year,and-2.8 ± 1.0,-2.4 ± 0.8,-2.5 ± 0.5,-2.3 ±0.3 respectively in the 2nd,3rd,4th,and 5th year.The change in HtSDSTs was similar to HtSDSNor.It was increased from 0.1 ± 0.9 to 1.0 ± 0.9 in the first year,and to 1.5 ± 0.8,1.9 ± 0.6,1.7 ± 0.4,1.7 ± 0.2 in the subsequent 4 years.The predicted adult height (PAH) in 13 girls was (142.8 ± 4.2) cm before treatment.FAH was (151.7 ± 4.1) cm,which was significantly higher than PAH (P＜0.01),and the mean height gain was (8.9 ± 2.8) cm (5.1 ～ 12 cm).FAHSDSNor was increased to-1.6 ± 0.8 from-3.8 ± 0.8.For girls with TS around 9 years of age,combined therapy with rhGH and low dosage of stanazolol may significantly increase growth velocity and improve final adult height.

Objective To assess the efficacy and impact factors of treatment with Gonadotropin-releasing hormone analogs (GnRHa) in central precocious puberty (CPP) or early and fast puberty (EFP) girls in a retrospective unicenter study.Methods One hundred and two girls (75 CPP and 27 EFP) were treated with GnRHa alone and were followed up to their final adult hight (FAH).Results FAH was (158.0 ± 4.8) cm,being significantly higher than pretreatment predicted adult height [(151.1 ±5.1) cm,P＜0.01].There was no significant difference between CPP [(7.3 ± 4.4) cm] and EFP [(5.5 ± 4.5) cm] in net height gain.There was no significant improvement in FAH and pretreatment PAH for the patients who had menarche before treatment or whose growth velocity was less than 4 cm during the first year.Conclusion GnRHa treatment improves FAH efficiently for both CPP and EFP girls.Nevertheless,those who had menarche before treatment or whose growth velocity was less than 4 cm during the first year can hardly improve FAH by GnRHa treatment alone.

Objective To explore the relationship between adrenarche and gonadarche.Methods Total 49 idiopathic central precocious puberty(ICPP)girls,whose serum dehydroepiandrosterone sulfate(DHEAS)Z scores for chronological age were higher than+2 s at diagnosis.were enrolled.Physical examinations during pubertal stage were repeated at 3-6 months intervals,and serum DHEAS levels were monitored yearly within an average period of 4.08 years.Of them,16 girls were followed up until more than one year after discontinuation of gonadotropin-releasing hormone analogue(GnRHa)treatment.Results Before GnRHa treatment,these49 girls presented a younger average age at attainment of pubic hair stage2(PH2)and pubic hair stage3(PH3)than normal(8.07 years vs 11.16 years,8.82 years vs 12.40 years respectively).During GnRHa treatment,the intervals between PH2 and PH3,PH3 and pubic hair stage4(PH4),breast stage 2(B2),and PH2 were longer than normal(1.69 years vs 0.83 years,1.64 years vs 0.60 years,and3.62 years vs 0.76 years respectively).The intervals between PH2 and PH3,as well as B2 and PH2 during GnRHa treatment were also longer than that before GnRHa treatment(1.69 years/35 0.88 years,3.62 years vs 1.13 years respectively).The serum DHEAS Z scores decreased during GnRHa treatment,and increased significantly after GnRHa cessation.Conclusion Gonadarche after age of 6-year-old may lead to earlier adrenarehe.GnRHa treatment might slow down the progression of adrenarche and suppress the hypothalamuspituitary-gonadal axis.