Objective To investigate the treatment options of clomiphene(CC) resistant polycystic ovary syndrome (PCOS) related infertility. Methods Figty nine PCOS patients with CC resistant anovulation were accepted and treated by the following three protcols :(1)follicle stimulating hormone (FSH) group, 49 cycles; (2)FSH +pulsatile gonadotropin releasing hormone(GnRH) group, 13 cycles; (3)conventional in vitro fertilization (IVF)_embryo transfer(ET) group, 19 cycles. Suppressive treatment on serum luteinising hormone (LH)and testosterone (T) levels was given in the first and second groups in advance. Serum estradiol level; pregnancy rate; miscarriage rate, ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy rate were compared among the three groups. Results The pregnancy rate in FSH group, FSH+GnRH group and IVF ET group werte 37%,54% and 22% respectively. The highest rate and multiple pregnancy rate was found in IVF ET group. Conclusion The rationale treatment options for CC resistant PCOS related infertility was the addition pre suppressive treatment, low dose FSH stimulated regimen subsequent pulsatile GnRH infusion. IVF were only accepted after failure with gonadotropin therapy.

Objective To investigate the variance of peripheral blood prolactin(PRL)in controlled ovarian stimulation.Methods Seventy-two patients,with totally 106 cycles receiving a long protocol of gonadotropin-releasing hormone agonist combined with gonadotropin(Gn)were randomly enrolled in this retrospective study.During controlled ovarian stimulation,peripheral blood hormones were measured by chemiluminescent microparticle immunoassay.Results Prolactin was positively correlated with estradiol (r=0.5897.P＜0.01)while there was no significant correlation between luteinizing hormone and PRLProgesterone had a positive relation with prolactin(r=0.1412,P＜0.01).Conclusions During controlled ovarian stimulation,prolactin secretion is not affected by Gn but may be stimulated by estradiol.Progesterone has a positive relation with prolactin.

Objective To establish a scientific and normative process for using physical restraint,and to increase the safety and efficiency of physical restraint.Methods On the basis of the previous studies,combined with the literature and clinical,we drafted a process framework of using physical restraint and then conducted consultation from 11 experts by using the Delphi technique.Results After 2 rounds of consulting,an evaluation form,consisted of 4 first-dimensions and 11 second-dimensions,and a process,consisted of 4 first-dimensions and 26 second-dimensions,were established.Kendall's W were 0.37 and 0.38 respectively,and expert authority coefficient was 0.84.Conclusions The results from the study is valid,feasible and reliable,however it still need to be further perfected.

Objective To investigate the value of extravascular lung water index(EVLWI) in assessment of prognosis of elderly patients with combined septic shock and pulmonary capillary leakage.Methods Totally 34 elderly patients with septic shock and pulmonary capillary leakage in our hospital from Jan.2011 to Dec.2012 were selected.Cardiac index (CI),global end diastolic volume index (GEDI),systemic vascular resistance index (SVRI),pulmonary vascular permeability index (PVPI) and EVLWI were detected by pulse-indicator continuous cardiac output (PiCCO) technology for 3 days.Based on the actual body weight (ABW) and predicted body weight (PBW),the actual extravascular lung water index and predicted extravascular lung water index were calculated.Peak airway pressure (Ppeak),plateau pressure (Pplat),mean airway pressure (Pm),tidal volume (VT),positive end expiratory pressure (PEEP),oxygen concentration (FiO2) and static lung compliance (Cst) were monitored,the arterial partial pressure of oxygen (PaO2) was detected by blood gas analysis,and the PaO2/FiO2 (P/F) and oxygenation index (OI) were calculated.Chest X-ray,lung injury score (LIS) were conducted.The correlations of EVLWI to actual body weight (EVLWIa) and predicted body weight(EVLWIp) with P/F,Cst and LIS were analyzed.The predictive value of EVLWIa and EVLWIp in the prognosis in elderly patients with septic shock and pulmonary capillary leakage was assessed.Results At day 1,non-survivors had higher levels of SOFA score and lactate level than survivors (both P＜0.05).However,these variables including SOFA score,LIS,PVPI,lactate level,fluid balance,norepinephrine level,EVLWIa and EVLWIp were higher and PaO2/FiO2 was lower in non-survivors than in the survivors at day 3 (all P＜0.05).EVLWIa and EVLWIp were positively correlated with LIS (r=0.461 and 0.588,both P＜0.05) and negatively correlated with PaO2/FiO2 (P/F) (r=-0.307 and-0.436,both P＜0.05).EVLWIa and EVLWIp had negatively correlations with Cst,but r=-0.141 and-0.154,both P＞0.05.Multiple logistic regression analysis showed that SOFA,EVLWa and EVLWp were independent predictive risk factors for mortality in elderly patients with septic shock and pulmonary capillary leakage.The areas under the receiver operating characteristic curve (ROC) of SOFA,EVLWIa and EVLWIp for predicting the prognosis were 0.769,0.832 and 0.855 respectively.With 11.96ml/kg as the cutoff point of EVLWIp,the sensitivity and specificity of EVLWIp predicting the survival of patients was 94.4％ and 61.5％ respectively.Conclusions Extravascular lung water can predict the prognosis and reflect the severity of lung injury in elderly patients with septic shock and puhnonary capillary leakage.Compared with EVLWIa,the EVLWIp has a better correlation with lung injury and a higher predictive value for survival.

To retrospectively analyze the clinical data of 176 patients of recurrent cerebral infarction at our hospital.Based upon the treatment of acute stroke trial (TOAST) classification,the types of recurrent ischemic stroke with initial brainstem infarction were classified.And univariate and multivariate logistic analyses of risk factors were performed.The major types in a decreasing order were atherosclerotic cerebral infarction (AT,n =24,70.6％),small arterial occlusive stroke (SA,n =8,23.5％) and cardiogenic cerebral embolism (CE,n =2,5.9％).Brainstem infarction was more likely to be affected by poor life habits and a history of diabetes mellitus (DM).And atrial fibrillation was a major independent risk factor for non-brainstem infarction.Multivariate logistic analysis showed that poor living habits (P =0.03),a history of DM (P =0.004),vulnerable plaque (P =0.01) and poor compliance of secondary prevention medication (P =0.02) were independent risk factors for recurrent ischemic stroke with initial brainstem infarction.Health education should be strengthened for preventing recurrent ischemic stroke with brainstem infarction.

Objective To investigate the etiology spectrum of hand , foot and mouth disease ( HFMD) and to analysis the molecular characteristics of three predominant human enterovirus stains in Qingdao in 2013.Methods The total enterovirus (EV) strains and strains of EV71, CVA16 and CVA6 in throat swabs of HFMD cases were detected by using multiplex real time RT-PCR.The full-length of the viral VP1 genes of the EV strains were amplified and sequenced .The sequences were phylogenetically analyzed by using the MEGA5.0 software package .Results A total of 841 patients with mild HFMD and 107 patients with serious HFMD were recruited in this study and 64 .3%of them were positive for EV .The predominant pathogens were EV71 (44.8%), CVA6 (28.2%) and CVA16 (9.5%) in 2013.CVA6 replaced CVA16 as the second most common pathogen for HFMD , accounting for 42.7% of all pathogens in children aged less than 3 years and 22.2%of all pathogens in the serious patients .The proportions of CVA6 in the etiology spectrum showed a downtrend along with the increasing age of the patients (P<0.001).Phylogenetic analy-sis of the complete VP1 gene sequences showed that all of the EV 71 strains identified in this study belonged to the subgenotype C4 (evolutionary branch C4a) and all of the CVA16 strains belonged to the subgenotype B1 (evolutionary branches B1a and B1b).There were 6 genogroups (A to F) regarding to the VP1 gene of CVA6 and all of the CVA6 strains identified in this study belonged to genogroups A and D .Among the CVA6 strains isolated in Qingdao in 2013, 83.9% belonged to genogroup A, while the rest 16.1% belonged to genogroup D.66.7%of the CVA6 strains isolated in 2012 belonged to genogroup A, while the rest 33.3%belonged to genogroup D .All of the CVA6 strains isolated from year 2008 to 2011 in Qingdao belonged to genogroup D.Conclusion EV71, CVA6 and CVA16 were the prevalent pathogens responsible for the de-velopment of HFMD in Qingdao in 2013.The proportions of CVA6 strains in the etiology spectrum showed a downtrend with the increasing age in children .C4a was the major subtype of EV71 strains circulating in Qingdao in 2013, while B1a and B1b were the major subtypes of CVA16 strains.The pattern of endemic cir-culation of CVA6 strains showed a trend of changing from genogroup D to A from year 2008 to 2013 .

Objective To investigate the relationship between amnestic mild cognitive impairment and functional genes associated with hyperphosphorylated tau protein.Methods One hundred and sixteen amnestic mild cognitive impairment (aMCI) patients and 93 normal controls were recruited for the study.Multi-dimension neuropsychologic tests were used to assess the cognitive function extensively.MassARRAY and iPlex systems were used to measure candidate SNP polymorphisms,analyze genotypic,allelic or haplotypic distributions and their interaction with ApoE ε4 and the correlation with the cognitive function in the subjects.Results ( 1 ) The scores of neuropsychologic tests in memory domain ( Auditory Verbal Learning Test (AVLT)-first immediate recall,AVLT-second immediate recall,AVLT-second immediate recall,AVLT-5 minute delayed recall,AVLT-20 minute delayed recall,AVLT-recognition,Rey-Osterrich Comolex Test-delay) in aMCI patients ( 3.0 ( 0-7.0 ),5.0 ( 1.0-10.0),6.0 ( 1.0-11.0 ),4.0 (0-11.0),3.0(0-10.0),20.0(8.0-24.0),11.2 ±8.3) were significantly lower than those in the normal controls(4.0(0-9.0),7.0(2.0-11.0),9.0(3.0-12.0),8.0(0-12.0),8.0(0-12.0),22.0 (10.0-24.0),16.1±8.0) (Z=-3.592,-6.802,-6.408,-8.173,-8.533,-5.647 andt=4.216 respectively,all P ＜0.01 ) ; (2) Genotypic distributions of rs242562 GG in aMCI (7.826％ ) were significantly lower than those in normal controls (20.65％,OR =0.3525,95％ CI 0.1411-0.8807,P =0.024 98),however there were no differences in the genotypic,allelic or haplotypic distributions between aMCI patients and controls of glycogen synthase kinase-3β,cyclin dependent protein kinase-5,calcium and calmodulin-dependent protein kinase-Ⅱ,cell division cycle 2,dual-specificity tyrosine-phosphorylation regulated kinase 1A and low density lipoprotein receptor-related protein 6; (3) MAPT/STH rs242562 genotype was correlated with AVLT-immediate recall,AVLT-delayed recall,Rey-Osterrieth Complex Test,Rey-Osterrieth Complex Test-delayed recall and Clock Drawing Test (H =9.763,12.258,10.508,9.624,10.767,F =3.700,3.123 and H =6.591 respectively,all P ＜ 0.05 ) ; (4) There were no differences in the distributions of MAPT/STH rs242562 GG genotype and ApoE ε4 haplotype between aMCI patients and normal controls.Conclusions MAPT/STH rs242562 GG genotype decreases the genetic risk of aMCI,which might have important role in memory function in aMCI.The interaction between rs242562 GG and ApoE ε4 doesn' t affect the susceptibility to aMCI.

Objective To find out the health status and community health care requirement of the elderly in urban Fuzhou and to provide suggestions on how to develop and consummate the community health care for elderly. Methods With the method of stratified random sampling, 3285 elderly people aged 60 years and over were surveyed by a questionnaire. Results The average quality of life of elderly people in urban Fuzhou was above the moderate level. But education level of the elderly was low. And the prevalence rate of chronic diseases was high. There were 2134 elderly people (65.0%) who had more than one chronic disease. The older the people, the higher proportion the coincidence of multiple diseases (P＜0.01). The first five chronic diseases in the elderly were hypertension, diabetes, coronary heart disease, arthropathy and stroke. The incidence rate of depression was high up to 60%. The requirement rate of community health care was 75.2%, and the older the people, the more items they needed(P＜0.05). The requirement of community health care at the first 5 rank position were regular physical examination, health education, regular home visiting, health direction and diet direction. Conclusions Elderly people have many health problems and requirements of community health care.We should provide more and more community health care, in order to improve the quality of life of elderly people.

AIM:To demonstrate the relationship between hormones in follicular fluid and the expression of LH receptor in granulosa cells(GC) in anovulatory women with polycystic ovary syndrome(PCOS).METHODS: Follicles were obtained from 12 women with PCOS and 15 women with normal menstrual period through surgery at time between day 7 and day 10 of menstrual cycle.The accumulations of estrogen(E2),progesterone(P),luteinizing hormone(LH),follicle stimulating hormone(FSH) and insulin in follicular fluid were determined by a automatism chemiluminescent microparticle immunoassay(CMIA) for the quantitative determination.The accumulation of androstenediol(A) was determined by ELISA.The amounts of the mRNA expressions of LH receptors from GC and theca cells(TC) respectively were measured by RT-PCR using ?-actin as intra-control simultaneously.RESULTS: The levels of LH [(3.8?2.1 vs 1.7?0.8)IU/L,P

Objective To evaluate the relationship between the extravascular lung water (EVLW) and other markers of lung injury and determine whether or not EVLW predicts survival in patients with acute respiratory distress syndrome (ARDS) and examine if indexing EVLW with predicted body weight (EVLWp) strengthens its discriminative power.Methods EVLW and other markers of lung injury [including:PaO2/FiO2(P/F),oxygenation index (OI) =mean pressure (Pm) × FiO2 × 100/PaO2,static compliance (Cst) and lung injury score (LIS)] were measured prospectively for 3 days in 27 patients with early ARDS between January 2011 and December 2011 at intensive care units (ICU) of Subei People's Hospital.The relationship between indexing EVLW with actual body weight (EVLWa),EVLWp and other markers of lung injury,the 28-day mortality were evaluated.Results Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),fluid balance in first 3 days,days of mechanical ventilation and ICU stay were significantly higher on admission in nonsurvivors compared with survivors (P ＜ 0.05).Nonsurvivors had higher OI,LIS,EVLWa and EVLWp than survivors at Days 1 and 3 (P ＜ 0.05).EVLWa and EVLWp were correlated positively with LIS (r =0.471,0.528 P ＜ 0.05) and OI (r =0.527,0.627,P ＜ 0.05) and negatively with P/F (r =-0.467,-0.646,P ＜ 0.05).EVLWp had a stronger correlation to LIS,OI and P/F than did EVLWa.No obvious correlation existed between EVLWa,EVLWp and Cst (r =-0.260,0.226,P ＞ 0.05).ROC curve analysis indicated that EVLWp (0.759,P ＜ 0.05) but not EVLWa (0.661,P＞0.05) discriminated between survivors and nonsurvivors.Three-dav average EVLWp ≥12.5ml/kg predicted the 28-day mortality with 62.5％ specificity and 80％ sensitivity.Conclusion Increased extravascular lung water is a feature of early ARDS and predicts survival.EVLWp,instead of EVLWa,improves the predictive value of extravascular lung water for survival and it is correlated with markers of disease severity.