Objective To evaluate the diagnostic value of sonohysterography (SHG)in uterine cavity diseases. Methods 48 patients suspected to suffer from uterine cavity diseases on the basis of transvaginal sonography underwent sonohysterography,hysteroscopy and biopsy.The results of sonohysterography were compared with those from hysteroscopy and biopsy. Results The diagnostic accuracy,sensitivity,specificity of SHG in detecting abnormal uterine cavities were 93.8%(45/48),91.4%(32/35),100%(13/13) and respectively. Conclusions SHG is a simple,effective and cheap method in the detectiou of uterine cavity diseases.

Objective To evaluate the factors associated with clinical pregnancy rate of in-vitro fertilization (IVF) in endometriosis related infertility.Methods Total of 326 patients with endometriosis related infertility undergoing IVF between January 2007 and December 2011 were studied in Department of Reproductive Medicine,First Affiliated Hospital,Nanjing Medical University,retrospectively,which were divided into 141 cases in clinical pregnancy group and 185 cases in non-pregnancy group.Those factors including age,body mass index (BMI),basic FSH,antral follicle count (AFC),CA125 and CA199,endometriotic stage and history of surgery,stimulation scheme were analyzed by bivariate analysis and multivariable logistic regression.Results (1) Pregnancy rate:total of 141 pregnant cases and 185 nonpregnant cases treated by IVF were observed,pregnancy rate was 43.2％ (141/326).(2) Basic parameters:there was no statistical difference in age,BMI,basic FSH,AFC,CA125 and CA199 between clinical pregnancy group and non-pregnancy group (P ＞ 0.05).(3) Bivariate analysis:clinical pregnancy rate of 50.0％ (87/174) among patients with infertility year less than five years was significantly higher than 35.5％ (54/152) in patients with more than five years.Pregnancy rate of 56.1％ (46/82) in stage Ⅰ-Ⅱ was significantly higher than 42.5％ (79/186) in stage Ⅲ-Ⅳ.Pregnancy rate of 46.6％(125/268) with history of surgery was significantly higher than 27.6％ (16/58) with no history of surgery (P ＜ 0.05).Pregnancy rate of 48.2％ (79/164) in long-term scheme was higher than 38.3％ (62/162) in short-term scheme,but there was no significant difference (P =0.075).(4) Multivariable logistic regression:clinical pregnancy rate of infertility year with less than 5 years,stage Ⅰ-Ⅱ,history of surgery proved stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ was significantly higher compared with infertility year more than 5 years,stage Ⅲ-Ⅳ and no history of surgery respectively (adjusted OR and 95％ CI:2.003,1.263-3.175; 1.899,1.110-3.248; 3.769,1.802-7.887,P＜0.05).Conclusion Factors affecting clinical pregnancy rate of IVF in endometriosis related infertility were infertility year,stage and surgery.

Objective To assess the significance of elevated serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in predicting 30-day mortality rate for patients in intensive care unit (ICU).Methods A retrospective study was conducted.The clinical data of 480 patients admitted to ICU in Tianjin First Center Hospital from June 2012 to October 2013 were studied.The characteristics of patients were recorded,the acute physiology and chronic health evaluation Ⅱ (APACHE I) score was calculated,and the routine blood tests,blood biochemistry,and serum NT-proBNP level within 24 hours after admission were determined.Patients were divided into non-survival and survival groups according to 30-day outcome,and the characteristics and clinical parameters were compared between two groups,and single factor analysis affecting prognosis was analyzed.All patients were divided into four groups according to four percentile method as NT-proBNP＜280 ng/L (group Q1),280 ng/L≤NT-proBNP＜ 1 200 ng/L (group Q2),1 200 ng/L≤NT-proBNP＜1 990 ng/L (group Q3),1 990 ng/L≤NT-proBNP＜4 700 ng/L (group Q4).A Cox regression analysis was used to test the independence of the predictors.A receiver operator characteristic curve (ROC curve) was plotted to compare the power of APACHE Ⅱ score and NT-proBNP in predicting the outcome.Kaplan-Meier analysis was used to assess survival rate among different NT-proBNP patients.Results By single factor analysis it was shown that age,APACHE Ⅱ score,creatinine,NT-proBNP and severe infection were those influencing the outcome.NT-proBNP 1 200-4 700 ng/L (groups Q3 and Q4) and APACHE Ⅱ score ＞20 were independent risk factors for predicting outcome [relative risk (RR) for group Q3 was 3.624,95％ credibility interval (95％CI) was 1.258-10.138; RR for group Q4 was 5.059,95％ CI was 3.202-9.993; RR for APACHE Ⅱ score ＞20 was 2.987,95％ CI was 1.345-5.823].The area under the ROC curve (AUC) for APACHE Ⅱ score and serum NT-proBNP was similar,and it was 0.831 (95％CI 0.778-0.884) and 0.876 (95％CI 0.827-0.925),respectively.The cut-off value of NT-proBNP for predicting mortality was 1 250 ng/L.Kaplan-Meier analysis showed that groups of Q2,Q3 and Q4 had lower cumulative survival rate compared with group Q1 (26.5％,25.4％,16.2％ vs.29.6％),and group Q4 showed most significant extent of lowering of survival rate (x2=122.920,P＜ 0.05).Conclusion Elevated NT-proBNP level in ICU patients signify severity of the disease,and it is an independent predictor of death of ICU patients.

Objective To discuss the operation style of filling,film-style,three-dimensional double-layer mesh tension-free for hernia and the repair materials,the selectlon of surgical operation style for reducing recurrence.Methods We used the style of plug-and-chip,two-dimensional mesh tension-free hernia repair for the treatment of 130 cases of inguinal hernia patients.Results In 130 cases of patients with 1~5 years of follow-up,there was no recurrence.Conclusion A reasonable choice of repair materials and improving the surgical operation can be effective in reducing recurrence.

Objective To summarize the keypoints of clinical diagnosis of chondroblastoma and the experience on the treatment Methods The clinical materials of 16 cases(11 males,aged from 12 to 26 years)from June 1992 to February 2003 of pathologically diagnosed chondroblastoma were analyzed retrospectively. The tumor located at distal femur in 6 cases,great trochanter in 1 case,proximal tibia in 6 cases,proximal humerus in 2 cases, talus in 1 case. The main symptoms were swelling and painful joint. All the 16 cases were treated with curettage and autologous bone graft from iliac crest. Results Twelve cases were followed up for 6 months to 5 years .averaging 3. S years. All the bone graft healed well. One case., recurred 2 years after the initial curettage and was treated with curettage again. No recurrence occurred at the last follow-up 6 months after the second curettage. The function of the involved joints was nearly normal in all cases except for one case with slight limitation of knee flexion. Conclusions Mastering the image and clinical characteristics of chondroblastoma can avoid misdiagnosis and mistreatment Curettage can control the tumor satisfactorily. Postoperative rehabilitation can improve the function of the involved limb.

Objective:To study the osseointegration of implant in fresh extraction socket with or without bone grafting.Methods:In the mandibular premolar region of 6 beagle dogs,bone defect in the size of (3~4)mm ×(3~4)mm ×(5 ~6)mm on the mesial wall of the mesial root socket was made.On control side implants were installed immediately into the extraction sockets(group A).On an-other side Bio-Oss grafts and membrane(GBR)were placed following implantation(group B).All animals were sacrificed 3 months af-ter implantation,specimens were examined for histo-morphometric analysis of bone to implant contact and new bone formation.Results:No implant was loosening in the 2 groups.New bone was filled in the bone defect areas in 2 groups.No statistical difference of the per-centage of new bone formation and bone-to-implant contact ration(BIC)was observed between 2 groups.Conclusion:With the defect in a certain size on the root socket wall osseointegration may occur between the new bone and implant without bone transplantation.

Objective To explore the over-expression of the CCAAT enhancer binding proteinα(C/EBPα)in hepatic stellate cells (HSC-T6) which activated by protease-activated receptor 1(PAR1) ,to explore its possible relationship with cell proliferation ,cell activation and collagen secretion of HSC-T6 cell .Methods HSC-T6 cells were divided into 4 groups ,control group ,SFLLR group;vehicle plasmid+SFLLR group ,C/EBPαplasmid+SFLLR group .The eukaryotic vector harboring the full length of C/EBPαcD-NA was transfected into PAR1 activated HSC-T6 cell ,then Western blot was applied to detect the expression of α-smooth muscle actin(α-SMA) and collagen I and evaluate the effect of transfection on proliferation of HSC-T6 by MTT .Results The expression of α-SMA and collagen I in C/EBPαplasmid+SFLLR group were dramatically decreased compared with other 3 groups ,as well as proliferation after 48 h(P<0 .05) .Conclusion Over-expression of C/EBPαgene by transfection had inhibitory influence on prolif-eration ,activation and collagen secretion of HSC-T6 which were activated by PAR1 .

Objective To investigate any potential and independent demographic and serologic risk factors contributing to bone destruction in patients with rheumatoid arthritis ( RA) . Methods A total of 445 patients with RA were recruited in this study. Three autoantibodies including rheumatoid factor ( RF) , anti-cyclic citrullinated peptide antibody ( anti-CCP antibody) and anti-citrullinated alpha-enolase peptide 1 antibody ( anti-CEP-1 antibody) were quantified by using specific ELISA kits. The hand radiographs of all subjects were graded by using the modified Sharp/van der Heijde score ( Sharp score) . The potential and in-dependent risk factors were assessed by using univariate linear regression analyses and the stepwise multiple regression analysis, respectively. Results Based upon the univariate regression analyses, 7 covariates were identified as the potential risk factors for bone destruction in patients with RA, which were female (β=0. 100, P=0. 035), longer disease duration (β=0. 498, P=3. 26×10-29), RF (β=0. 096, P=0. 042), younger age at onset (β=-0. 312, P=1. 60 × 10-11 ), anti-CCP antibody positive (β=0. 202, P=1.74×10-5), anti-CEP-1 antibody positive (β=0.148, P=0.017) and positive for either anti-CCP or anti-CEP-1 antibodies (β=0. 157, P=1. 42×10-3). However, smoking (β=-0. 121, P=0. 018) were identi-fied as the potential protective factors. The multiple regression analysis indicated that the longer disease du-ration (P=2. 24×10-15) and anti-CCP antibody positive (P=0. 012) were independent risk factors for bone destruction. Conclusion Female, longer disease duration, younger age at onset, RF, anti-CCP and anti-CEP-1antibodies are potential risk factors for bone damage in patients with RA. Moreover, longer disease du-ration and anti-CCP antibody are two independent risk factors contributing to bone destruction in RA.

Objective To investigate the clinical features,early diagnosis and individualized treatment of renal hypophosphatemia and osteomalacia induced by adefovir dipivoxil (ADV) in patients with chronic hepatitis B (CHB).Methods Thirty-nine CHB or hepatitis B virus (HBV)-related cirrhosis patients of renal hypophosphatemia and osteomalacia induced by ADV were consecutively collected.The clinical features were analyzed and treatment outcome was followed up.Results The mean age of the 39 patients was 54 (27-71) years old.There were 26 male and 13 female patients,and 19 patients with cirrhosis.The mean ADV treatment duration was 69 (range 18-116) months,and 31 patients were treated for 36-96 months.The mean serum phosphate was 0.68 (0.42-0.79) mmol/L.Twenty-six cases developed renal hypophosphatemic osteomaolacia,of which 14 had bone pain and 19 had abnormally elevated alkaline phosphatase (ALP).Three patients had increased serum creatinine and 24 patients had decreased estimated glomerular filtration rate (eGFR).After individualized treatment,patients gained normal serum phosphate in mean of 2.0 (range 0.5-6.0) months,and had bone pain remission in the mean of 0.8 (range 0.2-1.0) month and bone pain disappeared in the mean of 1.5 (range 0.5-5.0) months.Function indices of liver and kidney were improved gradually,and the bone mineral density examination improved slowly.Conclusions CHB and HBV-related cirrhosis patients treated with longterm ADV could develop renal hypophosphatemia and hypophosphatemic osteomalacia,which is partially reversible.Monitoring serum phosphate,creatinine and cystatin C is necessary during long-term ADV therapy.After confirmed diagnosis,withdrawal or dosage reduction of ADV,and switch to telbivudine or entecavir should be considered.Meanwhile,serum phosphate and HBV DNA level should be monitored.

Objective To discuss the experiences of management of female duplicated kidney with urinary incontinence. Methods The clinical data of 25 cases with duplicated kidney with urinary incontinence were retrospectively analyzed. They were all female, age ranged from 2 to 12 years old, averaging 7. Fifteen cases were with right side lesions, 10 with left side. The main complaint was urinary incontinence and itching of pudendum. The diagnosis was set up by physical examinations and imaging methods. Results Twenty-five cases reported continent after operation. For the patients taken ureteral replant, the upper kidney function kept or recovered during follow-up. Conclusions Sonography, IVU, and MRU play an important part in the diagnosis of duplicated kidney with urinary incontinence. Operation is the key treatment for this disease.