Surgical resection,radiotherapy and chemotherapy are the current mainstays of cancer treatments.During ovarian cystectomy,part of the normal ovarian cortex could be resected together with ovarian mass,which suppresses ovarian reserve postoperatively.This reduction in ovarian reserve is especially produced after resection of ovarian endometriomas.On the other hand,radiotherapy and chemotherapy may cause cell apoptosis,diminish blood supply in the ovaries and weaken the brake on follicular recruitment.Brought together,these mechanisms give rise to accelerated deprivation of ovarian follicles,and hence undermine fecundity of the affected individuals.Moreover,radiotherapy could result in alterations in structure and functions of uterus and other pelvic organs,which translate into increased incidence of obstetric complications later on.Currently antral follicular count and serum anti-Müllerian hormone are the most sensitive and accurate measurements of ovarian reserve.

Objective To explore the clinical value of laparoscopic-assisted vaginal hysterectomy(LAVH)in large uterus.Methods Retrospective analysis was conducted on clinical data of 94 patients(whose uterus were as big as 10-18 gestational weeks)who received hysterectomy from January 2005 to March 2007,in which 56 cases were performed laparoscopic-assisted vaginal hysterectomy(LAVH group)and 38 cases vaginal hysterectomy(VH group).The operation time,blood loss,postoperative hospital stay,and the incidence of postoperative complications were compared between the two groups.Results Compared with VH group,there were a lower chance of abdominal hysterectomy(0/56 vs 5/38,?2=5.389,P=0.020),a shorter operation time [(149?11)min vs(179?14)min,t=-11.610,P=0.000] and a shorter postoperative hospital stay [(5.8?1.4)d vs(7.3?3.6)d,t=-2.825,P=0.006] in the LAVH group.There were no significant differences in blood loss,morbidity and time to first flatus between the two groups.Conclusions The LAVH extends the indications of VH,ensuring the safety of VH for the uterus bigger than 10 gestational weeks,therefore it is an operative procedure to be recommended.

Objective To characterize the clinical manifestations and to evaluate the value of the electrophysio-logical examination in patients with peripheral nerves injuries caused by neurobrucellosis. Methods Electrophysiology examination was conducted in 32 patients with peripheral nerve injuries caused by neurobrucellosis and 32 normal controls who had equivalent age and gender. The results were further statistically analyzed. Results There were sig-nificant difference between patients and healthy control group in distal motor latency (DML), compound motor active potentials (CMAP) amplitude, motor nerve conduction velocity (MCV), sensory nerve action potential latency(SL),senso-ry nerve action potential (SNAP) amplitude and sensory nerve conduction velocity (SCV) ( P﹤0.05). Electrophysiology examination revealed peripheral nerve damage of limbs involving, both sensory nerve and motor nerves, of which sen-sory and motor nerve injuries accounted for 55.47% and 16.80%, respectively. Median and sural nerve injuries were most frequently affected in upper (64) and lower limbs (16). Motor and sensory nerve conduction velocity was delayed in 43 nerves (16.80%) of 256 examined motor nerves and in 142 nerves (55.47%) of 256 examined sensory nerves. The damage of the sensory nerves was more severe than those of the motor nerves and damage of nerves in the upper limbs was more severe than those in the lower limbs. Conclusion Electrophysiologoical examination provides objective basis for the diagnosis of peripheral nerve injuries in neurobrucellosis.

Background Clinical work found that triamcinolone acetonide (TA)bleeding during vitrectomy in proliferative diabetic retinopathy (PDR),but its mechanism is not clear.Objective This study was to explore the anastalsis of TA in vitrectomy for PDR.Methods A prospective study was performed.Twelve eyes of 12 patients who received vitrectomy combined with the intraocular use of TA for PDR were in cluded in Tianjin Medical University General Hospital from 2011 to 2014 and served as TA group.Thirty-two eyes of 32 patients who underwent vitrectomy for epimacular membrane or macular hole were enrolled as control group.The vitreous specimens of 0.6 ～0.8 ml was collected during the surgery.The concentrations of urokinase plasminogen activator (u-PA),tissue plasminogen activator (t-PA) and plasminogen activator inhibitors 1 (PAI-1) in vatreous were measured by ELISA.Results The mean contents u-PA,t-PA and PAI-1 in the vatreous were 25.45,127.44 and 0.42 ng/ml respectively in the TA group,and those the mean contents in the control group were 22.94,142.37 and 0.27 ng/ml respectively,shouwing a significant difference between the TA group and the control group (Z=-2.268,P＜0.05).NO significant difference was found in vitreous t-PA and PAI-1 between TA and control groups (Z =-0.092,-1.847,both at P＞0.05).Conclusions Vitreous u-PA content is increased in PDR eyes,which is more likely to lead bleeding.Anastalsis of TA during vitrectomy for PDR may be relatived to decreasing vitreous t-PA and u-PA contents as well as increasing PAI-1 contents.

Objective To conduct a prospective phase Ⅱ clinical study to explore the distribution of CYP2D6 gene polymorphism in Chinese population and its relationship with the metabolism of tamoxifen in early-stage hormonal receptor-positive breast cancer. Methods CYP2D6 genotype was tested by Sanger sequencing using the ABI 3500 Genetic Analyzer. Plasma concentrations of tamoxifen and endoxifen were measured using the HPLC-MS/MS(API 2000)assay. We downloaded the data of CYP2D6 allele from the CPIP database. Results In Chi-nese patients,the most common alleles were CYP2D6*1,*2,and *10;the predominant diplotypes were *1/*10 (38.3%)and*10/*10(18.8%). The distribution of metabolic phenotype,plasma concentration of endoxifen,and endoxifen:tamoxifen plasma concentration ratio were inconsistent between the normal metabolic phenotype(EM) and the intermediate phenotype(IM)under different CYP2D6 activity prediction criteria.The differences in the ratios and endoxifen plasma concentrations were statistically significant between the three groups by cluster analysis. Conclusions The CYP2D6 genotype distribution in Chinese population is different from that in the Western popu-lation. There is considerable variation of serum endoxifen concentration in Chinese breast cancer patients possess-ing the phenotype previously known as the intermediate active metabolizers of CYP2D6. Therefore,in the current era of precision medicine,the standard CYP2D6 genotype-phenotype classification system cannot properly stratify the Chinese population with different levels of endoxifen plasma concentration.

Objective To analyze the clinical characteristics and prognosis of neurobrucellosis(NB).Methods Twenty-seven cases of NB patients who received treatment in Disease Prevention and Control Center of Inner Mongolia Autonomous Region and Inner Mongolia Medical University Hospital from January to December in 2016 were collected.The clinical data of these patients were recorded and systematically analyzed.Results Twenty-four cases(88.89%)had a history of exposure to cattle and sheep.Twenty-four cases(88.89%)were admitted with fever,18(66.67%)cases with sweat,16 cases(59.26%)with headache,14 cases(51.85%)with neurological symptoms of meningitis and meningoencephalitis,4 cases(14.81%)with auditory nerve damage and 3 cases(11.11%)with spinal cord damage.Elevated white blood cells were found in 2 cases(7.41%),elevated serum C-reactive protein in 3 cases(11.11%),elevated procalcitonin in 2 cases(7.41%)and elevated erythrocyte sedimentation rate in 15 cases(55.56%).All the 27 patients underwent lumbar puncture and the cerebrospinal fluid test results were abnormal,of which increased protein levels in 17 cases(62.96%),increased mononuclear cell ratio 14 cases(51.85%),increased pressure in 14 cases(51.85%),and reduced chloride levels in 14 cases(51.85%),and reduced glucose levels in 6 cases(22.22%).Positive cerebrospinal fluid culture(CSF)was found in 1 case(3.70%).There were 8 cases(29.63%)with white matter damage,5 cases(18.52%)with meningeal enhancement,3 cases(11.11%)with spinal cord lesions,2 cases(7.41%)with cerebral edema and 2 cases(7.41%)with brain abscess.There were 10 cases(37.04%)with sensory nerve damage in the extremities,4 cases(14.81%)with auditory nerve damage and 2 cases(7.41%)with motor nerve damage.All patients were treated with regular anti-Berg's disease for 6 weeks and were followed up for 1 year(every 3 months)after the treatment.Nineteen patients(70.37%)were cured,7 patients(25.93%)developed sequelae and 1(3.70%)patient died.Conclusions The analysis suggests that NB have a variety of clinical characteristics.CSF examination,imaging examination and neuro electrophysiology detection have contribution to the diagnosis of the NB.