Objective To study ovarian development in vitrificatiou of embryos born mice and expression of growth differentiation factor 9 ( GDF-9 ) in its.MethodsThe vitrification recovery embryos (vitrified-embryo group) and fresh embryos (fresh-embryo group) were transplanted into pseudopregnant mice,respectively.The female offspring mice in two groups were sacrificcd on the 3rd,7th,14th,21st,28th and 60th day after birth,the ovarian tissues were taken,6 mice in each time point of each group.The ovarian development was observed by HE staining,the expression of GDF-9 mRNA and protein at each time point of two groups were detected by reverse transcription(RT)-PCR and western blot.ResultsHE staining showed that no abnormal ovarian development was observed in offsprings at two groups.On the 3rd,7th,14th,21st,28th and 60th day after birth,the expression of GDF-9 mRNA in vitrified-embryo group were 0.14 ± 0.07,0.42±0.16,1.00±0.24,1.59±0.28,2.05 ±0.32 and 2.23 ±0.21,respectively,which in fresh-embryo group were 0.13 ±0.06,0.45 ±0.18,1.00 ±0.21,1.56 ±0.26,2.01 0.37 and 2.26 ±0.23,respectively,there was no statistical difference between two groups ( P ＞ 0.05 ) ; the expression of GDF-9 protein in vitrified-embryo group were 0.040 ± 0.030,0.120 ± 0.060,0.170 ± 0.030,0.250 ± 0.040,0.320± 0.060 and 0.330 ± 0.010,respectively,which in fresh-embryo group were 0.030 ± 0.020,0.110 ± 0.040,0.150 ± 0.010,0.210 ± 0.020,0.360 ± 0.070 and 0.350 ± 0.030,respectively,there was no statistical difference between two groups ( P ＞ 0.05 ).Conclusion The ovarian morphology in vitrification of embryos born mice and expression of GDF-9 in ovary has no any obvious change.

Objective To discuss the surgical management of von Hippel Lindau(VHL) syn drome.Methods The clinical data of four VHL patients who were clinically diagnosed from March1999 to October 2006 were reviewed.The first patient was a 56 year old man with the chief complaintof hypodynamia and low serum glucose as 2.37 mmol/L.CT scan showed three masses in the the leftkidney.He had a history of cerebral haemangioblastoma ten years before.The second case was a 57 year old woman with the chief complaint of lumbago in the left side.CT scan showed masses in theleft kidney,adrenal gland and panerease.The third case was a 39 year old woman with the chief com plaint of an accident mass in the left adrenal gland.She had the history of cerebellar hemangioblastoma9 years before,spinal hemangioblastoma resection 7 years before.The fourth case was a 41-year oldwoman,she was found brain tumors and cured by gamma radiation abalation.Bilateral renal masseswere found by B ultrasound one month later,CT scan showed four masses in the both kidneys,leftadrenal gland and pancreas.Results All 4 cases underwent surgical approach.The first case under went radical nephrectomy which pathological report was PEComa of kidney.The blood glucose wasnormal one week later.The second case underwent resection of the left adrenal gland,kidney,pancre atic body and tail and spleen.Pathological report was clear cell carcinoma,islet cell tumor and adrenal cyst.Three months later she was found spinal hemangioblastoma and refused treatment.The thirdcase underwent adrenalectomy in the left side and pathologieal report was adrenal pheoehromocytoma.There was not tumor reeurrenee during 2 years' follow up.The nephrectomy and adrenalectomy wasperformed for the last ease whose pathological report was clear celt carcinoma and pheochromoeytoma.Three weeks later,tumor enueleating of the right kidney was undertaken; the result was clear cellcancer.During the follow up for one year there was no relapse of tumor.Conclusions For VHL ac companied with multiple organ tumors,surgery resection is the proper approaeh when tumors of centralnervous system is large.Different approaches could be taken to deal with multiple tumors of VHL such aswatchful waiting,nephron sparing surgery.

Objective To study the relationship between erythromycin sensitivity and drug-resistance gene in Mycoplasma pneu-moniae(Mp).Methods In 46 erythromycin-resistant MP clinical isolates,domain Ⅴ of 23S rRNA was amplified by polymerase chain reaction(PCR),followed by direct automatic sequencing method.The DNA sequences were compared to find molecular mecha-nisms of drug resistance.Results Among the 46 erythromycin-resistant Mp clinical isolates,44(95.65%)harbored an A-to-G tran-sition mutation at position 2063 in the 23S rRNA gene and 2(4.35%)harbored an A-to-G transition mutation at position 2064,but no A-to-C transition mutation at position 2063 and C-to-G/A transition mutation at position 2617 were detected.Conclusion E-rythromycin-resistant of Mp clinical isolates were closely related to A-to-G transition mutation at position 2063/2064 in domain Ⅴof 23S rRNA genes and the most important was the A2063G transition mutation.Rapid and accurate identification of the genetic mutations in domain Ⅴ of 23S rRNA may be help to diagnose the infection of Mycoplasma pneumoniae,provide the drug-resistant information,and instruct the application of antibiotics reasonably and effectively.

The canonical Wnt signaling pathway has been the hot spot in the signaling pathway studies which are related to ovary carcinogenesis in recent years,whose activation may induce the multiplication and self-renewal,survival and metastasis of ovarian cancer stem cells.The target gene mutations of key members in the canonical Wnt pathway and abnormal expresses of negative regulation molecules are closely associated with the occurrence and development of ovarian cancer.Deeply investigating the regulative mechanisms of canonical Wnt signaling pathway in ovarian cancer,and taking this as the therapeutic target to conduct the basic research and preclinical experiment may provide theoretical basis for treating better ovarian cancer patients in clinical practice.

Objectlve To discuss the characters and management of renal sinus tumors. Methods The clinical data of 3 tumors occurring in tenal sinus were reviewed.The first patient was a 33-year-old man with the chief complaint of lumbago in the right side for 6 months.B-ultrasound showed low echo in the right pelvis and CT scan showed that a mass measured about 3.5 cm in diameter in the right kidney collective system.Intravenous urography showed the upper collective system was tompressed.He was diagnosed for renal sinus tumor.The second case was a 34-year-old woman with the chief complaint of sudden lumbago in the right for 3 d.Color ultrasonography found hyperechoic in the right kidney.CT scan showed a mass measured 8 cm×6 cm × 8 cm in the right renal sinus,its CT value was about-70 HU.Intravenous urography showed the lower collective system was compressed.She was diagnosed for renal angiomyolipoma of right kidney.The third case was a 55+year-old woman with the chief complaint of lumbago for 1 year.B ultrasound showed hyperechoic in the leftrenal hilum.CT scan showed a nlass of 8 cm×5 cm×5 am in the left renal sinus with CT value of 50 HU.Intravenous urography showed the collective system of the left kidney was compressed.Mag-netic resonance imaging showed high signal on T1 WI and T2WI but low signal in fat suppression ima-ging.She was diagnosed for lipoma of the left renal sinus. Results All the 3 cases had undergone surgical approaches.The first case underwent surgical exploration of renal sinus tumor.Fast pathologic diagnosis was benign tumor,only the tumor was resected.Postoperative pathology confirmed the diagnosis of angioleiomyoma.There was no recurrence during follow-up of 3 years.The second case was scheduled for tumor enucleating,but nephrectomy was perform because of serious bleeding and damaged renal pelvis.Pathological report was angiomyolipoma.The third case was scheduled for lipoma enucleating but nephrectomy was performed because of tumor encapsulated renal pedicle vascular.Pathological report was lipoma.During the follow-up for 4 years there was no relapse. ConclusionsTumors occurred in renal sinus are rare, most of which are benign.CT scan, MRI and intravenous urography are the best imaging examination methods for differential diagnosis.Surgical operation is the major approach, while for the tumor radical nephrectomy less than 4 cm watchful waiting could be a choice.Tumor resection with nephron sparing is feasible while tumor is larger than 4 cm.Radical nephrectomy should performed for the malignant tumor.

The diagnosis and treatment of spontaneous rupture and massive hemorrhage of tuberous sclerosis-related renal hamartoma in a woman in the third trimester are reported. The patient was admitted at 39 weeks of gestation, with threatened labor and a history of bilateral renal hamartoma, which had been hidden. Placental abruption was considered due to persistent lumbago, abdominal pain, abdominal muscle tension, uterine tension and fetal heart rate dropping to 90 bpm, and an emergency cesarean section was performed at 39 +1 weeks. About 200 ml of bloody ascites was found in the peritoneal cavity. A live boy was delivered and no blood clot was seen in the maternal face of the placenta. After the uterine incision was closed, a huge bluish purple mass was detected on the right-side retroperitoneum and the renal angiography showed rupture and hemorrhage of a right renal hamartoma. A selective right renal artery embolization was performed. The patient recovered after the operation and was discharged seven days later required by the family. The patient was in good condition except for hematuria during a 30-day postpartum follow-up, and oral everolimus treatment and regular follow-up were continued. The newborn with a birth weight of 2 355 g was transferred to the neonatology department after birth due to severe asphyxia, and postnatal echocardiography suspected heart rhabdomyoma. The baby had one seizure but was otherwise well, and was discharged after eight days. The seizure did not recur to the neonate after discharge. Clinicians should pay attention to pregnant women with renal hamartoma. If abnormal abdominal distension, hematuria or lumbago occur during pregnancy, rupture of renal hamartoma and possible massive hemorrhage should be considered.

Objective:To summarize the classification of etiology, age of onset, prognosis of children with convulsion, so as to provide experience guidance for clinicians engaged in pediatric emergency department.Methods:The clinical data of children with convulsions received in the emergency department of Children′s Hospital Affiliated to Kunming Medical University from January 2015 to December 2018 were analyzed retrospectively.Results:During the four-year period, 2 957 children with convulsion were received in the emergency department, accounting for 22.20% of the total number of critically ill children in the observation room of the emergency department, and the ratio of male to female was 1.7∶1.The etiological diagnosis of convulsion in emergency are as follows: febrile convulsion(733 cases, 24.79%), central nervous system infection(477 cases, 16.13%), unexplained convulsion(476 cases, 16.09%), epilepsy(371 cases, 12.55%), benign infantile convulsions with mild gastroenteritis(240 cases, 8.12%). The age of onset: 8.25% were in neonatal period, 33.99% were in infant, 34.87% were in toddler′s age, 12.17% were in preschool age, 7.88% were in school age and 2.84% were in adolescence.Destination statistics: 72.00% were admitted to hospital for further treatment, 13.29% were transferred to neurology clinic, 7.85% to pediatric clinic, 1.66% to rehabilitation clinic, and 0.17% died.Inpatient department: 43.64% were admitted to department of neurology, 17.52% to pediatric intensive care unit, 13.71% to department of neonatology, 12.64% to department of gastroenterology and 2.72% to department of rehabilitation.Conclusion:Febrile convulsion is the main cause of convulsion in children who were received emergency treatment in our hospital.Most of the convulsion cases are from birth to preschool age, and the prognosis is good after active treatment.

The diaphragm is the main respiratory muscle in the body. The onset detection of the surface diaphragmatic electromyography (sEMGdi) can be used in the respiratory rehabilitation training of the hemiparetic stroke patients, but the existence of electrocardiography (ECG) increases the difficulty of onset detection. Therefore, a method based on sample entropy (SampEn) and individualized threshold, referred to as SampEn method, was proposed to detect onset of muscle activity in this paper, which involved the extraction of SampEn features, the optimization of the SampEn parameters and , the selection of individualized threshold and the establishment of the judgment conditions. In this paper, three methods were used to compare onset detection accuracy with the SampEn method, which contained root mean square (RMS) with wavelet transform (WT), Teager-Kaiser energy operator (TKE) with wavelet transform and TKE without wavelet transform, respectively. sEMGdi signals of 12 healthy subjects in 2 different breathing ways were collected for signal synthesis and methods detection. The cumulative sum of the absolute value of error was used as an judgement value to evaluate the accuracy of the four methods. The results show that SampEn method can achieve higher and more stable detection precision than the other three methods, which is an onset detection method that can adapt to individual differences and achieve high detection accuracy without ECG denoising, providing a basis for sEMGdi based respiratory rehabilitation training and real time interaction.

Objective:To explore the effectiveness, safety and cost between urinary follicle stimulating hormone (uFSH) and recombinant follicle stimulating hormone (rFSH) in controlled ovarian stimulation (COS) in China.Methods:Data were collected from 16 reproductive centers in China covering oocytes collection time from May 1, 2015 to June 30, 2018. Eligible patients were over 18 years old, adopting COS with uFSH (uFSH group) or rFSH (rFSH group) as start gonadotropins (Gn), and using in vitro fertilization (IVF) and (or) intracytoplasmic sperm injection for fertilisation, excluding frozen embryo recovery cycle. Generalised estimating equation was used to address the violation of independency assumption between cycles due to multiple IVF cycles for one person and clustering nature of cycles carried out within one center. Controlling variables included age, body mass index, anti-Müllerian hormone level, cause of infertility, ovulation protocol, type of fertilisation, number of embryos transferred, number of days of Gn use.Results:Totally 102 061 cycles met eligibility criteria and were included in the analyses. In terms of effectiveness, after controlling relevant unbalanced baseline characteristics, compared with rFSH group, the high oocyte retrieval (>15 oocytes was considered high retrieval) rate of uFSH group significantly decreased in gonadotropin-releasing hormone agonist protocol ( OR=0.642, P<0.01) and in gonadotropin-releasing hormone antagonist protocol ( OR=0.556, P=0.001), but the clinical pregnancy rate per transfer cycle and the live birth rate per transfer cycle significantly increased ( OR=1.179, OR=1.169, both P<0.01) in both agonist and antagonist protocols. For safety, multiple analysis result demonstrated that in the agonist protocol, compared with rFSH group, the incidence of moderate to severe ovarian hyperstimulation syndrome of uFSH group significantly decreased ( OR=0.644, P=0.002). The differences in ectopic pregnancy rate and multiple pregnancy rate between the uFSH and rFSH groups were not significant ( P=0.890, P=0.470) in all patients. In terms of cost, compared with rFSH group, the uFSH group had lower total Gn costs for each patient ( P<0.01). Conclusion:For patients who underwent COS, uFSH has better safety, and economic profiles over rFSH in China.