Objective To compare the efficacy of Letrozol ( LE) regimen for ovulation induction in elderly and younger patients with polycystic ovary syndrome (PCOS).Methods A total of 67 ovulation induction cycle by LE regimen in patients elderly than 35 years old or younger than 28 years old with PCOS were studied .The endometrial thickness,morphology,number of dominant follicles,ovulation on the day of injection HCG and pregnancy outcome were recorded.Results The endometrial thickness were significantly different between the two groups [(7.9 ±1.7) mm vs (9.4 ±3.2)mm,t=2.648,P<0.05],but the endometrial morphology of AB type ,the number of dominant follicles and ovulation,pregnancy rate were indifferent [71.9% vs 77.8%,(1.5 ±1.5) vs (1.4 ±1.2),(1.3 ± 0.8) vs (1.4 ±1.2),37.5%vs 27.8%,t=2.456,1.995,1.758,1.525,all P>0.05].Conclusion LE regimen for ovulation induction is effective for PCOS patients of all ages ,although the elderly patients with endometrial thick-ness is less than that in younger ones .The number of dominant follicles ,endometrial morphology and ovulation is no different,don′t reduce pregnancy rates .

Objective To discuss role of double intramedullary nail in the treatment of floating knee injuries under minimally invasive surgery.Methods From July 2006 to July 2010,23 patients with floating knee injuries ( Fraser type Ⅰ ) were fixed with tibial intramedullary nail and femoral retrograde intramedullary nail assisted by minimally invasive method such as portable bracket,AO large distractor and Schanz screw.The postoperative continuous passive motion (CPM) was performed for functional exercises of the knee.Results The operation lasted for average 95 minutes ( range,70-160 minutes),with average blood loss of 260 ml ( range,100-600 ml).All patients were followed up for average 11 months (range,7-35 months).According to assessment systems of Karlstrom and Olerud,the clinical results were excellent in 17 patients,good in 4 and fair in 2,with excellence rate of 91％.Conclusions Combined with the methods of portable bracket of lower limb,AO large distractor and Schanz screw,the intramedullary nail is much convenient and minimally invasive for the floating knee injuries.

Objective To survey the thyroid-hormone changes in gravidas,and to establish the reference intervals for thyroid-hormones in each trimester of normal pregnancy in Pingdingshan.Methods 2 645 gravidas who established documents in our hospi-tal were enrolled,The gravidas were divided to different groups by age (≤30 and >30 years old)and 425 cases of early pregnancy women,1 657 cases of middle pregnancy women and 563 cases of late pregnancy women were collected as research group.4 kinds of thyroid functions in the six groups were detected by electrochemical luminescence.Results FT3 and FT4 gradually reduced as the growth of the pregnancy period,but TSH and TPOAb increased.There is statistical difference in all thyroid-hormones between all trimesters of pregnancy and different age groups.Conclusion There is significant difference in thyroid-hormones for different sta-ges of pregnancy and different age groups.Therefore,establishing reference intervals of thyroid-hormones during different stages of pregnancy may be important for clinical practice.

BACKGROUND: Parkinson disease(PD) is a series of clinical symptom induced by decreased dopamine (DA) in the striatum due to nigral dopaminergic neuronal degeneration. The intracerebral transplantation of secretory DA can reverse or improve the symptoms to a certain extent, but immunologic rejection is still existed.OBJECTIVE: To probe into cell transplantation with immunoisolation in treatment of in rats without application of immunosuppress and observe its mechanical intensity and the biocompatibility of microcapsule .DESIGN: Randomized controlled experiment was designed.SETTING: Biomedical Material Engineering Group, Dalian Institute of ChemicalPhysics , Chinese Academy of Sciences, and Department of Neurology, Second Hospital of Jilin University.MATERIALS: The experiment was performed in Animal Experimental Center of Second Hospital of Jilin University from August 2003 to February 2004, in which, 40 male Wistar rats were employed. PC12 cell was provided from Shanghai Institute of Cellular Biology of Chinese Academy of Sciences.METHODS: 6-hydroxydopamine solution was infused in the striatum to prepare animal model of Parkinson disease. Twenty-five rats of those had been prepared successfully and were randomized into microencapsulated cell transplantation group (12 rats), in which, 25 μL cell-loading sodium alginate-chitosan-solium alginate(ACA)microencapsul suspension (equal to 2.5×104 cells) was injected stereotaxically on two points of the right (affected side) striatum of animal model; non-microencapsulated cell transplantation group (7 rats), in which, 25 μL PC12 cell suspension (equal to 5×104cells) was injected; and empty microcapsul transplantation group (6 rats),in which, 25 μL empty microcapsules suspension was injected . On the 7th day after transplantation, in every group, apomorphine (APO) prepared with saline solution was injected (0.05 mg/kg) subcutaneously in the neck; afterwards, the revolving behavior was recorded for each rat, once per week,totally for 12 weeks. In the 12th week after operation, the rats were sacrificed with anesthesia. The brain tissue was collected for pathological observation and microcapsule were retrieved to evaluation of biocompatibility and immunoisolation.numbers before and after transplantation of each group.RESULTS:Twenty-five rats entered result analysis and the rest was sule: the retrieved ACA microcapsule was integrative in morphology,munoisolation of microcapsule: microencapsuled PC12 cells were prolifercycles before and after transplantation of each group: the records of lateral revolving of rats in every group before transplantation were not significantly different (P ＞ 0.05). In microencapsuled cell transplantation group, 2weeks later, the average number of revolving was significantly lower than that before the transplantation, or even the revolving stopped; the improved symptoms were maintained till the 12th week after transplantation. In nonmicroencapsulated cell transplantation group, the average revolving number was also significantly lower than that before the transplantation, but that on the 8th and 12th weeks was in tendency of increase, without obvious change compared with that before the transplantation (P ＞ 0.05). The revolving number before and after transplantation in non-microencapsulated transplantation group was similar[(10.5±1.4), (10.5±1.3) cyclos/min, P ＞ 0.05].microcapsule provides immune protection. The grafted encapsulated PC12cells survive for along term in the brain of rats with PD, maintain continuously the normal physiological function and improve the symptoms of PD by synthesizing and releasing DA.

OBJECTIVE:To investigate the characteristics of central nervous system(CNS)ADR caused by olanzapine,and to provide reference for safe and rational drug use in clinic. METHODS:Thirty cases of CNS ADR caused by olanzapine reported by our hospital to national ADR monitoring center were collected during 2004-2015. General information of patients,drug therapy, ADR,treatment measures and outcomes were analyzed statistically. RESULTS:Among 30 cases of CNS ADR caused by olanzapine, the female was more than male(22/8);the age of patients mainly ranged 21-40 years old(10 cases,33.3%). The original disease was given priority to schizophrenia (18 cases,60.0%). When ADR occurred,average dose of olanzapine was (18.0 ± 7.0) mg/d. The daily dose of 20 mg accounted for the most of ADR(8 cases,26.7%). Main ADR was extrapyramidal syndrome(22 cases, 73.3%). When mostly reduced the drug dose,stopped olanzapine,switched to other antipsychotics,and actively adopted symp-tomatic support treatment,the symptoms were relieved or returned to normal. CONCLUSIONS:The extrapyramidal syndrome take up the majority of CNS ADR caused by olanzapine. ADR is also likely to happen even if the daily dose is small. CNS ADR are more likely to happen in women. At the beginning of the treatment within a month,close attention should be paid to ADR. It is sug-gested to grasp the indications strictly and observe ADR so as to ensure the safety of drug use.

OBJECTIVE:To analyze the features of risperidone-induced leucocytopenia ADR.METHODS:Twenty-one ADR cases of risperidone-induced leucocytopenia reported by our hospital were collected and analyzed during 2004-2015.The characteris tics of risperidone-induced leucocytopenia were discussed.RESULTS:Among 21 patients,there were 10 male and 11 female.The age was from 15 to 72 years old.Nine cases of patients were 31-40 years old (42.9％).Most of the original disease was schizophre nia.Incubation period of leucocytopenia caused by risperidone was (28.6 ± 21.4) d.Patients had no discomfort complain when leucocytopenia occurred.The lowest white blood cells reported was(3.1 ± 0.5)× 109 L-1.The leucocytopenia were improved after reduc tion,drug withdrawal and symptomatic treatment.CONCLUSIONS:Patients usually have no body discomfort complain when risperidone-induced leucocytopenia appears.Doctors should moniter ADR regularly,identify it earlier and treat carefully.

Objective To investigate the value of standardized ultrasound screening in diagnosis of fetal congenital heart disease (CHD) during the first trimester. Methods This study retrospectively analyzed the clinical data of 8 383 fetuses who received ultrasound screening during the first trimester in the Dongguan Maternal and Child Health Hospital from September 2015 to December 2016. Standardized ultrasound was performed to observe fetal heart position, apical direction, apical four-chamber view, three vessels and trachea view and the thickness of nuchal translucency (NT). Fetuses with thickened NT or fetal CHD observed during the first and second trimester were followed up. Pregnancy outcomes and the growth of newborns within one year after birth were recorded and analyzed. Pathological results after the termination of pregnancy were compared with the results of routine karyotyping and chromosome microarray analysis (CMA). Results (1) A total of 27 cases of fetal CHD were identified during the first trimester giving a detection rate of 0.32% (27/8 383). These included ten (37.0%) of single atrium and/or single ventricle, seven (25.9%) of endocardial cushion defect (including two complicated by persistent arterial trunk), three (11.1%) of hypoplastic right heart syndrome, three (11.1%) of interventricular septal defect, two (7.4%) of hypoplastic left heart syndrome, one (3.7%) of mirror-image dextrocardia and one (3.7%) of right atrial enlargement and severe tricuspid regurgitation. Nineteen out of the 27 cases had NT thickening (NT≥3.0 mm) and 17 of them had a cystic hygroma (NT≥6.0 mm). Among the 27 cases, 22 were terminated in the first trimester which autopsy results were consistent with ultrasound and the other five were rescreened during the second trimester. Thirteen out of the 27 cases received chorionic villus sampling, and seven of them were found to have chromosomal abnormalities by karyotyping and CMA, among whom one was microdeletion of 22q11. (2) Twenty-one cases of CHD were detected in the second-trimester ultrasound screening, including five initially identified in the first trimester. These cases included four (19.0%) of complex cardiac malformations (with three or more malformations), four (19.0%) of interventricular septal defect, three (14.3%) of dextroaortic arch, left subclavian artery vagus and 'U' shaped vascular ring, three (14.3%) of hypoplastic right heart syndrome (including one complicated by coronary artery-right ventricular fistula and one by interventricular septal defect), two (9.5%) of transposition of the great arteries, two (9.5%) of tetralogy of Fallot, one (4.8%) of hypoplastic left heart syndrome, one (4.8%) of Taussig-Bing anomaly and one (4.8%) of coarctation of the aorta. Among the 16 cases first identified in the second trimester, eight had NT thickening, including one with cystic hygroma. Among the 21 cases, two were lost to follow-up after being transferred to another hospital; four with negative results in karyotype analysis and CMA were delivered vaginally at term (37-40 gestational weeks) with 1-min Apgar scores of ten points and postpartum ultrasound of the baby was consistent with the second-trimester ultrasound screening; 15 were terminated and the autopsy confirmed those findings in the second-trimester ultrasound screening. Eleven out of the 21 cases received amniocentesis and five of them were found to be abnormal according to karyotype analysis and CMA, including one of microdeletion of 22q11. Conclusions Standardized first-trimester ultrasound screening is important and of great clinical value in the diagnosis of fetal CHD. Increased NT thickness could be a key indicator of fetal CHD and chromosomal abnormalities in early pregnancy. CMA may facilitate detecting the abnormality of genetic material in fetuses with normal chromosome karyotype.

ObjectiveTo explore the determinants of average length of stay of three county hospitals and eleven countryside hospitals of Xinjiang province.MethodsRelative data of the county and the countryside hospitals from 2009 to 2010 were collected,and descriptive analysis and rank sum test were employed to explore the determinants of average length of stay.ResultsThe average length of stay of the county hospital was longer than the countryside hospital,the average length of stay had significant differences between the gender,age,and the disease classfication.ConclusionThe average length of stay of the county hospitals and countryside hospitals had difference significantly.

Objective:To investigate the application value of contrast-enhanced ultra-sound, enhanced computed tomography (CT) and enhanced magnetic resonance imaging (MRI) in the diagnosis of small hepatocellular carcinoma.Methods:The clinical diagnositic trial was con-ducted. The clinicopathological data of 145 patients with small hepatocellular carcinoma who were admitted to the First Affiliated Hospital of Amy Medical University from January 2019 to June 2021 were collected. There were 121 males and 24 females, aged from 26 to 78 years, with a median age of 54 years. All patients were examined with contrast-enhanced ultrasound, enhanced CT and enhanced MRI, and underwent surgical resection of liver lesions within one month. Observation indicators: (1) postoperative histopathological examinations of patients with small hepatocellular carcinoma; (2) examination of small hepatocellular carcinoma by contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (3) imaging features of small hepatocellular carcinoma in the contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (4) enhancement mode distribution of small hepatocellular carcinoma in the arterial, portal and delayed phases of contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (5) the efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the Cochran′s Q test or the chi-square test. The sensitivity, specificity and accuracy were used to analyze the efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Results:(1) Postoperative histopathological examinations of patients with small hepatocellular carcinoma. There were 154 lesions detected in the postoperative histopathological examinations for the 145 small hepatocellular carcinoma patients, with the tumor diameter as (2.2±0.6)cm. (2) Examination of small hepatocellular carcinoma by contrast-enhanced ultrasound, enhanced CT and enhanced MRI. There were 153, 154 and 154 lesions detected in contrast-enhanced ultrasound, enhanced CT and enhanced MRI for the 145 patients with small hepatocellular carcinoma, respectively, with the detection rate as 99.35%(153/154), 100.00%(154/154) and 100.00%(154/154), showing no significant difference among the 3 imaging examination methods ( Q=2.00, P>0.05). (3) Imaging features of small hepatocellular carcinoma in the contrast-enhanced ultrasound, enhanced CT and enhanced MRI. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, 140 lesions showed "fast-in and fast-out" enhancement, 12 lesions showed "fast-in and slow-out" enhancement and 1 lesion showed isoenhancement in arterial phases and hypoenhancement in portal and delayed phase. Of the 154 lesions reported in enhanced CT for patients with small hepatocellular carcinoma, 112 lesions showed "fast-in and fast-out" enhancement, 13 lesions showed "fast-in and slow-out" enhancement, 14 lesions showed isoenhancement in arterial phase and hypoenhancement in portal and delayed phases, 5 lesions showed rim-like hyperenhancement in arterial phase and hypoenhancement in portal and delayed phases, 5 lesions showed hypoenhancement in the three phases, 3 lesions showed hyperenhancement in the three phases, 1 lesion showed isoenhancement in the three phases and 1 lesion showed isoenhancement in arterial and portal phases and hypoenhancement in delayed phase. Of the 154 lesions reported in enhanced MRI for patients with small hepatocellular carcinoma, 134 lesions showed "fast-in and fast-out" enhancement, 1 lesion showed "fast-in and slow-out" enhancement, 8 lesions showed isoenhancement in arterial phase and hypoenhance-ment in portal and delayed phases, 5 lesions showed rim-like hyperenhancement in arterial phase and hypoenhancement in portal and delay phases, 2 lesions showed rim-like hyperenhancement in the three phases, 1 lesion showed hyperenhancement in the three phases, 1 lesion showed hypoenhancement in the three phases, 1 lesion showed isoenhancement in arterial and portal phases and hypoenhancement in delayed late phase, 1 lesion showed edge delay enhancement in the three phases. (4) Enhancement mode distribution of small hepatocellular carcinoma in the arterial, portal and delayed phases of contrast-enhanced ultrasound, enhanced CT and enhanced MRI. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, there were 152 lesions with hyperenhancement and 1 lesion with iso or hypoenhance-ment in the arterial phase, there were 55 lesions with hyper or isoenhancement and 98 lesions with hypoenhancement in the portal venous phase, there were 12 lesions with hyper or isoenhancement and 141 lesions with hypoenhancement in the delayed phase. Of the 154 lesions reported in enhanced CT for patients with small hepatocellular carcinoma, there were 133 lesions with hyperen-hancement signal and 21 lesions with iso or hypoenhancement in the arterial phase, there were 53 lesions with hyper or isoenhancement and 101 lesions with hypoenhancement in the portal phase, there were 17 lesions with hyper or isoenhancement and 137 lesions with hypoenhancement in the delayed phase. Of the 154 lesions reported in enhanced MRI for patients with small hepatocellular carcinoma, there were 143 lesions with hyperenhancement and 11 lesions with iso or hypoenhance-ment in the arterial phase, there were 29 lesions with hyper or isoenhancement and 125 lesions with hypoenhancement in the portal phase, there were 5 lesions with hyper or isoenhancement and 149 lesions with hypoenhancement in the delayed phase. There were significant differences in the enhancement mode distribution of lesions in the arterial, portal and delayed phases among contrast-enhanced ultrasound, enhanced CT and enhanced MRI ( χ2=19.47, 13.21, 6.92, P<0.05). (5) The efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, there were 3 lesions misdiagnosed according to the postoperative histopathological examinations. Of the 154 lesions reported in enhanced CT and enhanced MRI for patients with small hepatocellular carcinoma, there were 7 lesions and 2 lesions misdiagnosed according to the postoperative histopathological examinations, respectively. Lesions misdiagnosed in one imaging examination method were correctly diagnosed in the other two imaging examination methods. The sensitivity, specificity, accuracy were 97.4%, 63.0%, 92.3% for contrast-enhanced ultrasound in the diagnosis of small hepatocellular carcinoma. The above indica-tors were 95.5%, 63.0%, 90.6% for enhanced CT and 98.7%, 63.0%, 93.4% for enhanced MRI in the diagnosis of small hepatocellular carcinoma. There was no significant difference in the sensitivity and accuracy among the 3 imaging examination methods ( Q=2.92, 0.00, 1.81, P>0.05). Conclusion:Contrast-enhanced ultrasound, enhanced CT and enhanced MRI all have good diagnostic value in diagnosis of small hepatocellular carcinoma, and they complement each other.

Objective:To investigate differences in the value of three chronic kidney disease epidemiology collaboration(CKD-EPI)estimation formulas in the evaluation of renal function damage in elderly patients with hypertension.Methods:A total of 58 patients with essential hypertension over 65 years of age were enrolled from November 2018 to March 2019 in this retrospective analysis.Patients with abnormal results in one or more items out of serum creatinine(Scr), blood urea nitrogen and urine protein were included in the hypertensive renal damage group(the positive group, n=25)and patients without abnormal results were included in the simple hypertensive group(the negative group, n=33). We measured Scr and cystatin c(Cys C)levels in fasting blood for each group.The estimated glomerular filtration rates(eGFR Scr, eGFR Cys C and eGFR Scr-Cys C)were calculated using the CKD-EPI formulas. Results:There was no statistically significant difference in gender, age, body mass index, grade of hypertension, onset time of hypertension, total cholesterol and triglycerides between the two groups( P> 0.05). There were significant differences in Cys C, eGFR Scr, eGFR Cys C and eGFR Scr-Cys C between the two groups( P<0.05). Spearman correlation analysis showed that Cys C was positively correlated with Scr( r=0.427, P<0.01), serum urate( r=0.266, P<0.05)and blood urea nitrogen( r=0.357, P<0.01)and was negatively correlated with eGFR Scr( r=-0.369, P<0.01), eGFR Cys C( r=-0.982, P<0.01)and eGFR Scr-Cys C( r=-0.845, P<0.01). Of the three formulas, eGFRScr-Cys C had the largest area under the receiver operating characteristic(ROC)curve(AUC)and its value was 0.707(0.565, 0.849). Conclusions:For the three estimation formulas, CKD-EPI Scr-Cys C has slightly better diagnostic efficiency than the others and may help improve the diagnosis of renal damage in elderly patients with hypertension.