Objective To research the effect of letrozole combined with clomiphene on women with polycystic ovary induced infertility and the effect on matrix metalloproteinases-9(MMP-9),vascular endothelial growth factor(VEGF)and hepatocyte growth factor(HGF)levels.Methods 108 patients with polycystic ovary syndrome combined with infertility from February 2013 to August 2015 in our hospitolwere divided into control group and experimental group by lottery,54 cases in each groups,control group treated with clomiphene,the experimental group based on control group treatment with letrozole,the linical curative effect,MMP-9,VEGF and HGF level,sex hormones,insulin resistance index,adverse drug reactions of two groups were compared.Results The number of ovulation,advantage of ovulation number,normal rate of menstruation,ovulation rate and pregnancy ratesofin experimental group was higherthan the control group,the difference was statistically significant(P<0.05).The MMP-9,VEGF and HGF levels of experimental group was lower than the control group,the difference was statistically significant(P<0.05).The sex hormone level of experimental group was better than that of control group(P<0.05).The adverse reactions was no differences between the two groups.Conclusion The efficacy of letrozole combined with clomiphene in treatment of polycystic induced infertility,can inhibits MMP-9,VEGF and HGF expression,and with high safety.

Background and purpose:The clear-cell cancer ovarian cancer have worse prognosis than the other ovarian cancer.The patient's survival rate of the clear-cell ovarian cancer has been analyzed in this article in order to study the effect of the treatment with CAPcytoxan(CTX),cisplatinum(DDP),epiadriamycin(E-ADM)plus mitomycin(MMC).Methods:33 cases(group A)with clear-cell ovarian cancer between Jan.1th 1999 and Dec.31th 1999 were compared to 37 cases(B group)with other pathological ovarian cancer.All cases underwent the tumor reductive surgery and been capable of remain the residual tumor size less than 1 cm.Patients in the two groups all underwent CAP based chemotherapy,and patients in group A with additional MMC chemotherapy at the same time.Group A had been compared with the clear-cell ovarian cancer with the CAP protocol(group C,stage Ⅰ/Ⅱ 15 cases,stage Ⅲ/Ⅳ 9 cases).Results:There was significant statistical different value of the CA125 in stage Ⅰ/Ⅱ before operation and no significant statistical difference for stage Ⅲ/Ⅳ between the two groups.There were significant decrease in the CA125 value for the stage Ⅰ/Ⅱ and no significant decrease for stage Ⅲ/Ⅳ between two groups after three and six courses chemotherapy.There were 11(33.33%)cases developed with endometriosis and 7(21.21%)with deep venous thrombosis(DVT),however the DVT had no direct correlation to the survival rate.The average survival time for stages Ⅰ/Ⅱ in group A and B was(38.3?2.4),and(38.3?2.7)months,compared to(20?3)and(34?4)months in stage Ⅲ/Ⅳ,respectively.There was no significant statistical difference(P=0.471)in four-year survival rate between groups A and B with stage Ⅰ/Ⅱ and there was significant statistical difference(P

Objective To compare the characteristics of MRI, CT, single photon emission computed tomography(SPECT) and transcranial Doppler sonography(TCD) in patients with spongiform leukoencephalopathy after inhaling heroin vapor. Methods Seventeen patients were investigated. MRI or CT was scanned in 17 patients, SPECT in 9 patients′ and TCD in 11 patients. Results MRI or CT: Brain MRI and CT revealed extensive symmetric white matter involvement of bilateral cerebral and cerebellar hemispheres and the brainstem.The lesions, which showed no contrast enhancement, were hypodense on CT and hypointense on T 1 weighted and hyperintense on T 2 weighted MRI. SPECT: The regional cerebral blood flows(rCBF) of white matter involvement on bilateral cerebral and cerebellar hemispheres was reduced obviously. The rCBF of temporal lobes, parietal lobes, occipital lobes, cerebellar hemispheres, and basal ganglion was reduced in varying degrees. TCD: The systolic peak became sharpened, and end diastolic flow velocity and mean flow velocity were reduced obviously and pulsatility index was increased markedly in patients with spongiform leukoencephalopathy after inhaling heroin vapor. Conclusion The characteristic manifestations of MRI and CT imaging may be regarded as the main foundation of diagnosing spongiform leukoencephalopathy after inhaling heroin vapor; SPECT and TCD can help comprehend the changes of hemodynamics of cerebral vessels and the degree of cerebral ischemia in patients with spongiform leukoencephalopathy after inhaling heroin vapor.

Objective To explore the stress perception among acute myocardial infarction (AMI) patients during acute stage.Methods Phenomenological method of qualitative study was adopted.18 AMI patients during the acute stage of 3～4 days after the onset of the disease were interviewed.Results Stress made AMI patients hard to accept the fact of illness,worry about the treatment of illness and the impact on future life,be difficult to alter living habits,be hard to relieve negative emotion.Conclusions AMI patients during acute stage will experience different levels of psychological stress.Stress management should be fabricated and effective measures should be adopted to relieve their negative emotions in terms of inducing factors.

Background and purpose:The greastest diameter of cervical cancer with stage Ⅰ_(b2) disease was more than 4 cm in diameter. surgery as the fi rst priority was diffi cult in these patients, bleeding was the most frequent adverse effect. This article studied the effect of the cervical cancer with stage Ⅰ_(b2) disease underwent neoadjuvant chemotherapy with gemcitabin plus cisplatinum(DDP). Methods:23 cases (A groups) stage Ⅰ_(b2) cervical cancer were treated with gemcitabin 1.5 g/m2 iv infusion at d1, plus cisplatinum(DDP) 20 mg/m2 iv infusion at d1-3. The interval between the two cycles was two weeks.19 cases (B groups) were treated with cisplatinum(DDP) 20 mg/m2 iv infusion at d1-3,plus VCR 1.5 g/m2 iv infusion at d1, and BLM 10 mg/m2 im at d1-3, The interval between the two cycles was three weeks. The assessment for clinical effect and side effect were conducted for the patients with completion of at least two cycles of chemotherapy. Results:42 cases were enrolled in this trial. There was signifi cant(P=0.004) difference between the two groups with the shrinkage of the greatest diameter after neoadjuvant chemotherapy. The main toxicities were myelosuppression. There was signifi cant (P

Objective To study the shift handover experience of ICU clinical nurses. Method About 19 ICU nurses were enrolled in the investigation using semi-structured interviews and the results were analyzed with phenomenological analysis. Result Their shift handover experience were summarized into 6 themes, that is high recognition on the importance of shift handover, lack of standardized processes, incomplete contents of shift handover, frequent interruption, forgotten information and repeated information. Conclusions Shift handover is an important part of ICU nursing function but there are many problems in the practical operation. The nurse managers need to standard the handover process, stipulate handover contents and enhance the training on shift handover with specialist examination and positive results for the purpose of improving the quality of the shift handover.

Objectives To investigate the clinical features of clomiphene citrate (CC) resisitant in patients with the polycystic ovary syndrome(PCOS). Methods A total of 145 women with PCOS were analyzed in the center for reproductive medicine of our hospital. According to the responses to CC ,patients were divided into two groups:(1)the CC resistant group(n = 32),(2)the CC response group(n = 113). The clinical features were compared between these two groups. Results (1)Body weight,body mass index(BMI),blood pressure and F?G scores were significantly higher in the CC resistant group than those in the CC response group (P < 0.05, respectively).(2)Basic antral follicle counts(AFC),C reaction protein(CRP),fasting insulin(FI)and HOMA?IR in the CC resistant group were significantly higher than those in the CC response group (P < 0.05, respectively),however,no significant difference was observed in sex hormones between these two groups. Conclusion PCOS patients with CC resistant are more likely to have higher body weight,BMI,blood pressure, insulin resistant?indexes and basic AFC ,the clinical doctors should consider these features before the treatment of ovulation induction.

Objective To determine the moisture content in Polygoni multiflori Radix rapidly by near-infrared spectroscopy. Methods The moisture content of the samples were determined by oven drying method and the near-infrared spectrum data were collected by near-infrared spectroscopy.The quantitative test model of moisture content in Polygoni multiflori Radix was established by chemometrics methods and was validated with validation samples. Results The correlation coefficients, root-mean-square error of calibration (RMSEC), root-mean-square error of predication (RMSCP) and the root-mean-square error of cross-validation ( RMSECV ) of the calibration model was 0. 984 75, 0. 161, 0. 181 and 0. 471 64, respectively.The absolute deviation of the analytical and predictive values of 21 validation samples was -0.35%-0.28%, and the average recovery was 99. 87%. Conclusion Near-infrared spectroscopy can be used to determine the moisture content of Polygoni multiflori Radix rapidly and accurately.

Objective To investigate urinary iodine and dietary iodine intake in adults, and to ana-lyze the relationship of urinary iodine and daily dietary iodine intakes with thyroid nodules.Methods To-tally 30 participants with nutritional background were enrolled prospectively from January to March 2015 in Shanghai.The 3-day survey of 24-hour's diet record was made using weighting method to evaluate the daily nutrient intakes.On the second and third days of dietary records, urine samples in fasting status and 2 hours after meals were collected from all the participants (n=240).The levels of urine iodine were meas-ured, and dietary iodine intake calculated.3-month food frequency questionnaire was completed and thy-roid ultrasonography performed.Results The median urinary iodine ( MUI) of fasting and 2 h postprandi-al urine samples was 137.56 μg/L ( 91.4-211.5 μg/L) .The portions of participants with iodine insuf-ficiency, iodine adequate, and iodine above requirements or excess were 20.2%, 56.7%, and 23.3%, respectively.Inter-individual MUI varied from 36.31 μg/L to 359.20 μg/L.No significant difference was found between the fasting urinary iodine and 2 h postprandial urinary iodine ( P=0.389 ) .The average di-etary iodine intake was (197.2 ±74.2) μg/d, and the proportions from iodine salt and drinking water were 70.2% and 5.4%, respectively.There was a significant positive correlation between dietary iodine intake and urinary iodine value of the same day (r=0.426, P=0.019).Participants with thyroid nod-ules had higher urinary iodine than participants without thyroid nodules [ ( 194.0 ±101.5 ) μg/L vs. (135.7 ±72.9) μg/L, P<0.001].Conclusions Inter-individual iodine nutritional status are signifi-cantly different under natural living status.Increased urinary iodine may be related with thyroid nodules. Repeat random urine iodine test combined dietary assessment may reduce the error in evaluating individual iodine nutritional status.

OBJECTIVE:To explore the clinical utilization of carbapenems in a hospital,analyze and evaluate its medication rationality. METHODS:All the 508 medical records of inpatients treated with carbapenems from Jul. 2012 to Jun. 2015 were retro-spectively investigated,the utilization and pathogenic examination of carbapenems were evaluated;by setting the carbapenems eval-uating standard,the medication rationality of carbapenems was evaluated and inappropriate cases were classified and analyzed statis-tically. RESULTS:The drug utilization indexed (DUI) of Imipenem and cilastatin sodium for injection and Meropenem for injec-tion were 0.80 and 1.32,respectively;the total rate of microbial inspection was 95.9%;according to the drug sensitive test result, the rate of drug selection was 62.8%;there were 54 cases(10.6%)of irrational use records,in which,irrational dosage(42.6%) and improper drug selection (31.4%) were the major problems. CONCLUSIONS:There are some inappropriate medication prob-lems in carbapenems utilization in the hospital. Developing the carbapenems utilization evaluation is helpful to discover typical medi-cation problems,which can provide reference for intervention and continuous improvement of rational drug use.