Objective　To investigate the relation between ovarian blood-flow resistance index (RI) measured with color Doppler ultrasound and the dosage of pituitary desensitization medication in controlled ovarian hyperstimulation cycle.Methods　Thirty infertile females were randomized into group at routine dose of gonadotropin releasing hormone agonist (GnRHa) (group A) and group at reduced dose of GnRHa (group B).Ovarian arterial blood-flow RI was checked on cycle day 8 and on the day of human chorionic gonadotropin ( HCG) administration with transvaginal color Doppler ultrasound.Results　The ovarian arterial blood-flow RI on cycle day 8,the total dosage and the duration of human manopausal gonadotropin (HMG) administration were significantly reduced in group B. In both groups,the ovarian arterial blood-flow RI was significantly decreased in the ovary with more dominant follicles (follicle diameter >10 mm) compared with the opposite one.Conclusions　In controlled ovarian hyperstimulation cycle,compared with routine protocol of GnRHa administration,reduced dose of GnRHa could decrease the ovarian arterial blood-flow RI,the total dosage and the duration of HMG administration without reducing pregnancy rate.

Background:Ulcerative colitis(UC)is often accompanied by a variety of extraintestinal manifestations. Recently, the role of extraintestinal manifestations in diagnosis and treatment of UC has aroused widespread concern in clinical practice. Aims:To study the extraintestinal manifestations of patients with UC in order to elevate diagnosis level of UC. Methods:A total of 208 inpatients from June 2008 to September 2011 at Beijing Military General Hospital were enrolled. The extraintestinal manifestations of UC were retrospectively analyzed. Results:The ratio of male to female was 1. 14: 1, mean age was(41. 17 ± 13. 57)years,mean disease duration was(62. 6 ± 79. 4)months. Thirty-three patients had proctitis,52 had left-sided colitis,and 123 had extensive colitis. Forty-nine patients were mild UC,80 were moderate UC, and 79 were severe UC. The incidence of extraintestinal manifestations was 28. 8%(60 / 208);13 patients(6. 3% )had more than one extraintestinal manifestation. The main extraintestinal manifestations were oral ulcer(13. 0% ),arthropathy (11. 1% ),hepatobiliary disease( 3. 8% ) and skin lesion( 1. 4% ). The trend of incidence of extraintestinal manifestations increased from patients with proctitis,left-sided colitis to extensive colitis(21. 2% ,28. 8% ,30. 9% , respectively),however,the difference was not statistically significant(P > 0. 05). No significant difference in incidence of extraintestinal manifestations in patients with mild UC,moderate UC and severe UC was found(22. 4% ,33. 8% ,27. 8% , respectively)(P > 0. 05). Conclusions:Patients with UC are often accompanied by extraintestinal manifestations,and the recognition of extraintestinal manifestations is helpful for improving diagnosis and treatment level of UC.

Objective To investigate the factors predicting endoscopic stone extraction complications during operation and 1 week within operation. Methods The clinical data of 136 patients with common duet stones during endoscopic procedures and 1 week within procedures were collected, and the impacts of the number, size of stones, and the first-attack versus recurrent-attack stone, with or without cholangeitis on the complications during operation and 1 week within operation were analyzed, and the effect of nasobiliary drainage was investigated. Results The success rate in single-stone group was high, the incidences of complications during endoscopy including sphincter hemorrhage, cardiac laceration, hyperamylasemia, acute pancreatitis were significantly lower than those in the multi-stones group ( P < 0. 05 ). The group of < 2 cm stone also had high success rate of stone extraction, the incidences of complications including sphincter hemorrhage, stone impaction, cardiac laceration, hyperamylasemia, acute pancreatitis were significantly lower than those in the ≥2 cm group. The first-attack group had low success rate of stone extraction, the incidences of complications including sphincter hemorrhage, stone impaction, hyperamylasemia, acute pancreatitis and biliary infection were significantly higher than those in the recurrent-attack group. The patients with cholangeitis had low success rate of stone extraction, the incidences of complications including sphincter hemorrhage, hypoxemia, hyperamylasemia, acute pancreatitis and biliary infection were significantly higher than those without cholangeitis. After nasobiliary drainage, the incidences of hyperamylasemia, acute pancreatitis and biliary infection significantly decreased while the incidence of sphincter hemorrhage significantly increased. Conclusions The number, size of stones, and the first-attack versus recurrent-attack stone, symptoms with orwithout cholangeitis could predict the complications of stone extraction;post-ERCP nssobiliary drainage could decrease the complications, but increase the possibility of sphincter hemorrhage.

Objective To understand the pattern of and influencing factors on leisure time physical exercises among adults in Zhejiang. Method Totally 17 437 residents aged 18 years and over selected by stratified cluster random sampling in Zhejiang in 2010 were investigated. Result Overall 21.82%(95%CI:17.12%-27.38%) of adults took part in leisure time physical exercises in 2010. The proportion was higher in urban (29.04%,95%CI:23.46%-35.33%) than in rural (18.81%,95%CI:12.89%-26.61%) (χ2=222.06, P<0.05) areas, and also higher in females (22.91%,95%CI:17.66%-29.15%) than in males (20.56%,95%CI:16.39%-25.48%) (χ2=13.94, P<0.05). Adults aged 18-24 and 55-74 years were more likely to take apart in physical exercises (χ2=266.73, P<0.05), and the lowest proportion was found among farmers (5.33%,95%CI:3.99%-7.11%) (χ2=2 078.40, P<0.05). These proportions both increased along with education level and family income increase (χ2=444.87, P<0.05;χ2=332.20, P<0.05). Overall 83.04%and 90.08%of physical exercisers took part in exercises at least 3 times per week and 30 minutes per time, only 30.67% of those reached moderate or vigorous intensity, and overall 5.38% (95%CI: 3.85%-7.48%) of adults took part in regular leisure time physical exercises in 2010. Multiple logistic regression showed that age, education level, occupation and chronic disease history have influence on regular physical exercises. Conclusion The leisure time physical exercises level was generally low among adults in Zhejiang. Young and middle-aged adults with less education and low income especially farmers should be put on emphasis.

Objective To analyze the miss rates of colorectal adenomas during colonoscopy as well as risk factors influencing the adenoma miss rates and to take corresponding measures. Methods A total of 432 patients who underwent index and follow-up colonoscopy in 18 months were randomized and investigated. The results of two colonoscopies were compared and the missed adenomas were defined as the adenomas de-tected only during the second colonoscopy. Miss rates were calculated according to patient-based methods. Chi-square test was used to analyze the relative factors influencing the adenoma miss rate of per-patient. Then the meaningful factors were chosen into the logistic regression model for multiple factors analysis. Results Of 432 patients,116(26. 9%)had missed adenomas on first colonoscopy. Single factor analysis found that the size of adenoma( χ2 = 89. 686,P = 0. 000),the shape of adenoma( χ2 = 68. 488,P = 0. 000),the location of adenoma(χ2 = 77. 055,P = 0. 000)and adenoma tissue types(χ2 = 417. 000,P = 0. 000)were the risk factors for miss rates of colorectal adenomas. Number of polyps(χ2 = 8. 450,P= 0. 038),the organi-zation type of polyp(χ2 = 10. 718,P= 0. 013)and proficiency of colonoscopists(χ2 = 56. 069,P= 0. 000), the quality of bowel preparation(χ2 = 39. 195,P = 0. 000),insertion time(χ2 = 13. 133,P = 0. 001)were also the risk factors for miss rates of colorectal adenomas. Logistic regression analysis showed that the bigger the adenoma size,the less missed adenomas(OR= 0. 341,95%CI:0. 173-0. 671). Also,the longer insertion time took,the lower the adenoma miss rate(OR = 0. 987,95% CI:0. 981-0. 994). Per-patient miss rates were lower for high-risk adenomas compared with low-risk adenomas(OR = 0. 324,95%CI:0. 154-0. 680). Adenomas happening in multiple parts of bowel easily leads to missing(OR= 3. 791,95%CI:1. 505-9. 546). Conclusion The missed diagnosis of adenomas is not only significantly associated with features of missed adenomas,but also with skills of colonoscopists,insertion time,and bowel preparation. The key is high-quality index colonoscopy to avoid adenomas missing.

Objective Glucose metabolism trend was dynamicly mornitored following liver transplantation, and its affecting factors were assessed. Methods The glucose metabolism status were assessed at four time points respectively after liver transplants, then they were divided into two groups:normal glucose metabolism (NGM) and abnormal glucose metabolism (AGM). The clinical data were univariate analyzed and multivariate analyzed to screen the risk factors. Results At 1 month, 3 months, 1 year and 3 years post-transplantation, the incidence of AGM were 74.0%, 43.9%, 29.4%, 24.1% respectively Between these two groups, age > 45 y had a significant difference at 1 month, 3 months, 1 year and 3years post-transplantation; the use of tacrolimus had a significant difference at 3 months, 1 year and 3years post-transplantation, but the dose of tacrolimus or tacrolimus blood concentration showed no significant difference; high dose of glucocorticoid had significant difference at 1 month , 3 months post-transplantation; high BMI and acute rejection had significant difference at 1 month post-transplantation. Conclusions There is a high incidence of abnormal glucose metabolism (AGM) in the early stage post-transplantation, and a considerable number of patients' glucose metabolism improved in the later period. Age>45 y and tacrolimus affect glucose metabolism for a longer period post-transplants. High BMI and acute rejection have an impact on glucose metabolism only in the early stage post-transplantation. Large dose of glucocorticoid affect glucose metabolism for at least 3 months post-transplantation , and there is no significant difference after 1 year.

Objective: To understand the underreporting rate of death among residents in Zhejiang Province from 2016 to 2018, so as to provide a basis for improvement of death surveillance measures. Methods: Multi-stage random cluster sampling was used to select residents in 30 public health surveillance areas of Zhejiang Province and all the residents were investigated the general information and death conditions that occurred during the period 2016-2018 by door to door visit. The underreporting rate of death was calculated and descriptive methods were used to analyze the causes of underreporting deaths. Results: A total of 358 992 residents were investigated in 30 public health surveillance areas of Zhejiang Province. There were 63 underreporting deaths among 5 896 deaths, with an underreporting rate of 1.07%. The underreporting rate in men was 1.30%, which was higher than 0.75% in women ( P<0.05 ). The underreporting rate of residents aged 20 to <40 years was 6.74%, the highest among all the age groups ( P<0.05 ). The underreporting rate was 4.46% on the way to the hospital, the highest among all the places of death ( P<0.05 ). The underreporting rate in Wuxing District of Huzhou was 5.80%, the highest among all the surveillance areas. There were 25 cases of "late report or untimely review", accounting for 39.68%; 38 cases of "not report", accounting for 60.32%, of which 14 cases were caused by doctors forgetting to report, accounting for 22.22%. Conclusion The underreporting rate of death in Zhejiang Province from 2016 to 2018 is generally low. In response to underreporting deaths, multi-departmental collaboration should be promoted to effectively strengthen the reporting and management of routine death surveillance.

Objective: To understand the epidemiological characteristics of nonfatal injury and its influencing factors among middle school students in Zhejiang Province,and to provide evidence for prevention and control of nonfatal injury of adolescents. Methods: Using multi-stage stratified cluster sampling method,24 157 middle school students from 442 schools in 30 counties（cities,districts）of Zhejiang Province were selected to investigate socio-demographic characteristics,the occurrence of nonfatal injury and injury-related behaviors from April to May of 2017. Logistic regression model was used to analyze influencing factors for nonfatal injury among middle school students. Results: The incidence of nonfatal injuries in 23 462 secondary school students in the past 12 months was 20.86%. The incidence of nonfatal injury was 24.15% in boys,which was higher than 17.33% in girls（P<0.05）. The incidence of nonfatal injury was 20.17% in urban students and 21.19% in rural students,and the difference between them was not statistically significant（P>0.05）. The incidence of nonfatal injury was 22.17% in junior high school students,19.42% in senior high school students and 19.51% in vocational high school students,and there was statistically significant difference between them（P<0.05）. The results of the multivariate logistic regression analysis showed that boys（girls：OR=0.805,95%CI：0.728-0.890）,poor academic performance（OR=1.149,95%CI：1.018-1.298）,smoking（OR=1.260,95%CI：1.083-1.466）,drinking（OR=1.410,95%CI：1.279-1.553）,more physical activity（OR：1.244- 1.527,95%CI：1.098-1.767）,loneliness（OR：1.336-1.500,95%CI：1.219-1.682）,sadness（OR=1.308,95%CI：1.186-1.441）,absenteeism（OR=1.390,95%CI：1.182-1.634）,running away from home（OR=1.242,95%CI：1.076- 1.435）,fighting（OR=1.771,95%CI：1.594-1.967）and being bullied（OR=2.071,95%CI：1.869-2.294）were risk factors for nonfatal injury in middle school students. Conclusion The incidence of nonfatal injuries among secondary school students was 20.86%. Male students were the high risk group. The incidence of nonfatal injury was related to gender,smoking,drinking,negative emotions and violence.

Objective: To investigate thestatus and control of blood lipid level among patients with type 2 diabetes mellitus（T2DM）in rural communities of Zhejiang Province，and to provide evidence for blood lipid control for T2DM. Methods: A sample of 10 343 patients with T2DM managed by communities from Jiashan，Suichang and Yongkang in 2016 were recruited. Through the diabetes registry system，physical examination and laboratory tests，data of demographic features，blood pressure，body mass index（BMI），waist circumstance（WC），glycated hemoglobin（HbA1c），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C）and high-density lipoprotein cholesterol（HDL-C）were collected to learn the status of blood lipid control. Logistic regression analysis was conducted to explore the influencing factors for blood lipid control. Results: The control rate of TC，TG，LDL-C and HDL-C in patients with T2DM was 29.84%，58.72%，48.25% and 61.27%，respectively. About 11.76% of patients had all the four indicators in control，while 9.22% of patients failed in all. The higher control rates of all of the four indicators were seen in males than females，in older age，in lower BMI and in normal people than in central obese people（all P<0.05）. The results of multivariate logistic regression analysis showed that sex（OR=3.556，95%CI：3.070-4.119），age（OR=1.130，95%CI：1.060-1.204），WC（OR=0.989，95%CI：0.980-0.998）， BMI（OR=0.768，95%CI：0.688-0.857），systolic blood pressure（OR=0.991，95%CI：0.984-0.999），HbA1c level（OR=0.914，95%CI：0.876- 0.953），smoking（OR=0.768，95%CI：0.639-0.924）and drinking（OR=0.688，95%CI：0.536-0.884）were associated with the control of TC，TG，LDL-C and HDL-C in patients with T2DM. Conclusion The control rate of blood lipid is low in patients with T2DM in rural communities of Zhejiang Province，surveillance and interventions should be focused on sex，overweight/obesity，smoking，alcohol intake，blood glucose and blood pressure.

Objective: To investigate the degree and influencing factors of glycosylated hemoglobin ( HbA1c ) control among patients with type 2 diabetes ( T2DM ) living in rural communities of Zhejiang Province, so as to provide the reference for optimizing the management of diabetes patients in rural communities. Methods: Permanent adult patients with T2DM that were registered and received standardized management in all communities of Jiashan County and Suichang County, and 6 communities of Yongkang City, Zhejiang Province in 2016 were recruited, and their demographic characteristics were captured from the health record system and chronic disease management system. The height, body weight, waist circumstance and blood pressure were measured, and HbA1c and blood lipid parameters were detected. The degree of HbA1c control ( <7% ) was analyzed, and its influencing factors were identified using a multivariable logistic regression model. Results: A total of 10 339 patients with T2DM were enrolled, including 4 520 men ( 43.72% ) and 5 819 women ( 56.28% ), with a mean age of ( 63.54±9.78 ) years and the mean course of diabetes of ( 6.36±4.73 ) years. The rate of HbA1c control was 47.89%. Multivariable logistic regression analysis showed that males ( OR=1.123, 95%CI: 1.024-1.233 ), region ( Suichang, OR=2.413, 95%CI: 2.106-2.765; Yongkang, OR=2.460, 95%CI: 2.188-2.767 ), course of disease ( 5-9 years, OR=1.724, 95%CI: 1.504-1.977; 10 years and longer, OR=2.881, 95%CI: 2.477-3.351 ), use of hypoglycemic drugs ( OR=1.203, 95%CI: 1.089-1.329 ), development of chronic complications ( OR=1.190, 95%CI: 1.027-1.379 ), uncontrolled blood pressure ( OR=1.140, 95%CI: 1.030-1.261 ), uncontrolled blood lipid ( OR=1.258, 95%CI: 1.104-1.433 ), and smoking ( OR=1.318, 95%CI: 1.165-1.491 ) were statistically associated with HbA1c control among T2DM patients. Conclusion The rate of HbA1c control was 47.89% among T2DM patients in rural communities of Zhejiang Province. HbA1c control should be given a high priority among men living in low-economic-level regions with long course of disease, use of hypoglycemic drugs, chronic complications, smoking, uncontrolled blood pressure and lipid.