Objective To study the effects of letrozole and clomiphene on the treatment of ovulation induction and the changes of reproductive hormone in the patients with polycystic ovary syndrome.Methods In Zhenhai District People's Hospital from January 2015 to December 2016, 100 cases with polycystic ovary syndrome as the research object in this study, were randomly divided into the control group and the experimental group, 50 cases in each group.The control group were treated with clomiphene, the experimental group were given letrozole combined clomiphene.The levels of reproductive hormones, ovulation rate and pregnancy rate were compared in the two groups.Results The ovulation rate was 90%, pregnancy rate was 46%, the numbers of follicles was(1.2±0.4).In the control group, the ovulation rate was 72%, the pregnancy rate was 22%, and the number of follicles was(2.2±0.5).The results showed that the ovulation rate and pregnancy rate in the experimental group were significantly higher than those in the control group, with statistical significance(P<0.05).The number of follicles in the control group was significantly higher than that in the control group, with statistical significance(P<0.05).There was no significant difference between the experimental group and the control group in the time of follicular maturation, which was not statistically significant.The levels of reproductive hormones in the experimental group were significantly lower than those in the control group, with statistical significance(P<0.05).Conclusion Letrozole combined clomiphene can improve the ovulation rate and pregnancy rate, reduce the reproductive hormone level, which has clinical application value.

Objective To investigate the effect of Daying-35 combined with metformin on ovulation induction after polycystic ovary syndrome, and to summarize the clinical experience.Methods Forty patients with polycystic ovary syndrome were treated with Daying-35 and treated as control group.Forty-five patients were treated with meta-35 combined with metformin and treated as observation group.After treatment, Level and ovulation induction, selected patients were our hospital in January 2016 to December 2016 between the treatment.Results There were no significant differences in T, FSH, LH, E2 and other hormone levels between the two groups before treatment.After treatment, the improvement of the treatment group was significantly more obvious;compared with the two groups of ovarian hyperstimulation syndrome and The rate of pregnancy was 47.5% in the observation group and 15.0% in the control group.The difference between the two groups was significant(P<0.05).Conclusion The effect of Daying-35 combined with metformin on ovulation induction after polycystic ovary syndrome was found to improve the progesterone level and improve the clinical status of the patients.Making the ovulation situation improved, improve the pregnancy rate, it is worth clinical reference.

Hepatocellular carcinoma(HCC)is one of the malignant tumors with the highest cause of death and increasing incidence worldwide.Accurate diagnosis in early stage is vital for the treatment of patients.Presently,routine screening strategies including ?-fetoprotein(AFP)and ultrasound every 6 months have been recommended for early detection in patients with liver cirrhosis to detect HCC at earlier stages.However,the sensitivity and specificity of AFP are far from satisfaction.With the development of recently techniques such as proteomics,it is possible for new HCC-specific markers being available in the near future.Golgi Protein 73(GP73)is most likely to be a promising serum marker.In a few available literatures,GP73 has sensitivity and specificity of 69% and 90%.And fucose-studded GP73 has sensitivity and specificity of 90% and 100%.Apart from GP73,lens culinaris agglutinin-reactive AFP,des-gamma carboxyprothrombin,?-L-fucosidase,glypican-3,hepatocyte growth factor,transforming growth factor-?1,vascular endothelial growth factor,and mucin 1 have been proposed as markers for HCC detection.Clinical trials are undergoing to estimate the value of the above markers,and may change the status in quo ofthe diagnosis of HCC.We have started a multi-centeral trial to investigate GP73 in HBV and HBV related HCC patients with positive preliminary results.

Objective To adopt the method performance decision chart to evaluate the performance of the Stago R Evolution au-tomatic blood coagulation analyzer .Methods The method performance decision chart was drawn by the results of external quality assessment and internal quality control according to the requirement of the total error in the clinical laboratory improvement amend-ment (CLIA′88) .The 6 indexes of 3 items including prothrombin time(PT) ,activated partial thromboplastin time(APTT) and fi-brin (Fg) were analyzed .Results The 2 indexes of the PT normal level and APTT abnormal level in the automatic blood coagula-tion analyzer were qualified .The PT abnormal level was fine and 3 indexes of the APTT normal level ,Fg normal level and abnormal level were excellent .Conclusion Six indexes of automatic blood coagulation analyzer could be evaluated by the method evaluation decision chart and it was more directly and clearly compared with σvalue statistical table .

Objective To quickly understand whether the newly introduced XE-2100 automatic hematology analyzer meets the precision promised by the manufacturer .Methods After adjusting and calibrating the new hematology analyzer ,the anticogulated blood samples by EDTA-K2 were detected for 10 times and the main parametric precisions were calculated by the Sigma unit .Results The Sigma score of this automatic hematology analyzer labeled by the manufacturer was 39 ,the actual coefficient of variation (CV) in 8 indexes was less than that labeled by the manufacturer ,the operating Sigma score was full mark 48 .Conclusion The ac-tual precision of the XE-2100 automatic hematology analyzer is preliminarily reached the precision promised by the manufacturer , the operating Sigma score is in the high quality level and achieves the expected requirements in daily use .

ObjectiveTo investigate the influence of internal sphincter deletions on postoperative fecal incontinence in rectal cancer patients after intersphincteric resection (ISR). MethodsSeventy one cases of rectal tumour were respectively treated by low anterior resection (group A, intact internal sphincter),partial ISR (group B,1/3 internal sphincter deletion),subtotal ISR (group C,2/3 internal sphincter deletion) and total ISR (group D,total internal sphincter deletion).Anorectal manometry and Vaizey scoring system were used to trace dynamic changes of fecal incontinence in the four groups in one year follow up. Data were analyzed with repeated-measures analysis of variance and multivariate analysis of variance. ResultsIn all cases the length of postoperative anal high-pressure zone shortened by groups.With time the length of high-pressure zone increased slightly.By the end of postoperative 12 months,there were still significant differences between groups( F =41.873,P =0.000).The maximum resting pressure of anal canal significantly reduced in all groups.By the end of postoperative 12 months,it almost restored to preoperative level in group A,while in group B and C it was about 2/3 of the preoperative level; and 1/3 of the preoperative level in group D.Vaizey score at postoperative 10 days,increased in all groups.In group B and C the score was on continuous decrease until the end of postoperative 12 months(P =0.158) it was close to that in group A.While in group D it was only 13.7 ±3.2 by the end of postoperative 12 months.Multiple regression analysis showed that by the end of postoperative 12 month,the maximum resting pressure of anal canal and postoperative anal high-pressure zone length were significantly and negatively related with the subjective Vaizey score of fecal incontinence ( t =- 4.802,P =0.000 ; t =- 2.011,P =0.048 ).ConclusionsIn patients of ultra-low rectal cancer undergoing intersphincteric resection,fecal incontinence severity indicator vaizey score as evaluated by the end of postoperative 12 months was associated with the maximum resting pressure of anal canal and anal high-pressure zone length.In addition,postoperative fecal incontinence severity carries reversible dynamic changes, and with time, most patients could restore satisfactory stool control function.

Objective To work out the Cerebral Palsy-Gross Motor Function Questionnaire(CP-GMFQ) and evaluate the reliability,validity and responsiveness of CP-GMFQ.Methods 160 children with cerebral palsy(CP)(97 males and 63 females;average age: 47.7±20.1 months,range: 18～90 months) were involved.The first 27 children received second assessment to assess test-retest reliability with a interval of 7 to 18 days.Criterion-related validity was evaluated by comparing CP-GMFQ scores with Gross Motor Function Classification System(GMFCS) levels and scores of Gross Motor Function Measure(GMFM).21 children were randomly selected for responsiveness analysis by effect size.After a interval of 3 to 7 months the re-assessment GMFQ and GMFM were tested.30 children were randomly selected for comparative testing time of GMFQ and GMFM.Results GMFQ had excellent test-retest reliability(ICC=0.9940);criterion-related validity was excellent between GMFQ scores and GMFCS levels and GMFM scores(r=0.77～0.92).Effect size of GMFQ(0.34) between GMFM88 and GMFM66,testing time of GMFQ(average 4.7±1.6 min) were significantly less than testing time of GMFM(average 17.7±4.6 min)(P<0.001).Conclusion The reliability,validity and responsiveness of GMFQ are satisfying.The gross motor functions of children with cerebral palsy could be easy and reasonably measured by GMFQ.

Objective To summarize the clinical experience of interspineter resection in treating ultra-lower rectal tumor. Methods Twenty-six ultra-lower rectal tumor cases (24 cases of rectal cancer, 2 cases of giant villous adenoma) without extrasphincter involvement underwent total mesoreetal excision and interspineter resection. Partial, subtotal or total innerspineter resection was performed respectively for patients in which the tumor lower margin was over 2 cm, between 1 -2 cm, and less than 1.0 cm above thedentate line respectively. Alimentary tract continuity was constructed by end to end anastomsis of the colon and anus. Results The lower margin of tumor in 26 patients was within 0 - 3 cm above the dentate line.The pathology was highly differentiated in 6 cases and medium differentiated in 16 cases, papillary carcinoma in 2 cases, giant villous adenoma in 2 cases. There were 11 cases of stage Ⅰ , 8 of stage Ⅱ A, 4 of stage Ⅲ A, and 1 of stage Ⅲ B according to pTNM system; 8 cases of T1, 15 of T2, and 1 of T3 according to T stage criteria. There was no mortality nor major complications. Two cases suffered from anastomotic stricture. The stool seepage was common at early stage after surgery, with immediately postoperative daily defecation of 3 -10, and one year later, most patients were able to hold back the defecation impulse for more than 5 min, and have daily defecation of 0. 5 to 4 times. Occasional seepage was reported in one patient with total innersphincter resection. The average postoperative follow up was 28 months. One recurrence was found on the 5th month, one suffered from liver metastasis in the 10 month, and one died of cardiac arrest in 26 month. Conclusion To those patients with very lower rectal cancer restricted within rectal wall,interspincter resection fulfils curative purpose while preserving the anal function.

Objective To investigate changes of GP73 after hepatectomy and its correlations with hepatocellular carcinoma (HCC) recurrence. Methods Perioperative serum GP73 was monitored in hepatic hemangioma and HCC patients undergoing hepatectomy. Clinicopathologic features and follow-up results were collected to evaluate the relationship between serum GP73 level and patients' prognosis.Results There was no statistical difference between preoperative GP73 and postoperative GP73 in hepatic hemangioma group.While preoperative GP73 in HCC group was 9.9(3.7 - 15.8) relative unit (RU),and that on POD3 (postoperative day 3 ) was 9.1 ( 3.4 - 13.3 ) RU,on POD7 was 74.3 ( 1.7 - 9.0) RU,on POD14 was 3.3(2.1 -5.4) RU ( F =72.606,P ＜ 0.001 ).HCC recurred in 21 cases during follow-up,GP73 in recurrent cases [ 11.0 (8.4 - 13.8 ) RU ] was significantly higher than postoperative trough values while it was not different from their preoperative GP73 level [ 9.9 ( 2.9 - 15.0) RU ] ( Z =1.185,P ＞0.05). The preoperative GP73 level between recurrent subgroup and nonrecurrent subgroup was not significantly different (Z =- 1.546,P ＞ 0.05 ).Preoperative GP73 did not correlate to patients' survival.Conclusions Hepatectomy for HCC leads to a significant decrease of GP73 and postoperative HCC recurrence accompanies reelevation of GP73. GP73 could be used as a postoperative monitor for HCC recurrence.

Objective To evaluate combined posterior excision of anus and modified Block′s repair for the treatment of constipation of anterior rectocele. MethodsClinical data of 82 patients treated by combined posterior resection of anus and modified Block′s technique in our hospital between Oct 2002 and May 2004 were retrospectively analyzed.ResultsThe overall effective rate was 96%, cure rate of 67%, significant improvement of 18%, and improvement of 11%. The mean hospital stay was 18.8?4.8 days, and no postoperative complication. Follow-up from 1 to 4 years found no recurrence of constipation and loss of control of evacuation.Conclusions This procedure is effective for the treatment of constipation of anterior rectocele type, and it prevents stricture of anus in patients with a relative narrow lumen of the anus.