Objective To analyze the outcome of patients receiving intrauterine insemination with husband sperm,in order to evaluate the effect of relative factors on pregnancy rate after intrauterine insemination. Methods Ninety-eight infertile couples who received intrauterine insemination in the Affiliated Hospital of Nantong University from March 2013 to May 2014 were selected as our subjects and 181 cycles were included. The information including clinical factors including maternal age,infertile time,infertile causes, ovulation induction protocol,time of insemination and postwash total motitle sperm(TMS)and pregnancy rate were recorded. Results (1)Totally 26 patients received clinical pregnancies,and clinical pregnancy rate(CPR) was 14. 36% per cycle. With age increase pregnancy rate decreased( χ2 = 1. 654 9,P = 0. 647).(2)The pregnancy rate of the patients was the same within the infertile time( χ2 = 1. 588 5,P = 0. 662).(3)The pregnancy rate of the patients with secondary infertility was lower than that of the patients with primary infertility,but there was no significant difference(χ2 = 0. 923 3,P = 0. 337).(4)The pregnancy rate of ovulation induction cycles was lower than that of nature cycles,but there was no significant difference(χ2 = 2. 222 0,P= 0. 136).(5)Postwash TMS was showed the same trend(χ2 = 0. 643 4,P = 0. 422). Conclusion In terms of intrauterine insemination with husband sperm,age,infertile time,infertile types,ovulation induction protocol and posrwash TMS can affect pregnancy rate,and the effects of various factors should be considered comprehensively in the process of therapy.

Optimization of the fermentation condition for human apolipoproteinA-I expression in recombinant Escherichia coli was investigated. The recombinant plasmid pBV220-ApoA-I was transformed respectively into different E.coli hosts such as JM109, BL21(DE3),DH5?, BMH7118,and TG1. The best host E.coli was DH5? in which the recombinant ApoA-I expression percentage was 21.2% corresponding to that in BL21(DE3) in flask shaker cultivation,while the ApoA-I expressed percentage in E.coli TG1 was 11%.Fed-batch cultivation was performed in FMG-5L fermentor,the optimum fermentation cultivation conditions were as following :optimum pH value was 7.0 in growth phase and 7.4 in the expression phase. The initial glucose concentration in batch phase was 3 g?L -1.The optimum C/N ratio was 2∶1.The recombinant ApoA-I reached about 40% of the total protein, and concentration of ApoA-I was 2.86 g?L -1.

The temperature effect on the recombinant protein production formation was investigated in present study. The culture temperature of growth phase is 30℃, and the culture temperature of induction phase was arranged according to three modes. Hign cell-density and high expression culture of E.coli to product recombinant human apolipoprotein A-I Milano by two temperature-shifted induction . Two temperature-shifted induction was carried out high density and high expression recombinant human ApoA-1 Milano. The recombinant protein ApoA-I Milano reached 4.8 g?L -1 with the final cell density of OD 600 150. And the two temperature-shifted induction avoided the acetic acid successfully to the influence of the high density and high expression. Two temperature-shifted induction was viable in high density culture and high expression of heterogenous protein in recombination E.coli.The sduty provides a basic work for production of recombinant ApoA-I Milano in scale.

Objective To investigate the epiderniology of fungemia and provide evidence for clinical therapy.Methods A retro- spective survey was done with the 31 cases of fungemia in our hospital from August 2004 to November 2005.Results More than 80% of the patients suffered from two and more underlying diseases.Over a half of infections developed following placement of catheters.And 83.9% of the patients had a history of antimicrobial agents use before blood culture.The pathogens of 24 (77.4%) cases were associated with Candida spp.Only 3 strains were C.albicans.The mortality rate of candidemia was 45.8%.Different Candida species had different resistance rates to antifungal agents.Conclusions Fungemia patients often have serious underlying diseases.Most fungemia cases were candidemia caused by non-C.albicans.Some fungal pathogens are re- sistant to fluconazole and itraconazole.

Objective To summarize the experience with salvage liver transplantation for patients with recurrent hetaptocellular carcinoma(HCC)after primary liver resection.Methods From 2004 to 2008,376 patients with HCC received liver transplantation in our single center.Among these patients,36 (9.6 %)underwent salvage liver transplantation after primary liver curative resection due to intrahepatic recurrence.There were 29 males and 7 females with the mean age of 46 years old.Sixteen received right lobectomy,10 received left lobectomy and the others received sectionectomy or segmentectomy.As a control group for comparison,we used clinical data of the 147 patients who underwent primary OLT for HCC within Milan Criteria.Results The mean interval between initial liver resection and salvage transplantation was 34.9±16.2 months(1-63 months).Intraoperative bleeding volume,transfusion volume and operative time in the salvage group were significantly different from those in control group (P<0.05).There were no significant difference in post-operative complications,tumor recurrence rate,survival rate and tumor-free survival between these two groups(P>0.05).Conclusion In comparison with primary OLT,although salvage liver transplantation would increase the operation difficulties,it still remains a good option for patients with HCC recurrence after curative resection.

ObjectiveTo summarize the clinical experience of simultaneous pancreas and kidney transplantation (SPK) after liver transplantation for patients with diabetes and uremia.MethodsThe clinical data of two patients who received SPK after liver transplantation were retrospectively analyzed.The two male patients had type 2 diabetes mellitus before liver transplantation,and suffered from endstage uremia due to diabetic nephropathy and immunosuppressant-induced toxicity.Rapid technique for combined abdominal multiple viscera procurement was performed.Kidneys,pancreas,duodenum segment and spleen were procured.Renal allograft was placed in the left iliac fossa,whereas pancreas allograft in the right iliac fossa. The pancreatic allograft exocrine secretion was drained into the proximal jejunum via a side-to-side duodenojujunostomy. Quadruple immunosuppressive regime including IL2 receptor monoclonal antibody induction,tacrolimus (Tac),mycophenolate mofetil (MMF) and steroid were used in case 1,and ATG and methylprednisolone were used in case 2.ResultsSPK was successfully applied to these two patients without serious surgical complications such as pancreatitis,graft and pancreatic fistula. The immunosuppressive regimen was based on tacrolimus with ATG induction,MMF and steroids.In the second case,serum creatinine level was decreased to the normal range within 1 week after the operation and then elevated continuously even he received empirical anti rejection treatment,Tac was tampered and rapamycin was used when the renal graft biopsy indicated drug toxicity,and creatinine level was decreased 3 weeks after the operation and recovered to the normal range at 5th week post-transplant. Both of the two patients achieved euglycemia with insulin independence about 10 days after the operation.And now these two patients have been followed up for 36 and 9 months,and the grafts function of the liver,kidney and pancreas was normal. Conclusion Immunologic reaction in patients undergoing simultaneous pancreas and kidneytransplantationafterlivertransplantationseemsmorecomplex, andareasonable immunosuppressive regimen is important to improVe the outcome.

Objective To explore the causes and management of intra-abdominal hemorrhage after orthotopic liver transplantation (OLT). Methods Clinical data of 638 OLT patients were analyzed retrospectively from January 2004 to December 2008 in the First Affiliated Hospital of Sun Yat-Sen University. The diagnosis and treatment of postoperative intra-abdominal hemorrhage after OLT were reviewed. Results Among the 638 patients, 53 suffered from posttransplant intra-abdominal hemorrhage,the morbidity was 8. 3% (53/638). Thirty-one cases suffering from bleeding on raw surfaces or around the liver due to impairment of coagulation function were treated by non-surgery methods, 22 cases who suffered from active postoperative intra-abdominal hemorrhage due to surgical factors underwent laparotomy and bleeding control operation after failure of anti-shock treatments such as hemostatic drugs, blood reperfusion.Among the 53 patients who suffered from intra-abdominal hemorrhage, 12 patients died, and the main causes were serious infections and multiple organ dysfunction syndrome. The mortality associated with intraabdominal hemorrhage was 22. 6%. Conclusions Intra-abdominal hemorrhage at different locations were found after OLT, and the fatal rate is quite high. Timely and appropriate treatments especially laparotomy may improve the prosnosis of these patients.

Objective:To construct an integrated Chinese and Western medicine health management plan for patients with acute mastitis so as to promote the recovery of patients and reduce the occurrence of adverse reactions.Methods:A research team was set up to search the fifth edition of Chinese Medical Dictionary database, domestic and foreign databases to obtain relevant evidence of health management of acute mastitis. The Evaluation Form of Evidence Quality recorded by ancient books, Appraisal of Guidelines for Research and Evaluation, A Measurement Tool to Assess Systematic Reviews 2, the Risk of Bias Tool in the Cochrane manual, Joanna Briggs Institute (JBI) quality level of evidence (2010 edition) and JBI grade of recommendation (2010 edition) were used to evaluate, grade and recommend the evidence. An integrated Chinese and Western medicine health management plan for acute mastitis was initially drafted, and the plan was further improved in conjunction with the expert consultation.Results:Totals of 326 ancient literatures, 44 randomized controlled trials, 1 clinical practice guideline, and 6 systematic reviews were included. In expert consultation, the expert judgment coefficient was 0.95, and the expert familiarity coefficient was 0.88, and the expert authority coefficient was 0.92. The constructed integrated Chinese and Western medicine health management plan for acute mastitis included two parts: background knowledge and specific implementation methods a total of 5 dimensions, and 82 implementation strategies.Conclusions:The integrated Chinese and Western medicine health management plan for acute mastitis is constructed based on evidence-based research methods and expert consultation methods, and its content has certain scientificity and clinical applicability, and can be used for the health management of patients with acute mastitis.

BACKGROUND: Periprosthetic joint infection (PJI) is a serious and catastrophic complication after hip or knee arthroplasty. With aging population increasing, more patients will undergo hip or knee arthroplasty. Studies have shown that the risk for PJI following arthroplasty is different in different populations. OBJECTIVE: To evaluate the risk factors for PJI after hip or knee arthroplasty in Mainland of China through a meta-analysis, thereby providing reference for the prevention and control of postoperative PJI. METHODS: A computer-based search of WanFang, CNKI, VIP, CBM, PubMed, Cochrane, Embase and Medline databases was performed and the literatures concerning the risk factors for PJI after hip or knee arthroplasty in Mainland of China published before September 2016 were collected by manual retrieval and retrospective approach. All the literatures were screened based on the inclusion and exclusion criteria, followed by data extraction and analyzed on RESULTS AND CONLUSION: (1) Finally 14 literatures were included, including 417 patients with PJI. (2) The results of the meta-analysis showed that the risk factors for PJI after hip or knee arthroplasty including the complication of diabetic mellitus, long-term use of steroids, long operation time (> 90 minutes), age (> 65 years), and history of hip or knee Stata 12.0 software. surgery. (3) To conclude, PJI after hip or knee arthroplasty is related to multiple factors, so physicians should pay attention to these factors to reduce the incidence of PJI.