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Objective: To study the long-term clinical effect of transvaginal mesh (TVM) and pelvic floor reconstruction with native tissue repair (NTR) in the treatment of advanced pelvic organ prolapse (POP). Methods: Totally 207 patients with advanced POP who were treated in Hunan Provincial Maternal and Child Health Care Hospital from Jan. 2016 to Sep. 2019 were enrolled. The patient's pelvic organ prolapse quantification were all at degree Ⅲ or above, and they all complained for different degree of symptoms. They were divided into two groups according to the different surgical methods, TVM group and NTR group. In TVM group, the mesh was implanted through the vagina for pelvic floor reconstruction, while in NTR group, the traditional transvaginal hysterectomy combined with uterosacral ligament suspension and anterior and posterior wall repair, as well as perineal body repair were performed. The median follow-up time was 60 months, during the follow up time, 164 cases (79.2%, 164/207) had completed follow-up, including 76 cases in TVM group and 88 cases in NTR group. The perioperative data and complication rates of the two groups were compared, and the subjective and objective outcomes of the two groups at 1, 3 and 5 years were observed, respectively. The objective efficacy was evaluated by three composite criteria, namely: (1) the distance from the farthest end of the prolapse of the anterior and posterior wall of the vagina to the hymen is ≤0 cm, and the descending distance of the top is ≤1/2 of the total length of the vagina; (2) determine the disappearance of relevant POP symptoms according to "Do you often see or feel vaginal mass prolapse？"; (3) no further operation or pessary treatment was performed due to prolapse. If the above three criteria were met at the same time, the operation is successful; otherwise, it was recurrence. The subjective efficacy was evaluated by the pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire-short form 7 (PFIQ-7). Results: The median follow-up time of the two groups was 60 months (range: 41-82 months). Five years after the operation, the subjective and objective cure rates of TVM group were 89.5% (68/76) and 94.7% (72/76), respectively. The subjective and objective cure rates in NTR group were 80.7% (71/88) and 85.2% (75/88), respectively. There were significant differences in the subjective and objective cure rates between the two groups ( χ 2 =9.869, P =0.002; χ 2 =3.969, P =0.046). The recurrence rate of TVM group was 5.3% (4/76), and that of NTR group was 14.8% (13/88). There was a significant difference between the two groups ( P =0.046). The postoperative PFDI-20 and PFIQ-7 scores of the two groups were significantly lower than those before surgery, and there were significant differences of the two groups before and after surgery (all P <0.05). Postoperative mesh exposure in TVM group was 1.3% (1/76). Conclusions: The long-term outcomes between the two groups show that the subjective and objective outcomes of pelvic floor reconstruction in TVM group are significantly higher than those in NTR group, and the recurrence rate is significantly lower than that in NTR group. TVM has certain advantages in the treatment of advanced POP.

Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia , Escherichia coli , and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs . 17.3% (142/820), 13.0% (103/790) vs . 9.1% (75/820), 4.6% (36/790) vs . 2.7% (22/820), χ 2 =18.71, 6.20, 4.07, all P <0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P >0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae , and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae . Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.

Objective: To explore the value of metagenomic next-generation sequencing (mNGS) in the etiology diagnosis of bacterial meningitis in children. Methods: The etiological results of 189 children diagnosed with "bacterial meningitis" or "purulent meningitis" or "central nervous system infection" in the Children's Hospital of Fudan University from 1st January 2019 to 31st December 2020 were analyzed retrospectively. The cerebrospinal fluid (CFS) of the children with bacterial meningitis was detected by culture and mNGS respectively, and the difference of pathogen detection rate between the 2 methods was analyzed. According to the age at the time of visit, the children were divided into neonatal group (≤28 days of age) and non-neonatal group (>28 days of age), and χ 2 test was used to compare the positive rate between the 2 groups. Taking CFS culture as the gold standard, the sensitivity and specificity of mNGS in the diagnosing of bacterial meningitis in children were analyzed. Results: Among these 189 children with bacterial meningitis, 116 were males and 73 were females. A total of 76 strains of pathogens were detected in blood and (or) CSF cultures, of which 50 strains (65.8%) were Gram-positive bacteria; among those, 18 strains (23.7%) of Streptococcus agalactiae , 17 strains (19.7%) of Escherichia coli and 15 strains (19.7%) of Streptococcus pneumoniae were detected with higher detection rate. The infection rate of Gram-positive bacteria in the non-neonatal group was higher than that in the neonatal group (76.0% (38/50) vs. 50.0% (13/26), χ 2 =5.24, P =0.020).The same CSF samples of 48 cases were tested by mNGS and culture at the same time, and the detection rate of mNGS was higher than that of CSF culture (20 cases (41.7%) vs. 12 cases (25.0%), χ 2 =16.45, P <0.001). The consistency of mNGS and culture results was 79.2% (38/48), and the same pathogen was detected in 11 children with both positive mNGS and CSF culture. Taking the results of CSF culture as the gold standard, the sensitivity of mNGS in the diagnosing of bacterial meningitis was 91.7%, and the specificity was 75.0%. Conclusions: The mNGS technology can improve the pathogen detection rate of bacterial meningitis in children, and has a high consistency with CSF culture. In suspected cases where the pathogen cannot be identified by traditional methods, CSF mNGS should be considered timely.

Objective: To screen and analyze the factors affecting the prognosis of replacing single missing tooth by autograft tooth, so as to provide reference for clinical judgment of surgical prognosis. Methods: A total of 176 patients (188 teeth) underwent autotransplantation of teeth in the Department of Oral & Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University from January 2017 to December 2019, including 85 teeth of males and 103 teeth of females were involved. The age was (33.0±9.8) years (16-65 years). The possible factors affecting the prognosis of replacing single missing tooth by autograft tooth were summarized and grouped, and the clinical and imaging data were recorded and judged. The surgical records and photographic data from the patients' previous medical records were retrospectively analyzed. The survival analysis method was used for statistical analysis to screen out the factors affecting the cumulative survival rate of transplanted teeth. Results: The 5-year cumulative survival rate of 188 transplanted teeth was 88.4%. Univariate Log-Rank analysis showed that age ( P <0.001), sex ( P =0.008), smoking ( P <0.001), position of recipient area ( P< 0.001), height of alveolar bone in recipient area ( P< 0.001), time of donor tooth in vitro ( P< 0.001), use of donor model ( P< 0.001) and initial stability ( P< 0.001) were significantly correlated with cumulative survival rate of transplanted teeth. Multivariate Cox proportional hazard regression analysis showed that smoking (β=-2.812, P= 0.049), alveolar bone height (β=1.521, P= 0.020), donor time (β=-2.001, P= 0.019), use of donor model (β=1.666, P= 0.034) and initial stability (β=-1.417, P= 0.033) were significantly correlated with the cumulative survival rate of transplanted teeth. Conclusions: The prognosis of autogenous tooth transplantation can be predicted by smoking, height of alveolar bone in recipient area, time of donor teeth in vitro , use of donor model and initial stability. Good prognosis of transplanted teeth can be obtained by using donor model during operation, reducing the time of donor teeth in vitro , taking effective methods to restore alveolar bone height, maintaining good initial stability, and good oral health education after operation.

Objective: To explore the etiologies and clinical characteristics of fever of unknown origin (FUO) and to provide clues for early diagnosis of FUO. Methods: The data about etiology, age, sex, clinical course, length of hospital stays and the expression levels of inflammatory factors in fever phase of 357 pediatric inpatients who were diagnosed with FUO in Children's Hospital of Fudan University from 1 January 2016 to 31 December 2020 were collected and retrospectively analyzed. Participants were grouped into infectious disease, inflammatory disease, malignancy and others and according to the classification of diseases and also grouped into those aged<1 year, 1-<3 years,3-<6 years, 6-<12 years and 12-<18 years. Comparisons between groups were performed using the Mann-Whitney U test, Kruskal-Wallis H test and χ² test. Results: Among the 357 patients (217 males and 140 females). The age of onset was 3.9 (1.3, 9.2) years and visiting age was 5.1 (2.0, 9.3) years. The time-consuming of diagnosis was 94 (66, 213) days. The hospital stay was 8 (6, 14) days. The most frequently identified cause of FUO was infectious diseases (163 cases, 45.7%), followed by non-infectious inflammatory diseases (133 cases, 37.2%), malignancy (21 cases, 5.9%) and others (40 cases, 11.2%). The patients at younger age were more likely to be attacked by malignancy, oncologic diagnoses, and others, nevertheless patients at older age were more likely to be attacked by non-infectious inflammatory diseases oppositely (9.8 (3.6, 11.5) vs . 3.0 (1.2, 7.0), 2.3 (1.0, 5.2), 0.9 (0.5, 1.8) years, U =41.30, 15.94, 37.08, all P <0.01);106 (65%) patients were male, and 57 (35%) patients were female. This result indicated that boys were more susceptible to infectious diseases (χ²=14.73, P <0.01). Analysis of inflammatory factors in serum among 103 patients, interleukin (IL)-6 level in 40 infectious diseases patients (9 (2, 38) ng/L) was significantly lower than those of 6 tumor patients (89 (64, 599) ng/L) and 57 non-infectious inflammatory diseases patients (25 (8, 78) ng/L, U =51.05, 15.70, both P <0.05), no significant difference was observed in IL-2, IL-4, IL-10, tumor necrosis factor α and interferon among the groups (all P >0.05). The patients grouped into those aged 1-<3 years and 3-<6 years were more likely to be attacked by infectious diseases (51.3% (59/115) and 57.1% (40/70)), while patients grouped into those aged 6-<12 years and 12-<18 years were more likely to be attacked by non-infectious inflammatory diseases (55.6% (65/117) and 72.4% (21/29)). Conclusions: Infectious disease is still the main cause of FUO in children and the boys are more susceptible to infectious diseases. However, the morbidity of non-infectious inflammatory diseases increases to number 1 in FUO of children over 6 years of age.

Objective: To investigate the clinical characteristics of pediatric methicillin-resistant Staphylococcus aureus (MRSA) infection and the antibiotic sensitivity of the isolates. Methods: The clinical data of children with MRSA infection and antibiotic sensitivity of the isolates from 11 children's hospitals in Infectious Diseases Surveillance of Paediatrics (ISPED) group of China between January 1, 2018 and December 31, 2018 were collected retrospectively. The children's general condition, high-risk factors, antimicrobial therapy and prognosis, differences in clinical disease and laboratory test results between different age groups, and differences of antibiotic sensitivity between community-acquired (CA)-MRSA and hospital-acquired (HA)-MRSA were analyzed. The t test and Wilcoxon rank sum test were used for statistical analysis of the quantitative data and Chi-square test were used for comparison of rates. Results: Among the 452 patients, 264 were males and 188 were females, aged from 2 days to 17 years. There were 233 cases (51.5%) in the ≤1 year old group, 79 cases (17.5%) in the>1-3 years old group, 29 cases (6.4%) in the >3-5 years old group, 65 cases (14.4%) in the >5-10 years old group, and 46 cases (10.2%) in the>10 years old group. The main distributions of onset seasons were 55 cases (12.2%) in December, 47 cases (10.4%) in February, 46 cases (10.2%) in November, 45 cases (10.0%) in January, 40 cases (8.8%) in March. There were 335 cases (74.1%) CA-MRSA and 117 (25.9%) cases HA-MRSA. Among all cases, 174 cases (38.5%) had basic diseases or long-term use of hormone and immunosuppressive drugs. During the period of hospitalization, 209 cases (46.2%) received medical interventions. There were 182 patients (40.3%) had used antibiotics (β-lactams, glycopeptides, macrolides, carbapenems, oxazolones, sulfonamides etc) 3 months before admission. The most common clinical disease was pneumonia (203 cases), followed by skin soft-tissue infection (133 cases), sepsis (92 cases), deep tissue abscess (42 cases), osteomyelitis (40 cases), and septic arthritis (26 cases), suppurative meningitis (10 cases). The proportion of pneumonia in the ≤1 year old group was higher than the >1-3 years old group,>3-5 years old group,>5-10 years old group,>10 years old group (57.5% (134/233) vs. 30.4% (24/79), 31.0% (9/29), 38.5% (25/65), 23.9% (11/46), χ(2)=17.374, 7.293, 7.410, 17.373, all P< 0.01) The proportion of skin and soft tissue infections caused by CA-MRSA infection was higher than HA-MRSA (33.4% (112/335) vs. 17.9% (21/117), χ(2)=10.010, P= 0.002), and the proportion of pneumonia caused by HA-MRSA infection was higher than CA-MRSA (53.0% (62/117) vs. 42.1% (141/335), χ(2)=4.166, P= 0.041). The first white blood cell count of the ≤1 year old group was higher than that children > 1 year old ((15±8)×10(9)/L vs. (13±7)×10(9)/L, t= 2.697, P= 0.007), while the C-reactive protein of the ≤1 year old group was lower than the 1-3 years old group,>5-10 years old group,>10 years old group (8.00 (0.04-194.00) vs. 17.00 (0.50-316.00), 15.20 (0.23-312.00), 21.79(0.13-219.00) mg/L, Z= 3.207, 2.044, 2.513, all P< 0.05), there were no significant differences in procalcitonin (PCT) between different age groups (all P >0.05). After the treatment, 131 cases were cured, 278 cases were improved, 21 cases were not cured, 12 cases died, and 10 cases were abandoned. The 452 MRSA isolates were all sensitive to vancomycin (100.0%), linezolid (100.0%), 100.0% resistant to penicillin, highly resistant to erythromycin (85.0%, 375/441), clindamycin (67.7%, 294/434), less resistant to sulfonamides (5.9%, 23/391), levofloxacin (4.5%, 19/423), gentamicin (3.2%, 14/438), rifampicin (1.8%, 8/440), minocycline (1.1%, 1/91). The antimicrobial resistance rates were not significantly different between the CA-MRSA and HA-MRSA groups (all P> 0.05). Conclusions: The infection of MRSA is mainly found in infants under 3 years old. The prevalent seasons are winter and spring, and MRSA is mainly acquired in the community. The main clinical diseases are pneumonia, skin soft-tissue infection and sepsis. No MRSA isolate is resistant to vancomycin, linezolid. MRSA isolates are generally sensitive to sulfonamides, levofloxacin, gentamicin, rifampicin, minocycline, and were highly resistant to erythromycin and clindamycin. To achieve better prognosis. clinicians should initiate anti-infective treatment for children with MRSA infection according to the clinical characteristics of patients and drug sensitivity of the isolates timely and effectively.

Objective: To investigate the clinicopathologic features and prognosis of the patients who had clear cell renal cell carcinoma (CCRCC) with metastasis to the pancreas. Methods: From Jan, 2000 to Dec, 2018, 18 patients with clear cell renal cell carcinoma (CCRCC) and had pathologically diagnosed metastasis to the pancreas were enrolled at Peking Union Medical College Hospital. The clinical and pathological data were retrospectively analyzed. Results: 11 out of 18 patients were male, and the other 7 were female. The average age of onset of CCRCC was 51.4 years. 8 cases (44.4%) occurred in the left kidney, and the other 10 cases (55.6%) with right kidney tumor. Three patients had synchronous pancreatic metastasis, and the other 15 patients had metachronous pancreatic metastasis. The median time from CCRCC onset to pancreas metastasis was 156 months. The main complaints of pancreas metastasis were abdominal pain, jaundice, gastrointestinal bleeding, nausea, weakness, loss of weight and so on. Seven patients (38.9%) had single lesion of pancreas, while 11 patients (66.1%) had multiple lesions of pancreas. Nine patients (50%) had other organs metastasis besides pancreatic metastasis at the same time. Five patients underwent pancreatic metastasis resection, while 15 patients received oral tyrosine kinase inhibitor(TKI). The mean follow-up was 171.7 months(1~361.5 months) and 5 patients died. The median overall survival (mOS) was 122 months, and the 5 year-survival rate was 81.4%. In univariate analysis, synchronous metastasis to the pancreas, relapse after 10 years, Memorial Sloan Kettering Cancer Center prognostic index, International Metastatic Renal Cell Carcinoma Database Consortium index were all significant parameters for patients'survival. Conclusions: Metastasis to the pancreas from clear cell renal cell carcinoma were rare. These patients had better survival outcomes, especially those relapsing after ten years. Pancreatic metastasis resection had no significant benefit on patient's survival.

Objective: To quantify optical coherence tomographic angiography (OCTA) images and to explore potential clinical values of each parameter in diabetic patients. Methods: A case-control and cross-sectional study of diabetic (129 eyes) and healthy (32 eyes) subjects was conducted. 3-mm OCTA scan, fundus photography and best corrected visual acuity measurement were performed. Image-pro plus was used to calculate microvascular and foveal avascular indices in nonsegmented and segmented OCTA images. Intraclass correlation coefficient and relative standard deviation were used to examine the reliability, reproducibility and accuracy. Correlation of each parameter was calculated, and so was the area under the receiver operating characteristic curve. Results: Vessel density (VD) of diabetic patients measured in the nonsegmented retinal layer (RL) and superficial retinal layer (SRL) was 49.146%±6.097%, 44.038%±5.641%, respectively, significantly lower than healthy subjects 52.212%±6.250%, 46.698%±5.417% ( t= 2.534, 2.405; P= 0.012, 0.017), and vessel length (VL) was (19.905±2.285)mm, (17.596±2.149)mm, (14.479±2.091)mm in the three layers, which was significantly shorter than that in the healthy control group (21.037±2.185)mm, (18.739±1.994)mm, (15.343±2.266)mm ( t= 2.529, 2.731, 2.059; P= 0.012, 0.007, 0.041). Compared with non-diabetes, foveal avascular zone (FAZ) in diabetes was (0.441±0.167)mm(2), larger compared to health eyes 0.352±0.109mm(2) ( t= -2.831, P= 0.005). FAZ demonstrated a negative correlation with VD and VL in RL or SRL( r= -0.227, -0.338; P< 0.05) ( r= -0.241, -0.332; P< 0.05), while best corrected visual acuity showed a negative correlation with VL in each layer ( r= -0.225, -0.201, -0.250; P= 0.01, 0.022, 0.004), and VD in DRL ( r= -0.197, P= 0.026). All parameters showed high reproducibility between graders(intraclass correlation coefficient > 0.965), while relative standard deviation was greater than 3.049%. AR had the highest area under the receiver operating characteristic curve (0.737), compared with AI (0.724). Conclusions: Our study demonstrates good reliability, reproducibility and accuracy of quantification of OCTA images and reveals changes of VD, VL and FAZ in diabetes, which may occur earlier than vision impairment. AR and AL may have great values in prompting early diabetic retinopathy in diabetic patients. (Chin J Ophthalmol, 2019, 55:273-279) .

Objective: Strabismus with diplopia is the main orbital complication of functional endoscopic sinus surgery (FESS). This study was to analyze clinical findings, treatment and outcomes of such cases. Methods: Retrospective case series. Twenty-three cases were divided into 3 groups based on the disease severity: group A, partial transection of the medial rectus muscle, group B, complete transection of the medical rectus, group C, transection of the medial rectus combined with the other orbital injuries. Complete ophthalmology examinations, including eye alignment, eye motility, force duction test, force generation test, general eye exam, and medical imaging (orbital CT or MRI), were performed for each case. The treatment included botulinum toxin (Botox) injection to the lateral rectus muscle, transposition of the vertical rectus muscle, and orbital surgery if needed. Results: In group A with Botox injection, all the cases achieved single vision in primary position, but still remained some adduction weakness. In group B treated by vertical transposition surgery combined with Botox, 22% of the cases got single vision in primary gaze. In group C, even with more efforts of treatment, the cases with orbital injury can only get cosmetic improvement, and diplopia and adduction dysfunction were found in most cases. Conclusions: Due to the variety of the complications of FESS, force duction test is a crucial exam to detect the direction and severity of synechia in the orbit, which will give solid information to surgery approach as well as prognosis. Botox injection at early stage will minimize the contraction of antagonist lateral rectus, helping to postpone the transposition surgery which may cause anterior segment ischemia when performed right after the medial rectus transection injury. Botox may even reduce the synechia by minimizing the scarring process. Partial vertical rectus transposition combined with muscle resection may effectively correct the eye misalignment in primary gaze and improve eye motility. The prognosis of FESS induced orbital complications is quite related with the severity of the injury. Botox combined with surgery may help medial rectus transection cases to achieve single vision in primary gaze, but when there is any other orbital injury, treatment may only improve cosmetic appearance. (Chin J Ophthalmol, 2017, 53: 917-923) .

Objective: To explore the application of endometriosis fertility index (EFI) in guidance after laparoscopic surgery of endometriosis patients combined with infertility and to explore methods to improve pregnancy rate in different EFI groups. Methods: A prospective research was done in endometriosis patients combined with infertility in Beijing Obstetrics and Gynecology Hospital from January 2010 to June 2011, after laparoscopic surgery, these 146 patients were divided into 3 groups by EFI score. Using different pregnancy guidance, these patients had 5 years follow-up. Results: (1) The 5 years overall pregnancy rate was 89.0% (130/146). The pregnancy rate was 95.7% (45/47) in EFI≥9 group, 92.8% (77/83) in EFI 5-8 group and 8/16 in EFI≤4 group, three groups were all reach satisfactory pregnancy rate; the rate of the first two groups had no statistically significance ( P= 0.498), but had significant difference with the last group ( P< 0.01). (2) In EFI≥5 patients, pregnancy rate was the highest in 6 months after operation; in EFI≥9 group, the pregnancy rate was 66.7% (30/45), and EFI 5-8 group was 50.6% (39/77). (3) EFI≥9 group had the highest natural pregnancy rate [83.6% (46/55)], natural pregnancy rate was significant statistical different in different EFI groups ( P= 0.001). Conclusions: EFI score is a useful evaluation in predicting and guiding pregnancy in endometriosis patients combined with infertility after laparoscopic surgery. EFI score guidance, strict post-operation management and positive pregnancy scheme could significantly improve the pregnancy rate of endometriosis patients with infertility.

Objective: To study the clinicopathologic features of IgG4-related ocular disease and differentiated diagnosis with non-IgG4-related ocular disorders., Methods: Forty-three cases were selected from the Department of Pathology, West China Hospital, Sichuan University from December 2008 to January 2015 with retrospective series case study. The clinical manifestation, laboratory examination, imaging findings, treatment and histopathological characteristics were analyzed. According to the diagnostic criteria for IgG4-related ocular disease in 2014 and relevant literatures, our cases were divided into two groups: IgG4-related ocular disease (23 samples from 18patients) and non-IgG4-related ocular disease (31 samples from 25 patients). The male-to-female ratio, the periductal fibrosis and the orbital lesion area was analyzed by Pearson chi-square. The Immunohistochemistry of IgG4+/HPF, IgG+/HPF and IgG4+/IgG+ ratio and age was analyzed by two sample t test. The involved structural tissue and the infiltration of eosinophils and lymphocytes and plasma cells was analyzed by signed-rank test., Results: The significant statistic differences were observed between these two groups in immunohistochemical staining of IgG4 (>40/HPF) (t=12.17, P<0.01), IgG (t=2.91, P<0.01) and IgG4+/IgG+ ratio (≥40%) (t=16.98, P<0.01), the lymphocytic and plasmacytic infiltration (F=3.62, P=0.03),the periductal fibrosis(F=4.71 , P=0.03), the involved region of orbit (t=1.11, P=0.01), but not in the mean age and male-to-female ratio (t=1.09, P=0.58). IgG4 ROD should be distinguished form the non-specific inflammation disorders, lymphoma and so on., Conclusions: IgG4-related ocular disease often arises from middle-old man, characterized by bilateral orbital painless swelling and abundant IgG4+ plasma cells infiltration. Nearly all orbital tissue could be involved by IgG4-related ocular disease, especially lacrimal gland. But the characteristic obliterating phlebitis were not seen. The immunohistochemical staining of IgG4 and IgG plays an important role in differentiating IgG4-related ocular disease from non-IgG4-related ocular disorders. Combining clinical manifestation, laboratory examination, imaging findings with histopathology is helpful for diagnosis and differential diagnosis. (Chin J Ophthalmol, 2016, 52: 256-262).

Objective: To determine the resistance reversion of mitomycin (MMC) by 3'-Keto-bmt1-val2-cyclosporin (SDZ PSC 833) in human cervical cancer in vitro and in vivo. METHEDS: A xenografted mitomycin resistant mice model of cervical cancer was devolped. The reversion of mitomycin resistance by SDZ PSC 833 (1 or 3 mg/L) was detected from human cervical cancer cell (Hela) and its resistant subline Hela/MMC in vitro and in vivo. Studies in vitro include drug resistance reversion experiment and the changes of morphology. Studies in vivo including tumor volume and tumor related histopathological changes in the autopsied specimen were evaluated by comparing random sections of each group., Results: Nontoxic doses of SDZ PSC 833 could result in almost partial reversion of MMC-resistance of Hela/MMC. In vivo studies also showed SDZ PSC 833 augmented the growth inhibitory effect of mitomycin on Hela/MMC xenografted in nude mice., Conclusion: SDZ PSC 833 can overcome mitomycin resistance of Hela/MMC in vitro and in vivo, so SDZ PSC 833 will be a better candidate clinically for reversing multidrug resistance.

Objective: To evaluate the biological response to three different designs of synthetic cornea in vivo., Methods: All devices consist of a transparent center and a porous blown periphery. Thirty-five devices were implanted into 35 rabbits' corneas and followed up to more than 6 months. Rabbit corneal stromal cells were inoculated onto the anterior surface of the synthetic cornea and cultured in vitro for one week before the operation. The anterior surface of the optic center hydrogel was modified with radio frequency (rf)-argon plasma treatment., Results: Fibroplasia occurred 2 weeks after surgery and collagen was detected by 28 days. The anterior chamber was normal without detectable leakage of aqueous humor. Basic fibroblast growth factor (bFGF) was detected at the interface between the device and the tissue by 42 days., Conclusions: It is demonstrated that rabbit limbal epithelial cells can migrate onto the synthetic cornea in vivo.

Objective: To investigate the relationship between the expression of matrix metalloproteinase-2 (MMP-2) and clinical characteristics of patients with epithelial ovarian tumor., Methods: Reverse transcriptase-ploymerase chain reaction and immunohistochemistry were used to detect the expression of MMP-2 in 41 epithelial ovarian cancer and 26 ovarian benign tumors. Western blot analysis was used to examine proMMP-2 and active MMP-2 in these tumors., Results: The expression of MMP-2 gene and protein was not significantly higher in malignant tissues than that in benign ones. The positive percentage of active MMP-2 expression in epithelial ovarian cancer was 71% and 42% in ovarian benign tumor (P < 0.05). The positive percentage of active MMP-2 in stage IlI and IV epithelial ovarian cancer was significantly higher than in stage I and II epithelial ovarian cancer (P < 0.05). The positive percentage of active MMP-2 in progressive patients with epithelial ovarian cancer was significantly higher than in patients in remission (P < 0.05)., Conclusions: MMP-2 gene and protein were generally expressed in epithelial ovarian tumor. There was a significant correlation between active MMP-2 and the invasion and metastasis of epithelial ovarian cancer. Active MMP-2 is a prognostic indicator in patients with epithelial ovarian cancer.

Objective: To investigate the effect on correction of occipito-posterior (OP) by changing maternal posture during labor., Methods: One hundred normal primigravida with head OP position in the latent phase of labor were randomly divided into 2 groups: Group A (n = 50), women were instructed to lay on the same lateral posture with the fetal spine during labor in order to correct the fetal position from OP to occipito anterior (OA); Group B (n = 50) lay on the opposite side to the fetal spine. The OP position was diagnosed by vaginal examination or B ultrasound, and the course of labor and mode of delivery were observed., Results: Thirty-four women delivered vaginally (68%) in group A, with 27 of them turned to OA position (54%); spontaneously while they were 22 (44%) and 12 (24%) in group B respectively, a significant difference was shown (P < 0.005). The average time interval for the 1st stage was (13.5 +/- 6.5) hour and (17.1 +/- 7.2) hour for group A and B respectively, also a significant difference was noted (P < 0.01)., Conclusion: To instruct women in labor to take the lateral recumbent position with the same side of fetal spine for correcting OP to OA is an effective method. It may increase vaginal deliveries and shorten the first stage of labor, thus reduce dystocia due to OP position. This method is simple and effective, and maybe adopted in most obstetric units.

Objective: To study the effect of a new Triclosan-containing mouthrinse--LIBO Anti-plaque mouth rinse on oral infection., Methods: 1. Before and after the use of triclosan mouthrinse: the gingival data were checked and secorded; plaque sausples were collected, cultured in selective and non-selective media, bacteria were isolated, sounted, and compased. 2. With Streptococcus mutans and P. Gingivalis as experimental bacteria, triclosan and chlorhexidine (CHX) mouthrinses anti-bacterium substance, the minimum inhibitory concentrations (MICs) of the two rinses were compared. 3. Smooth plates with the film of Streptococcus mutans C were set in different mouthrinses and water. Observing the exfoliation of bacteria film from the plates in three agents., Results: 1. Triclosan mouthrinse was effective to decrease the plaque index (PLI) and supragingival bleeding index (SBI). 2. The bacteria count obtained after use of triclosan mouthrinse was lower than that before using it. 3. The minimum inhibitory concentrations of triclosan mouthrinse against Streptococcus mutans C was much lower than that of chlorhexidine mouthrinse. 4. In triclosan mouthrinse, the bacterial films were most easily exfoliated from the plate. Triclosan mouthrinse has strongest anti-adhesion effect among the three tested agents., Conclusions: Triclosan mouthrinse has continuous disinfecting effect and help control the formation and adhesion of dental plaque.

Objective: To study the progression of destructive periodontal disease in adult and elderly aged 20 to 80. The examinees were followed 10 years to determine whether the rates for progression of periodontal disease were different than the populations in the more developed countries., Methods: In 1984, at baseline, 587 subjects had been examined and by 1994, 440 of them still available for follow-up study, and 398 persons remained dentate. Tooth mobility, plaque, calculus, gingival conditions, attachment levels, and probing depths on 4 sites of each tooth present were checked and recorded by the same two examiners., Results: All subjects had > or = 2 mm attachment loss over 10-year period. Some teeth, such as mandibular incisors and maxillary molars, had higher progression rate than others. The mean attachment loss rate did not differ significantly between age groups, and were similar to those reported for populations in the more developed countries., Conclusions: The rate for progression of periodontal disease in this study were not significantly different between the examinees and the populations in more developed countries; and also were not significantly different among the different age groups. The causes of destructive periodontal disease in humans are more likely intrinsic factors.

Objective: To report our experience of surgical treatment for stage T3-4N2M0 lung cancer., Methods: One hundred thirty one patients with lung cancer in stage T3-4N2M0 were surgically treated by extended tumor resection, lymph nodes dissection and resection of ipsilateral mediastinal pleura and fatty tissue., Results: The 3-year survival rate of patients in stage T3N2M0 with squamous-cell carcinoma and adenocarcinoma was 34% and 18%, respectively. That for stage T4N2M0 patients was only 13% and 5%, respectively. The survival rate was not improved in patients who received combination treatment in addition to surgery., Conclusion: The indication of extended resection with lymph node dissection in the treatment of T3-4N2M0 lung cancer is limited.

Objective: To describe the clinical characteristics and evaluate the surgical results in strabismus eyes which all had undergone retinal detachment surgery., Methods: This study covered 24 strabismus cases (28 eyes) following retinal detachment operations. For these, examinations involving prism with alternative cover test or Krimsky test, eyeball movement, and diplopia analysis were performed. Strabotomy was carried out combined with or without scleral buckling removal or secondary intraocular lens implantation. The post-operative follow-up period ranged from 1 month to 24 months., Results: (1) The main clinical feature in 16 strabismus cases (19 eyes) having managed by rhegmatogenous retinal detachment surgery was that the character of strabismus was related to the location of scleral explants. (2) Diplopia completely disappeared in 40.9% and partly disappeared in 54.5% of the cases. Strabismus was completely corrected in 63.6% of 27 eyes and partly corrected in 31.8% of them., Conclusions: (1) The strabismus following retinal detachment surgery is a restrictive strabismus, the clinical characteristics of which are different from that of palsy strabismus. (2) Strabotomy is effective in the treatment of restrictive strabismus.

Objective: To study the efficiency of chemo-hand instrument removal material., Methods: The effect on caries removal of N-monochlorochloraminobutyric acid and the electrical dental instrument was detected by the caries detection, microscope and SEM., Results: The positive for the caries detection and residual caries were zero in both groups., Conclusion: The effect on caries removal of N-monochlorochloraminobutyric acid is almost the same as the control.

Objective: To set up a large scale sequencing system and explore the gene expression profiles of CD(34)(+) hematopoietic stem/progenitor cells (HSPCs)., Methods: CD(34)(+) cells were isolated from umbilical cord blood and subjected to cDNA library construction. A primary profile of gene expression in HSPCs was emerged by EST sequencing and bioinformatics analyzing., Results: Among 9,866 ESTs thus obtained, 7 476 meaningful ESTs were clustered into 2,060 unique sequence species (USSs), representing 1,054 known gene species and 1,006 unknown gene fragments. The 1054 known genes were divided into 8 categories: (1) hematopoiesis associated: 73, (2) chromatin structure and cell division/apoptosis: 91, (3) signal transduction and receptors: 111, (4) cell structure/mobility: 48, (5) cell/organism defense/homeostasis: 41; (6) Gene expression (transcription, translation and modification): 265, (7) metabolism: 192; and (8) unclassified: 233., Conclusion: A gene expression profile including 1,054 known genes and 1006 new gene fragments of HSPCs was primarily obtained, which may lay a basis for the further study on the molecular mechanism of hematopoiesis regulation and provide candidates for new gene cloning.

Objective: To understand the mutations of pncA gene in M. tuberculosis isolates, and to evaluate their clinical value., Methods: Analyzing the pncA genes in 74 M. tuberculosis clinical isolates with PCR-SSCP and PCR-AS. M. tuberculosis strain H37Rv was used as control., Results: 32 drug-sensitive isolates all displayed normal pncA SSCP profile. Of 20 non-pyrazinamide-resistant isolates, 4 had abnormal pncA SSCP profile, in which 2 isolates were sequenced, one was TTC-->TTA mutation at codon 58, another was TGG-->CGG mutation at codon 68. Of 22 pyrazinamide-resistant isolates, 10 displayed abnormal pncA SSCP profile, in which 2 isolates sequenced had TTC-->TTA mutation at codon 58., Conclusions: The mutation of pncA gene is a pyrazinamide-resistant molecular mechanism in M. tuberculosis. Detecting the mutations of pncA genes might diagnose pyrazinamide resistance rapidly in some M. tuberculosis isolates.

Objective: To elucidate the effect of WT1 antisense oligonucleotide on and the role of WT1 gene in proliferation and apoptosis of leukemia cells., Methods: K562, U937, HL-60 cell lines, leukemic blast from 8 acute myeloid leukemia patients and normal bone marrow cells from 8 healthy subjects were treated in vitro with WT1 antisense oligonucleotide (WT1 ASO) targeting to the translation site of WT1 mRNA. The inhibitory effect on growth of leukemia cells was measured by Trypan blue exclusion and colony-forming unit assay. Apoptosis was measured by flow cytometric analysis and DNA fragmentation assay., Results: WT1 ASO significantly inhibited the proliferation of K562 cells expressing WT1 and leukemic blast of 4 in 8 acute myeloid leukemia patients, but didn't inhibit the growth of U937 cells which had no WT1 expression and CFU-GM of normal marrow cells from 8 healthy subjects. Whereas WT1 sense oligonucleotide (WT1 SO) had no effect on the proliferation of K562 cells, U937 cells and the CFU-GM of normal marrow cells. WT1 ASO could induce apoptosis of K562 cells and the level of apoptosis was increased markedly when combined with Vp16; WT1 ASO alone couldn't induce apoptosis of HL-60 cells, but could increase the apoptosis when combined with Vp16., Conclusion: WT1 ASO specifically inhibit the growth of leukemic cells, induce apoptosis of K562 cells and increase the apoptosis susceptibility of leukemia cells to Vp16. WT1 plays an important role in proliferation and apoptosis of leukemic cells.

Objective: To evaluate the clinical value of single photon emission computed tomography (SPECT) on classifying parotid lump as benign or malignant before treatment., Methods: SPECT images of the parotid region were obtained in forty-five patients with parotid lump before surgery. We used technetium-99m(V) dimercaptosuccinic acid as imaging agent. The results were compared with their pathological diagnoses, clinical examination, and ultrasonography., Results: The sensitivity, specificity and accuracy of Tc-99m(V)-DMSA SPECT imaging in determining malignancy of parotid lump were 93.7%, 72.4%, 80.0%, respectively. The uptake ratios of parotid lesions were higher in malignant tumors than benign tumors, cysts, and inflammatory lumps (P < 0.05)., Conclusion: It is suggested that Tc-99m (V)-DMSA SPECT can be a useful aided method of preoperative diagnosis of parotid lumps. The uptake ratios can help increase the accuracy of diagnoses. For the benign tumors and inflammatory masses of parotid gland, the diagnoses had some false positives which may be reduced by combined clinical examination and ultrasonography.

Objective: To evaluate retrospectively the results of extensive lymphadenectomy during second-look laparotomy in patients with ovarian cancer., Methods: An total of 63 patients with ovarian malignancies received second-look laparotomy (SLL). Retroperitoneal lymph nodes, including para-aortic nodes below the level of left renal vein and pelvic nodes were extensively dissected., Results: Of the 63 patients, residual tumor was found in 24 (38.1%) on SLL. The frequency of residual tumor was positively correlated with the clinical stage and with the amount of tumor left after initial debulking but not with the degree of differentiation of tumor cells. Lymph node metastasis was pathologically confirmed in 19 cases (30.2%), in which no residual tumor was found in 8 patients. Tumor recurred in only 4 of the 39 patients (10.3%) with negative SLL. The overall 3- and 5-year survival rate was 75.4% and 68.3%, respectively., Conclusion: Extensive retroperitoneal lymph node dissection is recommended during SLL. It favors a decrease in recurrence rate in ovarian cancer patients negative on SLL.

Objective: To estimate the morphologic characteristics of chronic obstructive pulmonary disease (COPD) induced pulmonary fibrosis., Methods: 41 autopsy cases of COPD were chosen as the study group and other 10 autopsy cases died from non-respiratory diseases as control group. Histochemical stain and image quantitative analysis were used to identify the type of collagen., Results: In 36 cases (88%) of study group, fibrosis proliferation could be seen in peri-bronchial area, especially in the bronchi under grade VI. Respiratory bronchiole and alveoli were also involved in 11 cases. The main component of collagen in fibrosis area was identified as type III collagen by sirius red stain, reticular fiber could also be seen by Gomori stain. The type III collagen in alveoli distributed interruptedly. Image quantitative analysis showed: the integral optical density (A) of type III collagen was much higher than that of type I collagen in peri-bronchial area (P < 0.01); Both A of type III and type I collagen in peri-bronchial area were higher than that in alveolar area (P < 0.01). Mucous purulent plugs, interrupted elastic fibers in bronchial wall and chronic inflammation accompanied with lymphocytes infiltration in fibrosis area could also be seen., Conclusions: COPD induced pulmonary fibrosis distributed mainly in peri-bronchial area, especially in the bronchi under grade VI. The main component of proliferative collagen was type III collagen. The genesis of pulmonary fibrosis might be associated with chronic inflammation accompanied with lymphocytes. Peri-bronchial fibrosis, interrupt of elastic fibers in bronchial wall caused the bronchial lumen narrowed or collapsed making both airway obstruction and ventilation insufficiency deteriorated.

Objective: To investigate the mutations of ahpC genes in M. tuberculosis isoniazid-resistant isolates, and to study the correlation between ahpC alterations and isoniazid resistance., Method: Analyzing the ahpC coding sequences and ahpC promoters in 62 M. tuberculosis clinical isolates with PCR-SSCP method. M. tuberculosis strain H37RV was used as control., Result: The ahpC coding sequences showed normal SSCP profiles in 62 clinical isolates. AhpC promoter mutations were identified in 5 of 12 high isoniazid-resistant strains, and were not altered in 18 low isoniazid-resistant and 32 drug-sensitive isolates., Conclusion: The mutation of ahpC coding gene was not correlated with isoniazid-resistant M. tuberculosis isolates. AhpC promoter mutation was a compensatory change in katG-defective and catalase-negative isolates, may be used as a indirect marker for high resistance to isoniazid.

Objective: To investigate intraocular pressure (IOP) changes early after phacoemulsification with posterior chamber lens implantation., Methods: The IOP was measured in 49 patients 53 eyes before and 10 - 12, 22 - 24, 46 - 48 hours after the operation., Results: The IOP increased obviously in all eyes 10 - 12 hours after the operation, and rose more significantly from the baseline to the maximum 10 - 12 hours after surgery in 20 sutured eyes than that in 33 unsutured eyes (t = 4.41 and 3.32, P = 0.0001 and 0.0020, respectively). It was higher than 3 kPa in 16 eyes, 10 (10/20, 50.0%) in the sutured group, 6 (6/33, 18.2%) in the unsutured group, respectively, and the difference was significant between the two groups (chi2=5.9820, P=0.014). The IOP decreased markedly 22 - 24 hours, and returned to the baseline level 46 - 48 hours after the operation., Conclusion: These results indicate that IOP increases early after phacoemulsification with posterior chamber lens implantation, especially in sutured eyes. Therefore, to apply corresponding management properly in time and obtain better therapeutic effects of the operation, IOP should be measured regularly.

Objective: To understand mutation of rifampicin-resistant genes in M. tuberculosis clinical isolates, and to develop a new method for detecting drug resistance., Method: Analyzing the rpoB genes in 50 M. tuberculosis clinical isolates with polymerase chain reaction-single-stranded conformation polymorphism (PCR-SS-CP) and PCR-direct sequencing(PCR-DS) techniques. M. tuberculosis strain H37Rv was used as control., Result: Of 3 drug-sensitive isolates and 2 non-rifampicin-resistant isolates selected, only 1 drug-sensitive isolate with abnormal rpoB SSCP profile had TCG-->TTG mutation at codon 531. Of 45 rifampicin-resistant isolates, 35 isolates with abnormal SSCP profiles had mutations in rpoB sequences, in which 14 isolates displayed TCG-->TTG or TGG or TAC mutations at codon 531, 14 had CAC-->TAC or GAC or CCC or CTC or GTC mutations at codon 526, 2 had GAC-->GTC or TAC mutations at codon 516, 2 had two point mutations, and 3 had different rpoB sequences from that of M. tuberculosis., Conclusion: Resistance to rifampicin in most M. tuberculosis isolates is due to the mutations on the genes encoding the RNA polymerase subunit (rpoB). PCR-SSCP and PCR-DS techniques might become simple, rapid and reliable diagnostic tests for rifampicin resistance in clinical isolates.

Objective: To investigate the technique of phacoemulsification for hard nucleus cataract extraction and evaluate its therapeutic effects., Methods: Three methods of phacoemulsification, the improved divide and conquer, the reserve lens cortex spin and no lens cortex spin, were performed on 62 eyes according to the type of nucleus hardness., Results: With foldable or 5.5 mm PMMA intraocular lens implantation, the improved divide and conquer phacoemulsification was performed on 26 eyes, the reserve lens cortex spin phacoemulsification on 23 eyes and no cortex spin phacoemulsification on 13 eyes. At postoperative 3 days, 5 days and 30 days, the visual acuities without correction 0.5 or better were obtained respectively in 46 eyes (74.2%), 60 eyes (96.8%) and 61 eyes (98.4%). The major complications were corneal edema and posterior capsular rupture., Conclusion: The technique of phacoemulsification for hard nucleus cataract is worthy to be spread due to safety, easiness and minimum complication.

Objective: To assess the role of the functional states of pituitary-ovary, adrenal and thyroid axes in the pathophysiology of polycystic ovarian syndrome (PCOS)., Methods: The stimulation tests of above-mentioned three endocrine axes by luteinizing hormone releasing hormone (LRH, 100 micrograms), adrenocorticotrophin (ACTH, 250 micrograms) and thyroid releasing hormoune (TRH, 500 micrograms), respectively, were performed in each subjects of two PCOS groups [luteinizing hormone/follicle stimulating hormone (LH/FSH) > or = 3, Group 1, n = 15; LH/FSH < 3, Group 2, n = 15] and the control (n = 20). Endocrine indices of corresponding target glands were evaluated by radioimmunoassay (RIA)., Results: After LRH administration, the amplitude of LH responses in three groups were as follows: Group 1 > Group 2 > control while mean testosterone levels were elevated to a similar extent in two PCOS groups and remained unchanged in the control. Following ACTH stimulation, PCOS subjects, especially of Group 2 with obvious insulin resistance, showed higher responses of cortisol, dehydroepiandrosterone sulfate and testosterone as compared with the controls. However, during TRH testing, exaggerated thyroid-stimulating hormone and prolactin responses in two PCOS groups and blunted free thyroxine response at two hour point in Group 1 were observed, as compared with the control., Conclusion: It appears that ovarian androgen excess in women with PCOS is mainly LH-dependent in Group 1 and insulin-dependent in Group 2. Enhanced adrenal activity may contribute to both hyperandrogenism and insulin resistance in this syndrome, and subclinical hypothyroidism may exist in affected subjects, especially of Group 1.

Objective: To elucidate the expression of Wilms' tumor gene (WT1) in leukemias and its clinical implication., Methods: Expression of WT1 mRNA was detected in four leukemia cell lines, 25 AML patients, 11 ALL patients, 9 CML patients, 15 healthy subjects and 10 non-blood diseases patients by using RT-PCR., Results: WT1 mRNA expression was revealed in K562, HL-60 and TF-1 cell lines, 21 of 25 (84%) AML patients, 8 of 11 (73%) ALL patients, 2 CML patients in blast crisis and 1 of 7 CML patients in accelerated and chronic phase. WT1 mRNA was undetectable in PBMNC from 15 healthy subjects and in bone marrow cells from 10 non-blood diseases patients., Conclusion: WT1 gene is expressed in the majority of acute leukemias and thus is involved in human leukemogenesis. WT1 is also a new important marker for monitoring MRD in acute leukemias.

Objective: To investigate the relationship between androgen excess, insulin resistance and altered lipoprotein lipids in polycystic ovarian syndrome (PCOS)., Methods: Both basal and luternizing hormone-releasing hormone (LHRH, 100 micrograms) induced responses of circulating testosterone (T), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C) and apoprotein A1 (apo A1) were measured in two PCOS groups with similar T levels (LH/FSH > or = 3, Group 1, n = 15, LH/FSH < 3, Group 2, n = 15) and the control (n = 20) of matched body mass index with Group 1. Insulin resistance was assessed by fasting insulin levels., Results: In basal state, the mean TG levels in women of three groups were as follows: Group 2 > Group 1 > control, while HDL-C showed the opposite. After LHRH test, mean T and TG concentrations increased and HDL-C decreased in all PCOS subjects, especially Group 2 whereas the indices remained unchanged in the controls., Conclusion: Our data suggest that altered lipid profiles in women with PCOS may result from the independent effects of androgen excess and insulin resistance.

Objective: To investigate expression of proliferating cell nuclear antigen (PCNA) in ovarian epithelial cancer and its relation to lymph node metastasis, second-look laparotomy (SLL) and prognosis., Methods: Monoclonal antibody PC10 was used to stain PCNA in archival paraffin-embedded tissues., Results: PC10 immunostaining was performed successfully in all 74 primary and 31 intraperitoneal metastatic tumors. The expression of PCNA was significantly elevated in 31 metastatic tumors compared with their primary tumor from the same patient (7.94 vs 6.89, P = 0.042). The expression was more marked in bilateral than in unilateral ovarian cancer but it was not associated with lymph node metastasis, clinical stage, histologic grade and subtype. In 28 patients with stage III ovarian cancer undergone SLL, the mean immunoreactive score (IRS) of PCNA of the primary tumor was significantly higher in patients with negative SLL than in those with positive SLL (7.59 vs 6.10, P = 0.03). Since chemotherapy was performed following surgical debulking, negative SLL more frequently seen in patients with high PCNA expression might suggest better chemotherapeutic sensitivity due to higher proliferation fraction of tumor cells. Univariate analysis of survival indicated that the overall survival was inversely associated with the level of PCNA expression, while multivariate analysis with Cox's model showed that independent prognostic factors were the residual tumor after primary debulking (P < 0.001) and clinical stage (P < 0.05), followed by PCNA expression (P = 0.09)., Conclusion: The expression of PCNA may be useful in predicting prognosis, but is not correlated with lymph node metastasis.

Objective: To study the molecular mechanism of multi-drug resistance in M. Tuberculosis, and to develop a new method for detecting genes related with multi-drug resistance., Method: The ropB, rpsL, katG genes and inhA regulatory sequence in clinical isolates of M. tuberculosis were analyzed with PCR and PCR-SSCP techniques., Result: The sensitivity of amplifing the drug-resistant genes with PCR was 1-10 pg DNA. Of the 20 multiple resistant strains with reduced sensitivity to streptomycin, rifampin and isoniazid, 90% showed mutations in more than two genetic markers associated with resistance to each of these three drugs, 10% revealed only mutations in rpoB gene., Conclusion: Multi-drug resistance in M. tuberculosis could be caused by an accumulation of mutations in chromosomal genes encoding drug targets or an alteration at a single multiple resistance locus. PCR and PCR-SSCP techniques might become simple, rapid and reliable diagnostic tests for multi-drug resistance.

Ceramic stains are used to modify the final colors of ceramic dental restorations. They are not color stable when subjected to glazing temperature. In order to understand the color change characteristics, the study tested the color stability of the five Vita VMK68 stains. The international color standard CIE1976LAB color system and CS-5 Spectrocolorimeter are used. The results indicate: significant color changes are noted for five stains; the color change characteristics among them are different; yellow-brown stain shows the most color unstability after firing.

Objective: In order to understand the changes of morphology and refractive power of cornea after radial keratotomy (RK) and its combination with transverse incision (T-incision), and the wound healing of the T-incision., Methods: Corneal topography aided with a computer was used to analyze the changes of patients having undergone RK and RK combined with T-incision. The wound healing was analyzed, and the refractive powers of strong axis and weak axis of corneas were measured., Results: Corneal surface regularity index (SRI) and surface asymmetry index (SAI) became greater and greater along with the increase of myopia-astigmatism. The refractive powers of corneal visual area 3, 5, 7 mm decreased when getting closer to the center of the cornea. The refractive power of the strong axis in cornea with RK combined with T-incision obviously decreased more than that of RK. There was no such difference at weak axis between RK and RK combined with T-incision., Conclusions: Corneal SAI and SRI will increase when myopia-astigmatism increases. The morphologic changes are from positive non-spherical lens before surgery to negative non-spherical lens after surgery. The increase of radius of curvature and the decrease of refractive power are due to incisions. These phenomena become clearer when the incision getting closer to the visual area or more incisions are performed. A T-incision less than 2 mm long along the strong axis of astigmatism not only can lessen refractive power of strong axis, but also can not affect RK results. This kind of T-incision does not delay the wound healing either.

Objective: To evaluate the altered dopaminergic modulation of growth hormone (GH) and prolactin (PRL) in polycystic ovarian syndrome (PCOS)., Methods: Responses of GH and PRL to L-Dopa (L-DA) (500 mg) were observed in two PCOS groups (LH/FSH > or = 3, Group I, n = 15, LH/FSH < 3, Group II, n = 15) and the control (n = 20)., Results: Significantly lower GH (P < 0.01) and higher PRL levels (P < 0.05 in group I) in the basal state, and lower responses of GH and PRL to L-DA were found in two PCOS groups as compared with the control., Conclusion: The altered basal levels and blunted L-DA evoked responses of GH and PRL suggest a relative decrease of the dopaminergic activity in PCOS patients.

Objective: To define the prevalence of acquired red cell enzymopathy in leukemia and MDS patients and explore its clinical significance., Methods: Red cell enzymes (G6PD, 6PGD, PK, ENOL, ADA, PNP,ALD) activities and PK,ADA isoenzymes were assayed by the methods recommended by ICSH and PAGE electrophoresis., Results: The prevalence rate of G6PD deficiency was 43.1%, and of PK deficiency was 27.8%, in leukemia and MDS patients. The prevalence rates of PK, G6PD and PNP deficiency in MDS patients were 50%, 48% and 39.1%, respectively, while of ADA, ENOL and ALD over production in MDS patients were 69. 6%, 40% and 30. 4%, respectively. PK activity was increased in CML, while the PK isoenzyme pattern was normal. Administration of antitumor antibiotics to AL decreased G6PD and 6PGD activities (P < 0.05). ADA2 was expressed in MNC of AML (M4 and M5) and in RBC of CMML, but not expressed in ALL (P < 0.001)., Conclusion: Determination of enzymes may be used as prognostic parameters in CML,a predictor of antitumor drug resistance in acute leukemia, and a differential parameter between MDS-RA and aplastic anemia and between CML and CMML.

Objective: To investigate the relationship between renin-angiotensin system (RAS) and polycystic ovarian syndrome (PCOS) METHODS: A pituitary-stimulating test with luteinizing hormone releasing hormone (LRH, 100 micrograms) was performed in two PCOS groups with similar mean testosteron (T) levels of luteinizing hormone/follicular stimulating hormone (LH/FSH) (LH/FSH > or = 3, group 1, n = 15; LH/FSH < 3, group 2, n = 15) and the controls (n = 20) of matched body mass index with group 1. The basal level and LRH-evoked responses of LH, plasma renin activity (PRA), angiotensin II (AT II ) and aldosterone (ALD) were measured by RIA with commercially available kits. In the basal state, a positive correlation was found between T and AT II levels (r = 0. 49, P < 0.05) in all PCOS subjects. After LRH administration, susceptible individuals, especially of group 1 had exaggerated responses of LH, PRA, AT II and ALD as compared with the controls, and a positive correlation was also found between peak levels of LH and AT II (r = 0.54, P < 0.01)., Conclusions: There is enhanced RAS function in PCOS especially in group 1. This may contribute to the excess androgen production and high incidence of ovarian hyperstimulation syndrome in this disorder.

Objective: To evaluate sputum culture and serology for detection of chlamydia pneumoniae (C. pneumoniae) in adult patients with acute respiratory tract infection and normal subjects., Methods: Microimmunoflorescence (micro-IF) test for IgG and IgM antibodies to C. pneumoniae specific antigen was performed in every subject. Thirty-seven patients also had sputum HEP-2 cell culture tested for C. pneumoniae., Results: Twenty-six patients (29.7%) with micro-IF IgG titres equal to or greater than 1:512 or/and IgM titres equal to or greater than 1:32 indicated recent infection. Eight patients (21.3%) with positive sputum culture of C. pnuemoniae were identified. No similar titer was shown in control normal subjects., Conclusions: Acute infection of C. pneumoniae was common in symptomatic patients with acute respiratory tract infection and attention should be drawn to this special illness.

Objective: To observe the mutations of rpsL gene in M. tuberculosis streptomycin-resistant isolates, and to develop a new method for detecting drug resistance., Method: Detecting the rpsL genes with PCR-SSCP and analyzing their codons 43 by PCR-RFLP., Results: Strain H37Rv was used as a control. In 22 M. tuberculosis clinical isolates, the rpsL PCR fragments from 5 drug-susceptible isolates had no differences in the SSCP profiles with strain H37Rv, and were restricted by Mbo II. 11 of the 13 streptomycin-resistant isolates showed apparent differences in the SSCP profiles and were not digested with Mbo II. 1 of the 4 other drug-resistant isolates also had apparent SSCP differences and was not digested by Mbo II., Conclusions: The results suggested that the rpsL gene mutation was frequently observed in M. tuberculosis streptomycin-resistant isolates, and usually situated at codon 43, PCR-SSCP and PCR-RFLP might become a simple, rapid and reliable diagnostic test for drug resistance.

Objective: To investigate the incidence and the significant risk factors of retroperitoneal lymph node metastasis (LNM) in primary ovarian cancer for considering the necessity of systematic lymphadenectomy., Methods: 117 cases of retroperitoneal lymphadenectomy performed on primary ovarian cancers in our hospital from November, 1987 to January, 1994 were studied. The relationship between clinicopathologic characters and the incidence of LNM were determined by univariate and multivariate analysis., Results: In 44 (37.6%) of the 117 patients studied, LNM was confirmed pathologically. The chances of pelvic LNM (29.9%) were smilar to that of para-aortic LNM (20.9%) (P > 0.05). Univariate analysis showed that significantly increased incidence of LNM was clinically associated with bilateral involvement of the ovaries, presence of ascites, advanced stages, poor tumor differentiation, rather large residual tumors and some histopathological subtypes such as undifferentiated and serous adenocarcinoma. The size of the residual tumor, clinical stage and grade of differentiation were the most important risk factors for LNM (P < 0.05) by multivariate analysis. The indication, optimum time, the scope and model of systematic lymphadenectomy were evaluated and discussed., Conclusion: systematic lymphadenectomy was suggested only for early cases with high risk factors. For late cases with residual tumor the operation may be done at a chosen time, for instance, at second cytoreductive or second-look surgery.