To investigate genetic causes in Chinese women with primary ovarian insufficiency (POI) for genome-wide copy number variations (CNVs), focusing on novel autosomal microdeletions and microduplications. Methods: Genome-wide CNVs analysis using Affymetrix SNP 6.0 array was carried out in 30 Chinese POI subjects. And quantitative PCR (qPCR) was further performed for selected coding regions with microdeletions and microduplications in 30 POI subjects and another 40 POI cases. Results: A total of 101 CNVs were identified by SNP arrays, ranging in size from 0.1 MB to 5.6 MB. These CNVs included 8 novel microduplications and 12 novel microdeletions. Then 4 microdeletions identified in chromosomal regions (10q26.12, 10q26.3, 2p16.3, and 6p26) and 2 microduplications which contained the coding regions (20p12.3 and 7p22.2) were verified by qPCR. Conclusion: We report the high-resolution rare CNV analysis, revealing novel microdeletions/microduplications in Chinese POI patients. In the selected verified coding regions, we find that the five genes including SYCE1, CYP2E1, NRXN1, PARK2 and CARD11 may be involved in reproduction, thus representing potential candidate genes in POI.

To investigate the correlation of human oocyte morphometric parameters with fertilization and embryo development in the intracytoplasmic sperm injection (ICSI) cycles. Methods: The morphometric parameters of oocytes collected and submitted to evaluation using OCTAX Eye-ware software just before ICSI. Oocyte diameter (OD), perivitelline space width (PSW), zonapellucida thickness (ZPT) and the shape of first polar body (FPB) (intact or fragmented) were analyzed. A stepwise multivariate Logistic regression was used to test the association between the morphometric parameters and fertilization and embryo development. Results: In the study, 436 oocytes were measured and 370 were ferti-lized (84.9%), 225 fertilized oocytes were developed to high-quality embryos (60.8%). ZPT and PSW were associated with fertilization. The oocytes fertilized had thicker ZPT ［(18.0±2.3) μm vs. (16.9±2.7) μm］ and wider PSW ［(14.4±3.3) μm vs. (13.2±3.9) μm］. The OD and shape of FPB were associated with embryos development. The oocytes developed to high-quality embryos had larger OD ［(116.6±3.7) μm vs. (114.7±3.6) μm］ and more intact FPB (86.2% vs. 66.7%). Conclusion: The morphometric parameters of oocytes can indicate fertilization and embryo development.

To explore the application of multiple displacement amplification(MDA) combined with short tandem repeats (STRs) in preimplantation genetic diagnosis (PGD). Methods: MDA was applied to amplify the whole genome of a single cell and to retrieve and assemble the highly heterogeneous STR loci among human population. Haplotype analytic system was established with aiming at diagnosis of the single gene diseases by selecting the STR loci located within the pathogenic genes or on both bounding sides of the pathogenic genes. At the same time, allele specific amplification, PCR-reverse dot-blotting hybridization methods and gene sequencing methods were employed for direct detection of the pathogenic genes. The STR loci located at related chromosomes were selected to carry out allele number analysis on the basis of chromosome number and structural abnormality. Results: In the study, 12 PGD systems were set up including 6 different monogenic diseases (spinal muscular atrophy, Duchenne muscular dystrophy, X-linked chronic granulomatous disease, osteopetrosis, achondroplasia, X-linked severe combined immunodeficiency), Robertsonian translocations, αthalassemia combined with Robertsonian translocation, α- and β-double thalassemia, β- thalassemia with HLA typing and DMD with HLA typing. Then 44 PGD cycles were performed for 35 couples with different kinds of inherited diseases, which resulted in 20 healthy liveborns (12 singletons and 4 twins) and 5 ongoing pregnancies. The clinical pregnancy rate was 47.7% (21/44) per PGD cycle. The overall diagnostic rate was 94.6% (367/388). The MDA failed in 3.6% (14/388) single blastomeres. The amplification rate of the subsequent PCR was 97.1% and the average allele drop out (ADO) rate was 12.6% (range: 0-47.5%). Conclusion: The application of MDA combined with STRs provided a generic PGD approach for different genetic disorders, especially for simultaneous diagnosis of two or more hereditary statuses. The method could greatly shorten the time of developing PGD system of new diseases, which broadens the indications of PGD.

To study the expression of PPARγ mRNA in granulosa cells of patients with polycystic ovary syndrome (PCOS) and the impact of testosterone, insulin and PPARγ agonist rosiglitazone on granulosa cells (GCs).Methods: The expression of PPARγ mRNA in GCs of patients with PCOS and normal controls were analyzed by Real-time PCR. We assessed the level of PPARγ mRNA in GCs from normal controls after treatment with testosterone, insulin, and rosiglitazone.Results: The expression of PPARγ mRNA was lower in the GCs of PCOS than that of the controls (P<0.05). When testosterone concentration was 1 nmol/L, the expression of PPARγ mRNA was lower in the GCs as compared with  the blank control (P<0.05). When testosterone concentration was 10 nmol/L, PPARγ mRNA increased in the GCs as compared with the blank control, which was of no significance (P>0.05). When insulin concentration was 10 nmol/L, the expression of PPARγ mRNA was higher in the GCs as compared with the blank control (P<0.05). When insulin concentration was 100 nmol/L, the expression of PPARγ mRNA increased, but the difference was not statistically significant (P>0.05). When rosiglitazone concentration was 1 nmol/L, the expression of PPARγ mRNA in ovarian GCs significantly increased, as compared with the blank control (P<0.05). When rosiglitazone concentration was at 10 nmol/L, the PPARγ mRNA expression significantly increased, as compared with the concentration at 1 nmol/L (P<0.05).Conclusion: PPARγ mRNA expression is down-regulated by testosterone, and up-regulated by insulin and rosiglitazone with different dosages. Decreased PPARγ mRNA in the GCs of PCOS is related to the clinical characteristics of PCOS.

To investigate the roles of mitochondrial oxidative phosphorylation (OXPHOS) capacity in oocyte maturation, fertilization and embryo development. Methods: Carbonyl cyanide p- (tri-fluromethoxy) phenyl-hydrazone (FCCP), a metabolic inhibitor of mitochondria, was introduced into culture medium. The integrity of spindle and chromosome alignment, reactive oxygen species (ROS) levels, and rates of maturation, germinal vesicle breakdown, fertilization and blastulation were assessed in vitro. Results: Significant decreases were detected in the percentages of oocytes with nuclear maturation, normal spindle formation and chromosome alignment, ROS levels and capable for blastocyst formation between oocytes treated with FCCP and non-treated (control group), 55.8%, 37.9%, 0.67 and 57.9% (FCCP 10 nmol/L group), 47.3%,34.7%, 0.59 and 41.8% (FCCP 100 nmol/L group) versus 62.9%, 61.9%,0.94 and 68.3% (control group) respectively, P < 0.05. However, No significant differences were found in the rates of GVBD and fertilization in oocytes from the FCCP treated and the control. Conclusion: Inhibition of mitochondrial metabolic capacity resulted in decreased the percentages of oocytes with nuclear maturation, normal spindle formation and chromosome alignment, ROS levels and capable for blastocyst formation. But the treatment of FCCP did not affect the rate of fertilization.

To explore the efficiency of using aromatase inhibitors during luteal phase in in vitro fertilization IVF stimulated cycles for patients at high risk for ovarian hyperstimulation syndrome (OHSS). Methods: A total of 139 infertile women undergoing assisted reproductive technique with high risk for OHSS were enrolled in this clinical trial. In the treatment group 43 patients received five consecutive doses of aromatase inhibitors (letrozole) and support therapy combined with embryo cryopreservation. In the control group 96 patients received support therapy alone. All the patients were evaluated clinically, echographically, hematologically and tested for their steroid hormone. Results: There was significantly lower estrogen level in the treatment group 2, 5 and 8 days after oocyte retrieval compared with the control group (P<0.001), There was no significant difference in luteinizing hormone and progesterone levels 2, 5 and 8 days after oocyte retrieval in the treatment group and control group (P>0.05). There were 7 cases of severe OHSS in the treatment group and 18 cases of severe OHSS in the control group. The rate of severe OHSS was not significantly different in the treatment group and control group (P=0.12). No side effect was reported in either group. Conclusion: Treatment with letrzolein luteal phase decreases serum estrogen levels of patients after oocyte retrieval，but it couldn’t reduce the risk of severe OHSS.

To investigate the influence of duration of gonadotropin (Gn) administration on the clinical outcome of in vitro fertilization embryo transfer (IVF-ET). Methods: A total of 3 221 cycles of short protocol or antagonist protocol in our center from January 2012 to December 2012 were included in the retrospective study. According to the different duration of Gn administration, all patients were divided into group A (≤7 days, n=58) and group B (＞7 days, n=3 163). The different clinical parameters, such as age, duration of infertility, body mass index (BMI), basis estradiol (E ₂), folliclestimulating hormone (FSH), the number of antral follicle, the number of oocytes, endometrium thickness, fertility rate, good quality embryo rate, impatation rate and clinical pregnancy rate were compared between the two groups．Results: There was no significant difference in age, duration of infertility, BMI, basis E ₂, FSH, the number of antral follicle between the two groups. The number of oocytes in group A was fewer than that in group B ［（8.2±5.6）vs.（12.1±8.3），P=0.009］; endometrium thickness on the day of HCG in group A was thinner than that in group B ［（9.9±2.1） mm vs.（10.4±1.6） mm，P=0.002］. There was no significant difference in fertility rate, good quality embryo rate, impatation rate and clinical pregnancy rate (36.2% vs. 33.6%, P> 0.05). There was no significant difference in clinical pregnancy rate between the two groups in short protocol (33.3% vs. 27.2%, P> 0.05). In the same way, there was no significant difference in clinical pregnancy rate between the two groups in antagonist protocol (37.5% vs. 36.6%, P> 0.05). Conclusion: Although short duration of gonadotropin administration in short protocol and antagonist protocol has association with fewer number of oocytes, it may not affect the outcome of IVF- ET.

To compare the clinical outcomes of GnRH agonist （GnRH-a） long protocol and GnRH antagonist （GnRH-ant）protocol in vitro fertilization (IVF)-embryo transfer (ET) cycles, and to explore the optimized protocol for infertile women. Methods: From June 2010 to June 2012, 2 444 infertile women underwent their IVF cycles in Peking University Third Hospital, which were divided into 1 706 GnRH agonist long protocol and 738 GnRH antagnist protocol groups. The data of the general demographic、treatment and clinical outcome were compared between the two groups. Results: The age, body mass index(BMI), infertile duration, antral follicle count (AFC) did not reach statistical difference, the level of estradiol on the day of HCG： injection was higher in GnRH agonist group  ［（10 595±7 368）pmol/L vs. （9 087±7 035） pmol/L］, and the mean length of stimulation was longer in GnRH agonist group［（12.5±1.8） d vs.（9.4±1.7） d］, The dose of Gn ［（3 107±1 377） IU vs. （2 084±903）IU］was higher in GnRH agonist group. The number of ovum was 13.4±6.6 in GnRH agonist group and 11.8±6.4 in GnRH antagonist group. Those clinical parameters all reached statistical difference (P<0.05). The number of the transfer embryos, fertilization rate, and cleavage rate did not reach statistical difference, but the number of the embryos was 5.6±4.5 in GnRH agonist group and 5.1±4.3 in GnRH antagonist group,reached statistical difference (P<0.05). The abortion rate, embryonic death rate, ectopic pregnancy rate, preterm labor rate, postterm pregnancy rate, fatal malformations rate showed no statistical difference, but the GnRH agonist long protocol had higher pregnancy rate (44.0% vs. 38.3%), and higher term pregnancy rate (64.2% vs. 56.9%) compared with GnRH antagonist protocol, thus those parameter reached significant difference (P<0.05). Conclusion: Compared with GnRH-antagnist protocol, GnRH agonist long protocol had higher pregnancy rate and better pregnancy outcome.

To investigate the clinical outcome of patients who underwent cryopreservation of all embryos. Methods: A retrospective analysis was made in the clinical data of patients with cryopreservation of all embryos between April 2011 and September 2011 in four hospitals of North China. The patients were divided into five groups according to the reasons of cryopreservation of all embryos: ovarian hyperstimulation syndrome (OHSS) group, serum progesterone elevation group, endometrial group, hydrosalpinx group and others. The clinical pregnancy rate per transfer, implantation rate and cumulative clinical pregnancy rate were analyzed. Results: The clinical pregnancy rate, implantation rate and cumulative clinical pregnancy rate of the OHSS group were 55.4%, 34.8% and 73.7%, respectively. The rates of the serum progesterone elevation group were 25.5%, 11.2% and 43.1%, respectively. The rates of the endometrial group were 54.8%, 34.4% and 61.5%, respectively. The rates of the hydrosalpinx group were 60%, 30% and 60%, respectively. The rates of the other factors group were 36.0%, 24.5% and 44.0%, respectively. Conclusion: The strategy of cryopreservation of all embryos could improve the clinical outcomes of patients with severe OHSS. It still needs a large multicentre, randomized trial to evaluate its effectiveness and side effects, although it has the positive clinical application for other reasons of cryopreservation of all embryos.

To analyze the factors affecting clinical pregnancy rate of intrauterine insemination in Center of Reproductive Medicine, Peking University Third Hospital, to guide clinical treatment. Methods: In the study, 5 167 intrauterine insemination cycles were retrospectively analyzed from May 2011 to October 2012 in our reproductive center. The data were collected, the single-factor was analyzed with χ² test, and the multifactor was analyzed with Logistic regression with a significant level of 0.05. Results: The cycle clinical pregnancy rate was 12.8%, which decreased with the increase of the female age and infertile duration. The clinical pregnancy rate was low when the sperm density was less than 1×10⁶/mL. In the ovulation group, the clinical pregnancy rate was higher than the natural group. The group with more than 2 dominant follicles had higher clinical pregnancy rate as compared with the single dominant follicle group. The clinical pregnancy rate was the highest in the third cycle but decreased after the fourth cycle. The clinical pregnancy rate was higher in cervical factors, sexual dysfunction, and polycystic ovary than in the group with other reasons. Conclusion: The female age, infertile duration, ovarian stimulation and follicle number, cause of infertility were the main factors affecting clinical pregnancy outcome; the sperm density, and cycle numbers have influence too; the insemination timing, and frequency have little effect.

To investigate the practical application value of the mild-stimulation method used in in vitro fertilization and embryo transfer (IVF-ET) treatment for IVF patients with normal ovarian function. Methods：The patients (ages from 26 to 38 years) with normal ovarian function, who were treated with IVF-ET in Affiliated Reproductive Center of China Medical University from January 2004 to July 2012 were selected as our samples. We compared the clinical results of treatment between the mild-stimulation (104 cycles in experimental group) and the conventional stimulation (198 cycles in control group).Results: The number of retrieved oocytes (3.1±1.6 vs. 10.2±5.7, P<0.05) and clinical pregnancy rate ［34% (33/97) vs. 49.7% (93/187), P<0.05］ of the mild-stimulation group (104 cycles) were lower than those of the control group (198 cycles), however, the duration of stimulation (4.7±2.1 vs. 9.16±1.87) and total doses of 75 U gonadotropins used (5.7±3.7 vs. 30.9±10.3) were also lower in the mild-stimulation group than in the control group obviously (P<0.05).Conclusion: For the normal ovarian function patients, the mild-stimulation method has clear clinical effects, but not as good as the conventional-stimulation one.

To assess the interobserver reliability of antral follicle counts (AFC) using real-time two-dimensional (2D) ultrasound and three-dimensional (3D) ultrasound. Methods: Two observers conducted transvaginal ultrasound examinations in 51 subfertile women in the early follicular phase of the menstrual cycle. Antral follicles were counted using real-time 2D ultrasound and the time taken was recorded. A 3D volume was then acquired from each ovary and stored for subsequent offline analysis using the multiplanar view. The time taken for each step was recorded and the total time was calculated. Intraclass correlation coefficients (ICC) and limits of agreement were used to assess the reliability. Results: There was no difference in the mean antral follicle counts using real-time 2D (18.63±11.39) and 3D (18.73±11.74) ultrasound. According to the ICC, there was a significantly higher interobserver reliability for counts made using 3D (mean, 0.994; 95% CI, 0.990-0.997) as compared with real-time 2D ultrasound (mean, 0.979; 95% CI, 0.963-0.988), P<0.01. 3D ultrasound was also associated with narrower limits of agreement (-3.46, 3.35) than was 2D ultrasound (-6.78, 6.31). While the total time taken was significantly longer for the 3D technique ［(204.0±53.0) s  vs. (112.4±34.8) s, P<0.001］, the time required for the actual ultrasound examination was significantly less ［(48.0±7.5) s  vs. (112.4±34.8) s, P<0.001］.Conclusion: 3D ultrasound significantly improves the interobserver reliability of antral follicle counts. While this is at the expense of time overall, the duration of the actual ultrasound examination and the patient exposure is significantly reduced using 3D compared with real-time 2D ultrasound.

To evaluate the combined effect of premedication of parecoxib sodium and local infiltration of ropivocaine on postoperative shoulder pain and incisional pain in patients undergoing diagnostic hysteroscopy and laparoscopy. Methods: In the study, 60 patients undergoing elective diagnostic hysteroscopy and laparoscopy were randomly allocated to two groups (each with 30 patients). The patients in group 1 were premedicated with 40 mg parecoxib sodium (diluted with 2 mL normal saline), and 0.5% ropivacaine (20 mL) were infiltrated around the incision site before establishment of CO2 pneumoperitoneum. The patients in group 2 received 2 mL normal saline intraveniously before anesthesia induction, and infiltration of 0.5% ropivacaine 20 mL were also applied as group 1. After anesthetic withdrawal, the patients’ postoperative anesthesia recovery time and the time point of opening eyes on verbal command were noted. The intensities of postoperative shoulder pain and incisional pain were evaluated at 0, 2, 4, 8, 12, 24, and 48 h after surgery. The postoperative analgesic requirement was met by administration of tramadol. Results: Compared with group 2, the incidence of postoperative shoulder pain was less in group 1 (37% vs. 67%, P=0.020), and the occurence of severe pain was lower (4 vs. 11, P=0.037). The numerical rating scales (NRS) of right shoulder pain of group 1 were significantly reduced than those of group 2 at 12 h postoperatively ［0 (0, 2) vs. 0 (0, 8), P=0.012］. Left shoulder pain did not appear at 0 h and 2 h in both groups, while at 12 h and 24 h postoperatively, the NRS scores of group 1 were lower than those of group 2 ［0 (0, 1) vs. 0 (0, 8), P=0.026; 0 (0, 4) vs. 2 (0, 9), P=0.014］. The dynamic and static abdominal pain scores of group 1 were significantly decreased than those of group 2 in postanesthesia care unit (PACU) after surgery (P=0.001, P=0.005). The NRS scores of static abdominal pain of group 1 were significantly reduced than those of group 2 at 12 h and 24 h postoperatively (P=0.042, P=0.029). More patients in group 2 needed tramadol within 24 h postoperatively (8 vs. 0, P=0.002). Conclusion: Premedication of parecoxib sodium combined with local infiltration of ropinvocaine before incision could significantly reduce the postoperative shoulder pain and incisional pain as well as reduce opioid consumption in patients undergoing diagnostic hysteroscopy and laparoscopy.

To identify the mutation in the disease gene and provide prenatal diagnosis for a hereditary multiple osteochondromas (HMO) family. Methods: The exons of EXT1 gene in the proband with HMO and his family members were amplified by PCR. The products were analyzed by direct sequencing. Prenatal genetic diagnosis was performed by amniocentesis sampling after genotyping the proband. Results: In the family, the affected proband was heterozygous of the mutation of 1476_1477delTC in the EXT1 gene, and the proband’s father carried the same mutation in part of his somatic cells. No mutation was found in the EXT1 gene of the proband’s mother and other 11 siblings of his father. Conclusion: Methods for molecular diagnosis and prenatal diagnosis of HMO were established and applied to a family of HMO.

To evaluate the effectiveness of neoadjuvant chemotherapy (NAC) followed by radical hysterectomy plus postoperative chemotherapy but no radiotherapy for stage ⅠB2-ⅡB cervical cancer. Methods: Seventy-nine patients with stage ⅠB2-ⅡB cervical cancer were treated with NAC followed by radical hysterectomy. According to different adjuvant therapies, patients were divided into postoperative chemotherapy group (47 cases) and postoperative radiotherapy/concurrent chemoradiothe-rapy group (32 cases). Regimens for NAC and postoperative chemotherapy were BIP (bleomycin+ ifosfamide+ cisplatin/carboplatin) or TP (paclitaxel+ cisplatin/carboplatin). An average of 1.1±0.3 cycles of NAC and 3.4±1.2 cycles of postoperative chemotherapy were prescribed. Results: Toxicities due to chemotherapy were generally tolerable. Overall response rate of NAC was 88.6%. With a median follow-up period of 42 months, the three-year progression-free survival rates of the two groups were 88.5% and 84.3%, the total survival rates were 90.3% and 86.4%, respectively. There was no statistically significant difference. The recurrent rates were 10.6% and 21.8% in the two groups. In the absence of radiotherapy, pelvic recurrence was observed in two patients; the other three had distant metastases. Conclusion:The results indicate that NAC followed by surgery plus postoperative chemotherapy but no radiotherapy offers a viable option in the treatment of stage ⅠB2-ⅡB cervical cancer. The patients can tolerate the side effects of chemotherapy with better efficacy.

To investigate the relationship between radial augmentation index (AI) and other noninvasive indices for evaluating arteriosclerosis. Methods: From April to June 2010, a cross-sectional survey was performed in two communities of Shijingshan District, Beijing, China. This study involved 1 752 subjects (aged 23 to 90 years). AI was measured using Colin pulse wave detection device HEM9000AI. Brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) were measured using Colin noninvasive arteriosclerosis tester VP-1000．Color Doppler flow imaging was used to measure intima-media thickness (IMT) of the bilateral carotid arteries. Results: Compared with the control group, baPWV≥14 m/s, ABI≤0.9 and IMT≥0.9 mm groups showed no significant difference in AI₇₅ (P>0.05). Hypertensive individuals had significantly higher baPWV than the healthy group. Elderly hypertensive individuals with diabetes mellitus or (and) dyslipidemia had lower ABI than the control group. There was no significant difference of AI₇₅ between the disease groups and the healthy group (P>0.05). Pearson correlation analysis showed that AI₇₅ was associated with women, central aortic systolic pressure, total cholesterol, low-density lipoprotein, high-density lipoprotein, and inversely associated with body mass index, waist hip ratio, triglycerides, fasting serum glucose, and not associated with age (r=0.045, P=0.064). There was negative correlation between AI₇₅ and ABI, IMT. AI₇₅  was positively correlated with baPWV in the male group (r=0.101, P=0.005), but not correlated in the female group. Partial correlation analysis found that AI₇₅ was inversely associated with ABI, baPWV and IMT. There was negative correlation between AI₇₅ and baPWV, IMT in the female and male groups, and no correlation between AI₇₅ and ABI (P>0.05). Multivariate gradual regression analysis demonstrated that the independent positive correlation factors of AI₇₅ included female, age, waist hip ratio, central aortic systolic pressure, and the negative correlation factors were body mass index, height, fasting serum glucose (R²=0.372). Conclusion: The lack of correlation of radial augmentation index with indices for evaluating arteriosclerosis suggests that AI is not a sensitive and reliable index for evaluating the degree of arterial stiffness.

To explore the predictive value of serum iron in differentiating between vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS) in children. Methods: Totally 57 children (aged 4-17 years, POTS 40 cases, and VVS 17 cases) who were at the syncope clinic or admitted to the Department of Pediatrics, Peking University First Hospital from August 2009 to September 2012 were included in the study. The diagnoses were analyzed by the value of serum iron and receiver operating characteristic (ROC) curves used to explore the predictive value of different serum iron in differential diagnosis between VVS and POTS. Results: There were significant differences in the median value of POTS ［17.4 (interquartile range 13.5-21.8) μmol/L］ and VVS ［8.9 (interquartile range 7.5-17.6) μmol/L］ (P<0.01). When the value of serum iron was 11.8 μmol/L, the sensitivity and specificity of the differential diagnosis between VVS and POTS were 92.5% and 64.7%, respectively. Conclusion: The serum iron might be used as an initial diagnostic method in differential diagnosis between VVS and POTS, based on the history of the patients.

To analyze the impact of passing items above the roof level in the gross motor subtest of Peabody development motor scales (PDMS-2) on its assessment results. Methods: In the subtests of PDMS-2, 124 children from 1.2 to 71 months were administered. Except for the original scoring method, a new scoring method which includes passing items above the ceiling were developed. The standard scores and quotients of the two scoring methods were compared using the independentsamples t test.Results: Only one child could pass the items above the ceiling in the stationary subtest, 19 children in the locomotion subtest, and 17 children in the visualmotor integration subtest. When the scores of these passing items were included in the raw scores, the total raw scores got the added points of 1-12, the standard scores added 0-1 points and the motor quotients added 0-3 points. The diagnostic classification was changed only in two children. There was no significant difference between those two methods about motor quotients or standard scores in the specific subtest (P>0.05). Conclusion: The passing items above a ceiling of PDMS-2 isn’t a rare situation. It usually takes place in the locomotion subtest and visual-motor integration subtest. Including these passing items into the scoring system will not make significant difference in the standard scores of the subtests or the developmental motor quotients (DMQ), which supports the original setting of a ceiling established by upassing 3 items in a row. However, putting the passing items above the ceiling into the raw score will improve tracking of children’s developmental trajectory and intervention effects.

To explore the effect of sleep duration including napping, night sleep and total sleep duration on cognitive functions among preschoolers. Methods: The samples consisted of 94 preschoolers, aged from 2.58 to 6.75 years, from Hangzhou and Beijing. Peabody Picture Vocabulary Test-Revised (PPVT-R), Picture Deletion Task for Preschoolers (PDTP) and Spatial Working Memory Test were applied to assess the cognitive functions of these preschoolers. Basic demographic information and sleep information were collected with self-made questionnaires. Results: The results of the present study indicated that among all the participants, there were significant grade differences in napping duration and total sleep duration (F _{0.05(3, 90)} =6.346, P=0.001; F _{0.05(3, 90)} =2.925, P=0.038). The total sleep duration was decreased with age. However, the night sleep duration was not changed significantly with age. The correlations between the night sleep and total sleep duration and the scores of attention and working memory were significantly positive (r=0.202-0.282). No significant correlations were noted between the napping and all the scores of cognitive tests. The regression analysis showed that the total sleep duration especially the night sleep duration could well explain the variance of attention and working memory. Conclusion: Total sleep duration, especially night sleep duration may have great impact on preschoolers’ cognitive functions, such as attention and working memory. Enough sound night sleep may help to promote the cognitive functions of the target population.

We investigated the clinical characteristics and therapeutic of elderly patients (≥55) with acute lymphoblastic leukemia (ALL). Methods: From Jenuary 2000 to July 2012, 45 elderly patients (≥55) were enrolled in the study. Patients assighed into CVDP VDP/VP induction chemotherapy based on organ function. Patients in complete remission (CR) undertake consolidation therapy, maintenance therapy or follow up. The patient who had appropriate donor received allogeneic hematopoietic stem cell transplantation (allo-HSCT). CR, Overall survival (OS), disease free survival (DFS), relapse rate and prognosis factors were analyzed. Results: 45 elderly patients (≥55) about 9.6% in all 470 cases ALL simultaneity, and B-ALL about 88.9%. 27 patients (60%) obtained CR after 1 cycle of induction chemotherapy. 33 patients (73.3%) obtained overall CR. The CR rate significantly decreased in the elderly patients more than 60 years old vs. 55-60 years old patients (86.2% vs. 50%；P=0.009). All 45 patients 2 years OS rate was 33.7%, The median OS was 12 months (95%CI，6.68-17.32). 55-60 years (P=0.014), CR (P=0.002) and consolidation therapy (P=0.001) were independent favorite prognostic factors for OS. CVDP induction chemotherapy (P=0.013) and consolidation (P=0.049) were independent favorite prognostic factors for DFS. Conclusion: The outcomes of elderly patients with ALL were poor, 55-60 years, CVDP induction chemotherapy, CR and consolidation therapy were independent favorite prognostic factors.

To investigate the influence of inhaled anesthesia on bispectral index (BIS) of elderly patients with cognitive decline at loss of consciousness and regain of consciousness, and on deepening of sedation. Methods: The patients aged more than 65 years undergoing elective operations from January 2012 to September 2012 were recruited, then 60 cognitive intact patients and 60 cognitive decline patients were screened by mini-mental state examinations. Inhaled anesthesia was administered using sevoflurane. BIS’s of the two groups at loss of consciousness and regain of consciousness, and during endtidal concentration of sevoflurane (C_ETSev) changing from 0.7% to 2.8% were recorded. The data were compared with independent-samples t test and repeated-measures general linear model of ANOVA. Results: In the study, 117 patients finshed the investigation, The BIS’s of the cognitive decline group at loss of consciousness were significantly higher than those of the cognitive intact group (P<0.01). There were no significant differences at regain of consciousness between the two groups (P>0.05). The BIS’s of the cognitive decline group during C_ETSev changing from 0.7% to 2.8% were significantly lower than those of the cognitive intact group (P<0.05). The BIS’s of the cognitive decline group at C_ETSev 0.7%, 1.05%, 1.4% and 1.75% were significantly lower than those of the cognitive intact group (P<0.05), but there were no significant differences at C_ETSev 2.1%, 2.45% and 2.8% between the two groups (P>0.05). Conclusion: During inhaled anesthesia, the BIS of the elderly patients with cognitive decline at loss of consciousness is higher than that of the patients with cognitive intact, The BIS of elderly patients with cognitive decline on deepening of anesthesia is lower than that of the patients with cognitive intact, especially during light anesthesia, and its mechanisms may attribute to cognitive decline related neurodegeneration and neurotransmitter system dysfunction.

To discuss treatments of spinal polyostotic fibrous dysplasia (PFD) and their clinical outcomes. Methods: A group of spinal PFD patients treated in orthopaedic department of Peking University Third Hospital from January 2005 to December 2010 was retrospectively reviewed. There were 3 males and 1 female. The age was 53, 17, 32, 38 years, respectively. Two cases underwent preoperative CT-guided biopsy and the other two had previous pathologic results. All the patients complained localized pain and VAS (visual analogue scale) ranged from 3 to 5. All the cases had pathologic fractures and 3 cases had neurological impairment. The surgical procedures for each patient were as follows: lesion resection combined with cervicothoracic fixation and fusion; reduction combined with occipitocervical fixation and fusion; vertebroplasty (VP); VP combined with posterior decompression and fixation. Results: Fibrous dysplasia in each patient was confirmed by postoperative pathological examination. The operation time was 420, 150, 120, 300 minutes and blood loss was 3 400, 500, 200, 2 000 mL. The follow-up period was 84, 24, 34, 12 months. The primary symptoms were fully relieved without any surgery related complication. There was no symptom recurrence or lesion progress during the follow-up. No signs of radiological improvements (filling of lytic lesion, cortical thickening, or both) were detected. Conclusion: Spinal PFD is a rare disease and mostly affects adults. Conventional excision therapy is an effective and reliable treatment for spinal PFD, but vertebroplasty is less invasive. VP alone might be more appropriate for patients complaining only pain symptoms and/or with pathologic fractures. VP combined with limited decompression and stabilization may be more suitable for patients with neurological deficits.

To evaluate the feasibility, accuracy and efficacy of the real time virtual sonography navigation and planning system in radio frequency ablation (RFA) of hepatic colorectal metastases. Methods: Seventeen hepatic colorectal metastases lesions in 12 patients diagnosed pathologically or clinically in Peking University Third Hospital from Oct. 2011 to Apr. 2013 were enrolled, and all the lesions were diagnosed by CT/MRI but invisible in B-mode ultrasound. The patients included 9 males and 3 females, who were 45-82 years old, with an average age of (64.6±19.2) years. Before RFA, the puncture ablation plan of each lesion was made in the planning system, and during RFA the lesion and the 5 mm ablative margin around were ablated according to the puncture ablation plan. After the image fusion between the ultrasound and CT/MRI, the navigation system could decide the location and boundary of the hepatic colorectal metastases in the ultrasound image. Navigation assisted contrast-enhanced ultrasound (CEUS) was employed right after ablation to decide whether the area of the ablative zone had covered the whole tumor. Additional puncture was applied if the ablative zone had not completely covered the tumor. All the patients received CT/MRI one month after ablation to decide whether the carcinoma had been completely ablated. Results: The image fusion was successfully applied in all the 17 hepatic colorectal metastases, and on average, 12 min (8-21 min) was spent in the image fusion. One tumor (1/17, 14.3%) received extra one puncture after navigation assisted CEUS. No severe complications and death occurred in all the 12 patients. Complete ablation of the 17 lesions were observed through CT or MRI scan one month after RFA, showing that all the 17 lesions had been completely ablated. Conclusion: The real time virtual sonography navigation system had high detection rate for invisible focal liver lesions in B-mode ultrasound. Navigation assisted CEUS could decide whether the area of the ablative zone had covered the whole tumor. Ultrasound CT or MRI navigation and planning system is safe, feasible and accurate in assisting ablation of hepatic colorectal metastases lesions with satisfactory clinical efficacy.

To explore the clinical diagnosis and surgical treatment of  pelvic solitary fibrous tumor (SFT). Methods: The data of nine cases of pelvic solitary fibrous tumor from April 2008 to February 2012 were reviewed retrospectively. Results:  There were 7 male and 2 female patients in this group with a median age of 56 years, of whom 6 were asymptomatic. Their CT showed the tissue density was inhomogencous. Multivisceral resections were performed in 5 patients. Microscopically, the tumor cells were shuttle-shaped, short spindle-shaped or round, and mitoses was rare, immunohistochemistry: CD34, CD99, Bcl-2, Vimentin positive rates were 100%. One patient died 34 months after the surgery, and there was no recurrence in other patients. Conclusion: Pelvic SFT is rare. It is difficult to make an accurate diagnosis. Surgery is the most effective therapy. Multivisceral resections are needed sometimes. The prognosis is good for most patients.

To determine the epidemiological characteristics and associated risk factors of hepatitis B surface antigens (HBsAg) prevalence in rural areas of Hua County, Henan Province, and to provide scientific evidence for Hepatitis B prevention and control in local areas. Methods: On the basis of an ongoing esophageal cancer cohort study in rural Anyang, a total of 5 104 subjects aged 25-65 years were clustered and selected from 5 targeted villages for this study in rural areas of Hua County, Henan Province. HBsAg was detected in their blood samples and a questionnaire was completed by all the subjects in a manner of one-on-one interview. All statistical analyses were conducted using SPSS for Windows version 13.0. Results: Of the 5 104 studied subjects (overall participation rate: 92.05%), 5.17% were positive for HBsAg. The detection rate was significantly higher in males than in females (6.54% vs. 3.87%, P<0.001) and the highest detection rates were observed in the 25-29 and 55-59 years groups in both males and females. Multiple Logistic analyses showed unmarried status (OR=1.80, 95% CI: 1.00-3.25) and high frequency of sexual intercourse (P_trend =0.049) were associated with higher the risk for hepatitis B virus (HBV) infection. Conclusion: The prevalence of HBsAg in rural Hua County, Henan Province, was slightly lower than the national average of the same time period. More attention should be attached to high risk groups of HBV infection in this population, i.e. males aged 25-29 years and 55-59 years and sexually active population. Immunization and health education projects against hepatitis B should be carried out in this population to further reduce the overall prevalence of hepatitis B.

To explore the risk and protective factors of kidney calculi in order to put forward theoretical basis for preventive and control measures. Methods: A 1∶1 matched case-control study was performed using data from a hospital in Beijing. The case group included 100 inpatients who were diagnosed kidney calculi using B ultrasonic, X-ray and intravenous pyelography during the survey while other 100 urolithiasis and endocrine disease excluded inpatients who shared the same sex, within five years gap to the case group inpatients were for the control group. A face-to-face survey was conducted with selfmade questionnaires which covered demographic characteristics, water issues, dietary habits, genetic and medical history. Epidata 3.0 was used to build the database and SPSS 19.0 for the statistical analysis. Results: In the univariate Logistic regression analysis, ten variables were found showing statistical significance. For the multivariate Logistic regression analysis, variables left in the model were labor intensity (OR=0.622, 95%CI: 0.435-0.889), preferring to drink after dinner (OR=0.316, 95%CI: 0.122-0.815), loving drinking (OR=0.232, 95%CI: 0.084-0.642), drinking tea regularly (OR=1.463, 95%CI: 1.033-2.071), eating more vegetables (OR=0.571, 95%CI: 0.328-0.993), the history of the urolithiasis (OR=2.127, 95%CI: 1.065-90.145). Conclusion: Drinking tea regularly, urolithiasis history and brain work are the risk factors of kidney calculi while loving drin-king and eating more vegetables for the protection.

To observe the effect of icariin on human periodontal ligament cells (hPDLCs) differentiation to osteoblast gene expression. Methods: The fifth generation of the cultured hPDLCs was added with the concentration of 0.01 mg/L icariin, and the added osteogenic medium used as blank control group, alizarin red staining of icariin on human periodontal ligament cells was observed for 21 days; the 2, 4, and 6 days of Q-PCR quantitative analysis of icariin on human periodontal ligament cells were made for osteogenesis gene alkaline phosphatase (ALP), type I collagen and osteocalcin (OC) gene expression. Results: For the 21 days, alizarin red staining icariin group formed more mineralized nodules; on the 2^nd, 4^th, and 6^th days, the group of icariin promoted the expression of ALP and OC mRNA, reached the peak value on day 6, compared with the control group with significant difference (20.15±6.67 vs. 7.90±0.71, 4.13±0.56 vs. 3.55±0.08, P<0.01). The second day, the highest expression of type Ⅰ collagen appeared, then decreased gradually after, statistically compared with the control group (P<0.05). Conclusion: Icariin can promote the human periodontal ligament cells differentiation to osteoblast, and promote the osteogenesis gene expression.

To analyze the effects of dental health awareness and behaviours on the relationship between glycemic metabolic characteristics and periodontal disease of type 2 diabetic patients. Methods: In the study, 83 subjects with type 2 diabetes mellitus were recruited. The clinical periodontal indexes, such as pocket probing depth (PPD), attachment loss (AL), modified bleeding index (mBI), plaque index (PLI) were obtained with a Williams type periodontal probe; Laboratory examinations including glycosylated haemoglobin A₁(HbA₁C) were made, glucose assay tested, and the structured questionnaire interview conducted evaluationg the knowledge, attitude and practice (KAP) about periodontal health. Results: The prevalence of moderate and severe periodontitis was 67.5%, compared with mild periodontitis, whose severities were affected by the higher level of HbA₁C (≥8.0％) (OR 54.1-143.1), followed by using glycemic drug (OR=12.9-44.6), stress (OR=16.9-29.6), and the dissatisfaction with diabetic therapy (OR=16.9-18.0) et al. Meanwhile the attachment loss conditions were also correlated with the poor periodontal knowledge level（OR=3.4）,older age（OR=1.1）,and misjudgement of gingival inflammation （OR=13.3） et al. On the other hand, individuals with moderate and severe periodontitis, having bad teeth brushing effects and knowing about dental plaque inadequately, had a significantly higher risk for the poorly controlled glycemic results (HbA₁C≥8.0％), and the OR was 8.61, 8.07, and 7.49 respectively. Conclusion: In patients with type 2 diabetes the severity of periodontal disease and the glycemic metabolic level (HbA₁C) have a definite bidirectional adverse interrelationship, which is affected by the dental health awareness and behaviours.

To retrospectively analyze the clinical features of children who received dental treatment under general anesthesia (GA) and the characteristics of dental treatment. Methods: The records of 693 patients treated under GA in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, between Jan. 2001 and Dec. 2012 were collected and analyzed. Results: The numbers of patients treated under GA increased year-to-year. Most of them were under 4-year-old. The main reasons of dental treatment under GA were uncooperative and disabled. The average number of teeth treated was 12±4 for each child, and the average time for treating one tooth was 12 min. The 3 months follow-up rate was 60.31%, and the older, the fewer treated tooth number and out-of-town associated with the less follow-up rate. Conclusion: The main reasons of dental treatment under GA are uncooperative and disabled. GA is an effective and safe method for dental rehabilitation in children.

To quantitatively evaluate the artifacts appearance of eight kinds of common dental restorative materials, such as zirconia. Methods: For the full-crown tooth preparation of mandibular first molar, eight kinds of full-crowns, such as zirconia all-ceramic crown, glass ceramic crown, ceramage crown, Au-Pt based porcelain-fused-metal (PFM) crown, Pure Titanium PFM crown, Co-Cr PFM crown, Ni-Cr PFM crown, and Au-Pd metal crown were fabricated. And natural teeth in vitro were used as controls. These full-crown and natural teeth in vitro were mounted an ultraviolet-curable resin fixed plate. High resolution cone beam computed tomography (CBCT) was used to scan all of the crowns and natural teeth in vitro, and their DICOM data were imported into software MIMICS 10.0. Then, the number of stripes and the maximum diameters of artifacts around the full-crowns were evaluated quantitatively in two-dimensional tomography images. Results: In the two-dimensional tomography images，the artifacts did not appear around the natural teeth in vitro, glass ceramic crown, and ceramage crown. But thr artifacts appeared around the zirconia all-ceramic and metal crown. The number of stripes of artifacts was five to nine per one crown. The maximum diameters of the artifacts were 2.4 to 2.6 cm and 2.2 to 2.7 cm. Conclusion: In the two-dimensional tomography images of CBCT, stripe-like and radical artifacts were caused around the zirconia all-ceramic crown and metal based porcelain-fused-metal crowns. These artifacts could lower the imaging quality of the full crown shape greatly. The artifact was not caused around the natural teeth in vitro, glass ceramic crown, and ceramage crown.

To report 2 rare cases of 8p11 meyloproliferative syndrome cured by allogeneic hematopoietic stem cell transplantation. Methods: The clinical and laboratory features of 2 cases of 8p11 meyloproliferative syndrome were summarized, including the diagnosis and treatment process of allogeneic hematopoietic stem cell transplantation. Results: Patient 1 was presented with bilateral cervical lymphadenopathy and leukocytosis. The pathology of bone marrow showed extremely hyperplasia. The cytogenetic analysis showed a 46, XY, (8;13)(p11;q12) karyotype. The biopsy of the lymph node was peripheral T-cell lymphoma, unspecified. Patient 2 was presented with extensive lymphadenopathy with abnormal hemogram, which was leuekcytosis and thrombpenia. The bone marrow was hypercellular. The cytogenetic analysis on the bone marrow cells showed a translocation of t(8;9)(p11;q32). The CEP110-FGFR1 fusion transcript was detected by RT-PCR. The biopsy of the lymph node was T lymphoblastic lymphoma. These two patients received human leukocyte antigen (HLA)identical allogeneic hematopoietic stem cell transplantation, remained disease-free and survived 16 years and 6 years after transplantation, respectively. Conclusion: Allogeneic hematopoietic stem cell transplantation is the curative therapy for 8p11 meyloproliferative syndrome.

Priapism is defined as abnormal persisting penile erection beyond or unrelated to sexual stimulation. It is rare in children and the appropriate management consensus is lacking. We have reviewed the literature on the treatment and prevention of priapism in children in the last 5 years. The following advances were reported: (1) compression or thrombin injection guided by ultrasound in nonischemic priapism prior to selective angioembolization; (2) anti-androgen therapy is the key for the prevention of nonischemic priapism occurring and reoccurring after angioembolization; (3) etiological interventions are enough to resolve some priapism in children; (4) T tunnel may be applied to the distal shunt failed cases in children. Combined with the new progress in treatment of priapism in children, we have designed the algorithm of priapism management and the algorithm of stuttering priapism prevention. The two algorithms will be helpful for clinicians dealing with the clinical challenges in children’s priapism management.