Dens in dente is a rare malformation of teeth.This article reports one case of type Ⅲ dens in dente of maxillary bilateral incisors with acute periapical lesion.The case was treated successfully by apexification with Vitapex paste.

Objective To study the function of aminophenylboronic acid(APB)and clavulanate(CA)for detecting ESBLs in Enterobacter cloacae.Methods The phenotype of ESBLs of 61 Enterobacter cloacae isolates was detected with adding single beta-lactamase inhibitor CA to ceftazidime(CAZ)and cefotaxime(CTX),and double beta-lactamase inhibitors CA/APB to ceftazidime(CAZ)and cefotaxime(CTX)respectively.PCR was used to detect ESBLs genes of 61 Enterobacter cloacae isolates.The results of the enzymatic inhibitor potentiation test and PCR were compared and analyzed.Results With adding single enzymatic inhibitor CA to CAZ,28 isolates of Enterobacter cloacae producing ESBLs were detected,while 14 isolates were detected with adding CA to CTX.With adding double enzymatic inhibitors CA/APB to CAZ,28 isolates of Enterobacter cloacae producing ESBLs were detected,while 44 isolates were detected with adding CA/APB to CTX.By PCR positive ESBLs genes were detected in 47 isolates of Enterobacter cloacaes.Conclusions The potentiation test with double beta-lactamase inhibtion can be used to detect ESBLs in Enterobacter cloacae.

Objective To compare the effects of thoracoscopic 2 hole and 3 hole for congenital pulmonary bulla resection.Methods 38 cases of congenital pulmonary bulla patients,both in the VATS downlink congenital pulmonary bulla resection.According to the number of holes,thoracoscopic operation were divided into the two groups. To observe the use of group 19 cases of 2 holes,19 cases 3 holes were adopted in the control group.Pull the chest tube operation time,operation time of the two groups were compared after.and the average hospitalization time after opera-tion,postoperative analgesia drug application.Results The observation group operation time,operation time,pulling the chest tube after operation the average hospitalization time, analgesic drug application rate respectively were (46.89 ±9.11)min,(3.95 ±0.85) d,(7.37 ±1.34) d,21.1%,The control group were (66.05 ±12.09) min, (4.37 ±0.98)d,(7.32 ±1.57)d,52.6%.There were statistically significant differences in rate of the two groups in operation time,analgesic drug application.(t=-5.516,χ2 =4.071,P<0.05);38 cases were cured,followed up for 3-24 months,no recurrence occurred in 1 cases.Conclusion Video assisted thoracic descending congenital pulmona-ry bulla resection,the 2 hole 3 hole more than minimally invasive,short operation time,postoperative analgesic use rate is low.

Objective To establish a New Zealand rabbit bone marrow mesenchymal stem cells (BMSCs)-gentamicin- calcium alginate 3D sustained-release culture system and to study the growth and differentiation of BMSCs. Methods BMSCs- calcium alginate 3D culture system (W group) and BMSCs-gentamicin-calcium alginate 3D sustained-release culture system (U group) were constructed and were cultured with HG-DMEM (15% FBS, 10 ng/mL TGF-fh) under saturated humidity, 37°C and at 5% CO2, with the culture medium changed on a daily basis, and the cell morphology and microsphere morphology changes were observed. H-E staining, toluidine blue staining and type H collagen staining were performed for the microspheres on week 2,4, and 6. Results Cell clusterswere formed locally in the two groups after the 3D microspheres were cultured for 10 days. A large number of cell clusters were formed after 21 days, and BMSCs maintained a spherical or approximate spherical shape. There was no significant difference in cell proliferation or growth between the two groups (P>0. 05). After a 2-week culture, toluidine blue staining of microspheres showed positive staining in both groups, but with no obvious extracellular matrix formation, and staining for collagen type H antibody was weakly positive. After a 4-week culture, toluidine blue staining was obvious in the periphery of the cell microspheres in both groups, but the staining was unapparent in the center; extracellular matrix around the cell clusters had less blue colored substance, and the central cell clusters had more mauve substance; collagen type E staining was strongly positive in both groups. Conclusion Local sustained-release of appropriate amount of gentamicin has no noticeable effect on the growth and transformation of BMSCs while reaching the minimum inhibitory concentration. The influence of Gentamicin on ultrastructure of BMSCs and chondrocytes remains to be further investigated.

During the latest researches on knee ostarthritis,it is discovered that before the morphology changes of cartilage,there were changes of the content of proteoglycan and water and changes of alinement of surface layer collagen fibers in cartilage matrix.By the new technologies of DWI,proton density mapping image,23Na MRI,T2Mapping image and so on,not only the pathological changes of cartilage can be disclosed,the component changes of cartilage matrix can also be detected.Accompany with the progress in the technology of software and hardware,MRI will have more and more prospects in early diagnosis and therapeutic effect evaluation of knee ostarthritis.

AIM: To observe the curative effect of excision combined with concavity-convex amniotic membrane transplantation in the treatment of intraepithelial epithelioma.

METHODS:Totally 24 cases of intraepithelial neoplasia(24 eye)diagnosed in our department were studied. The tumors of 12 cases were removed and the wound were covered by the concavity-convex amniotic membrane in the conjunctiva and part of the resection, and other 12 were covered by the amniotic membrane. The effect of these two surgeries were assessed via observing the epithelial healing, degradation of biological amnion, tear break-up time, tumor recurrence and other complications. The resection of the tumor were analyzed histopathologically.

RESULTS: The pathological results of all the patients were epithelial carcinoma. There were 24 patients that diagnosed -intraepithelial epithelioma pathologically. The conjunctival epithelium healed rapidly and were completed in 5d after operation in both groups. The amniotic membrane was completely degraded in about 14d. Postoperative visual acuity improvement was not statistically significant in two groups. All patients were followed up for more than 1y. The recurrence rates were significantly lower in concavity-convex amniotic membrane group than that in amniotic membrane group.

CONCLUSION: Tumor resection combined with concavity-convex amniotic membrane transplantation is an effective operation method for the treatment of intraepithelial epithelioma.

Objective To investigate the clinical feature of perioperative management of non-small cell lung cancer(NSCLC) in aged patients and improve the efficacy of surgical treatment.Methods The clinical data of 35 aged patients with NSCLC were retrospectively analyzed.The risk factors of postoperative complications were analyzed by single factor analysis,the factors had statistical significance were included in Logistic regression analysis.Results Postoperative complications occurred in 10 cases,accounting for 28.6％,and 1 case died,accounting for 2.9％.Logistic regression analysis showed that smoking,chronic bronchitis,coronary heart disease,pulmonary lobectomy were independent risk factors of postoperative complications.ConCLusion Correct staging before operation,strict surgical indication,choose the standard surgical method to reduce surgical trauma,strengthen the perioperative management can still achieve satisfactory therapeutic effect in surgical operation for aged patients with NSCLC.

Objective To explore the safety and effectiveness of stent angioplasty for acute intracranial large artery atherosclerosis occlusion. Methods We retrospectively analyzed the clinical data of 460 patients with acute ischemic stroke undergoing endovascular thrombectomy in our hospital from May 2013 to Feb. 2018. We selected the patients with stent angioplasty and evaluated the safety and effectiveness. Results Fifty-six patients were included in this study, and there were 36 cases (64.3%) with occlusion of the anterior circulation and 20 cases (35.7%) of the posterior circulation. Twenty patients underwent intravenous thrombolysis before operation, and the door-to-needle time was (39.9±13.2) min. All scaffolds were successfully released to the designated location with a technical success rate of 100% (56/56). Fifty-five patients (98.2%) achieved recanalization of modified thrombolysis in cerebral infarction grade 2b and 3, and one patient had failed recanalization. The National Institutes of Health stroke scale score was 2.0 (0.0, 6.0) at 7 d after operation, which was significantly improved compared with the preoperation one (12.5 [6.0, 20.0], Z＝－4.073, P0.05). Intracranial hemorrhage occurred in 7 patients (12.5%) after operation, in which 2 patients (3.6%) had symptomatic intracranial hemorrhage. Thirty-nine patients (69.6%) received skull computed tomography perfusion (CTP) examination at 3-5 d after operation, and CTP showed that 33 cases (84.6%) had patency, 4 cases (10.3%) had reocclusion, and 2 cases (5.1%) had moderate stenosis; and 17 cases (30.4%) were not examined by CTP. Thirty-four patients (60.7%) had a good prognosis at 90 d after operation (modified Rankin scale score 0-2), 9 (16.1%) died, and 13 (23.2%) were lost. Conclusion Stent angioplasty is a safe and effective treatment method for acute intracranial large artery atherosclerosis occlusion. However, short-term stent reocclusion after operation should not be ignored.

Objective To explore a suitable separation protocol for exosomes derived from urine of patients with aortic dissection. Methods Urine samples were collected from the patients with aortic dissection. The exosomes were extracted and purified by ultracentrifugation, dialysis-ultrafiltration and precipitation kit methods. The biological morphology of exosomes was observed under transmission electron microscope. The particle size, distribution and concentration of the exosomes were detected by nanoparticle tracking analysis. Results The exosomes extracted with ultracentrifugation method had half cup-like or concave-hemispherical morphology; the particle size was large and well-distributed; the range of the particle size was wide with a mean value of (236.4±46.5) nm; and the concentration was low, being (2.82±0.21)×1012 per 1 mL urine. The exosomes extracted by dialysis-ultrafiltration method had normal morphology and large quantity; the particle size was small and concentrated; the range of the particle size was narrow with a mean value of (128.7±6.3) nm; and the concentration was high, being (2.16±0.15)×1014 per 1 mL urine. There were no exosomes in the extractive by precipitation kit method under transmission electron microscope. Conclusion Dialysis-ultrafiltration method is a suitable method for extracting exosomes from urine of the aortic dissection patients and can yield a high concentration, while it is not suitable when exosomes of very high purity are required.

Independent duty corpsmans (IDCs) are mainly responsible for the primary health care service of United States Navy. United States Navy has established a set of strict system and accumulated rich practical experience in the selection and training of IDCs. The training modes and methods of IDCs can provide an important reference for the training of medical officers in Chinese navy warship troops. In this paper, we introduced the training modes of IDCs, and analyzed the problems and countermeasures of the training of medical officers in our navy warship troops in terms of talent cultivation, education and training system, curriculum reform, and teaching techniques by combining the actual situation of our navy.