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 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.

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.

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.

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 investigate the expression and clinical significance of chemokine receptor CXCR7 in epithelial ovarian carcinoma (EOC) tissues. Methods Immunohistochemical technique was used to detect the protein expression of CXCR7 in 57 EOC tissues, 15 benign ovarian tumor tissues and 15 normal ovarian germinal epithelium tissues. The chi-square test, Kaplan-Meier method and multivariate Cox regression analysis were used to evaluate the relationship between the expression of CXCR7 and clinicopathological features and its prognosis. Results The positive expression rates of CXCR7 in EOC tissue, benign ovarian tumor tissue and normal ovarian germinal epithelium tissue were 68.42% (39/57), 26.67% (4/15) and 13.33% (2/15), respectively (χ2=19.97, P=0.000 1). The positive expression of CXCR7 was significantly correlated with the International Federation of Gynecology and Obstetrics (FIGO) stages, histological grade, lymph node metastasis and peritoneal metastasis (P<0.05), but not with age, preoperative CA125 level, histological type of EOC, residual tumor diameter, ascites content, or tumor size (P>0.05). Univariate analysis and multivariate analysis results showed that the positive expression of CXCR7, FIGO stage, histological grade, lymph node metastasis and peritoneal metastasis were statistically correlated with the overall survival and disease-free survival of EOC patients. Kaplan-Meier curve revealed that both overall survival and disease-free survival in EOC patients with positive expression of CXCR7 were significantly lower than those in EOC patients with negative CXCR7 (P<0.05). ConclusionThe high expression of CXCR7 is closely related to the recurrence and metastasis in EOC patients, which indicates that CXCR7 might be a potential predictor and an important therapeutic indicator of EOC.

Objective To validate the value of MRI and ultrasound three-dimensional matrix positioning technique in transperineal targeted prostate biopsy so as to improve the positive rate of prostate biopsy. Methods A total of 15 patients received transperineal targeted prostate biopsy using MRI and ultrasound three-dimensional matrix positioning technique + traditional systemic prostate biopsy from Feb. 2015 to Jun. 2015 in Changhai Hospital, Second Military Medical University. The 15 patients met the following criteria:(1) at least one negative prostate biopsy; (2) had the indications for performing re-biopsy; and (3) MRI showed suspected sites of prostate cancer (the PI-RADS scores were 4-5). Before biopsy, all the MRI images were reconstructed and the three-dimensional coordinates(X, Y, Z axis) were confirmed. After general anesthesia, systemic prostate biopsy was performed under the guidance of transrectal ultrasound. Then the transrectal ultrasound-guided biopsy was carried out according to the location in previous MRI images, which were located by the three-dimensional coordinates (X, Y, Z axis). Results Fourteen (93. 3%) of the 15 patients were finally confirmed with prostate cancer, with 13 (86. 7%) being positive only in targeted biopsy, and 6 (40. 0%) being positive only in systemic biopsy. There was only 1 (6. 7%) whose targeted biopsy result was negative and systemic biopsy result was positive, and there were 8 cases (53. 3%) with positive targeted biopsy but negative systemic biopsy. Only 1 case (6. 7%) was negative in both targeted biopsy and systemic prostate biopsy. There was significant difference in positive rates between the targeted biopsy and systemic biopsy (P=0. 002). Conclusion Transperineal targeted prostate biopsy with MRI and ultrasound three-dimensional matrix positioning technique can accurately locate and target puncture the suspected site of prostate cancer in MRI images, and it has a higher diagnostic efficiency especially for the sites which are relatively easy to be missed by systemic prostate biopsy, but its performance still needs further large sample studies.

Objective To discuss the timing of surgery, operation strategy and technique of upgrading chronically right ventricle-paced heart failure patients to cardiac resynchronization therapy. Methods Six chronically right ventricle-paced heart failure patients underwent surgery of upgrading to CRT in our department between March 2009 to February 2014. The clinical characteristics, surgical techniques and follow-up data were retrospectively analyzed. Results Six patients, including single-chamber pacemaker (VVI) 2 cases, dual-chamber pacemaker (DDD) 4 cases, were successfully complete the upgrade operation, no complications. In two cases which original pacemaker pockets were on the left, the left ventricular electrodes were implanted through the left subclavian vein, without subcutaneous tunnel. In 4 cases which original pacemaker pockets were on the right, the left ventricular electrodes implanted through the right internal jugular vein in 2 patients, running in the subcutaneous tunnel from right internal jugular vein to the right chest, while in other 2 cases, the left ventricular electrodes implanted through Left subclavian vein, running in the subcutaneous tunnel from the right chest to the left chest. There were a total of 10 primary electrode wires, the two wires were removed, the eight were continued to use. Follow-up data showed that in the postoperative 3 days, compared with admission, CRT significantly reduced the mean ORS duration(P0.05)and BNP(P0.05),while left ventricular end-diastolic diameter, ejection fraction and NYHA class no significant changes. In the postoperative 3 months, CRT significantly reduced the mean ORS duration and BNP, and increased the LV ejection fraction, left ventricular end-diastolic diameter were reduced significantly, the patients cardiac function was improved by an average of one grade of NYHA functional class. Conclusion Correct preoperative operation strategy and intraoperative operation skills is the key of upgrading chronically right ventricle-paced to cardiac resynchronization therapy,Upgrade surgery can significantly improve the synchronization of left and right ventricular contraction, improve heart function and quality of life.

Common bile duct stones (CBDSs) are a common biliary tract disease, and endoscopic therapy is the first-line treatment modality for this disease; however, some CBDSs are difficult to remove by conventional endoscopic techniques and are thus called difficult CBDSs. Therapies for difficult CBDSs include endoscopic papillary large balloon dilation, mechanical lithotripsy, choledochoscopy-assisted lithotripsy, and extracorporeal shockwave lithotripsy. This article reviews the advances in the above mentioned techniques for the treatment of difficult CBDSs, including indications, clinical effect, and adverse events.