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.

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.

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.

Objective To investigate the correlation between serum 1,5-anhydroglucitol (1,5-AG) and mild cognitive impairment (MCI). Methods According to the diagnostic criteria of MCI and the cognitive function test results by Montreal cognitive assessment (MoCA) scale Chinese version, 80 volunteers receiving health check in our hospital from Nov. to Dec., 2019 were divided into MCI group (33 cases) and normal control (NC) group (47 cases). The demographic and clinical data were collected, and the blood glucose-related indexes, including 1,5-AG, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and 2 h-postprandial glucose (2 h-PPG), were measured. Anxiety and depression were assessed by self-rating anxiety scale (SAS) and geriatric depression scale (GDS), respectively. Linear correlation analysis and multiple linear regression analysis were used to study the correlation between the blood glucose-related indexes and MCI. Results There were no significant differences in the demographic data, clinical data, SAS score or GDS score between the two groups (all P＞0.05). Compared with the NC group, the MoCA score and the level of 1,5-AG were significantly lower in the MCI group (P＜0.01, P＝0.023), and the levels of FPG and 2 h-PPG were significantly higher (P＝0.041, 0.027). Linear correlation analysis showed that the MoCA score was negatively correlated with the levels of FPG, 2 h-PPG and HbA1c (all P＜0.05), but not with 1,5-AG level (P＝0.134); the score of delayed recall, a cognitive domain of MoCA scale, was negatively correlated with the levels of FPG, 2 h-PPG and HbA1c (all P＜0.05), and positively correlated with the 1,5-AG level (P＝0.027). Multiple linear regression analysis showed that FPG was an independent factor of MoCA score (β＝－0.291, P＝0.009), and 1,5-AG and FPG were independent factors of delayed recall score (β＝0.199 and －0.390, P＝0.015 and 0.001). Conclusion 1,5-AG may be a potential biomarker for predicting cognitive impairment, especially for delayed recall; the blood glucose fluctuates greatly in MCI individuals at early stage, and maintaining the stability of blood glucose may be beneficial to the prevention of MCI.

Objective To report a case of Kennedy disease confirmed by gene diagnosis and to retrospectively reviewed the clinical features of genetically-confirmed patients with Kennedy disease in China. Methods The clinical data of this patient from our hospital were collected. Two electronic databases (Wanfang Data and CNKI) were searched using keywords “Kennedy disease” and “X-linked recessive hereditary amyotrophy of spinal cord and medulla oblongata” from Jan. 2007 to Dec. 2017. And a total of 63 articles (170 cases) were finally identified, including one case reported by us. The clinical data and biochemical indicators of Kennedy disease in China were summarized and analyzed. Results All the 170 patients were male. The average age of onset was (39.12±10.21) years old in 164 patients with described age of onset, mainly ranging 30-50 years old, and the average age of treatment was (48.04±8.94) years. We also noticed that the age of onset was negatively correlated with the number of CAG repeats in 161 patients (r＝－0.272, P＝0.001). In 170 Kennedy disease patients, the most common symptoms were proximal weakness of the lower extremities (93 cases, 54.71%), followed by weakness of limbs (38 cases, 22.35%). With the progression of the disease, 93 (54.71%) patients had breast development and/or decreased sexual function; and 143 (84.12%) patients had atrophy and fibrillation of tongue muscles, but no obvious drinking water choking was found in the literature. The main signs of lower motor neuron were mild muscle atrophy, fascicular fibrillation, mild muscle degeneration, especially the proximal limb, with diminished or disappeared tendon reflex. We also noticed that 91.18% (155/170) of the patients had increased creatine kinase. Some patients had diabetes, elevated blood lipids, thyroid dysfunction and/or mild liver dysfunction. Conclusion The diagnosis of suspected Kennedy disease patients can be confirmed by genetic tests with the deep understanding of the disease by physicians and the popularization of genetic examination, although there have been no effective methods for treatment of Kennedy disease.

Objective To explore the mechanism by which specific agonist of farnesoid X receptor (FXR) GW4064 inhibits the growth and invasion of colon cancer cells. Methods Human colon cancer cell lines HT-29 were in vitro cultured. After treatment with GW4064 of 0, 0.1, 1, 3, 5, 7 and 10 μmol/L for 72 h, cell viability was measured by MTT assay. After treatment with GW4064 of 0, 1 and 5 μmol/L for 24 h, the cell morphology was observed under phase contrast microscope, and the mRNA expression levels of FXR and stromal cell-derived factor 1 (SDF-1) were detected by PCR. After treatment with GW4064 of 0 and 1 μmol/L for 24 h, the cell invasive ability was detected by cell scratch test. After treatment with GW4064 of 0, 1, 5 and 7 μmol/L for 24 h, the SDF-1 expression in the culture medium was detected by ELISA. Nude mouse. tumorigenesis model was established by subcutaneous inoculation of HT-29 cells. After intragastric administration with GW4064 or DMSO for 16 d, the tumor growth and the mRNA expression of FXR and SDF-1 in the tumors were determined. ResultsGW4064 inhibited the growth of HT-29 cells in a dose-dependent manner, and there was significant difference in the cell viability of HT-29 cells between the GW4064 groups (1, 3, 5, 7 and 10 μmol/L) and the control group (0 μmol/L, all P<0.05). After treatment with GW4064, phase contrast microscopy showed contracted and rounded colon cancer cells and slender cells transforming into epidermoid cells. The cell scratch test showed that the invasion ability of the colon cancer cells was significantly reduced after treatment with GW4064 compared with the control group (0 μmol/L, P<0.05). PCR results showed that the mRNA expression level of FXR was increased in a dose-dependent manner after GW4064 treatment, while the expression of SDF-1 mRNA changed in the opposite way. ELISA results showed that the SDF-1 expression in the cell culture supernant was decreased with the increase of GW4064 concentrations, and there were significant differences between the GW4064 (1, 5 and 7 μmol/L) groups and the control group (0 μmol/L, P<0.05). GW4064 significantly reduced tumor size compared with the control group (DMSO, P<0.05). In addition, the mRNA expression of FXR in the tumors was increased, and the mRNA expression of SDF-1 was decreased. ConclusionThe activation of FXR can inhibit the invasive growth of colon cancer cells and the expression of SDF-1.