Objective To investigate the feasibility, indications, operating technique and the clinical value of laparoscopeic surgery for ectopic pregnancy with prior history of obstetric and gynecologic operations. Methods 82 ectopic pregnancy patients with prior history of the obstetric and gynecologic operation were subjected to laparoscopic surgery. Among them, 60 patients had undergone prior obstetric and gynecologic operation only once, 21 patients had undergone twice, and the remaining one had undergone obstetric and gynecologic operation three times. The laparoscopic operation was completed in different ways as follows: puncture and injection of drug under laparoscopy, salpingectomy, resection of pregnancy in oviduct, removal of embryo through incision of oviduct under laparoscope, suction removal of embryo from oviduct, and new technique for pregnant surgery at interstitial portion. Results Of these 82 patients undergoing laparoscopic surgery, 73 cases had adhesion in different degree, and the adhesion rate was 89.0% (73/82). In the 60 patients with history of one operation, pelvic peritoneal adhesion was found in 51 patients, the adhesion rate was 85.0%. All 22 patients with two prior operations had pelvic peritoneal adhesion, and the rate was 100.0%. The laparoscopic surgery was successful in 70 cases. The rate of success was 85.4%, while in 12 patients, the operation was changed into laparectomy due to dense adhesion, and the rate was 14.6%. Of these 12 patients, in 5 of them there was endometriosis, in 6 patients chronic pelvic inflammation was found, 9 patients had a surgical history for ectopic pregnancy, 2 patients with the history of caesarean section, and one patient had a history of complicated gynecologic operation. Complications included colonic injury in one patient with ectopic pregnancy, and the operation was changed to laparotomy. Injury to the ureter happened in one patient. The operation time for laparoscopic surgery was 30-180 min. Conclusions The laparoscopic operation is an effective procedure and it has become a routine procedure for ectopic pregnancy with prior history of obstetric and gynecologic operation. Because of chronic pelvic inflammation and endometriosis, it is difficult to perform laparoscopic surgery successfully, and laparotomy should be anticipated at all time.

Objective To conduct the endoscopic sinus surgery on chronic nasosinusitis by the image guided navigation system (IGNS) and to analyze the curative effect and complication compared with traditional methods .Methods 81 cases of chronic nasosi-nusitis were randomly selected and performed endoscopic sinus surgery by using IGNS ,and compared with the other 111 cases of chronic nasosinusitis by using traditional nasal endoscopic surgery in the aspects of curative effect ,complications ,etc .Results TypeⅠ and type Ⅱ nasosinusitis had no significant difference in the effective rate between the navigation group and non-navigation group;type Ⅲ nasosinusitis had significant difference in the effective rate between navigation group and non-navigation group .The total incidence rate of complications had significant difference between the navigation group and non-navigation group(P<0 .05);the incidence rate of complications in type Ⅰ and type Ⅱ nasosinusitis had no significant difference between the navigation group and the non-navigation group(P>0 .05);the incidence rate of complications in type Ⅲ nasosinusitis had significant difference be-tween the navigation group and the non-navigation group with statistical significance (P< 0 .05);the effective rates of Haller gas room and Onodi gas rooms showed no significant difference between the navigation group and the non-navigation group (P>0 .05);the total effective raates of anatomical deformity of the frontal recess or the sinus area had significant difference between the naviga-tion group and the non-navigation group(P<0 .05);the total effective rates of agger nasi cell had significant difference between the navigation group and the non-navigation group (P<0 .05) ,the total effective rates of non-agger nasi cell had no significant differ-ence between the navigation group and the non-navigation group (P>0 .05) .Conclusion For the patients with type Ⅲ chronic na-sosinusitis ,chronic frontal sinusitis ,conduct endoscopic sinus surgery by using IGNS is a reasonable choice ,can increase the opera-tive effect and accuracy ,and reduce the occurrence of complications .

Objective To study the relationship between extraocular muscle thickness and exophthalmos degree in patients with thyroid-associated ophthalmopathy (TAO),so as to provide a scientific basis for guiding clinical treatment.Methods Forty seven patients diagnosed with TAO from May 2005 to May 2011,in the 451 Hospital of the People's Liberation Army were chosen in this study,and divided into TAO group(23 cases) and treatment group (24 cases).Meanwhile,another 32 healthy people were selected as control.Extraocular rectus muscles (including the medial rectus muscle,lateral rectus muscle,superior rectus muscle and inferior rectus muscle) of all participants were measured with B-scan ultrasonography,and exophthalmos degree with Hertel exophthalmometer.Results The thicknesses of medial rectus in control group,TAO group and treatment group were (3.35 ± 0.25),(4.38 ± 0.85),(3.58± 0.52)mm,respectively; the thicknesses of lateral rectus muscle were (2.95 ± 0.61),(4.24 ± 0.75),(3.65 ± 0.42)mm,respectively; the thicknesses of superior rectus muscle were (3.15 ± 0.20),(4.65± 0.68),(4.01 ± 0.15)mm,respectively; the thicknesses of inferior rectus muscle were (3.17 ± 0.72),(4.75 ± 0.52),(3.71 ± 0.91)mm,respectively; the sums of binocular rectus thickness in these three groups were (21.95 ± 0.65),(28.02 ± 1.51),(22.95 ± 0.65)mm,respectively; the difference between the three groups was statistically significant(F=2.32,2.43,2.25,2.17,5.63,all P ＜ 0.05),and TAO group was significantly higher than that in the control group and in the treatment group(all P ＜ 0.05),while there was no statistically significant between the control group and the treatment group(all P ＞ 0.05).The eyes exophthalmos degree in TAO group and treatment group were (16.82 ± 2.46),(14.52 ± 1.83)mm,respectively.The sum of the rectus muscle thickness and eyes exophthalmos was positively correlated(r =0.65,0.58,all P ＜ 0.05).Conclusions Extraocular muscle thickness in patients with TAO is positively correlated with exophthalmos degree,and using B-scan ultrasonography to detect the changes is practical for clinical diagnosis and treatment.

OBJECTIVETo assess the temperature variation of the root surface using Nd: YAG laser irradiation in the root canal with different power and to evaluate the safety of laser application on the periodontal region.

METHODSThirty extracted human teeth with single-roots were collected. The teeth were cross-sectioned in the cervical portion, standardizing the roots at a 12-mm length. The roots were used as specimen. The roots were radiographed in the buccal-lingual direction to measure the thickness of the proximal walls, by means of a digital radiographic system. The specimens were divided into three groups according to the laser potency (1.5, 3.0, and 4.5 W). Each group was subdivided into two subgroups according to laser frequency (15 and 30 Hz). With the Nd: YAG laser irradiation for 20 s, the temperature variation of the root surface was monitored by thermocouples located at different parts of the root external wall and recorded by digital thermometers.

RESULTSThe groups irradiated with 4.5 W presented the greatest temperature variation (above 10°C), followed by 3.0 and 1.5 W. The temperatures were statistically different (P < 0.01). The groups irradiated in the same potency, regardless of whether 15 Hz or 30 Hz was used, presented with no statistical difference (P > 0.05). The apical half of the root presented statistically higher temperature rises than the cervical half of the root (P < 0.01).

CONCLUSIONThe temperature variation of the root surface was associated with laser power, irradiation time, and the thickness of dentin. Application of Nd: YAG laser in the root at 1.5 W for 20 s can safely be used in endodontic treatment.

Objective To evaluate the sensitivity of three different clinical consciousness scales to patients with disorders of consciousness.Methods A total of 84 patients in vegetative state (VS) were selected and scored by the consciousness scales including Glasgow Coma Scale (GCS),Coma Recovery Scale-Revised (CRS-R) and Chinese Vegetative State Scale (CVSS) respectively.The patients were followed every 2 weeks for 12 weeks or every 4 weeks for 12-24 weeks.The assessment finished in 6 months or till the time when patients emerged from minimally conscious state ( MCS.The diagnostic sensitivity and the sensitivities of each sub-scale in CRS-R were evaluated when the patients with MCS emerged from VS.The diagnostic consistency with other scales was observed and analyzed by Spearman correlation as well.The Spearman -relate was used to analyze the correlations among the total scores of three scales in the patients on admission (36 patients with acute and 48 patients with chronic phase).Results Of 84 VS patients,there were 47 emerged to MCS.CRS-R was the most sensitive in the diagnosis of MCS (P ＜ 0.05 ) among all scales.The visual subscale is the most sensitive among all the CRS-R subscales ( P ＜0.01 ).Among the 84 patients,the remaining 37 were diagnosed as VS by all three scales.The total scores correlation analysis showed that the score of CRS-R significantly correlate with that of GCS in acute and chronic phase ( P ＜0.01 ) and significantly correlate with that of CVSS only in the acute stage ( P ＜ 0.05 ).Conclusions It is indicated that CRS-R,especially the visual subscale of CRS-R is the more sensitive tool for detecting.MCS during recovery process in the disorders of consciousness.As to the patients with deep unconsciousness and with no significant recovery,the three instruments are in good agreement to determine the degree of disorders of consciousness.It is suggested that CRS-R can be widely used to assess the level of consciousness in various stages.

This study is to investigate the therapeutic effect and mechanism of indole-3-carbinol (I3C) on pig serum-induced liver fibrosis of rats. The liver fibrotic model of rats was induced by pig serum. After models were successfully established, rats in the treatment groups were administered with I3C through intraperitoneal injection or curcumin by intragastric administration, daily for 17 days. Hepatic hydroxyproline (Hyp) content was measured. The liver histology and immunohistochemistry with a-smooth muscle actin (alpha-SMA) were assayed. Hepatic stellate cells line, HSC-T6 was incubated with different concentrations of I3C (25, 50, and 100 micromol x L(-1)) for 24 h. The effect of I3C on cell apoptosis was identified by FITC-Annexin V/PI double labeled assay. And the mRNA expressions of Bax and Bcl-2 were measured by real time RT-PCR. The results showed that hepatic content of Hyp decreased by I3C treatment, as compared with the fibrotic model control. Histopathological changes, such as steatosis, necrosis, deposition of collagenous fiber reduced remarkably and the expression of alpha-SMA was significantly down-regulated in the I3C-treated groups (P < 0.01). Apoptosis analysis showed that I3C significantly increased HSC-T6 apoptosis rate and the expressional ratio of Bax to Bcl-2. The results indicated that I3C could effectively cure pig serum-induced liver fibrosis in vivo by inducing HSC apoptosis and promoting ECM degradation.

Objective To study the relationship between parameter settings in the intensity-modulated radiation therapy (IMRT) planning in order to explore the effect of parameters on absolute dose verification.Methods Forty-three esophageal carcinoma cases were optimized with Pinnacle 7.6c by experienced physicist using appropriate optimization parameters and dose constraints with a number of iterations to meet the clinical acceptance criteria.The plans were copied to water-phantem,0.13 cc ion Farmer chamber and DOSE1 dosimeter was used to measure the absolute dose.The statistical data of the parameters of beams for the 43 cases were collected,and the relationships among them were analyzed.The statistical data of the dosimetry error were collected,and comparative analysis was made for the relation between the parameters of beams and ion chamber absolute dose verification results.Results The parameters of beams were correlated among each other.Obvious affiliation existed between the dose accuracy and parameter settings.When the beam segment number of IMRT plan was more than 80,the dose deviation would be greater than 3％ ; however,if the beam segment number was less than 80,the dose deviation was smaller than 3％.When the beam segment number was more than 100,part of the dose deviation of this plan was greater than 4％.On the contrary,if the beam segment number was less than 100,the dose deviation was smaller than 4％ definitely.Conclusions In order to decrease the absolute dose verification error,less beam angles and less beam segments are needed and the beam segment number should be controlled within the range of 80.

Objective To investigate the expression of Hedgehog signaling pathway members,Shh,Gli1,Sufu and TAK1 as well as phosphorylation-TAK1 (p-TAK1) protein in human pancreatic carcinoma tissues and to explore its relationship between the expression of proteins and the clinicopathologic parameters.Methods The expressions of Shh,Glil,Sufu,TAK1,p-TAK1 proteins in 38 samples of pancreatic cancer tissues and pairing adjacent normal pancreatic tissues were detected by immunohistochemical method.The relationship among the proteins and the relationship between the expression of the proteins and the clinicopathologic parameters were examined.Results The positive expression rates of Shh,Glil,Sufu,TAK1,p-TAK1 protein in human pancreatic carcinoma were 86.8％ (33/38),52.6％ (22/38),68.4％(26/38),55.3％ (21/38),52.6％ (20/38),but they were not expressed in adjacent normal pancreatic tissues.Gli1 expression was positively related to distant metastasis and clinical staging (r =0.524,0.361,P ＜0.05),Sufu expression was positively related to patient's gender (r =-0.378,P ＜0.05),TAK1 expression was positively related to clinical staging (r =0.468,P ＜ 0.05),p-TAK1 expression was positively related to clinical staging and distant metastasis (r =0.418,0.361,P ＜ 0.05).Gli1 expression was positively related to TAK1 and p-TAK1 expression in pancreatic cancer tissues (P ＜ 0.05).Conclusions Hedgehog signaling pathway and p-TAK1 may play a role in the pathogenesis of pancreatic cancer,and the two pathways may interact with each other.

Objective To investigate the clinical features and pathogenesis of severe congenital neutropenia (SCN) by detecting the gene mutation of a SCN patient suspected by clinical diagnosis. Methods The intravenous anticoagulant and clin-ical data and laboratory results of this child were collected;the phagocyte and oxidation function of neutrophils were evaluated by flow cytometry;ELANE, HAX1, WAS, GFI1, CSF3R and CXCR4 genes were screened by PCR amplification and sequencing. Results The neutrophil function of this patient was normal; sequencing results revealed no mutation occurred in ELANE, HAX1, WAS, GFI1, CSF3R and CXCR4;and granulocyte colony-stimulating factor (G-CSF) can obviously enhance the level of neutrophils. Conclusion SCN is a kind of genetic heterogeneity syndrome associated with multiple gene mutations, gene diag-nosis will contribute to understanding of the pathogenesis of the disease and provide theoretical basis for treatment. Though more and more pathogenic genes were found to be connected with SCN, the cases of unknown mutation still account for a large proportion of this disease.

Aim To investigate the roles of p53-dependent signaling pathways in the process of ginsenoside Rg1 protection against 8-methoxypsoralen(8-MOP) and subsequent ultraviolet A(UVA) irradiation induced photoaging model in human dermal fibroblasts(HDFs).Methods Photoaging model was established by 8-MOP/UVA in skin HDFs.Flow cytometry, enzyme cytochemistry, immunofluorescence and Western blot were employed.Results Pretreatment with ginsenoside Rg1 could significantly reduce the amount of UVA-generated 8-oxo-dG and relieve the photoaging representation.Compared with 8-MOP/UVA treatment group, pretreatment with Ginsenoside Rg1 could decrease the expression of SA β-galatosides(SA-β-Gal), and down-regulate the level of senescence associated proteins(p16 and p21).Conclusions Ginsenoside Rg1 has prominent dose-dependent antagonism on senescence of skin HDFs induced by 8-MOP/UVA, and its mechanism may be due to its antioxidation which reduces the production of photoproducts to protect telomere against abnormal shortening.