Objective To evaluate the outcomes of single-point anastomosis of the fallopian tube under a laparoscope.Methods Totally,31 patients(58 fallopian tubes)were treated with laparoscopic single-point anastomosis using 3-mm laparoscopic instruments after ligation(17 cases)or failed hysteroscopic recanalization(14)of the fallopian tubes.Ureteral catheter or transcervical guidewire or stents were used if the sizes of the tubes were irregular.Results The 58 fallopian tubes were anastomosed successfully by a single operation.Radiography performed 3 months postoperation showed bilateral fallopian tube occlusion in 2 patients,and lateral tube occlusion in 5.The postoperative patency rate was 84.5%(49/58).A 6-to 36-month follow-up was carried out in 26 of the 31 patients.Among the 26 patients,17 had uterine pregnancy with a pregnancy rate of 65.4%(17/26),2 patients had fallopian tubal pregnancy,and 7 had no pregnancy.Conclusions Laparoscopic single-point anastomosis is feasible after ligation or failed recanalization of the fallopian tube.Patients have less surgical trauma,faster recovery and less intra-abdominal injury by treating with the procedure.

Familial spontaneous pneumothorax(FSP) is a specific type of primary spontaneous pneumothorax.FSP means there are more than one individuals develop pneumothorax and is a rare inherited disease.FSP is different from primary spontaneous pneumothorax in several clinical manifestations.So far the genetic basis and inheritance pattern of this disease are not clear.Progress in this field are reviewed here.

AIM:To observe the expression and tissue localization of matrix metalloproteinase 9 (MMP-9) and transforming growth factor beta 1 ( TGF-β1 ) in the rat acute cerebral ischemia model.METHODS:Male Wistar rats were used to establish acute cerebral ischemia model by a suturing method.The rats were divided into normal control group, sham group and ischemia 6 h, 12 h, 1 d, 2 d, 6 d and 14 d groups.The rat cerebral cortex and hippocampus of the brain were collected at different time points.The mRNA and protein levels of MMP-9 and TGF-β1 in the brain tissues were detec-ted by real-time PCR and in situ histochemistry staining, respectively.The levels of MMP-9 and TGF-β1 in the plasma were also measured by ELISA.RESULTS:The results of real-time PCR showed that the mRNA levels of MMP-9 began to in-crease 6 h after acute ischemia and reached to a peak 2 d after acute ischemia.Similarly, the mRNA level of TGF-β1 began to rise 12 h after acute ischemia and reached to the highest level 6 d after acute ischemia.Compared with the sham rats, the mRNA levels of MMP-9 and TGF-β1 in the rat brains that collected at ischemic time of 12 h, 1 d, 2 d, 6 d and 14 d were significantly increased.Moreover, results of in situ histochemical staining showed that the expression of MMP-9 was detected at cerebral cortex and hippocampus 1 d after acute cerebral ischemia.Further studies showed that MMP-9 dyeing of the rat cerebral cortex was most obvious 2 d after the acute cerebral ischemia.Similarly, the rat cortex and hippocampus began to express TGF-β1 2 d after acute ischemia and TGF-β1 staining at rat cerebral cortex was most obvious 6 d after the acute cerebral ischemia.In addition, ELISA showed that the increase in MMP-9 and TGF-β1 was detected in the plasma 12 h after ischemia.Compared with the sham rats, the level of these 2 factors significantly upregulated since 1 d after ischemia. CONCLUSION:The brain tissue itself contributes to the upregulation of MMP-9 and TGF-β1 post acute cerebral ischemia, which shed light on the related research in the field.

Objective To analyze the delay in diagnosis and treatment lung cancer expressed as solitary pulmonary nodules (SPN) found by physical examination,and to discover the relative reasons and consequence for future improvement.Methods From January 2000 to August 2011,162 patients (93 males,69 females,ranging 33-82 years,median age 63.9 years) with SPN found by physical examination and diagnosed lung cancer by surgical pathology subsequently were enrolled to this study.Depending on the interval between the date when finding SPN and the date of surgery,these cases were divided into 6 groups,including the group with interval less than 1 month (74 patients),1-3 months (48 patients),3-6 months (10 patients),6-12 months (7 patients),12-24 months (8 patients),and more than 24 months (15 patients).Factors which impact the delay interval between SNP finding and surgery were discussed.The change of tumor' s diameter during observation period,and the pathological characters were also analyzed among each group.Results Of all the delay cases,30.2％ were attributed to doctor,30.9％ attributed to patients themselves,and 38.9％ attributed to hospitals.51.0％ (25/49) of the cases delayed by doctors were misdiagnosed as inflammation,16.3％ (8/49) misdiagnosed as tuberculosis,and 16.3％ (8/49)misdiagnosed as old lesions,which were three common reasons.Patients delayed more than 3 months were more likely to be related to doctor's misdiagnosis than those delayed less than 3 months[70.0％ (28/40) vs.36.8％ (21/57),x2 =10.338.P =0.001].Moreover,the possibility of SPN enlargement was positively correlated with the delay interval.In groups with delay interval more than 24 months or between 12 and 24 months,the percentage of SPN enlargement were 73.3％ (11/15) and 87.5％ (7/8) separately.The proportion of patients with stage IV disease in groups whose delay interval exceeded 12 months (13.3％ for more than 24 months and 12.5％ for 12-24 months) also significantly surpassed others groups with shorter delay interval.Conclusion There exists obvious delayed diagnosis and treatment in lung cancer initially expressed as solitary pulmonary nodules (SPN) during physical examination.Nearly 1/3 patients were delayed by doctors and half of them were misdiagnosed as inflammation.Increase of observation time could result in enlargement of SPN and advancement of disease staging.Thus,patients and doctors should pay more attention and clarify the diagnosis through surgery in less than 3 months after finding SPN,which could remarkably benefit early treatment.

Objective To investigate the incidence,characteristics and risk factors of cognitive impairment in patients with transient ischemic attack(TI A) or minor stroke.Methods Montreal cognitive assessment(MoCA) was carried out in 279 patients with TIA or minor stroke and 150 healthy controls to assess their cognitive function.Results (1) Compared with the healthy controls,the TIA/minor stroke patients scored significantly lower on MoCA total score((23.98±2.55) vs (26.60±0.99),t=12.084,P＜0.01) and subtests including visuoexecutive function((3.68±0.94) vs (4.41±0.64),t=8.483,P＜0.01),digital span ((1.81±0.40) vs (1.95±0.23),t=3.771,P＜0.01),attention((0.84±0.37) vs (0.95±0.23),t=3.357,P＜ 0.01),repetition((1.59±0.62) vs (1.89±0.37),t=5.496,P＜0.01),verbal fluency((0.88±0.33) vs (0.95 ± ±0.23),t=2.286,P＜0.05),abstraction((1.55±0.64) vs (1.91±0.34),t=6.357,P＜0.01) and recall ((2.87±1.13) vs (3.18±0.41),t=3.281,P＜0.01) were significantly decreased.(2) Of 279 TIA/Minor stroke patients,213 (76.3％) suffered from cognitive impairment.The incidence of cognitive impairment was positively correlated with the gender,age,educational level,smoking,course,leukoaraiosis,comorbidities such as hypertension,diabetes mellitus(P＜0.05),and negatively correlated with hyperlipidemia(P＞0.05).Conclusion Extensive impairments of cognitive functions occur along with the incidence of TIA or minor stroke.It is thus suggested that cognitive assessment and interventions may be carried out at an early stage.

Objective To investigate the mRNA and protein expressions of nine integrin subunits in human keloid-derived mesenchymal stem cells (KD-MSCs).Methods Cultured KD-MSCs and normal skin-derived MSCs (NS-MSCs) served as the experiment group and control group respectively.Real-time quantitative PCR and Western blot were performed to measure the mRNA and protein expressions of nine integrin subunits in the two groups respectively.Statistical analysis was carried out by t test.Results Real-time quantitative PCR showed no significant difference in the mRNA expression level of any of the integrin units α2,α3,α5,αV,α10,α11 or β1 between KD-MSCs and NS-MSCs (all P ＞ 0.05).The mRNA expression level of integrin α8 was decreased,while that of integrin β3 was significantly increased in KD-MSCs compared with NS-MSCs (both P ＜ 0.01).Western blot revealed that the changes in protein expression levels of integrin units α8 and β3 were consistent with those in their mRNA expression levels in both KDMSCs and NS-MSCs (both P ＜ 0.01).Conclusions Integrin units α8 and β3 may be involved in the occurrence and development of keloid,and the receptors made up of them may play important roles in the pathogenesis of keloid.

Objective To analyze the related factors of carotid atherosclerosis in type 2 diabetes mellitus pa-tients complicated with nonalcoholic fatty liver disease .Methods 288 type 2 diabetes mellitus patients complicated with nonalcoholic fatty liver disease were divided into carotid atherosclerosis group (group A) and non-carotid athero-sclerosis group ( group B ) , according to whether they had carotid atherosclerosis .The related factors of these two groups,such as BMI,blood pressure,blood glucose,blood lipid,liver function were analyzed.Results The two groups had no significant differences in systolic pressure and diastolic pressure (P>0.05).ALT,BMI,HbA1c,FPG,TG,TC, AST of group A were significantly higher than group B [ALT (55.12 ±9.13)mmol/L vs (36.22 ±8.76)mmol/L, BMI (28.48 ±4.69)kg/m2 vs (23.96 ±3.73)kg/m2,HbA1c (8.57 ±1.69)mmol/L vs (7.62 ±1.28)mmol/L, FPG (9.36 ±2.24)mmol/L vs (8.67 ±1.98)mmol/L,TG (2.12 ±0.38)mmol/L vs (1.23 ±0.17)mmol/L,TC (5.56 ±1.25)mmol/L vs (4.31 ±1.09)mmol/L,AST (25.34 ±5.23)mmol/L vs (21.19 ±4.71)mmol/L](t=17.564,8.726,5.163,2.694,8.788,6.894,all P<0.01).The multiple stepwise regression analysis showed that there was a positive correlation between ALT and BMI (r=0.132,P<0.01),a negative correlation between ALT and AST(r=-0.091,P<0.01).Conclusion The level of ALT could be used as a risk index to judge whether the type 2 diabetes mellitus patients complicated with nonalcoholic fatty liver disease had carotid atherosclerosis .

Objective: To invent the cost efficient home made bovine pericardium buttressing the staple lines in lung volume reduction surgery, and evaluate its feasibility by the means of animal test. Methods: the bovine pericardium of certain type of cattle was chosen, and special management was applied on it, making a sheath like product especially for LVRS. A serial types named A 1, A 2 and A 3 were prepared for the dog model pre clinical experimental test. The smoothness of stapling and dividing, the effectiveness of sealing, and the endurance of pressure were recorded as the index of judgment. Results: Products of all these three types were satisfactory in different degree for utilization, while the type of A 3 was found to suit best. Conclusion: In this study, the home made bovine pericardium buttressing the staple line in LVRS showed satisfactory characteristic in the animal test, and it should have great potential value in the coming clinical use.

BACKGROUND:With the development of three-dimensional (3D) printing technology, 3D printed porous titanium scaffolds as bone substitutes have become a research hotspot. OBJECTIVE:To introduce and discuss the effects of each parameter of 3D printed porous titanium scaffolds on bone ingrowth, and to sum out the optimal parameters for bone ingrowth. METHODS:The first author retrieved PubMed, Springerlink and Medline databases with“three-dimensional (3D) printing, scaffold, titanium, bone ingrowth”as keywords for relevant articles published from 2006 to 2016. 125 articles were retrieved initial y, and final y 42 eligible articles were included for analysis. RESULTS AND CONCLUSION:Pore size, porosity, pore structures and surface modifications of 3D printed porous titanium scaffolds al make effects on bone ingrowth or osteoblasts in scaffolds. Scaffolds with appropriate pore size and porosity can promote the vascularization and provide adequate nutrition and oxygen supplement, to ensure high cel viability. Regulations of cel performances, such as cel attachment, proliferation and differentiation, are also affected by pore structures and nano-scale surface modification. Herein, a detailed combination of the parameters, as mentioned above, can create a better porous scaffold for better bone ingrowth. Hence, the high-stability interface between bone and scaffolds may be obtained through the parameter adjustment.

Objective Analyze the clinical feature of patients failed for diagnosis through endobronchial ultrasound transbronchial needle aspiration(EBUS-TBNA).Optimize the indication and increase diagnosis rate of EBUS-TBNA.Methods A total of 669 patients failed for diagnosis of EBUS-TBNA were included.Fifty-three of them(7.92％) were not exactly diagnosed.Perioperation clinical data and clinical feature were collected and evaluated based on specific disease,lesion location,size and operator' s experience.Results The undiagnosis rate was higher in lymphoma (77.78％),tuberculosis (23.08％) and sarcoidosis(9.09％) when analyzed from specific diseases.If the lesion location was taken into consideration,15.38％ upper paratracheal lymph nodes(R2) could not be diagnosed exactly by EBUS-TBNA,and the bilateral hilar lymph nodes(15.00％ for right,11.54 for left) were followed.Size of the lesion was not associated with the diagnosis rate.The operator's experience could also affect the results.The undiagnosis rate was highest in the first 10 cases among all operators.After at least 10 EBUS-TBNA processes,the undiagonsis rate stayed near 7.50％,which was close to the average.Conclusion It is necessary to select suitable indications for EBUS-TBNA based on the disease,lesion location and operatior experience,and cooperate with mediastinoscopy to rise diagnosis rate.