Objective To investigate the role of hysteroscopy combined with laparoscopy in treatment of infertility.Methods 102 patients with infertility treated by hysteroscopy combined with laparoscopy were retrospectively analyzed.Results Of 102 cases of infertility,there were 57 cases with Pelvic adhesions and tubal obstruction,24 cases with endometriosis,12 cases with polycystic ovary syndrome,4 cases with endometrial polyp,3 cases with hysteromyoma and 2 cases with uterus septum.The first three cases were chronic pelvic inflammatory with salpingemphraxis ( 55.88% ), endometriosis Ⅰ -Ⅱ (23.53% ) and polycystic ovary syndrome (11.76% ).The postoperative pregnancy rate was 41.18%, 3 patients with ectopic pregnancy (7.14%) and 4 spontaneous abortion (9.52%).Conclusion Laparoscopy with hysteroscopy played an important role in treatment of infertility.It was an effective method and worthy to be widely used.

Investigate the cleaning ability of manual ProTaper on mandibular second molars with C-shaped (c-shaped root) or normal root canal(separated root). Twenty mandibular second molars with C-shaped root or with separated roots were sectioned at 3.0, 5.5 and 8.0 mm from the root apex. The images of pre-preparation and F1, F2, and F3-prepapared of manual ProTaper were captured respectively. The cross-sectional areas of the canals were measured and the formula of area after treatment/area before treatment was used to calculate the area ratio. The data were analyzed by SPSS 10.0. The results showed that there was no statistically difference between cross-section root canal area ratios in two groups. Significant differences were found between the cross-section canal area ratio of F1 and F2, F1 and F3 at section 5 mm of S group, and F1 and F3 at section 3 mm of C group. The results suggested that the increasing of cross-section ratio of the two kinds of canals was not obviously concerned with their anatomical morphology.

Animals ; Gene Expression ; Hypoxia ; metabolism ; Prefrontal Cortex ; metabolism ; Rats ; Somatomedins ; metabolism

Objective To investigate the incidence of diabetes mellitus and risk factors for the disease in chronic pancreatitis (CP) patients.Methods A historical cohort study on subjects with painful CP who were admitted to hospital from Jan.1997 to July 2007 were conducted.A life-table method was used to estimate the cumulative probability of the development of diabetes mellitus once clinical onset of abdominal pain.Cox proportional-hazards model was used for multivariate analysis of the variables including age,sex,drinking and smoking habits,etiological factor,presence of pancreatic masses,pancreatic calcifications,measure of intervention,diarrhea,weight loss and degree of pain.Results Data were obtained from 354 patients (239 males,mean age at onset of pain (38.1±17.6) years;alcoholic origin 18.1%) with painful CP.The mean follow-up period was (45.2±32.9)months.The rate of diabetes mellitus in CP patients was 16.1%.There was a high incidence (29.8%)of diabetes mellitus 1 year before the episodes of abdominal pain.The cumulative risk of diabetes mellitus in subjects 5 and 10 years after the episodes of pain was 9.3% and 20.7%,respectively.Cox proportional-hazards model selected smoking (＞10 pack years) (hazard rate (HR)= 3.3),mild abdominal pain (HR=5.2),weight loss (HR = 2.6) and pancreatic calcifications (HR = 2.2) as variables identifying subjects with diabetes mellitus in patients with painful CP before they were performed therapeutic endoscopy or surgical intervention.Smoking (＞10 pack years) (HR = 3.0),weight loss (HR= 2.8) and distal pancreatectomy (HR =7.3) were identified with an increased risk of diabetes mellitus in these cases after they received therapeutic endoscopy or surgical intervention.Conclusion The risk factors of diabetes mellitus for CP appears to be independent of smoking (＞10 pack years),mild abdominal pain,weight loss,pancreatic calcifications and distal pancreatectomy.

Objective To investigate the effect of α-tocopherol on fibrosis of chronic pancreatitis (CP) rat and explore its mechanism.MethodsMale Wistar rats were randomly divided into control group,acute necrotizing pancreatitis (ANP) group,α-tocopherol group.CP was induced by dibutyltindich loride ( 8 mg/kg) infusion into the tail vein.Gastric lavage of α-tocopherol (800 mg/kg body weight,daily) was started 24 hours after dibutyhindich loride infusion for 4 weeks.The rats in ANP and control group received 0.6 ml salad oil gastric lavage.The rats were sacrificed 4 weeks later.Pancreatic tissue was harvested for histological examination and collagen staining,and measurement of the levels of hydroxyproline and malondialdehyde (MDA) of the pancreas were performed.The mRNA expression of transforming growth factor (TGF)-β１ was measured by real time PCR.ResultsAfter gastric lavage for 4 weeks,the pancreatic tissue inflammation,fiber deposition and abnormal structure in rats of α-tocopherol group were greatly reduced.The levels of MDA and hydroxyproline in rats of α-tocopherol group were significantly lower than those in ANP group [ (0.40 ±0.20) vs (1.07 ±0.41) nmol/100mg,(402.49 ±27.62) vs (664.92 ±29.04) μg/g,P＜0.05].The expressions of TGF-β1 mRNA in rats of o-tocopherol group were significantly lower than those in ANP group (2.24 ± 0.89 vs 3.35 ± 0.66,P ＜ 0.05 ).Conclusions Tocopherol gamma can improve pancreatic inflammation and fibrosis by reducing the oxidative stress level and down-regulating the expression of TGFβ1mRNA in rats with CP.

Objective to determine the basal levels of several pancreas-related endocrine hormones in patients with chronic pancreatitis.Methods according to inclusion and exclusion criteria,consecutive patients from February 2016 to August 2016 in Department of Gastroenterology,Changhai Hospital,Second Military Medical University and ten healthy control (matched for age and gender) were included.Basal levels of glucagon-like peptide 1,pancreatic polypeptide,Secretin,glucagon,somatostatin between groups of CP vs healthy control,CP with abnormal glycometabolism vs CP with normal glycometabolism and alcoholic CP vs non-alcoholic CP were compared.Results a total of 53 patients with chronic pancreatitis and 8 healthy subjects were included in this study.(1) CP vs healthy controls:the level of secretin in healthy control patients is significant lower than that in CP patients;(2) CP with abnormal glycometabolism vs CP with normal glycometabolism:the level of triglyceride and somatostatin is significant lower than that in CP patients;the prevalence of patients with chronic alcohol consumption and the level of glucagon-like peptide 1 in CP with abnormal glycometabolism is significant higher than that in CP with normal glycometabolism;(3) the prevalence of abnormal glycometabolism in alcoholic CP group is significant higher than that in non-alcoholic CP.The results above are all of statistical significance.Conclusions in addition to dysfunction of islets/3-cells,CP also easily affects the level of other pancreas-related hormones such as secretin,somatostatin and glucagon-like peptide 1.Otherwise,chronic alcohol consumption is also strongly related with abnormal glycometabolism,the mechanism deserves further researches.

Objective To explore the treatments and their effects on painless chronic pancreatitis (CP) in adult. Methods A historical cohort study of adult subjects with CP, who were hospitalized in our center in the last decade, was performed, and the clinical data were analyzed. Results There were 56 cases of adult painless CP, and 46 (82.1%) (31 males and 15 females, age 51.6±14.5 years) were followed up(34.5±27.1 months). Imaging findings showed 26 cases of pancreatic duct stones and morphological changes. These patients received endoscopic intervention therapy(n=14), surgical procedures(n=7), combined endoscopic and surgical treatment(n=3) and conservative treatment(n=2). Another group of 18 cases of pancreatic or peripheral occupying lesions received surgery. During follow-up of the above 2 groups, 1 patient died of pancreatic cancer in each group. The symptoms of diabetes and diarrhea were not relieved, but there was improvement of general condition in some patients. Stones re-occurred after surgery in one patient. Two patients with pancreatic duct dilation and cysts underwent endoscopic treatment(n=1) and surgical procedure(n=1), respectively. But the latter patient experienced gastric bleeding, cirrhosis and jaundice with unknown reason after the surgery. Conclusion In adult patients with CP, endoscopic and surgical procedures had similar effect in patients with pancreatic duct stones and dilation. Surgical procedures are preferably performed in those with pancreatic occupying lesions. Further study is needed in those only with pancreatic duct dilation. The above treatments can improve general conditions in some patients. Intensive surveillance is suggested to the patients with painless CP.

Objective To analyze the clinical characteristic of Chinese autoimmune pancreatitis (AIP) patients.Methods All clinical data of 81 patients with a diagnosis of AIP in Shanghai Changhai Hospital from February 2005 to May 2012 were analyzed.Results The sex ratio was 7.1∶1 and the mean age was (57± 12) years old in 81 patients with AIP.Obstructive jaundice was the initial symptom in 51.9％ (42/81) patients.In patient receiving CT,focal and diffuse type accounted for 45 and 35 patients.respectively,and pseudocyst was the main manifestation in 1 patient,biliary tract was involved in 59(72.8％ ) patients,dilatation of main pancreatic duct was observed in 5 ( 11.1％ ) patients.In patients receiving PET-CT,diffuse increased Flourine-18 FDG uptake by the pancreas was found in 11 patients,focal increased uptake in 2patients,and significant extra-pancreatic uptake was found in 5 patients.The positive rate of serum IgG4,CA19-9,ss DNA,anti-nuclear antibody and ds-DNA antibody was 94.6％ (53/81),54.4％ (37/68),14.3％ (4/28),10.7％ (3/28),7.1％ (2/28),respectively.The pathological findings of H-E staining and IgG4 immunohistochemical analysis in 20 patients were consistent with lymphoplasmacytic sclerosing pancreatitis.Conclusions Type 1 AIP is the main subtype of AIP in China.Combining clinical symptoms,extra-pancreatic manifestations,imaging or nuclear medicine findings,serology,cytology or histology can effectively increase the correct diagnosis rate of AIP.

Objective To evaluate and compare the effects of surgical and endoscopic therapy for common bile duct stenosis (CBDS) induced by chronic pancreatitis (CP). Methods A historical cohort study of CBDS subjects induced by CP, who underwent endoscopic or surgical treatments at Changhai Hospital from Januraryl997 to July 2007, was performed. Results Of 514 cases of CP, CBDS occurred in 51 (9.9%), in which complete follow-up data were available in 41 survived patients with a mean follow-up period of 42.9±28. 3 months. The mean ages of first onset and hospitalization were 46. 3±14.0 and 49. 8±11.9 years, respectively. Endoscopic therapy was applied in 13 patients, including bile duct stenting in 7, 6 of whom presented with cholangitis, cholestasis and/or jaundice. Surgery was performed in 26 patients, in which 7 also underwent endoscopic therapy, and occupying lesion in pancreatic head was found in 14. The other 2 patients were treated without endoscopy or surgery. At the end of the follow-up, all symptoms including cholangitis, cholestasis and jaundice were relieved and no recurrence or choler cirrhosis was recorded.Conclusion Surgical approach is the main treatment for CBDS induced by CP. Endoscopic therapy is an alternative for patients unfit for surgery, especially for those who had jaundice, cholestasis or cholangitis.

The vitamin K epoxide reductase complex subunit 1 (VKORC1), the rate-limiting enzyme for vitamin K recycling, is significantly down-regulated in the kidneys of urolithiasis patients. This study searched for direct evidence to define the inhibitory activity of VKORC1 against calcium oxalate (CaOx) crystal formation. In the experiment of VKORC1 overexpression, HK-2 cells were transfected with the pFLAG-CMV-7.1-VKORC1 plasmid as a pFLAG-CMV-7.1-VKORC1 transfection group or the pFLAG-CMV-7.1 plasmid as a pFLAG-CMV-7.1 control group. In the experiment of VKORC1 knockdown, HK-2 cells were transfected with the PGPU6/GFP/Neo-VKORC1shRNA-2 as a PGPU6/GFP/Neo-VKORC1shRNA-2 transfection group or the PGPU6/GFP/Neo-shRNA-NC plasmid as a PGPU6/GFP/Neo-shRNA-NC control group. The expression of VKORC1 in HK-2 cells was detected by real-time quantitative PCR and Western blotting. The CaOx crystal formation was observed under the laser-scanning confocal microscope. It was found that the expression levels of VKORC1 mRNA and protein were significantly higher in the pFLAG-CMV-7.1-VKORC1 transfection group than in the pFLAG-CMV-7.1 control group (P<0.01). The number of CaOx crystals in HK-2 cells incubated in fluorescently labeled CaOx monohydrate (COM) crystal medium for 48 h was 14±4 per field (100×) in the pFLAG-CMV-7.1-VKORC1 transfection group and 26±5 per field (100×) in the pFLAG-CMV-7.1 control group respectively under the laser-scanning confocal microscope. The amount of CaOx crystal aggregation and formation in the pFLAG-CMV-7.1-VKORC1 transfection group was significantly reduced as compared with the pFLAG-CMV-7.1 control group (P<0.05). The expression levels of VKORC1 mRNA and protein were significantly lower in the PGPU6/GFP/Neo-VKORC1shRNA-2 transfection group than in the PGPU6/GFP/Neo-shRNA-NC control group (P<0.05). The number of CaOx crystals in HK-2 cells incubated in fluorescently labeled COM crystal medium was 65±11 per field (100×) in the PGPU6/GFP/Neo-VKORC1shRNA-2 transfection group and 24±6 per field (100×) in the PGPU6/GFP/Neo-shRNA-NC control group respectively under the laser-scanning confocal microscope. The amount of CaOx crystal aggregation and formation in the PGPU6/GFP/Neo-VKORC1shRNA-2 transfection group was significantly increased as compared with the PGPU6/GFP/Neo-shRNA-NC control group (P<0.05). These findings suggested that the VKORC1 protein could inhibit CaOx salt crystallization, adhesion and aggregation. This research would help us to understand the mechanisms involving the interaction between crystallization and epithelial cells and the formation of CaOx.