Study on the comparison of diagnostic of K-TIRADS, ACR-TIRADS and ATA in CAD and diagnosis of thyroid nodules by computer-assisted ultrasonography / 中华超声影像学杂志

Objective@#To explore the diagnostic efficiency of K-TIRADS, ACR-TIRADS and ATA risk stratification in computer-aided detection and diagnosis(CAD) software and the application value of CAD-assisted ultrasound physicians in diagnosing thyroid nodules.@*Methods@#One hundred and ninety-two thyroid nodules with postoperative pathological results were retrospectively analyzed. All of them were graded by K-TIRADS, ACR-TIRADS and ATA with CAD software, and the best guide was recognized by calculating the area under the ROC curve, sensitivity and specificity. Then, based on the best guidelines for the classification criteria, the double-blind method was used to compare the ability of the same ultrasonologist to diagnose thyroid nodules before and after CAD.@*Results@#The AUC value of K-TIRADS, ACR-TIRADS, ATA was 0.88, 0.77, 0.62 respectively in the CAD software. The difference between the two groups was statistically significant (P<0.05). There was no significant difference in the specificity between K-TIRADS and ATA(P=0.176), which were both higher than ACR-TIRADS with statistically significant differences (P<0.05). The AUC value of the diagnosis among CAD itself, ultrasound physicians and physicians combined CAD was 0.88, 0.80, 0.93, respectively. The difference between the two groups was statistically significant (P<0.05). There was no significant difference in the sensitivity between CAD itself and physicians combined CAD(P=0.163), which were both higher than ultrasound physicians with statistical significant differences(P<0.05). Among ultrasound physicians, CAD itself and physicians combined CAD, the difference in specificity between the two groups was statistically significant(P<0.05).@*Conclusions@#All the three risk stratification systems of thyroid ultrasound in CAD software have good diagnostic values, among which K-TIRADS has the largest AUC. The CAD software can assist ultrasound physicians to improve the thyroid nodule diagnostic performance, and has a good clinical application prospect.

PET-CT tracing and fluorescence imaging to monitor the colonization and distribution of combined transplantation of islets and BMSC / 中华器官移植杂志

Objective To further observe the efficacy of combined transplantation of islet and bone marrow mesenchymal stem cells (BMSC) in diabetic rats ,PET-CT was used to trace cells in vivo to determine the homing and distribution of cells in vivo .Methods Streptozotocin (STZ)was used to construct a rat model of diabetes mellitus .BMSC could be isolated and cultured by full adherence method;islets were isolated by collagenase ;Islets and BMSC were labeled with 18F-FDG in vitro . Diabetic rats were randomly divided into 4 groups ,15 rats in each group :A ,Control group;B ,Stem cell transplantation group ;C ,Islet Transplantation group ;D ,Combined transplantation group ,a total of four groups ,all transplanted through portal vein ,PET-CT tracing the distribution of cells transplanted into the body .7 days after transplantation ,the livers of each group were taken ,and the homing and distribution of transplanted cells were detected by immunofluorescent staining .The SUV was calculated by the analysis of variance of random block , and the difference between groups was compared by t-test .Results PET-CT results showed that BMSC were mainly distributed uniformly in the right liver ,and the islets of the pancreas were mainly clustered in terminal branches of hepatic portal vein ,and BMSC were around the islets of pancreas ,but there was no obvious development in the liver of the control group .Conclusions PET-CT can directly reveal the distribution of islets and BMSC in liver after transplantation through portal vein .

Study on the comparison of diagnostic of K‐TIRADS ,ACR‐TIRADS and ATA in CAD and diagnosis of thyroid nodules by computer‐assisted ultrasonography / 中华超声影像学杂志

Objective To explore the diagnostic efficiency of K‐T IRADS ,ACR‐T IRADS and AT A risk stratification in computer‐aided detection and diagnosis ( CAD ) software and the application value of CAD‐assisted ultrasound physicians in diagnosing thyroid nodules . Methods One hundred and ninety‐two thyroid nodules with postoperative pathological results were retrospectively analyzed . All of them were graded by K‐T IRADS ,ACR‐T IRADS and A T A with CAD software ,and the best guide was recognized by calculating the area under the ROC curve ,sensitivity and specificity . T hen ,based on the best guidelines for the classification criteria , the double‐blind method was used to compare the ability of the same ultrasonologist to diagnose thyroid nodules before and after CAD . Results T he AUC value of K‐T IRADS , ACR‐T IRADS ,A T A was 0 .88 ,0 .77 ,0 .62 respectively in the CAD software . T he difference between the two groups was statistically significant ( P ＜0 .05 ) . T here was no significant difference in the specificity between K‐T IRADS and A T A ( P ＝0 .176 ) ,w hich were both higher than ACR‐T IRADS with statistically significant differences ( P ＜ 0 .05 ) . T he AUC value of the diagnosis among CAD itself , ultrasound physicians and physicians combined CAD was 0 .88 ,0 .80 ,0 .93 ,respectively . T he difference between the two groups was statistically significant ( P ＜0 .05) . T here was no significant difference in the sensitivity between CAD itself and physicians combined CAD ( P ＝0 .163 ) ,w hich were both higher than ultrasound physicians with statistical significant differences( P ＜0 .05) . Among ultrasound physicians ,CAD itself and physicians combined CAD ,the difference in specificity between the two groups was statistically significant ( P ＜0 .05) . Conclusions All the three risk stratification systems of thyroid ultrasound in CAD software have good diagnostic values ,among w hich K‐T IRADS has the largest AUC . T he CAD software can assist ultrasound physicians to improve the thyroid nodule diagnostic performance , and has a good clinical application prospect .

PET-CT tracing and fluorescence imaging to monitor the colonization and distribution of combined transplantation of islets and BMSC / 中华器官移植杂志

Objective@#To further observe the efficacy of combined transplantation of islet and bone marrow mesenchymal stem cells (BMSC) in diabetic rats, PET-CT was used to trace cells in vivo to determine the homing and distribution of cells in vivo.@*Methods@#Streptozotocin (STZ)was used to construct a rat model of diabetes mellitus. BMSC could be isolated and cultured by full adherence method; islets were isolated by collagenase; Islets and BMSC were labeled with 18F-FDG in vitro. Diabetic rats were randomly divided into 4 groups, 15 rats in each group: A, Control group; B, Stem cell transplantation group; C, Islet Transplantation group; D, Combined transplantation group, a total of four groups, all transplanted through portal vein, PET-CT tracing the distribution of cells transplanted into the body.7 days after transplantation, the livers of each group were taken, and the homing and distribution of transplanted cells were detected by immunofluorescent staining.The SUV was calculated by the analysis of variance of random block, and the difference between groups was compared by t-test.@*Results@#PET-CT results showed that BMSC were mainly distributed uniformly in the right liver, and the islets of the pancreas were mainly clustered in terminal branches of hepatic portal vein, and BMSC were around the islets of pancreas, but there was no obvious development in the liver of the control group.@*Conclusions@#PET-CT can directly reveal the distribution of islets and BMSC in liver after transplantation through portal vein.

Diagnostic value of contrast enhanced ultrasound combined with ultrasound-guided fine-needle aspiration in differentiating malignant and benign thyroid nodules / 中华超声影像学杂志

Objective To evaluate the diagnostic value of contrast enhanced ultrasound ( CEUS ) combined with ultrasound-guided fine-needle aspiration ( US-FNA) in differentiating malignant and benign thyroid nodules . Methods A retrospective review of preoperative CEUS and US-FNA data of 161 thyroid nodules confirmed by surgical pathology from 145 patients was performed . The CEUS enhancement patterns of whole phase hypo-enhancement ,uneven hypo-enhancement and early phase hypo-enhancement were taken as the diagnostic criteria for malignant thyroid nodules . According to the Bethesda System ,the grade≥ Ⅳ was taken as the cytologic criteria for diagnosis of malignant thyroid masses . The 161 thyroid nodules were divided into large nodules group( the longest diameter of thyroid nodules were higher than 1 .0 cm) and small nodules group ( the longest diameter of nodules were higher than 0 .5 cm but lower than 1 .0 cm) . The diagnostic value of CEUS ,US-FNA and the combination were evaluated respectively in the the two groups . Results In large nodules group ,the sensitivities of CEUS ,US-FNA and the combination were 88 .0% ,81 .3% ,94 .7% ,respectively ;their specificities were 88 .5% ,100% ,88 .5% ,respectively . There was no statistically difference in sensitivity between CEUS and US-FNA ( P ＝ 0 .301) ,the sensitivity of the combination was higher than US-FNA ( P ＝0 .004) . In small nodules group ,the sensitivities of CEUS ,US-FNA and the combination were 52 .4% ,78 .6% ,92 .9% ,respectively ;their specificities were 94 .4% ,100% , 94 .4% ,respectively . There was statistically difference in sensitivity between CEUS and US-FNA ( P ＜0 .05) ,the combination had the highest sensitivity ( P ＜ 0 .05).Conclusions For thyroid nodules whose longest diameter higher than 1 cm ,there is no statistically difference in sensitivity between CEUS and US-FNA .The combination had higher sensitivity than US-FNA .For thyroid nodules whose longest diameter higher than 0 .5 cm but lower than 1 .0 cm ,US-FNA provided higher sensitivity than CEUS ,the combination provided higher sensitivity than single CEUS or US-FNA .

Developmental Exposure to Di-(2-ethylhexyl) Phthalate Induces Cerebellar Granule Cell Apoptosis via the PI3K/AKT Signaling Pathway

Di-(2-ethylhexyl) phthalate (DEHP) is an ubiquitous environmental contaminant because of its extensive use in plastics and its persistence. As an environmental endocrine disruptor, it is suspected to interfere with neurodevelopment in people. However, evidence of the effects of maternal DEHP exposure on cerebellar development in offspring is scarce. The objective of this study was to investigate maternal exposure to DEHP and its effect on apoptosis of cerebellar granule cells (CGCs) and related mechanisms. Pregnant Wistar rats were administrated DEHP (0, 30, 300 and 750 mg/kg/d) by gavage from gestational day (GD) 0 to postnatal day (PN) 21. Primary CGCs were also exposed to mono-(2-ethylhexyl) phthalate (MEHP), the main metabolite of DEHP, for 24 h with concentrations of 0, 25, 100 and 250 µM. The CGCs of male offspring from 300 and 750 mg/kg/d DEHP exposure groups showed significantly increased apoptosis. In addition, the PI3K/AKT signaling pathway was inhibited in the male offspring of the 300 and 750 mg/kg/d DEHP exposure groups. However, effects on female pups were not obvious. Apoptosis was also elevated and the PI3K/AKT signaling pathway was inhibited after primary CGCs were exposed to MEHP. Furthermore, apoptosis was reduced after treatment with the PI3K/AKT signaling pathway activator, insulin-like growth factor (IGF) 1, and increased after treatment with LY294002, an inhibitor of the PI3K/AKT signaling pathway. These results suggested that maternal DEHP exposure induced apoptosis in the CGCs of male pups via the PI3K/AKT signaling pathway, and the apoptosis could be rescued by IGF1 and aggravated by LY294002.

Analysis of 399 Cases of ADR in County-level Second Grade Class A Hospital / 中国药房

OBJECTIVE:To explore the regularity and the characteristics of ADR in county-level second grade class A hospi-tal,in order to promote rational drug use in the clinic. METHODS:In retrospective study,399 ADR reported to National ADR Monitoring Network by county-level second grade class A hospital from 2011 to 2014 were analyzed. RESULTS:399 cases of ADR most happened in 0-10 year-old children (39.35%);most of ADR cases (91.98%) were related to intravenous administra-tion;56.39% of ADR cases were caused by antibiotics(56.39%),among which cephalosporin antibiotics took up the highest pro-portion(19.55%). ADR mainly manifested as lesion of skin and appendants(50.38%). CONCLUSIONS:It contributes to guaran-tee the safety of drug use that mastering the situation of ADR monitoring and report and extracting valuable warning sign.

Effect of carbon monoxide releasing molecule on experimental periodontitis in rats / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the effects of carbon monoxide releasing molecule-2 (CORM-2) on experimental periodontitis in rats.</p><p><b>METHODS</b>Forty-two Wistar rats were divided into three groups. Rats in the normal group (NL group) did not undergo any procedure, whereas the other rats were ligatured and treated with saline solution (NaCl 0.9%) (LO group) or treated with CORM-2 (10 mg kg(-1) per day) (CO group). A 3-0 silk suture was placed around the mandibular first molars. Rats were sacrificed after 3, 7, and 10 d. Blood samples were collected from all animals for tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) analysis. Changes in alveolar bone levels were measured clinically, and periodontal tissues were histopathologically examined to assess the infiltration of inflammatory cells.</p><p><b>RESULTS</b>Ligature placement increased alveolar bone loss and inflammatory cell infiltration in periodontal tissue. Alveolar bone loss in CO group was significantly higher than that in NL group, but was lower than that in LO group (P<0.05). The ratio of inflammatory cell infiltration in LO group was significantly higher than that in CO and NL groups, and that in CO group was lower than in LO group (P<0.05). Serum levels of TNF-alpha and IL-1beta in the LO group were significantly higher than those in the CO and NL groups, and those in CO group were lower than in LO group (P<0.05).</p><p><b>CONCLUSION</b>Systemic administration of CORM-2 reduced periodontal inflammation and alveolar bone loss in experimental periodontitis in rats.</p>

The quantitative assessment of left ventricular regional diastolic function after intracoronary stent implantation by strain rate imaging / 中国医师进修杂志

Objective To investigate the application of strain rate imaging in quantitative assessment of left ventricular regional diastolic function after intracoronary stent implantation.Methods Fifty-six healthy person and 60 patients with coronary artery disease were performed quantitative assessment of left ventricular regional diastolic function by apical four chamber view,apical two chamber view and left ventricular long axis view before and after intracoronary stent implantation using strain rate imaging.Results Compared with those of normal myocardium,the peaks of strain rate curve at diastole of ischemic myocardium were reduced,and were increased after operation (P ＜ 0.05).Conclusions Intracoronary stent implantation can significantly improve the blood supply to the ischemia myocardium.Strain rate imaging can quantitatively analyze the changes of left ventricular regional diastolic function.

Autologous peripheral blood CD34+ stem cells transplanted into 100 patients with advanced cirrhosis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate whether transplantation of autologous peripheral blood CD34+ stem cells is a viable approach for treating patients with advanced cirrhosis,which is currently hindered by a shortage in liver donors.</p><p><b>METHODS</b>A total of 100 patients with advanced cirrhosis and who had failed to respond to conservative therapy were recruited for transplantation of autologous peripheral blood CD34+ stem cells.The success of transplantation was investigated 6-and 12-months later by measuring markers of liver biosynthesis function (coagulation,albumin level,indocyanine green clearance,Child-Pugh score) and assessing pathological changes (Knodell score) and morphologic changes in the liver tissue.Complications were also recorded during follow-up.</p><p><b>RESULTS</b>The 1-year cumulative survival rate was 100%. Fifty-two patients with massive ascites showed gradual reduction and disappearance of the ascites.Four patients experienced upper gastrointestinal bleeding and three patients developed with hepatic encephalopathy (I-II degree) at 3 months post-transplantation.All patients showed significantly improved liver biosynthesis function,liver elasticity and Knodell score after transplantation (P less than 0.05).</p><p><b>CONCLUSION</b>Autologous peripheral blood CD34+ stem cell transplantation is a safe and effective treatment for advanced cirrhosis,and has high cost-benefit since it improves liver function,liver histology,and quality of life.</p>

Mechanism of carbon monoxide affecting the expression of cellular adhesion molecule under stimulation of inflammatory cytokines to human gingival fibroblasts / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the mechanism by which carbon monoxide inhibits the expression of adhesion molecules on human gingival fibroblasts (HGF) stimulated with inflammatory cytokines.</p><p><b>METHODS</b>HGF were cultured in vitro, and stimulated with 50 ng x mL tumor necrosis factor-alpha (TNF-alpha) and 10 ng x mL(-1) interleukin-1beta (IL-1beta) concurrently in the presence or absence of carbon monoxide releasing molecule-3 (CORM-3) at 500 micromol x L-1. Expression of phosphorylated extracellular regulated protein kinase (ERK), phosphorylated c-Jun N-terminal kinase (NK) and phosphorylated p38 in mitogen-activated protein kinase(MAPK) pathway was studied by Western blot at 10 min and 20 min, respectively. Nuclear expression of nuclear factor-kappaB (NF-kappaB) was checked by Western blot after 4 h stimulation. In some experiments, cells were prestimulated by 1H-[1,2,4]oxadiazolo[4,3-alpha]quinoxalin-1-one (ODQ) for 8 h before cytokine stimulation and the expression of intercellular adhesion molecule-1 (ICAM-1) was checked by Western blot after 24 h.</p><p><b>RESULTS</b>CORM-3 significantly inhibited the phosphorylation of MAPK p38 after 10 min stimulation with cytokines, but had no signifi-cant effect on the phosphorylation of ERK and JNK. CORM-3 significantly inhibited the nuclear expression of NF-KB-p65 on HGF after 4 h stimulation by inflammatory cytokines. The inhibitory effect of CORM-3 on the expression of ICAM-1 was not influenced by guanylate cyclase inhibitor ODQ.</p><p><b>CONCLUSION</b>The inhibitory effect of carbon monoxide on the expression of adhesion molecules might be exerted by its inhibitory effect on the NF-kappaB activity and MAPK p38 phosphorylation.</p>

Expression of high mobility group box 1 in gingival tissues of chronic periodontitis / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the expression of high mobility group box 1 (HMGB1) in gingival tissues of chronic periodontitis.</p><p><b>METHODS</b>Human peripheral blood mononuclear cells(PBMC) were stimulated with 1 microg x mL(-1) lipopolysaccharide (LPS) for 24 h or 48 h. Expression and release of HMGB1 were checked by immunofluorescence and enzyme-linked immunosorbent assay (ELISA), respectively. PBMC were stimulated with 100 ng x mL(-1) HMGB1 or 50 ng x mL(-1) tumor necrosis factor-alpha (TNF-alpha), the expressions of TNF-alpha and HMGB1 in the supernatant were studied by ELISA. Gingival tissues and gingival crevicular fluids (GCF) were collected from patients and healthy people. Expression of HMGB1 in gingival tissues and GCF was studied using immunofluorescence and ELISA, respectively.</p><p><b>RESULTS</b>HMGB1 was translocated from nucleus to cytosol in PBMC after LPS stimulation for 24 h. The content of HMGB1 in the supernatant from stimulated cells was significantly higher than that from unstimulated cells after 48 h (P < 0.01). HMGB1 was released by PBMC in response to TNF-alpha stimulation, it also stimulated PBMC to release TNF-alpha (P < 0.01). Translocation of HMGB1 from nucleus to cytosol was also found in infiltrated cells in gingival tissues from patients, and HMGB1 in GCF from patients was significantly higher than that from healthy people P < 0.01).</p><p><b>CONCLUSION</b>The results suggest that HMGB1 may play an important role in the pathological progress of chronic periodontitis.</p>

Influence of carbon monoxide on the expression of adhesion molecules stimulated with tumor necrosis factor-alpha and interleukin-1beta on human gingival fibroblasts / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the influence of carbon monoxide on the expression of adhesion molecules stimulated by inflammatory cytokines on human gingival fibroblasts.</p><p><b>METHODS</b>Human gingival fibroblasts were stimulated with 50 ng x mL(-1) tumor necrosis factor (TNF)-alpha and 10 ng x mL(-1) interleukin (IL)-1beta concurrently in the presence or absence of 500 micromol x L(-1) carbon monoxide releasing molecule (CORM). Expression of intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 at protein and mRNA level was examined by Western blot and reverse transcription polymerase chain reaction (RT-PCR), respectively. Activity of transcription factor NF-kappaB was evaluated by reporter gene assay.</p><p><b>RESULTS</b>Expression of ICAM-1 and VCAM-1 on human gingival fibroblasts increased dramatically after concurrent stimulation of TNF-alpha and IL-1beta, while CORM inhibited the upregulation of ICAM-1 and VCAM-1. CORM decreased the activity of NF-KB stimulated by TNF-alpha and IL-1beta.</p><p><b>CONCLUSION</b>Carbon monoxide could be a promising way in treating of periodontitis.</p>

Study on the effect of Qingre-Lishi Recipe on insulin resistance in patients with obese type 2 diabetes / 国际中医中药杂志

Objective To observe the effect of Qingre-Lishi Recipe on insulin resistance in patients with obese type 2 diabetes. Methods 60 patients of obese type 2 diabetes were randomly divided into two groups, the treatment group (30 patients) and the control group (30 patients). On the basis of routine treatments that were received by both groups, the treatment group was given Qingre-Lishi Recipe additionally, taking twice a day, one in the morning and the other in night, with the total amount as much as one dose. The course for both treatments is 8 weeks. When the treatments were finished, alleviation of main symptoms of Chinese medicine, the levels of FBG (6.52±0.45) mmol/L、 HbAlc (6.02±0.43) ％、 FINS (7.52± 1.28) μIU/ml、 IAI ( 1.62±0.21 )、TG ( 1.13 ± 0.36) mmol/L、 HDL-C ( 1.69 ± 0.20) mmol/L of patients in both groups were compared. Results After treatments, the changes in alleviation of main symptoms of Chinese medicine, in the level of FPG, HbA 1 c,FINS, IAI, TG and HDL-C between the two groups were of statistical significance, (P＜0.05 or P＜0.01).Conclusion Qingre-Lishi Recipe has an obvious clinical effect in bettering clinical symptoms and alleviating Insulin Resistance in patients with obese type 2 diabetes.

Clinical observation on the effect of Yiqi Huoxuehuatan recipe on 68 patients with elderly diabetic coronary heart disease / 国际中医中药杂志

Objective To observe the effect of Yiqi Huoxuehuatan Recipe in treating elderly diabetic coronary heart disease. Methods 68 patients with elderly diabetic coronary heart disease were randomly assigned to the treatment group (34 patients) and control group (34 patients). The former received a routine western medicine treatment plus Yiqi Huoxuehuatan Recipe, one dose per day; while the latter group received a routine western medicine treatment only, both treated for a course of 60 days. When the treatments were finished,angina curing effect, alleviation of main symptoms, ECG, FPG, 2hPG, HbA1c, TC, TQ LDL-C, HDL-C, and indicators of blood rheology (low shear whole blood viscosity, plasma viscosity, RBC aggregation index, RBC deformation index) were compared. Results Changes in angina curing effect, alleviation of main symptoms,ECQ lipid and indicators of blood rheology were significant (χ2=4.53> 4.12, P<0.05) between the two groups.Conclusion Yiqi Huoxuehuatan Recipe has an obvious clinical effect in treating elderly diabetic coronary heart disease by improving clinical effect, helping in alleviation of angina, ameliorating lipid metabolism disorder and correcting the abnormal indicators of blood rheology.

Research and application of cell transplantation in the treatment of diabetes mellitus: a review / 生物医学工程学杂志

In the conventional treatments of type I diabetes, there are various problems. As a new adequate treatment of diabetes, cell replacement therapy of diabetes has been applied and given research priority. We have investigated the applications of cell transplantation in the treatment of diabetes and have retrieved the relevant articles on cells transplantation for the treatment of diabetes. In this paper, we review the history, development, merits and demerits of cell transplantation and the recent advances in pancreatic islet transplantation research. The latest progress in the induction of stem cell to differentiate into the insulin-producing cells was also introduced.

Fallopian Tube Interstitial Pregnancy:Transvaginal Color Doppler Ultrasound Diagnosis / 实用放射学杂志

Objective To study the clinic diagnostic value of transvaginal color Doppler ultrasound(TVCDU)in fallopian tube interstitial pregnancy.Methods US 2D images,blood distribution and frequency spectrum of 28cases with fallopian tube interstitial pregnancy proved by pathology were analyzed retrospectively.Results Before the operation,17 cases of fallopian tube interstitial pregnancy were diagnosed by US(17/28,61%),the signs included asymmetrical enlargement uterus,bulging uterine angle on one site,pregnancy sac or mass in the bulging uterine angle,the mass was discontinuance with the endometrium,which enveloped thin or thick muscle.The fallopian tube interstitial pregnancy could be divided into three types on US: blastula type(N=7),inhomogeneous mass type(N=16) and rupture type(N=5).Conclusion TVCDU is of important clinic value in the early diagnosis and differential diagnosis of fallopian tube interstitial pregnancy.