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Introduction: Lumbar spinal stenosis (LSS) is caused by structural changes of the spine, which lead to several severe symptoms, including back pain, leg pain, numbness and tingling in the legs, as well as reduced physical function. However, there is little evidence suggesting whether a patient with LSS should be treated with surgery. If surgery is recommended, which type of surgery benefits the patient most? To answer these questions, we will conduct a network meta-analysis and a systematic review to compare surgical and nonsurgical interventions in terms of efficacy as well as safety in adult patients with LSS., Methods and Analysis: We will search the PubMed, Cochrane library, and EMBASE databases for articles published prior to October 10, 2019. We will search for randomized controlled trials assessing surgical and nonsurgical interventions for adult patients with degenerative LSS without any language restrictions. The primary outcome measures will be pain and disability. The secondary outcomes will include adverse events (number of events or number of people with each type of adverse event), reoperations, complications, blood loss and operation time. We will obtain the full texts of the potentially relevant studies and independently assess them. The quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework. A random-effects network meta-analysis will be performed to analyze all the evidence under the frequentist framework, and the ranking results will be presented. We will generate plots depicting the network geometry using Stata. The network meta-analysis will be performed according to the Bayesian framework. Ethics and dissemination Ethics approval is not required. The research will be published in a peer-reviewed journal.

Cerebral hemorrhage may cause cognitive dysfunction. Electroencephalogram (EEG) is a noninvasive diagnostic tool for assessment of cerebral function. A total of 174 patients (including cognitively impaired and cognitively normal) with cerebral hemorrhage, and 120 healthy persons (CN), were recruited between August 2008 and July 2012 at the Department of Neurology. EEG was used to analyze cerebral function of patients and normal persons. Correlation, clustering and concordance analyses were performed to analyze the relationship between EEG power and Montreal Cognitive Assessment (MoCA) scores. Cognitively impaired patients had a significantly decreased EEG beta power (0.793 ± 0.176 µV(2)) compared with cognitively normal patients (1.589 ± 0.205 µV(2), P < .01) or healthy persons (1.651 ± 0.185 µV(2), P < .01). Significantly negative correlations between beta power and hemorrhage region, size, amount, and patients' age were apparent (r = -0.91888, -0.78569, -0.84961, and -0.80365, respectively, all Ps < .001). There was good concordance between the K-means clustering algorithm calculating beta power and MoCA scoring (κ = .904, P < .001). In conclusion, the analysis method of EEG (beta power) abnormalities holds considerable promise to assess cognitive impairment after cerebral hemorrhage. Cognitive impairment was negatively correlated to hemorrhage region, size, amount, and age.

Background: The authors report a new technique of umbilical single-incision laparoscopic surgery (SILS) in the treatment of gastrointestinal stromal tumors (GISTs) of the stomach using conventional laparoscopic instruments., Methods: Preliminary experience with umbilical SILS operation in 13 patients with GIST was introduced., Results: Umbilical SILS operation for GISTs was feasible with conventional laparoscopic instruments. No intraoperative or postoperative complications, such as secondary hemorrhage, anastomotic leakage, or obstruction, were recorded. The patients fully recovered and the single umbilical scar healed well., Conclusion: SILS for GISTs is a feasible and safe technique when performed by experienced laparoscopic surgeons. With advanced surgical technology and technique, truly minimally invasive surgical procedures, such as SILS, are feasible.

Introduction: Laparoscopic hilar cholangiocarcinoma is rarely performed because of its aggressive growth and complicated anatomy. The authors successfully performed single-incision laparoscopic resection of Bismuth I hilar cholangiocarcinoma in 2 cases., Method: Two cases with Bismuth I cholangiocarcinoma were chosen for the laparoscopic surgery. Segmental bile duct resection and hepatoduodenal ligament lymphadenectomy were performed using single-incision laparoscopic technique with conventional instruments., Results: Two operations were successfully performed without conversion. The operation time was 300 and 350 minutes, respectively. The margins of proximal and distal bile ducts were negative. The hospital stay was 6 and 9 days, respectively. One dosage of analgesic was administered after surgery. The abdominal wound recovered very well with good cosmesis., Conclusion: Single-incision laparoscopic surgery cholangiocarcinoma resection can be optional in strictly selected patients with Bismuth I cholangiocarcinoma. Long-term follow-up and more data are needed to evaluate its benefits.

Aim: The authors report 1 case of emergency splenectomy for the treatment of traumatic rupture of the spleen where a laparoendoscopic single-site surgery technique was performed., Method: A 17-year-old male with a diagnosis of traumatic rupture of the spleen underwent emergency transumbilical single-incision laparoscopic splenectomy. Three ports, including 5 mm and 10 mm ports, were placed through a transumbilical incision for the procedure., Results: Intraoperative and postoperative courses were uneventful. The patient was discharged home 8 days after the surgery in a stable condition. Discussion. The Laparoendoscopic single site surgery technique is still in its infancy, but because of its reduced invasion and ideal aesthetic results, it is well received by patients. Improvements are needed to widen its application., Conclusion: To the authors' knowledge, this is the first report where an emergency laparoendoscopic single site surgery technique has been used in the management of a ruptured spleen.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) has been shown to induce cleft palate, in which the molecular etiology of the defect is poorly characterized. Recently, transforming growth factor-beta3 (TGF-beta3) has been indicated to play an essential role in the development of palatal shelves. In this developmental toxicity study, we investigated the effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on the expression of TGF-beta3 in fetal mice. Pregnant C57BL/6 mice were exposed to corn oil or TCDD (32 microg/kg/day 64 microg/kg/day, per os) at embryonic day 10 (ED10), a drastic inhibition of palatal shelves was induced. By using RT-PCR (reverse transcription-polymerase chain reaction) and Western blot, the expressions of TGF-beta3 was investigated. We found that the expression of TGF-beta3 was gradually up-regulated in TCDD-treated group. These results suggest that cleft palate can be induced by TCDD exposure, the modification of TGF-beta3 is related to its pathogenesis.