With the introduction of Western Medicine, the hospital began to be center of medical practice in the Republic of China, the masses knew the Western Medicine gradually and accepted it. Due to many reasons, conflicts between doctors and patients occurred during medical practice, even disputes between doctors and patients were sued, which were called" cases of medical disputes" at that time. To dissect typical cases, analyze the reasons for formation of medical disputes, expect reference to problems of medical disputes at present.

OBJECTIVE To study anatomical features of the cavernous segment of the internal carotid artery(ICA)via the extended transsphenoid approach under endoscope.METHODS Extended transsphenoid approach was performed on 11 adult cadaver heads.The appearance features of the cavernous segment of the ICA and its vessel branches were observed under endoscope.RESULTS The cavernous segment of the ICA can be divided into 5 segments and has 3 vessel branches.The optico-carotid recess is the landmark to define the ICA and optic nerve during operation.The optico-carotid recess is located between internal carotid and optic prominences,all of them are located on the lateral wall of the sphenoid sinus.CONCLUSION The cavernous segment of the ICA is the most important anatomic structure via the extended transsphenoid approach.The cavernous segment of the ICA,branch vessels,and important nerve tissue structures can be clearly visualized under endoscope via the extended transsphenoid approach.An extended transsphenoid approach with the help of an endoscope is an optimal surgical approach for the lesions that invade the internal wall of cavernous sinus.

Objective To evaluate the role of nucleotide‐binding oligomerization domain 2(NOD2) stimulation in innate immuni‐ty against M ycobacterium tuberculosis .Methods Plate counting as used to evaluate the effect of resisting M ycobacterium tubercu‐losis in human alveolar macrophages .Intracellular NOD2 expression were detected by flow cytometry .Quantitative real‐time PCR was performed to determine the NOD2 ,inducible nitric oxide synthase(iNOS) ,and DEF4B mRNA expression levels using the com‐parative threshold cycle method of relative quantitation .Reactive oxygen species(ROS) were detected by the DFCH probe .Results NOD2 stimulation enhanced the control of intracellular mycobacterial growth in human alveolar macrophages .Although ROS con‐centration did not changed ,the secretion of Nitro Oxygen and the expression of cathelicidin DEFB4 were significantly increased fol‐lowing NOD2 stimulation in human alveolar macrophages .Conclusion NOD2 stimulation may be involved in the early innate con‐trol of Mycobacterium tuberculosis primary infections inducing the generation of Nitro Oxygen and the peptides cathelicidin DEFB4 .

Purpose To study X-ray and CT findings of pulmonary infection in AIDS. Methods We evaluate 10 cases who have chest abnormalities. The all patients have X-ray and CT examination. Results Imaging of pulmonary tuberculosis in AIDS, including infiltrative imaging and diffuse patchy imaging, enlarged mediastinum lymph nodes and extra chest enlarged lymph nodes. The imaging of legionella species is infiltrative imaging. Carinii pneumonia appearances diffuse infiltrative and interstitial abnormalities. Conclusion Pulmonary tuberculosis, legionella species and carinii pneumonia are common infections in AIDS. The patchy, consolidations, diffused diseases and enlarged lymph nodes are important imaging appearances.

AIM: To investigate the protective effects and its mechanism of Ginkoglide A on stress ulceration in fats. METHODS: Wistar rats were randomly assigned to control, and Ginkgolides pretreatment group. The stress ulceration was produced by water immersion restraint, and gastric myoelectric activity during during was recorded by implanting electrodes in the stomach antrum smooth muscle. The malondialdehyde (MDA) concentration and superox- ide dismutase (SOD) activity in plasma, and gastric mucusal lesions were examined after the rat was killed. RE- SULT: Compared with the control group, previous intraperitoneal administratin of Ginkgolide A (5 - 20 mg/kg) not only had a highly significant decrease on stress - induced myoelectric activity disorder (P

Palliative care is a way to help end-of-life populations improve their quality of life， and its development in practice cannot be separated from the level of education in palliative care. At present， some medical schools in palliative care education compared with western developed countries have problems such as imperfect construction of hospice curriculum system， lack of medical students’ hospice knowledge； insufficient interdisciplinary teaching faculty， weak palliative care awareness of medical students； single teaching evaluation mode； weak palliative care practice teaching links. To this end， it is necessary to improve the palliative care curriculum system， explore rich and diverse teaching methods； strengthen interdisciplinary teaching and faculty development， enhancing the awareness of palliative care among medical students；establish a scientific and effective evaluation method， carry out multi-dimensional dynamic assessment； expand the palliative care practice teaching base， and accurately improve the practical skills of medical students in palliative care， and other countermeasures to improve the level of palliative care education， and to help the strategy of Healthy China.

Objective To study the morphological appearance and pathological basis of the fine pulmonary reticulation at HRCT.Methods One hundred and seven patients were analyzed about the morphology findings and dynamic changes on pulmonary HRCT.Twenty-four coal worker's pneumoconiosis(CWP)specimens were examined to make comparison between CT and pathology.The data was analyzed by using the Chi-square test.Results The reticular gap was less than 3 mm in diameter.The morphology of reticulation was round or irregular.Pulmonary parenchyma was seen between the gaps.The reticular wall was smooth or coarse.The thickness was less than 1 mm.One hundred and seven patients had accompanying signs including ground-glass opacity(68.2%,73 patients),crazy paving(23.4%,25 patients),interlobular septal thickening(84.1%,90 patients),emphysema(32.7%,35 patients),interface sign(58.9%,63 patients),traction bronchiolectasis(41.1%,44 patients)and honeycombing(26.2%,28 patients).The differences of the honeycomb,traction bronchiolectosis,interbobular septal thickening,interface sign and paving were statistically significant between the fibrotic group and pneunonia(P＜0.01).Pneumonia showed extensive area of ground-glass opacity(GGO)with fine reticulation.Fine reticulation with both interlobular septal thickening and small nodules were observed more frequently in lmphangitic carcinomatosis.Idiopathic pulmonary fibrosis(IPF)showed fine reticulation among the honeycombing.Connective tissue disease (CTD)showed fine reticulation with rarely honeycombing and it could be partly absorbed.Fine reticulation with emphysema was seen in chronic bronchitis.In the 58 follow-up patients,the fine reticulation increased in 26 patients,decreased or disappeared in 22 patients and showed no change in 10 patients.The major pathological basis of the fine reticulation was intralobular interstitial thickening,including fibrosis hyperplasia,inflammatory cells and tumor cells infiltration,effusion filling,smut deposition and so on.Conclusions The fine reticulation was caused by intralobular interstitial thickening including inflammation,interstitial hyperplasia,pulmonary fibrosis and tumor.The fine reticulation is helpful to prompt the diagnosis of these diseases,but the diagnosis need its combination with the other CT findings and dynamic changes.

Objective To evaluate the effect of biofeedback therapy for the treatment of myogenic fecal incontinence. MethodsA general assessment about anorectal function was made on 17 cases receiving biofeedback therapy including muscle power training,sensory training and coordination training. Results The clinical scores before and after biofeedback therapy were 1.66?0.23,3.80?0.42 respectively,with an effective rate of 82%. The anus maximum contracting pressure elevated,(73?20) mm Hg vs. (123?30) mm Hg; myoelectric amplitude increased,(122?32) ?V vs. (230?41) ?V;Contracting time prolonged,(4.1?2.0) s vs. (9.4?3.0) s; The sensory threshold was lowered,(50?12) ml vs. ( 20? 10) ml;The feel-contract time increased,(3.1?0.4) s vs. (1.2?0.3) s. Positive rectal contraction reflex was seen in 41% patients before therapy compared with 82% after therapy. Conclusions Biofeedback therapy increases contractility of sphincter,decreases threshold of rectal sensory,and is a therapy of choice for myogenic fecal incontinence.

Objective To describe varied features of pulmonary metastases of lung cancer on CT imaging .Methods 194 patients with pulmonary metastases of lung cancer were evaluated on CT scan , including 106 men and 88 women . The median age of the patients was 45 years ( range from 22 to 78 years ) . The histology of the lung cancer included 56 squamous carcinomas(28.9%),107 adenocarcinomas(55.2%),26 small cell carcinomas(13.4%),and 5 adenosquamous carcinomas(2.1%).Results The usual pattern of pulmonary metastases of lung cancer were parenchyma nodules. The unusual form of metastases that were mainly found in adenocarcinomas were cavitary lesions, ground-glass nodules and lesions with unusual signals including lobulated structure, spiculated margin,pleural indentation and air-bronchogram. The manifestations of lymphangial spread to intrapulmonary were extensive uneven thickening of the interlobular septa and fissures, nodular thickening of brochovascular bundles and many fine nodulars distributed along the brochovascular bundles and interlobular septa.Conclusion The manifestations of intrapulmonary metastases of lung cancer are varied morphologic features.

Objective To study HRCT appearances,clinic value and pathological fundament of the pulmonary honeycombing.Methods 60 patients including three groups with pulmonary honeycombing underwent HRCT scan.The comparative study of HRCT-pathology was done in 6 pulmonary postmortems with honeycombing.Results On HRCT images,honeycombing cysts were round-like with air inside,the cyst walls included remains of pulmonary inherent components and hyperplastic fibrotic tissue in pathology.The diameter of cysts was small,58 cases of them belonged to small group(90.6%).The distribution of lesions was mainly at lower(47cases,71.9%)and peripheral lung zone(52cases,81.3%),but there were differences in different type of the diseases.The cysts might become larger and it is impossible to recovery.Conclusion The honeycombing cysts appear as cystic cavities arranging as multiple layers,the cystic walls consist of different tissues in pathology,that are the manifestations of the end-stage of pulmonary fibrosis.HRCT appearances in different patients in three groups were different.