The open-closed question of TCM theoretical system, which based on the ancient ideology, was always the core question which the scholars pestered. In four aspects: "the concept of yin-yang and wuxing——TCM methodology cornerstone, the TCM theory construction methodology, macroscopic judgment randomness of the human body pathology mechanism, the difficult problem of TCM theory extension",this article had analyzed this question and tried to elaborate it. The authors considered that TCM standed in the closed-like theoretical system of yin-yang and wuxing, the objective idealism speculation was its essential characteristics. TCM developed from this and kept its step originally also.

Objective The anterior dentition defects of geriatric patients were restored with modified fixed Maryland Bridge.The clinical design,tooth preparation,fabrication of prosthesis and clinical indication were summarized.Method 24 cases of geriatric patients with anterior dentition defects were restored with modified fixed Maryland Bridge.All selected cases were accompanied with different degree of loosening of neighboring teeth,gingival atrophy and exposure of root.The dentition defects were successfully restored and followed up for 3 to 5 years.Results The overall success rate was 87.5%.Three patients had the prosthesis loosened and re-bonding was necessary.No loosening was found in other patients.There was no swelling or inflammation of gingival underneath the prosthesis.All patients were quite satisfactory with the function and appearance of the prosthesis.Dental calculus was observed in 12 patients,and 2 patients complained of a feeling of foreign body on the side of tongue.Conclusion The modified fixed Maryland Bridge,when used in restoring the dentition defect of geriatric patients,showed the advantages of less tooth reduction,perfect esthetic effect,good fixation of loosening teeth as well as restoration of missing teeth with its splint wings.However,the long-term effect of this technique needs to be further observed.

Objective To evaluate the clinical effect of removable partial denture combined with composite resin veneer on occlusal reconstruction for aged patients with dentition defects,and discuss the critical steps of operation.Methods From Mar.2002 to May 2003,16 outpatients with Kennedy 1 type dentition defects with severe anterior attrition were selected.The distal extension removable partial denture(RPD) was used to reestablish the occlusal vertical dimension.The anterior teeth were bonded with the light-cured composite resin based on removable partial denture.The therapeutic effects for all the patients were assessed at 3-month,2-year and 4-year follow-up after treatment.Composite resin restorations were evaluated with modified USPHS criteria,and removable partial denture were assessed by routine examination and subjective questionnaire.Results After 4 years of observation,all prosthesis remained in good condition.The masticatory ability was increased than ever before and the patients were satisfactory with the esthetic appearance of dentures.The remaining rate of light-cured composite resin was 85.7% 4 years after reconstruction,fulfilling the requirements of esthetics and function.Meanwhile,the dental structure could be preserved and the unsatisfactory appearance of removable partial denture was improved by light-cured composite resin.Conclusions The dentition defects of aged people may be effectively restored by combined application of removable partial denture and composite resin veneer.This treatment has many advantagcs,including less trauma,economy and satisfactory in esthetics,and besides,it may better preserve the dental structure.This treatment is well accepted by aged patients,so it is worthy to do further clinical study.

Objective To compare the concentrations of alpha-enolase (ENO1),CYFRA21-1,and CA125 in the patients with malignant pleural effusion ,tuberculous exudative pleural effusion ,or parapneumonia pleural effusion. To explore the clinical value of ENO1 in pleural effusion combined with serum CYFRA21-1 and CA125 in diagnosis of malignant pleural effusion. Methods Enzyme-linked immunosorbent assay(ELISA)was used to detect the concentration of ENO1 in pleural effusions. The concentrations of CA125 and CYFRA21-1 in the blood samples were measured using chemiluminescence and magnetic particle-based chemiluminescence respective-ly. The sensitivity and specificity of ENO1 combined with serum CYFRA21-1 and CA125 detection were calculated. Results The concentration of ENO1 in malignant pleural effusion group was significantly increased(P<0.001);the concentrations of ENO1 did not differ significantly between tuberculous exudative pleural effusion and parapneu-monia pleural effusion(P>0.05). The sensitivity and specificity of ENO1 combined with serum CYFRA21-1 and CA125 detection in malignant pleural effusion were 94％ and 74％,98％ and 98％,respectively. Conclusions ENO1 combined with serum CYFRA21-1 and CA125 detection can improve the sensitivity of diagnosis of malignant pleural effusion and enhance the diagnostic rate of malignant pleural effusion.

OBJECTIVE：To st udy the chemical constituents of diterpenoids from Buyi medicine Isodon coetsa ，and to provide reference for the development and utilization of the medicinal resources. METHODS ：The 95％ methanol extract of Buyi medicine I. coetsa were isolated and purified with silica gel column ，Sehadex LH- 20 gel column and MCI column. The structures of the compounds were obtained by spectral analysis （mass spectrum ，hydrogen spectrum and carbon spectrum ），and then compared with active components of Miao medicine “Isodon flavidus ”. RESULTS & CONCLUSIONS ：Ten diterpenoids were obtained from I. coetsa，including rabdocoetsin B （Ⅰ），megathgrin B （Ⅱ），rabdocoetsin A （Ⅲ），enanderianin N （Ⅳ），rabdocoetsin D （Ⅴ）， megathyrin A （Ⅵ），lophanic acid （Ⅶ），rubesanolide D （Ⅷ），excisanin D （Ⅸ），excisanin K （Ⅹ）. The compounds Ⅶ，Ⅸ and Ⅹ were isolated from this specie for the first time. Compound Ⅶ（lophanic acid ）is a common active component in the Buyi medicine I. coetsa and Miao medicine “I. flavidus ”.