One hundred cases with pneumatized sphenoid sinus were studied, based on the cranial X-ray film, sagittal tomograms and coronal CT scan as well as the observation during the course of operation. A new bilateral combination classification scheme was suggested and used in this study. It was shown that the identical type was 58% and non-identical, 42% and the former could be further divided into 5 subtypes and the latter, 10 subtypes. The incidence of supra-sphenoid-ethmoidal cell (SSEC) was 22%. Some of SSEC may be mistaken for sphenoid sinus, if the surgeons are not familiar with its anatomy. We emphasize that the bilateral combination classification is very important for selecting a suitable method from among different trans-naso-sphenoid approaches.

Multi-partners,unprotected sex,and alcohol and drug use are the main causes of HIV/STD transmission among MSM,and related interventions should be taken promptly.MSM are good candidates for studies and interventions as the retention rate is relatively high among this population group.

The reasonable distribution of healthcare human resources is the fundamental requirement to improve medical efficiency and service quality,satisfy public's diverse requirement for medical care,and realize medical service fairness.However,various factors hinder the reasonable distribution of healthcare human resources and the realization of medical service fairness in the present medical system,including the imperfect system of human resources management,the immature system of performance appraisal,the imbalanced development of different regions,and the unpleasant environment of medical practice.This paper reflects on those issues from an ethical perspective.

Visceral hypersensitivity is the core pathogenesis process of functional gastrointestinal disorders( FGIDs). Numerous studies showed that psychological stress plays a key role in the development of visceral hypersensitivity. Brain center is the key part involved in psychological stress-induced visceral hypersensitivity, especially senior central sensitization. However,the specific pathophysiological mechanism remains unclear. This article reviewed studies on central role mechanism of psychological stress-induced visceral hypersensitivity.

Objective To establish a method for determining the content of Naringin and Hesperidin in Zengshi Keli by HPLC. Methods The Kromasil C18 column with acetonitrile-water-phosphoric acid (20∶80∶0.02) as the mobile phase was used. The flow rate was 1.0 mL/min, the detective wavelength was 283 nm, the temperature of column is 35 ℃. Results The calibration curve were linear in the range of 0.178 5～0.892 5 ?g for Naringin and 0.073 68～0.368 4 ?g for Hesperidin (r=0.999 9) respectively. The average recovery was 97.24% (RSD=1.21%) and 96.95% (RSD=1.49%) respectively. Conclusion The method was simple, accurate, reproducible and can be used for quality control of Zengshi Keli.

Objective To find out the optimum extraction process for Weiweining pill. Methods The extraction process was studied by uniform design with the yield of extracted Paeoniflorin, n-butanol extract and ethyl acetate extract as markers. Results The optimum extraction process was adding 16 times amont of 60% alcohol, refluxing and extracting for 2 times, 65 min for each time. Conclusion This extraction process shows good stability and is available for the production of Weiweining pill.

Drug resistance is the most important obstacle in the treatment of cancer.People can know more about the mechanisms of drug resistance by study of cancer stem cells,and then identify new therapeutic targets and to develope better anticancer strategies.If we regard cancer stem cells as the therapeutic targets we can selectively kill cancer stem cells without harming normal ones,so overcome the drug resistance and avoid cancer relapse or metastasis.

Objective To investigate the efficacy of minimally invasive treatment by combination of external fixation with limited internal fixation for unstable distal radius fractures. Methods From September 2003 to September 2007,43 patients with unstable distal radius fractures were treated with external fixation combined with Kirschner wire fixation. According to AO classification,there were 10 cases of C1,21 cases of C2,and 12 cases of C3. Two external fixation clamp stand screws were inserted into the dorsal radius in operation,then external clamp stand was fixed when manipulative reduction were performed after C-arm perspective. The broken bones were sledged by Kirschner wire when articular facet and bone block were not peaceful and could not achieve reduction by traction. When the bone block was instable,a Kirschner wire fixation was needed. Bone graft through a limited incision were performed for bone defect if necessary. Results All of the 43 cases achieved anatomical reduction after the operation. The mean operaton time was 62.4 min (range from 43 to 121 min). And the mean intraoperative blood loss was 15.3 ml (ranged from 6 to 30 ml). The patients were discharged from hospital in 3 to 14 days with a mean of 5.5 days. After being discharged,they were followed up for 6 to 24 months (mean,12 months),during which,re-examination showed bone union and improved articular activities in all the cases. According to the Dienst scale system,30 patients achieved excellent,8 were good,and 5 were fair. The rate of excellent and good results was 88.4% (38/43). Conclusion External fixation combined with limited internal fixation is a simple,reliable and effective method for treatment of the unstable distal radius fractures.

Objective To study the pattern of intragastric acid secretion in bleeding ulcer patients to assess the role of gastric acid suppression in the prevention and treatment of ulcer bleeding.Methods 43 cases of peptic ulcer(PU) with ulcer bleeding and 53 cases of age-and sex-matched PU controls without ulcer bleeding were included. All patients received 24 hours gastric pH monitoring. PU was diagnosed by endoscopy. Hp infection was diagnosed by rapid urinase test, biopsy and C 13 breath test.SPSS software was used for statistic analysis.Results In bleeding group, average gastric pH in supine was 1 6,and the percent of accumulative time and the longest lasting time within 0～1 of gastric pH in supine were 21% and 26 0 minutes respectively,while in control group those were 2 0%, 4 5 minutes respectively.However, no differences of gastric pH were found between severe bleeding patients and other bleeding ones. Hp infection rate was 56 1%,54 8% in bleeding group and control group respectively.Conclusions Multiple factors might induce peptic ulcer bleeding. Higher gastric acid secretion at night might be one of the risk factors causing peptic ulcer bleeding.It is suggested that giving PU patients with a high risk of bleeding some acid inhibitor before sleeping may prevent PU hemorrhage. Hp infection may be the direct risk factor leading to ulcer bleeding.

Objective To explore the relationship between nonalcoholic fatty liver (NFALD)and apolipoprotein E (ApoE)gene polymorphism in Shanghai undergraduate students. Methods A cross-sectional survey was performed in 4 148 students from Shanghai Tongji University. Quesgionary, physical measurement, ultrasonography and biochemical parameters were used to diagnose NFALD. In patients with NAFLD and 200 healthy subjects (served as control), ApoE genotypes were determined by PCR-RFLP. Results (1)Totally 398 subjects were diagnosed as NAFLD (prevalence 9.6%). Body mass index, waist-to-hip ratio, triglycerides, total cholesterol, alanine transaminase, aspartate aminotransferase and γ-glutamyltransferase in NAFLD group were higher than those in control, which were related to the degree of NAFLD (P＜0.01). (2)ApoE genotypes distributions were significantly different between two groups (χ2=10.52, P＜0.01). In NAFLD,E4/4 genotype frequency (5.5%)increased, and E3/3 (61.8%)decreased . (3)Unconditional logistic regression showed that E4/4 were closely associated with lipid profiles. Conclusion ApoE point mutations 112 and 158 may cause different dyslipidosis. E4/4 genotype seems to be one of the genetic predisposition factors of NAFLD.