OBJECTIVE To demonstrate the bleeding sites and the major blood supply in patients with hidden epistaxis. METHODS The clinical data of 106 patients with hidden epistaxis were studied retrospectively. The bleeding sites and hemorrhagic focus was not found by routine anterior nasoscope examination was defined as hidden epistaxis. The bleeding sites were located and the bleeding was stopped under nasal endoscope. RESULTS The hemorrhagic foci were found in the following sites: 55.7%(59/106)at the top of inferior meatus, 33.0% (35/106)middle turbinate and the top of middle meatus, 9.4%(10/106)olfactory cleft and the nasal septum, and 1.9%(2/106)unknown. The bleeding sites were found and the bleeding was stopped with radiofrequency under nasal endoscope in 104 cases. Bleeding was stopped by treatment once in 102 cases(96.2%)and treatment twice in 2 cases(1.9%). All the patients were followed up for over one month without recurrence and the cure rate was 98.1%. Bleeding sites were not found in 2 cases because of heavy damage of the nasal mucosa. CONCLUSION ①The majority of hidden epistaxis is supplied by the sphenopalatine artery. ②To find the bleeding sites and stop the bleeding in hidden epistaxis patients under nasal endoscope using radiofrequency is effective, minimally invasive and worth of clinic application extensively.

AIM: To study and analyze the clinical efficacy of diclofenac sodium eye drops combined with sodium hyaluronate eye drops in treating dry eyes after ophthalmic surgery.METHODS: Totally 94 eyes from 94 patients with dry eyes were slected, and they were randomly divided into orbervation group and control group.Fouty-seven patients in the control group using conventional treatment combined with sodium hyaluronate eye drops.Other 47 patients in orbervation group were treated with diclofenac sodium eye drops on the basis of control group.We compared symptoms, fluorescein station, tear film break time, Schirmer Ⅰ test between the two groups.RESULTS: Compared with before treatment, patients of both groups with sympotom, fluorescein station score, BUT, and Schirmer Ⅰ test were significantly improved(P<0.05).At the same time, sympotom, fluorescein station score, BUT and Schirmer Ⅰ test of control group were better than observation group(P<0.05).The cure rates of the orbervation group (98%) were more significant than control group (74%)(P<0.05).CONCLUSION: Diclofenac sodium eye drops combined with sodium hyaluronate eye drops have significant efficacy in treatment of dry eyes after ophthalmic surgery, which can effectively relieve clinical symptoms, improve BUT and Schirmer Ⅰ test.

Objective To evaluate the clinical effect of group cognitive behavioral therapy on blood glucose levels,anxiety and depression in patients with type2 diabetes mellitus.Methods Ninety three patients with type 2 diabetes mellitus were recruited and randomly divided into intervention group (n =48) and control group (n =45).Both groups received diabetes health education,patients in intervention group received additional group cognitive behavioral therapy.The glucose tolerance,glycosylated hemoglobin A1c were measured; the HAMA(Hamilton Anxiety Scale)scores,HAMD(Hamilton Depression Scale)scores and CSQ (Coping Styles Questionnaire) scores in patients were analyzed before and 6 months after treatment.Results After 6-month treatment the fasting blood glucose (6.33 mmol/L vs.5.94 mmol/L),1 h postprandial plasma glucose(12.40 mmol/L vs.11.46 rmool/L),2 h postprandial plasma glucose (10.24 mmol/L vs.9.13 mmol/L),A1 c (6.31％ vs.6.07％) in intervention group were decreased significantly,compared to baseline values (all P ＜ 0.05).The HAMA total score (9.98 vs.8.14),somatic anxiety (3.98 vs.3.48),psychic anxiety(6.00 vs.4.67),HAMD total score(10.74 vs.6.93),anxiety somatic(5.02 vs.3.26),block(2.24 vs.1.38)and sleep disorders(2.40 vs.1.40)in intervention group were all decreased significantly(P ＜ 0.01 or 0.05).There were significant differences in HAMA total score (8.14 vs.9.15),HAMD total score(6.93 vs.9.33),anxiety somatic(3.26 vs.4.38),block(1.38 vs.1.98)and sleep disorders(1.40 vs.2.03)between the intervention group and control group(P ＜ 0.01 or 0.05).And the negative coping style scores in intervention group was also lower than that of the baseline (26.74 vs..29.43).Conclusion The group cognitive behavioral therapy combined with diabetes health education for patients with type 2 diabetes mellitus may improve the glucose metabolism and depression and anxiety status of patients.

BACKGROUND: Cancer stem cells have bean a hot topic in life science research. EpCAMhigh/CD44+ colorectal cancer stem cells are beneficial to observe morphological characteristics and distribution of cancer stem cells.OBJECTIVE: To investigate the quantity, location, distribution and hematoxylin-easin staining morphologic features of colorectal cancer stem cells (Co-CSCs).DESIGN, "rIME AND SETrlNG: The observational study was performed at the Department of Pathology, Lanzhou General Hospital of Lanzhou Military Area Command of Chinese PLA from March to August 2008.MATERIALS: A total of 67 colorectal cancer paraffin embedding samples were collected from 200512007 archive at the Department of Pathology, Lanzhou General Hospital of Lanzhou Military Area Command of Chinese PLA, comprising 27 males and 40 females, aged 29 90 years.METHODS: EpCAM and CD44 was used to label cancer stem cells in paraffin embedding colorectal cancer samples. The locations of EpCAM and CD44 double positive cells were detected by SP(streptavidin HRP) immunohistochemical staining and double immunohistochemical staining. The morphologic features of them were investigated on hematoxylin-easin staining at the same position.MAIN OUTCOME MEASURES: Number, location, distribution of EpCAM and CD44-posltive cells, and morphology following hematoxylin-eosin staining.RESULTS: The number of double-positive cells accounted for 0.1% to 30.0% of all tumor cells, and the cells were scattered or distributed focally along the basement of glandular-like structure. The cells with scarcely cytoplasm were cube or oval, and its nucleus was oval or high cylindrical, deep stained and homogeneous; The quantity of double-positive cells were negatively correlated with the differentiation of colorectal cancer.CONCLUSION: Cancer stem cells are the causes of tumor development, metastasis and recurrence and drug resistance. To observe the number, location, distribution and morphology of Co-CSCs and to analyze the relationship between Co-CSCs and pathological parameters will provide guidance for the diagnosis, staging, prognostic evaluation and clinical prognosis of cotorectal carcinoma.

Objective To investigate the characteristics of cerebral vascular imaging and risk factors of stroke in popu?lation with family history of stroke in rural areas of Ji County, Tianjin. Methods The volunteers with family history of stroke were recruited in the study to undergo computed tomography and computed tomography angiography (CTA) of head as well as physical and laboratory examinations. A total of 281 subjects, including 153 male and 128 female, underwent exami?nation, and were divided into stroke group and non-stroke group. Results The detection rates were significantly higher in male subjects than those of female subjects, including smoking rate, drinking rate, educational level, and decreased level of high density lipoprotein cholesterol (HDL-C), whereas the detection rate of high level of triacylglycerol (TG) was significant?ly higher in female than that of male subjects (P<0.05). There were 38 subjects in stroke group. The age, internal carotid ar?tery calcification rate (ICAC) and internal carotid artery tortuosity (ICAT) rate were significantly higher in stroke group than those of non-stroke group (P<0.05) . The results of multivariate Logistic regression analysis indicated that age, hyperten?sion, ICAC, and ICAT were independent risk factors for stroke. Conclusion For population with family history of stroke, age, hypertension, ICAC and ICAT were risk factors of stroke.

Objective To find a selection method system appropriate for China's essential drug list.Methods Collection and analysis of technical paper literature on essential drug list developement,adjustment technical papers,and literature on evidence-based medicine,pharmacoeconomics evaluation,and medical insurance budget analysis from WHO and other countries.On such basis,a method system for selecting China's essential medicine list can be proposed,with its feasibility analyzed and demonstrated.Results The GRADE assessment proposed by WHO was used to evaluate the efficacy and safety of the drug;the pharmacy economics evaluation is added to assess the economic efficiency;these were aided by the pharmacoeconomics evaluation for a comprehensive evaluation of the pharmacoeconomics of the drug in question,supplementing analysis of the medical insurance,and ensuring its affordability of essential medicine so selected.The theory of this system is well developed,and supporting software ready for application.Examples in Zhejiang Province regarding essential medicine for diabetes have proved this method feasible.Data acquisition constitutes a major roadblock for scientific selection due to barriers against medical insurance data sharing.Conclusions Theoretic basis and method tools are fully available for essential medicine selection,and the selection method system as proposed in this study prove feasible to some extent.Decision makers are recommended to scientifically select the essential drugs,and to encourage data sharing,in order to make the list more scientific and pragmatic.

AIM:To observe the changes of tear film on the patients after laser in situ keratomileusis ( LASIK) with corneal flap created by femtosecond laser with Oculus corneal topography.
METHODS:Totally 120 myopic patients (240 eyes) were collected who underwent femtosecond laser surgery LASIK from August to September 2013, and these patients can be followed up for 3mo. Tear break-up time ( BUT) and tear meniscus height ( TMH ) with Oculus corneal topography were recorded preoperatively and postoperatively at 1wk;1, 2 and 3mo.
RESULTS: Oculus BUT: there existed obvious differences (P=0. 012, 0. 000, 0. 023<0. 05) in 1wk, 1 and 2mo compared with the preoperative level. While no such obvious difference ( P = 0. 236 > 0. 05 ) existed in 3mo compared with the preoperative level. TMH:there existed obvious differences (P=0. 025, 0. 019, 0. 026<0. 05) in 1wk, 1 and 2mo compared with the preoperative level. No such obvious difference ( P = 0. 375>0. 05 ) existed in 3mo compared with the preoperative level.
CONCLUSION: Femtosecond laser surgery affects the stability of the tear film at a certain time and a certain extent. The mechanism related to many factors. It is temporary and lighted.

AIM: To observe the changes of tear film on the patients after laser in situ keratomileusis ( LASIK ) with corneal flap created by femtosecond laser with the different gender.
METHODS: The 120 myopic patients ( 240 eyes ) who underwent femtosecond laser surgery LASIK from August to September 2013 were collected, and these patients were followed up for 3mo. The patients were divided into two groups according to the gender, group A was male (110 eyes of 55 patients); group B was female (130 eyes of 65 patients). Dry eye symptom score, tear break-up time ( BUT ) , Schirmer Ⅰ test, corneal fluorescein staining were recorded preoperatively and postoperatively in 1wk,1,2,3mo.
RESULTS: Dry eye symptom score: it was statistically significant between two groups after operation in the 1wk, 1, 2mo(P = 0. 000,0. 023, 0. 030). It had no statistical significance between the two groups in 3mo(P=0. 283). BUT: it was statistical significance between two groups after operation in the 1wk, 1, 2, 3mo ( P= 0. 000, 0. 017, 0.026, 0. 032 ). Schirmer Ⅰ test: it was statistically significant between two groups after operation in the 1wk, 1, 2mo(P = 0. 012,0. 024, 0. 018). It had no statistical significance between the two groups in 3mo ( P=0. 206 ) Corneal fluorescein staining:it was statistically significant between two groups after operation in the 1wk, 1, 2, 3mo (P=0. 022,0. 015, 0. 036, 0.041).
CONCLUSION: The influence of tear film after femtosecond laser surgery for men less than that for women.

To observe the changes of tear film on the patients after laser in situ keratomileusis(LASlK)with corneal flap created by femtosecond laser and microkeratome.
●METHODS: Totally 150 patients (300 eyes) with myopia received operation of LASlK. Patients were divided into two groups according to the methods of making corneal flap. The patients of group one were assigned to receiving LASlK with corneal flap creation by lntralase femtosecond laser (190 eyes of 95 patients), group two were assigned to receiving LASlK with corneal flap creation by microkeratome ( 110 eyes of 55 patients ). Dry eye symptom score, tear break-up time (BUT), Schirmer Ⅰtest(Slt), corneal fluorescein staining(FL)were recorded preoperatively and postoperatively at 1wk; 1, 3 and 6mo.
●RESULTS: Dry eye symptom score: there existed obvious differences at 1wk; 1, 3mo between two groups(P<0. 05). While no such obvious differences existed in the 6mo between two groups(P>0. 05). BUT: there existed obvious differences at 1wk, 1, 3mo between two groups(P<0. 05). While no such obvious differences existed at 6mo between two groups(P>0. 05). SchirmerⅠ test: there existed obvious differences in the 1wk, 1, 3mo between two groups(P<0. 05). Whileno such obvious differences existed in the 6mo between 2 groups(P>0. 05). FL: there existed obvious differences in the 1wk, 1, 3mo between two groups(P<0. 05). While no such obvious differences existed in the 6mo between two groups(P>0. 05).
●CONCLUSlON: The early stability of tear film decrease after operation in both of the two groups. The dry eye symptoms are lighter and recover faster.

Objective To find out the situation of Kashin-Beck disease and it's dynamic changes in Yan'an city, and provide basis for decision-making on prevention and control of the disease. Methods In accordance with the national monitoring program on Kaschin-Beck disease, 21 villages were selected from 6counties in Yan'an, clinical and X-ray inspection of 7 to 13 year-old children were made according to historical illness information from 2006 to 2008. Clinical monitoring on Kashin-Beck disease was made in 2008 for people over 16 years old from 5 villages in 5 counties. Results One thousand and one hundred eighty children were found positive with the illness from 2006 to 2008, with 7 cases of grade Ⅰ , the detection rate was 0.59%(7/1180).One thousand and one hundred sixty-two people were taken X-ray photo on right hand, with no positive case found.In 2008, 1444 adults were taken clinical examination, the detection of grade Ⅰ and over were 160 cases, the detection rate was 11.08%(160/1444), mainly in the age of 36 years[93.75%(150/160)]. Conclusion KashinBeck disease in Yan'an city is in stable condition, but surveillance and preventing measures are stilled needed.