Volume 89  ·   Issue 14  ·  2009

Clinically, functional gastrointestinal disease (FGID) seriously affects the physical and mental health and quality of life of patients, and there is no evidence of structural or metabolic abnormalities or can explain the symptoms after repeated examination.There are many patients with FGID, and the cost is huge, and a more active and effective diagnosis system is urgently needed in clinic.Some researchers started clinical research on FGID earlier, but due to the great differences in the inclusion criteria of FGID, the clinical significance is limited.

Objeetive To evaluate the therapeutic value of transcutaneous electrical nerve stimulation(TENS)at acupoints in slow transit constipation(STC).Methods Thirty-nine patients with (STC)who met the Rome Ⅲ diagnostic criteria,were randomly assigned to 2 groups:TENS treatment group including 2 males and 18 females,aged(46±14),undergoing TENS at the acupoints ST36(Zusanli)and PC6(Neiguan)twice a day,30 min after breakfast and 30 min before going to bed,for 2 weeks,and control group,including 2 males and 17 females,undergoing sham TENS treatment at 2 sham acupoints.Questionnaire survey was conducted to investigate the dyrschesia scores.Self-rating depression scale(SDS)and self-rating anxiety scale(SAS)were used to assess the depression and anxiety status.X-ray examination with barium strips.radio-opaque marker,wag used to detect the colonic transit status.Results (1)The dyschesia symptom total score after treatment in the TENS treatment group was(9.05±0.58),significantly lower than that before treatment(18.30 ±0.45,P<0.01),and the oppilative symptom total score after the sham treatment of the eontrol group was(18.00±0.46).not significandy dliferent from that before the treatment(18.03 ±0.45.P>0.05).(2)The number of vestigial barium strips of the TENS treatment group was(7.2±1.2),significantly lower than that before treatment(15.1±1.1,P<0.01),and the change was especially obvious in the colon sector(3.3±0.8 vs 11.0±1.0,P<0.01).However,there was no significant difference in the number of barium strips in the control group before and after the sham treatment.(3),The score of SDS and SAS of the TENS treatment group after the treatment were 34.7±0.9 and(43.7±1.5 respectively,both significantly lower than those before the treatment(37.3±0.9 and 48.1±1.8 respectively,both P<0.05),however,there were not significant differences in the SDS and SAS scores before and after the sham treatment in the control group.Conclusion TENS at the aeupoints Zusanli and Neiguan is capable of improving the oppilative symptoms and ameliorating anxiety and depression state,promoting colonic transit in STC patients.

Objective To establish the methodology of 3-dimensional CT reconstruction of colon and rectum in evaluating anorectum and pelvic floor function.Methods 19 healthy volunteers,8 males and 11 females,aged 42.8,received both defeeography and 3-dimensional CT reconstruction of colon and reetum.Relevant parameters were compared between the two methods. Results (1)CT reconstruction shewed that the average vahe of anorectal angle(ARA)was(101±13)°when resting,(83±12)°when squeezing,and(124±13)°when defecating;the average values of the distance between the upper part of anal canal and the pubocoecygeal line(DUAC)was(10±6)mm when resting,-2(-8-3)mm when squeezing,and(27±11)mm when defecating;and the average value of the anal canal length(ACL)was (29 ±7)mm when resting,(39±8)nlin when squeezing,and(22 ±5)mm when defecating.The change trends of ARA,DUAC,and ACL during squeezing and defecating in CT reconstruction were the same as those in defecography.(2)No significant differences were found in ARA and ACL meagured by the two methods;but the DUAC values measured by defeeography when resting,squeezing,and defecating were (31 ±11)mm,18(-1-26)mm,and(50±12)mm respectively,all significandy longer those measured bv CT reconstruction(all P<0.01).(3)During defecation,the value changes of ARA was not Bignificantly correlated between these 2 methods(r=0.315,0.361,beth P>0.05).Conclusion 3-dimensional CT reeonstmction of colon and rectum is helpful in evaluation of anoreetum and pelvic floor function.

Objective To investigate the response of NRI subunit of N-methyl-D-aspartate (NMDA)receptor to restraint stress in intestinal tract.Methods Thirty Sprague-Dawley rats were randomly divided into 3 equal groups:acute stress group undergoing intrapeitoneal injection of normal saline (NS),acute stress+MK-801 group,undergoing intrapeitoneal injection of MK-801,a NMDA receptor inhibitor.and then acute restraint for 1 h,30 min after the injection.Control group underwent intrapeitoneal injection of NS without acute restraint to be used as.Then all rats underwent eolorectal distension(CRD)at the pressure levels of 20.40,60,and 80 nun Hg respectively for 10 s 3 times with an interval of40 s so as to establish visceral hypersensitivity models.Electremyography was performed at the extemal oblique muscle of abdomen to record the frequency of discharge to evaluate the viseers]sensitivity.Then tlle rats weTe killed and specimens of ileocecum and the proximal and distal ends of colon were obtained.RT-PCR and Westem blotting were used to detect the mRNA and protein expression of NMDA receptor NR1 subunit in intestinal tract.Results (1)The frequencies of discharge of external oblique muscle of abdomen responding to CRD of the acute stress group at the pressure levels of 40.60.and 80 mm Hg were 925±217,1480±347,and 1732±344 respectively,all significantly higher than those of the control group(188±31,510±68,and 765±103,all P<0.01)and the acute stress+MK-801 group(210±47,525±97,84l±156,all P<0.05).But no significantly different from the acute stress+MK-801 group and the control group(all P>0.05).(2)The A valuese of the mRNA expression of NR1 in the ileocecal junction,proximal colon end,and distal colon end of the acute stress group were 1.57±0.20.2.00±0.20,and 1.36±0.17respectively,all significantly higher than those of the control group(0.68±0.10,0.87±0.19,and 0.74±0.15,all P<0.01)and the acute stress+MK-801 group(0.84±0.13,0.91±0.16,0.79±0.13,all P<0.05).But no significantly difierent from the acute stress+MK-801 group and the contml group(allP>0.05).(3)The A vaiues of the protein expression of NR1 in the ileocecal junction,proximal colon end.and distal colon end of the acute stress group were 1.69±0.20,1.41±0.12,and 1.63±0.15respectively.all significantly higher than those of the control group(0.54±0.11,O.71±0.06,0.71±0.07.all P=0.000)and the acute+MK-801 group(0.75±0.09,0.70±0.11,0.63±0.11,all P=0.000).But no signiilcanfly different from the acute stress+MK-801 group and the control group(all P>0.05).Conclusion NMDA receptor plays an important role in the visceral sensitivity induced by acute restraint stress.

Objective To analyze the clinical features of pregnancy and lactation-associated osteoporosis(PLO).Methotis The clinical data of 4 patients with PLO were retrospectively analyzed.Results Bone pain and limitation of motion appeared witllin 2 months after ehildbirth in these 4 patients.X-ray films showed multiple vertebral fractures of thoracic and/or lumbar spine.Thtee of the 4 patients had positive family history of osteoporosis or low trauma fractures.After the diagnosis of PLO was confirmed,lactation was discontinued,and treatment of calcium,active vitamin D analogues,and bisphosphonates were initiated.After these managements,no new fracture occurred and the BMD at L2-4 was markedly increased by 12.7%-22.7%during their follow-up period of 1-4 years.Conclusion Women with positive family history of osteoporosis or low trauma fractures may be susceptible to PLO.PLO should be considered when lumbar or back pain Occur during pregnancy and lactation.Besides calcium and active vitamin D analogues,anti-resorptive agents (bisphosphonate or ealcitonin)may be effective on PLO.

Objective To compare the outcomes of renal transplantation with donor kidneys with multi-branched renal arteries.Methods The data about operation time,volulne of intra-operational blood loss,postoperative complications,and post-operational renal function status of 251 recipients of donor kidneys with single-branched renal artery(Group A),12 recipients of donor kidneys with double-branched renal arteries the diameter of one of which was<2 mm or the estimated blood supply areas of one of which were<10%(Group B).and 35 recipients of donor kidneys with renal arteries with 2 or more than 2branches(Group C).Results The operation time Was(115±34)min in Group A and was(120±31)rain in Group B,both shorter than that of Group C[(133±55)win],however,not significantly.There were not significant difierences in the intra-operational volme of blood loss.1-year survival rate of patient/transplanted kidney,and post-operational ereatinine level among these three groups.The complication rate WaS 7.6%(19/251)in Group A,16.7%(2/12)in Group B,and 11.4%in Group C(4/35).Conclusion There are not signitlcant differences in the intra-operational status and post-operational outcomes among the operations of renal transplantation with donor kidneys with different mounts of renal arteries.

Objective To analyze the association between the disease duration and bladder dysfunction in lumbar disk herniation patients.nethods The urodynamic parameters of 85 lumbar disk herniation patients with different disease duration,26 with the duration<1 year(Group A).31 with the duration of 1-5 years(Group B),and 28 of the duration>5 years(Group C),were retrospectively analyzed.Results The average post-voiding residual voluine of Group A Was 50 ml.significantly lower than tlloBe of Groups B and C(80 ml and 120 ml respectively,both P<0.05)with significant difference between Groups B and C too(P<0.05).111e average maximum eystometrie capacity of Group A Was(375±147)ml,significantly hisher than those ofGroups B and C[(481±184)ml and(562±173)ml respectively,both P<0.05]and there Was significant differenee between Groups B and C too(P<0.05).The average volume at the first desire to void of Group A Was(220±88)ml,significantly lower than those of Groups B and C [(247±132)ml and(356±199)ml respectively,both P<0.05],however,there Was no significant difierence between Groups A and B(P>0.05).There were no significant differences in the maximum flow rate,maximum detrusor pressure,and bladder compliance among the three groups(all P>0.05).Conclusion Prolonged disease duration of lumbar disk herniation worsen8 the bladder function.

Objective To investigate the efficacy and safety of131 I therapy on hyperthyroidism in adolescents,middle-aged people,and the elderly.Methods 940 patients with hyperthyroidism,106 aged <25(Group A,group of young people),768 aged 25-60(Group B,middle-aged group),and 66 aged >60(Group C,group of the elderly),underwent131 I therapy and were followed up for2 years to evaluate the efficacy and safety.Results Forty-six patients in group A(43.4%)became euthyroid,34(32.1%)turned beaer,24(22.6%)suffered from hypothyroidism,and 2(1.9%)remained un-changed,with a general effective rate of 98.11%(104/106).346 patients(45.1%)in Group B became euthyroid,260(33.9%)turned better,140(18.2%)suffered from hypothyroidism,and 22(2.9%)remained unchanged,with a general effective rate of 97.14%(746/768).And28 patients(42.4%)in Group C became euthyroid,24(36.4%)turned better,10(15.15%)suffered from hypothyroidism,and4(6.1%)remained unchanged,with a general effective rate of 93.93%(62/66).There were not significant differences in the recovery rate,improvement rate,hypothyroidism rat,and ineffective rate among the 3 groups(all P>0.05).Conclusion There are no significant differences in the efficacy and safety of131 I therapy in hyperthyroidism on the patients of different ages,including adolescent,adult and elder persons.131I therapy is safe and effective for adolescents.

Objective To compare the effects of sperm chmmatin dispersion(SCD)test and TDTmediated dUTP nick end labeling(TUNEL)assay in assessing the DNA fragmentation in human spem.Methods Motile sperms were isolated from the semen samples obtained from 20 healthy fertile men and 32clinically infertile pailents by swim-up technique,and underwent SCD and TUNEL to analyze the DNA fragmentation.Results The rate of sperm with DNA damage of the infertile pailents was 12.8%±5.8%tested by SCD,significantly higher than that of the healtby fertile men(7.6%±3.3%,t=3.576,P=0.001),and the rate of sperm with DNA damage of the infertih patients wag 11.1%±5.1%tested by TUNEL assay.significantly higher than that of the healthy fertile men(6.8%±2.8%.t=3.467,P=0.001).The proportion of sperm cell wlth abnormal DNA integrity meagured by SCD test wag correlated strongly with that determined by TUNEL for the infertile men(r=0.841.P=0.000)and for the fertile men too(r=0.823.P=0.000).The rote of sperm with DNA damage meagured by SCD were not signitlcandy different from those of TUNEL-positive sperm in fertile men(t=1.996,P=0.060).The rate of sperm with DNA damage meagured by SCD wag significantly higher than that meagured bv TUNEL among infertile patients(t=3.023,P=0.005).Conclusion The presence of sperm DNA dsmage may lead to male infertility.SCD is simpler.cheaper and more reliable than TUNEL in testing the sperm DNA damage.

Objective To investigate the effect of glucagon on ghrelin seretion in type 2 diabetes mellitus(T2DM)patients.Methods Circulating ghrelin and C-pepetide were measured during glucagon stimulation test in 38 cases with T2DM and 30 cases in normal controls(NC)at the 1st Affiliated Hospital of Shantou University from May 2006 to December 2007.Results(1)There w88 no significant difference in the fasting C-peptide and fasting ghrelin levels of the NC group were(1.3±0.6)μg/L and(3.0±1.0)ng/ml respectively,both not significantly different from those of the T2DM group[(1.2±0.4)μg/L and (2.7±0.8)μg/L respectively,P>0.05 and P>0.05];six minutes after the injection of glucagon,the C-peptide level of the T2DM group increased to(2.0±0.8)μg/L(P<0.01),and that of the NC group increased to(3.0±0.8)μg/L(P<0.01),and the C-peptide level 6 min after of the T2DM group was significantly lower than that of the NC group(P<0.01).The ghrelin level 6 min after the injection of glucagon of the NC group wss(2.3±0.7)μg/L,significantly lower than that before the injection(P<0.01).But the ghrelin level 6 min after the injection of glucagon of the T2DM group was(2.9±0.9)μg/L,NOT significantly different from that before the injection(P>0.05).(2)Fasting ghrelin level was significantly negatively correlated with the waist circumference(r=0.343,P<0.05).Conclusion In healthy subjects exogenous slucagon decreases the ghrelin level.Ghrelin may be associated with the beta-cell hypofunetion and first-phase insulin socretion defects in T2DM.Insulin,glucagon,and ghretin secreted influence each other to regulate glucose homeostasis.

Objective To study the differences in expression of several common immunohistochemical markers:epidermal growth factor receptor(EGFR),topoisomerase Ⅱ(TOPO Ⅱ),glutathione S-transferaseπ(GST-π),proliferation cell nuclear antigen(PCNA),Her-2/Neu,P27,P21,and P53.between cardiac carcinoma and carcinoma in antrum of stomach and the correlation thereof with clinicopathological factors.Methods 211 paraffin-embedded tissue samples of gastric cancer were randomly chosen from the patients of cardium and stomach operated in 2005.including 110 cages of cardiac carcinoma and 101 cages of carcinoma in antrum of stomach.Immunohistochemical Envision two step method Was used to detect the expression of the above mentioned markers.Results Compared to the cardiac carcinoma,the carcinoma in antrum of stomach showed higher rate of clinicopathological staging Was significantly higher,degree of differentiation lower,invasion deeper,and degree oflymph node metastasis higher(all P<0.05).The expression rates of P21,Her-2/Neu,and GST-π of the cardiac carcinoma group were 80.0%(88/110),30.9%(34/110),and 92.7%(76/82)respectively,all significantly higher than those of the carcinoma in antrum of stomach group[67.0%(65/97),16.7%(16/96),and 74.5%(41/55)respectively,P=0.034,0.017,and 0.003 respectively].In the cardiac carcinoma,P21 expression was positively correlated with the expression of P27 and EGFR.the P27 expression WaS positively correlated with the expression of EGFR and TOPO Ⅱ.and the GST-π expression was positively correlated with the TOPO Ⅱexpression(r=0.255,P=0.021).In the antrum of stomach carcinoma,GST-π expression Was positively correlated with the expression of EGFR,TOPOⅡ,and Her-2/Neu,however,it was negatively correlated with the expression of PCNA,and the P27 expression was positively correlated with the P53 expression(r=0.275,P=0.042).Conclusion Different molecular mechanisms may lead to the tumorigenesis and development of stomach carcinoma at different sites.

Objective To investigate the effects of Helicobacter priori(Hp)on blood glucose fluctuation in type 2 diabetic mellitus.Methods 130 type 2 diabetic patients were selected,72 patients with Hp infection and 58 without Hp infection.Relevant clinical data:blood pressure,body mass index,cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol,glycosylated hemoglobin,insulin resistance index,liver function,and renal function were collected.The data of blood glucose levels at 7 time points,6-7 am,9-10 am,11-12 am,14-15 pm,17-18 pm,19-20 pm,and 22-23 pm in 3 days,totally 21 data,were collected.And input into the OTDMS data analysis software to evaluate the blood glucose fluctuation indexes:standard deviation of meoJi blood glucose (SDBG),mean amplitude of glycemic excursions(MAGE),large amplitude of glycemic excursions (IAGE).Results There were no significant differences in age,course of disease,blood pressure,body mass index,cholesterol,triglyceride,low density lipoprotein cholesterol,glycosylated hemoglobin,and insulin resistance index between these 2 groups(all P>0.05).The levels of MBG,SDBG,MAGE,LAGE,(mmol/L:9.0±1.1 vs 7.6±0.5,3.3±1.1 vs 1.7±0.5,6.7±4.5 vs 3.0±1.1,8.6±3.8 vs 4.2±1.5,all P<0.05)and incidence of hypoglycemia[16.6%(12/72)vs 5.1%(3/58),P<0.05]were all higller in the Hp positive group than in the Hp negative group.Conclusion Hp infection has a significant effect on the daily blood glucose level and blood glucose fluctuation in the patients with type 2 diabetes.

Objective To summarize the experience in ultrasound guided transrectal prostate biopsy and analyze the influeneing factors of the biopsy results.Methods 687 patients with prostate specific antigen(PSA)>4μg,tubemles in prostate detected by digital rectal examination and/or prostate abnormality detected by magnetic resonance imaging,aged(70±8),underwent ultrasound guided transrectal 6-12 core prostate biopsy 1996-2007.Since 2006 the criteria for biopsy ineluded PSA of 4-10μg/ml,free PSA/total PSA ratio(F/T ratio)≤0.16,and PSA density>0.15.Results 269 of the 687 cases.witll the mean age of(72±8),were diagnosed as wlth pmstate cancer.294 and 121 of the 687patients(42.8%and 17.6%respectively)accepted prostate biopsy beeanse of elevated PSA or abnormality of DRE.The number of patients accepting prostate biopsy increased yearly(10 cases in 1996 to 98 cases in 2007).The positive biopsy rate was 39.8%.with the highest rate of 60.0%in 1999 and lowest rate of 30.4%in 2005.The highest number of prostate cancer diagnosed was the highest(42 cases)in 2007 and the lowest(4 cases)in 1996.PSA level was positively co-related with positive biopsy rate.The application of F/T ratio improved the positive biopsy rate in the patient with the PSA of 4-10μg/ml.The incidence rates of the main complications hematuria,bloody stool,and fever were 46.3%,8.7%,and 1.9%respectively.Conclusion Elevated PSA has become the most common resson for prostate biopsy.The combination with PSA.F/T ratio.and increased biopsy core number improve the positive biopsy rate.The ultrasound guided transrectal prostate biopsy is efficient and safe in the diagnosis of prostate cancer.

Objective To investigate the effect of adjuvant therapy on the treatment of carcinoma of the body and tail of pancreas.Methods The clinical data of 137 patients with carcinoma of the body and tail of pancreas,91 males and 46 females,aged 58.9(24-76),of which 38 underwent radieal resection,24 underwent palliative resection,and 75 did not undergo resection,and 58 of which underwent adjuvant therapy,were analyzed.Results The overall 3-year survival rate was 10.7%for the whole group.27.3%for the radical resection group,4.2%for the palliative resection,and 4.5%for the no resection group.The median survival time(MST)was 8 months for the whole group,15 months for the radical resection group,8months for the palliative resection group.and 6 months for the no resection group.The 3-year survival rate Was 13.9%for the patients undergoing adjuvant therapy and 7.2%for those without adjuvant therapy,and the MST wag 11 months for those undergoing adjuvant therapy.and 5 months for those without adjuvant therapy.Intra-arterial therapy and radiation therapy were protective factors for those whose cancerous tissues were not radically resected(OR=1.56,95%CI:1.04-2.35,P=0.033).Conclusion Adjuvant therapy significantly improves the survival of the patients with pancreatic carcinoma of the body and tail.The clinical effect of intra-arterial therapy is better than those of radiation therapy and chemotherapy.

Objective To investigate effect of temperature on δ-aminolevulinic acid(AIA)induced photodynamic reaction in laryngeal squamous carcinoma cells.Methods Human laryngeal squamous carcinoma cells of the line Hep-2 cells were co-cultured with 2 retool/L ALA(Group A)or without ALA(Group B)at the culturing temperature 19-46℃.Three hours later celhlar protoporphyrin IX(PpⅨ)level was determined by hish performance liquid chromatography with fluorescent detection.Lager scanning confocal microscopy was used to observe the fluorescent strength in the Hep-2 cells.The ratio of cell death(including necrosis and apoptosis)was detected with flow cytometer before and after phtotedynamic reaction.Results In Group A the PpIX level at the temperature of 19℃Was(0.25±0.06)μg/L,and raised to(1.07±0.11)μg/L at 46℃.There Wag no cellular PpⅨdetected in Group B at any temperature.Before laser radiation the cell death ratios of both groups were the same at the temperature 19-37℃.and at the temperature 37-46℃.After laser radiation the cell death ratio of Group A raised from 31.11%t0 98.92%as the temperature went up steadily.but tIle results of Group B showed the sine curve as before laser radiation.At any same temperatures the cell death ratios of Group A were all significantly higher than those of Group B(all P<0.05),and as the temperature was elevated the difference between the 2 groups raised from 28.99%t0 59.26%.Conclusion Moderate higher temperature enhances the PpⅨproduction and photodynamic reaction in human laryngeal squamous carcinoma induced by ALA in vitro.

Objective To investigate whether Hepatitis B virus X protein(HBx)regulates the transcription aetivity of zinc finger transcription factor SNAl1.and to define the main regulation domain.Methods A series of 5'truncated promoters of SNAI1 were amplified and subcloned into tIle pGL3-Basic vector to construct promoter luciferage report plasmids.The promoter lueiferase report plasmids were cotransfected with HBx recombinant adenovirus and pRL-TK plasmid into human hepatocellular cancer cells of the line SMMC7721.Luciferase activity was meagured.and relative luciferase activity was ealculated.Results Luciferase reporter plasmids containing 5'flanking deletion of SNAI1 promoter were successfully constructed.HBx obviously upregulated the activity of the SNAI1 promoter(-869-+59),other than the SNAI1 promoter(-514-+59)and SNAI1 promoter(-194-+59).Conclusion HBx can stimulate the transcription of SNAI1.and the transcription regulation domain iS loeated in the segment from-869-514 of the SNAI1 promoter.

Objective To investigate the feasibility of applying carbocyanines fluorescent dye chioromethyl-benzamidodialkyl carbocyanine(CM-Dil)in tracing fetal fibroblagt transplant.Methotis Sixteen-day-gestation fetal rat skin tissue samples were harvested and digested with trypsin to isolate fibrublagts.The fibroblagts proliferated in logarithmic phage and were incubated with CM-Dil for 15 minutes.Flow cytometry wag used to calculate the proliferate index(PI)so as to determine the effect of CM-Dil on cell proliferation.Labeled fibroblasts were transplanted to the deep partial thickness burn wounds in the back of allogenic rats.Samples weYe harvested on 0,1,3,7,14,and 28 days post bums(DPB)and observed under fluorescence microscope in 6μm section.Results The eultured fibroblagts were labeled with CM-Dil within 15 minutes,appearing as red fluorescent discs with bilayer membrane structure.The PI of the labeled fibroblasts wag(76.9±2.8),not significant different from that of the cells not labeled(75.8±2.0,t=0.80,P>0.05).The area with fluorescence markers was sinail on 1 DPB,began to expand and be distributed in a beaker shape on 3 DPB.and then the bottom of the"beaker"broadened indicating cell proliferation significantly on 7 DPB.Fluorescence signals determined were moderate on 14 DPB,and can be still determined feebly on 28 DPB.Conclusion Proper concentration of CM-Dil shows no cytotoxicity to fletal 6bmblasts.CM-Dil is an ideal fluorescent label to fetal fibroblagts for its fairly stable fluorescent tracing and slow quenching in skin tissue within 4 week's duration.

The patient was a 21-year-old woman who came to the clinic for 3 years because of the discovery of skull defect. In 2002, the patient accidentally discovered a skeletal defect in the occipital region of the head, which was 4~5 cm in size, without headache, fever and other discomfort, and denied skeletal pain in the skull and other parts. The CT in the outside hospital showed a skeletal defect in the occipital bone with clear boundary, and underwent cranioplasty in the brain surgery department. The postoperative pathology showed "fibrous tissue and a small amount of broken bone tissue, fibrous tissue hyperplasia between trabeculae and a large number of thin-walled blood vessels and lymphatic vessels" (Figure 1, 2).

A 65-year-old female was admitted to hospital on June 10, 2003 due to "repeated fatigue, anorexia for 2 years, aggravation for 2 months with weight loss". The patient had a history of hepatitis B for more than 10 years, and her weight lost about 5 kg in the last 2 months.

Clinical factors, demographic factors and changes in two genes (CYP2C9 and VKORC1) play an important role in determining the warfarin dose required by patients.

Doctors should do three things around scientific research in their career: reading papers, doing research (including writing papers) and reviewing manuscripts. According to the experience of teaching and research of clinical research methodology for many years, the author proposes to use "reduction method" to obtain information from papers faster and better; Improve research capability and level; Improve the ability and level of writing and revising clinical research papers; Improve the ability and level of review.

Objective To evaluate the clinical value of neuronavigation system in stomatology.Methods The clinical data of 3 patients were reviewed.Thin-slice CT scanning was conducted on the 3patients and the CT data were input into the CT neuronavigation system that in turn guided the operations later.Patient I with trigeminai neuralgia,aged 51,underwent puncture of oval foramen and radiofrequency thermo-coagulation therapy.Patient Ⅱ of canister shots injury,aged 32,witll 3 metal grains in the face and 1 metal grain in the neck.underwent removal of the metal grains.Patient Ⅲ with relapse of tongue cancer after operation,aged 62,underwent plantation of radiate granules.Results Guided by neuronavigation,puncture was accurate and curative effect Was excellent in patient I.and no visible complication Was seen;all the metal grains in face were found and removed in patient Ⅱ,however,because of registration error,the metal grain in neck failed to be positioned;and thee radiate granules were implanted accurately in patient Ⅲ.Conclusion Neuronavigution significantly increases the successful rates of puncture into the oval foramen,orientation of metal grains,and implantation of radiate granules,and reduces the complications rato.