Objective:To evaluate the effect of reduction by leverage with minimally invasive and internal fixation with Ideal Compression Screw to treat fracture of calcaneus.Methods:13 patients(17 fee)twith fracture of calcaneus were treated by reduction by leverage with minimally invasive and internal fixation with Ideal Compression Screw.According to Sanders'classification,10 sides were classified as typeⅡfracture and 7 sides as typeⅢfracture.Results:The post-operative functional evaluation by American Orthopaedic Foot and Ankle Society ankle score system revealed excellent outcomes in 12 feet(70.6%),good in 3(17.6%),fair in 2(11.8%).The excellent rate was 88.2%.Conclusion:Reduction by leverage with minimally invasive and internal fixation with Ideal Compression Screw to treat fracture of calcaneus is an effective and micro-invasive method in treatment of fractures of calcaneus.The technique can contribute to sta-ble fixation,low operation complication and high rate of excellent to good outcomes,et al.

Retrograde HRP technique was used to study the somatotopical organization of the raphe—spinal projection of the rat. HRP or wheat germ agglutinin conjugated HRP was injected into unilateral gray matter or dorsal horn of the cervical cord or lumbar cord. The following conclusions have been reached.The caudal part of NRM projects to areas ventral to the dorsal horn. Projection to the dorsal horn was found to originate from the rostral part of NRM, which is somatotopically localized. Cells projecting to the cervical dorsal horn are distributed more rostrally than those to the lumbar dorsal horn, although an extensive overlapping of these two parts is evident. Somatotopical localization in the form of "gap" as suggested by Watkins et al. could not been verified in our experiment.The functional significance of the sornatotopical organization of NRM is discussed.

Based upon Ju and Swanson's studies on the eytoarchitecture of the bed nuclei of stria terminalis (BST) of the rat, the present work studies in detail the distribution of serotonin-immunoreactive fibers and terminals (5-HT-ir fibers) in the BST of the rat with ABC or PAP technique visualized with glucose oxidase-DAB-nickel method. The results are as followsithree types of 5-HT-ir fibers were identified in the BST, viz. thick fibers, thin fibers and varicose fibers. Only varicose fibers were found in the stria extension of the BST, whereas the rest of the BST contained other types as well. In the oval nucleus, juxitacapsular nucleus, fusiform nucleus, posterior dorsal nucleus and principle nucleus,all three types of 5-HT-ir fibers were observed, while the remaining parts of the BST were occupied with thin and varicose fibers. These fibers were distributed unevenly in the BST, with highest density in the ventromedial part of the anterior ventral area and the ventrolateral part of the posterior division; moderate density in the anterior dorsal area, the ventrolateral part of the anterior ventral area and the dorsolateral part of the posterior division; and were scattered in the anterior lateral area and the medial part of the posterior division. The difference in density of 5-HT-ir fibers among various areas of the BST corresponds generally with the sequence of ontogenesis of the BST. Mismatch of the distribution of 5-HT-ir fibers and 5-HT receptors in the BST of the rat is also discussed.

The present work studies the origin of serotonin-immunoreactive fibers and terminals (5-HT-ir fibers) in the bed nuclei of the stria terminalis (BST) of the rat, with combined retrograde tracing and 5-HT immunoperoxidase methods. The results are as follows: 5-HT-ir fibers in the main part of the BST originate mainly from the dorsal and median raphe nuclei in addition to the region adjacent to the medial lemniscus and the caudal linear nucleus raphe. About one third of HRP-labelled neurons in every above-mentioned raphe nucleus are also 5-HT immunoreactive and innervate mainly the ipsilateral BST, and they are constituted by part of every type of 5-HT-ir cells in most regions of these nuclei.

In our previous studies, substance P-like immunoreactive varicose nerve fibers have been demonstrated in the pars distalis of the adenohypophysis of the dog. They were found, at light microscopical level, to be closely related to gland cells. In the present study, the ultrastructure of substance P-like immunoreactive nerve fibers and their relationship with the gland cells of the pars distalis in the dog were investigated by use of pre-embedding immuno-electron microscopy. Direct contacts could be ascertained on every cell type of the gland, including folliculo-stellate cells. Typical synapses were identified on somatotropes and corticotropes, more on the latter. Most of them were of asymmetrical type with round to oval small clear vesicles and scattered large dense cored vesicles. It is considered morphologically proved that the substance P-like immunoreactive nerve fibers have effector role in the pars distalis of the dog.

Based upon Ju and Swanson's recent studies on the cytoarchitecture of the bed nuclei of the stria terminalis (BST) in the rat, the present work studied in detail the distribution of GABA-immunoreactive (GABA-ir) neurons and fibers in the BST of the rat with ABC immunohistochemical method. A large number of GABA-ir neurons were distributed in the dorsal regions of the anterolateral (AL) and anterodorsal (AD) areas as well as the ventral regions of the anteroventral (AV) area and posterior part of the BST, whereas the other regions contained relatively less numbers of GABA-ir cells. GABA-ir neurons which were displayed moderate to high densities in the oval and juxitacapsular nuclei of the AL, the parastrial and fusiform nuclei of the AV, and the principal nucleus of the posterior part were limited within the extent of these nuclei, while the remained regions of the BST were scattered by GABA-ir cells; GABA-ir fibers were concentrated mainly in the dorsal regions of the AL and AD, the parastrial and fusiform nuclei of the AV, and the dorsal regions of the posterior part. In the strial terminalis, numerous GABA-ir fibers were located chiefly in the ventrolateral and ventromedial angles of it. Combined with the results of availlable studies, the above mentioned results indicate that all the fibers which project, by way of the stria terminalis, from the oval nucleus of the BST to the ipsilateral amygdaloid central nucleus (Ce), or from the Ce and amygdaloid medial nucleus to the ipisilateral oval and principal nuclei of the BST may be GABAergic, and among them, the GABAergic projections from the oval nucleus of the BST to the Ce may play an important role in the generation and propagation of epilepsy.

Objective To discuss surgical techniques of laparoscopic treatment for intrahepatic stones.Methods A total of 57 cases of intrahepatic stones from March 2000 to March 2005 were studied. Under laparoscopic visualization,openings of left and right hepatic bile ducts were exposed through a longitudinal incision in the common hepatic duct to the bifurcation of left and right hepatic ducts.Stones in left and right hepatic bile ducts were evacuated with the use of a lithotomy forceps,a tiny basket,or pressure irrigation.Then openings of secondary hepatic ducts were exposed through the dilated primary ducts for the removal of stones in secondary hepatic ducts.Sometimes even openings of tertiary hepatic ducts could be seen for stone removal.When mud-or sand-like calculi were encountered,repeated irrigation of bile ducts was carried out.Results Conversions to open surgery were required in 3 cases(3/57,5.3%).The time of operation was 75～275 min(136?54 min).Residual stones were found in 49 cases(49/57,86.0%),which required postoperative choledochoscopy for 1~4 times to clear the intrahepatic stones.Complete clearance of all intrahepatic stones was achieved in 53 cases(53/57,93.0%).In 2 cases of calculi impacted in the lower common bile duct,laparoscopic electrohydraulic lithotripsy was performed for stone extraction.Postoperative bile leakage occurred in 5 cases(5/57,8.8%),and was cured with tube drainage.Follow-up observations for 0.5~5 years(2.3+1.5 years) in 43 cases showed excellent outcomes in 38 cases(88.4%),good outcomes in 3 cases(7.0%),and poor in 2(4.6%).Conclusions Intrahepatic stones can be removed laparoscopically through a longitudinal incision in the common hepatic duct to the bifurcation of left and right hepatic ducts for the exposure of primary and secondary hepatic ducts,or even tertiary hepatic ducts.

There are also many unanswered questions on the duodenogastroesophageal reflux(DGER),though it has been studied for more than 100 years.Based on the references and our studies,we reviewed the bile' injury on esophageal mucosal epithelial cells,the diagnosis and treatment of bile reflux into esophagus.The relationships of the biles with Barrett's esophagus and esophageal adenocarcinoma were elucidated especially.

Nowadays doctor-patient conflicts have benn a focus problem,which the important reason is "trust crisis"between doctors and patients.Doctor-patient trust is the guarantee of medical profession.It is the key to build binding mechanism of sincerity and trust in hospitals,promote humanistic accomplishment and medical ethics accomplishment of medical professinal.