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.

Objective To investigate the role of glucocorticoid-induced tumor necrosis factor ligand (GITRL) in regulating the inflammatory reaction of kupffer cells.Methods The kupffer cells and T cells of mice were isolated and divided into 6 groups after being co-cultured:control group,kupffer cells and T cells were cultured in DMEM only; lipopolysaccharide (LPS) group,kupffer cells and T cells were cultured in media with LPS (1 mg/L) ; LPS + GITRL siRNA group,kupffer cells and T cells were cultured in media as the LPS group after transfected with GITRL siRNA ; LPS + control siRNA group,kupffer cells and T cells were cultured in media as the LPS group after transfected with control siRNA; LPS + pEGFP-N1 GITRL group,kupffer cells and T cells were cultured in media as the LPS group after transfected with pEGFP-N1 GITRL plasmid; LPS + pEGFP-N1 control group,kupffer cells and T cells were cultured in media as the LPS group after transfected with control plasmid.After 24 hours of treatment,the expressions of GITRL and PDL1 of kupffer cells were detected by immunofluorescence and western blot,respectively.The proliferation and apoptosis of T cells were measured by MTF assay and Annexin V/PI flow cytometry,respectively.The expression of tumor necrosis factor (TNF-α) in the supernatant fluid was measured by ELISA.All data were analyzed using the independent t test and one-way analysis of variance.Results The transfection efficiencies of GITRL siRNA and pEGFP-N1 GITRL were 90％ and 85％,respectively.Compared with normal kupffer cells,the protein expression of GITRL of kupffer cells transfected with GITRL siRNA was significantly decreased,while the protein expression of GITRL of kupffer cells transfected with pEGFP-N1 GITRL was significantly increased (t =41.72,13.10,P ＜ 0.05).There was no significant difference in the protein expressions of GITRL between normal kupffer cells and those in the control groups (F =2.27,P ＞ 0.05).The fluorescence intensity of GITRL in the LPS group was significantly higher than that in the control group (t =49.29,P ＜ 0.05).Compared with LPS group,the activation of GITRL expression by the LPS was significantly suppressed in the LPS + GITRL siRNA group (t =9.84,P ＜ 0.05),while the expression of GITRL in the LPS + pEGFP-N1 GITRL group was significantly increased (t =5.78,P ＜ 0.05).There was no significant difference in the GITRL expression among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =0.86,P ＞ 0.05).The expression of PDL1 in the LPS group was significantly lower than that in the control group (t =18.83,P ＜0.05).Compared with LPS group,the expression of PDL1 in the LPS + pEGFP-N1 GITRL group was significantly suppressed (t =11.79,P ＜ 0.05),while the expression of PDL1 in the LPS + GITRL siRNA group was significantly stronger (t =19.08,P ＜ 0.05).There was no significantly difference in the expression of PDL1 in the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =2.22,P ＞ 0.05).The proliferation of T cells was increased and the number of apoptotic T cell was decreased in the LPS group when compared with control group (t =49.43,40.11,P ＜ 0.05).Compared with LPS group,the proliferation and apoptosis of T cells in the LPS + pEGFP-N1 GITRL group had the same trend (t =5.77,12.64,P ＜0.05); while the proliferation of T cells was decreased and the apoptosis of T cells was increased in the LPS + GITRL siRNA group (t =17.00,49.90,P ＜ 0.05).There was no significant difference in the proliferation and apoptosis of T cells among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =1.87,1.35,P ＞ 0.05).The expression of TNF-α was significantly higher in the LPS group than that in the control group (t =125.68,P ＜ 0.05).Compared with the LPS group,the expression of TNF-α was significantly decreased in the LPS + GITRL siRNA group (t =119.65,P ＜ 0.05),while the expression of TNF-α in the LPS + pEGFP-N1 GITRL group was significantly increased (t =147.70,P ＜ 0.05).There was no significant difference in the TNF-α expression among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =0.14,P ＞ 0.05).Conclusion Kupffer cells suppress the expression of PDL1 by upregulating GITRL,and thus activate the proliferation of T cells and promote the inflammatory reaction.The immunologic balance may be recovered after the interference of GITRL to restrain the inflammatory reaction.

Objective To analyse clinical effects and influence on serum creatinine and blood urea nitrogen of Danggui Niantong pill in treatment of gouty nephropathy. Methods 80 patients with gouty nephropathy were divided into two groups and each with 40 cases.The control group were treated with general therapy,and observation group was treated another with Danggui Niantong pill. Results After treatment,effective rate of observation group was 92.50％,higher than that of control group 72.50％(P<0.05).After treatment,renal function serum markers and urine related factors level of observation group were lower than control group(P<0.05).ESR,WBC and N level of observation group were lower than that of control group(P<0.05).The proportion of adverse reactions of observation group was 15.00％ and control group was 12.50％.Conclusion Danggui Niantong pill can improve clinical effects of gouty nephropathy,reduce renal damage amd does not increase adverse reactions.

Objective To explore the effect and mechanism of aerobic exercise on islet β-cells in type 2 diabetic rats.Methods Thirty healthy SPF 8-week old Wistar rats were randomly divided into control group (C, n=10), diabetic control groups (DMC) and diabetic exercise (DME) groups, 10 rats in each group, among which 7 successful rat models were used in the experiment.The diabetic rat model was established by high fat and sugar diet and i.p.injection of streptozotocin in a dose of 50 mg/kg.The rats of group DME were forced to perform 20 m/min running for 30 min, once a day, 6 days in a week, for 8 weeks.Other rats were allowed free movement.At the end of experiment, serum glucose and insulin were measured and homeostasis model assessment (HOMA) was calculated, and pancreatic tissue samples were collected for histopathological examination.The morphology and structure of pancreatic islets were observed under a digital microscope, the perimeter and area of islets were analyzed by image analysis, and shape factor of islets was calculated.The insulin content, glucokinase and ultramicro-ATPase activity in the pancreatic homogenate were determined.Results In the DME group, the perimeter and area of islets were significantly higher than the DMC group (P< 0.05), but still lower than the control group.The shape factor was significantly increased, the cell hypertrophy, vacuolization and nuclear pyknosis were markedly alleviated than those in the DMC group, the insulin content, glucokinase and the trace total ATP activity in the DME group were significantly higher than those in the DMC group (P<0.05), and the SF and HOMA were significantly changed.Conclusions Aerobic exercise can reduce the blood glucose level, improve the morphology of islets and β-cells in the type 2 diabetic rats.It may be due to increase of the activity of glucose kinase and ATP-synthase, and increased insulin sensitivity in the pancreas.

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.

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.