Objective　To explore a new way of treating refractory residual gallstones by endoscopy. Methods　Choledochfiberscope(CHF) combined with air pressure ballistic lithoclast(APBL) under ureterscopy were used on 28 cases of large or impacted residual gallstones. Results　All refractory stones were crushed and extracted completely in 1-3 times, including sufficient once in 16, twice in 10 and thrice in 2. No severe complications were occurred in this series. Conclusions　This procedure is a safe, effective, simplicity, less complication and no heat injury methods. It is proved to be a new way of treating refractory residual gallstones, especially for large or impacted lithiasis. It is worthy for clinical application widely in the future.

Objective To explore a new way of treating refractory residual gallstones by endoscopy. Methods Choledochfiberscope(CHF) combined with air pressure ballistic lithoclast(APBL) under ureterscopy were used on 28 cases of large or impacted residual gallstones. Results All refractory stones were crushed and extracted completely in 1 3 times, including sufficient once in 16, twice in 10 and thrice in 2. No severe complications were occurred in this series. Conclusions This procedure is a safe, effective, simplicity, less complication and no heat injury methods. It is proved to be a new way of treating refractory residual gallstones, especially for large or impacted lithiasis. It is worthy for clinical application widely in the future.

Resection of the trachea for more than half of its length requires implantation of an artificial trachea to allow safe reconstruction. The article introduced the recent progress on tissue engineered trachea.The problems encountered in this field and the study direction in the future are also mentioned.

The distribution of TrkA and the postnatal development(PD) of TrkA and ChAT-immunoreactive(-IR) neurons andthe relation between them in the basal nucleus of Meynert of rats were studied with immunohistochemical method. The number,mean profile areas and grey degree of TrkA-IR and ChAT-IR neurons were examined with image analyser. The data revealed thatTrkA-IR neurons were localized in the basal forebrain of rats. TrkA immunostaining was present at PDI, but ChAT was not.ChAT immunostaining was present at PD5. Most densely stained TrkA and ChAT neuronal bodies and fibers were present atPD20, the mean grey degrees of TrkA-IR and ChAT-IR neuronal profiles reached its peak. Both TrkA and ChAT neurons beganto cline at PD30 and maintained a relatively higher level in the adult. However, during aging both TrkA and ChAT-IR neuronsatrophy and became smaller than that in the adult. The number of TrkA-IR and ChAT-IR neurons were decreased by 41.38% and 51.61%; the mean profile areas decreased by 15.7% and 12.8%; and the mean grey degrees by 29.9% and 9.9%, respec-tively. The mean profile areas of TrkA-IR and ChAT-IR neurons from PD5 to aged rats were positively correlated. The resultsindicated that the expression of TrkA was earlier than ChAT. The expression of TrkA and ChAT followed a very similar tempo-ral pattern in the basal nucleus of Meynert from PD5 to aged rats, suggesting that TrkA might participate the regulation ofChAT-IR neuronal development, differentiation, maturation, and ageing. The down-regulation of TrkA and ChAT of aged ratsis associated with neuronal atrophy and loss and may contribute to the pronounced vulnerability of these neurons to degenerationin aging animals and Alzheimer's disease.

This paper introduces reformation of course system for five-year clinical medicine specialty in three aspects: orientation of course arrangement ,basic structure and major features of new teaching model. By adjusting the teaching plan and setting up new course system optimally, we have made an active attempt on new teaching model for bringing up high-quality medical talent.

OBJECTIVE:To study the effects of electrolyte on the stability of the neonatal parenteral nutrition. METHODS:Under room temperature(25 ℃),the neonatal parenteral nutrition containing only monovalent or bivalent ion electrolyte(10% So-dium chloride injection,10% Potassium chloride injection,25% Magnesium sulfate injection,and Calcium gluconate injection) and containing both monovalent and bivalent ion electrolyte were investigated by the change of appearance to determine the pH val-ue,insoluble particles and the size and distribution (polydispersity index,PDI) within 24 h. RESULTS:The pH of the nutrition with electrolyte was over 5 and also met the quality requirements;there were no precipitate,flocculation and discoloration in the appearance;the neonatal parenteral nutrition containing only monovalent ion electrolyte appeared a small amount of hanging wall phenomenon for 24 h,but did not appear demulsification phenomenon;the neonatal parenteral nutrition containing only bivalent ion electrolyte appeared a small amount of hanging wall phenomenon and demulsification phenomenon for 24 h;the neonatal paren-teral nutrition containing both monovalent and bivalent ion electrolyte appeared a small amount of hanging wall phenomenon and de-mulsification phenomenon for 12 h and the hanging wall phenomenon was more obvious for 24 h. Meanwhile,a size bigger than 5μm microns and particle size bigger than 25 μm microns of insoluble particles appeared,and both the average particle size and PDI value were higher than those in the previous two situations(P<0.05). CONCLUSIONS:As more and more monovalent and biva-lent ion electrolyte being added into the neonatal parenteral nutrition,especially divalent ion electrolyte,the stability of the neona-tal parenteral nutrition decreases,which behaves as a phenomenon that the size of grains and the number of insoluble particles in-crease.

Objective To investigate the postnatal developmental rule of TrkA and ChAT\|immunoreactive(ChAT\|ir) neurons and the relationship between TrkA and ChAT\|ir neurons in the horizontal limb of diagonal band(HDB) of rats. Methods Immunohistochemistry technique combined with image analyser were used. Results TrkA and ChAT\|ir neurons localized in the neurons of basal forebrain of rats. TrkA immunostaining was present at postnatal day 1(PD1), but ChAT immunostaining was present at PD5 Most densely stained TrkA and ChAT neuronal bodies and fibers were present at PD20, while the mean grey degrees of TrkA and ChAT\|ir neurons reached to the peak. Both TrkA and ChAT began to decline at PD30 and maintain a relatively higher level in the adult. However, during aging both TrkA and ChAT\|ir neurons atrophied and became smaller than that of adult. The number of TrkA and ChAT\|ir neurons decreased 39 8% and 33 3%;the mean areas 15 7% and 12 8%; the mean grey degree values were 29 9% and 9 9%, respectively. The mean areas, grey degrees and numbers of TrkA and ChAT\|ir neurons from PD5 to aged rats had positive correlation. Conclusion The results indicate that the expression of TrkA was earlier than ChAT. The expression of TrkA and ChAT followed a very similar temporal pattern in HDB from PD5 to aged rats, suggesting that TrkA may participate in the regulation of ChAT\|ir neuronal development, differentiation, maturation and aging. The down\|regulation of TrkA and ChAT of aged rats is associated with neuronal atrophy and loss and may contribute to the pronounced vulnerability of these neurons to degeneration in aging animals and Alzheimer disease.\;

OBJECTIVE:To observe the analgesia effects of transdermal fentanyl in the treatment of pharynx oralis pain caused by radiotherapy.METHODS:30patients with pate squamous carcinoma and serious membrana mucosa ulcerate and pain after a whole range radiotherapy,who were treated with3to5patches2.5mg(25?g/h)of transdermal fentanyl every9～15days if their VAS scores were found to be more than6scores.The analgesia effect,life quality and the adverse reaction were evaluated respectively with VAS,Digit-scale and east American carcinoma cooperation group toxicity criteria.RESULTS:The average VAS scores has been lowered from7.86?1.18before the treatment to2.24?1.31on10th day of the treatment(P

Objective To quantify the risk factors for aspirin resistance so as to increase the prognosis for risk of coronary heart disease,and to establish a predictive model for aspirin resistance in order to guide the clinical anti-platelet therapy.Methods A total of 938 elderly male patients with stable coronary heart disease (CHD) receiving oral aspirin therapy (＞75 mg/d) over 2 months were included in this study.Their clinical data were collected.Logistic regression analysis was performed to establish a predictive model and risk score for aspirin resistance.Hosmer Lemeshow (H-L) test and an area under the receiver operating characteristic (ROC) curve (the area under the ROC curve) were performed to test the calibration and discrimination of the model.Results Seven risk factors were included in the predictive model,including serum creatinine (＞110 μmol/L:score of 1),fasting blood glucose (＞7.0 mmol/L:score of 1),hyperlipidemia (score of 1),number of coronary arteries in lesion (2 branches:score of 2,≥≥3 branches:score of 4),body mass index[(20-25) kg/m2:score of 2,＞25 kg/m2:score of 4],percutaneous coronary intervention (score of 2),smoking (score of 3).H-L test showed P≥0.05 and the area under the ROC curve＞0.70 in this model.Conclusions the risk factors for aspirin resistance,and establishing a valid predictive model for aspirin resistance,could provide an important reference for anti-platelet therapy in CHD patients.

Objective To study the effect of anterolateral calf flap with extra-territorial blood supply in repairing large area of foot skin tissue injury. Methods 40 cases of arge area of foot skin tissue injury were divided into the observation group which were given anterolateral crural flap transplantation and the control group which were given anterolateral thigh flap transplantation. The wound healing condition and walking ability were observed. Results The level of wound healing, Holden walking ability and FAC walking ability were better than control group (P<0. 05). In the observation group, wound healing time was (15. 2 ± 6. 2) d and donor skin crusting time was (9. 4 ± 1. 5) d, which were less than the control group(P<0. 05). Conclusion Anterolateral calf flap with extra-territorial blood supply has positive clinical value as it can improve wound healing and walking function.