Objective To observe the branches and distribution of the tibial nerve and analyze the compressed position of it.Methods Twenty sides of adult cadavers were anatomized and the tibial nerve branches in ankle,foot,the internal and external plantar tunnel were observed.Correlated data was measured and recorded.Results ① The tendinous part of abductor hallucis muscle that was located under the muscle and consisted the surface of the internal and external plantar tunnel was(8.62?0.79)cm in length,(3.01?0.30)cm in width,and the thickness of it was about(0.24?0.02)cm.The internal and external nerves were located in the internal and external tunnel.The length of the internal tunnel was about(4.58?0.41)cm,and the diameter was(1.11?0.10)cm.The length of the external tunnel was about(2.58?0.23)cm,the diameter was about(0.96?0.08)cm.② Internal hell nerve was in an isolated tunnel interior the hell,which was the hell tunnel.The length of the hell tunnel was about(3.03?0.21)cm,the diameter was(1.07?0.09)cm.Conclusion The tibial nerve branches can be compressed at internal,external plantar tunnel or the heel tunnel.When making neurolysis of the tibial nerve for tarsal tunnel syndrome patients,except for the flexor retinaculum,the internal and external plantar tunnel and the hell tunnel should also be decompressed especially for the patients with the symptom of compressed single branch.

AlM:To investigate the effect of teaching mode of problem- based learning ( PBL ) in the teaching of medical students' clinical ophthalmology.
METHODS: Five classes ( total 148 students ) were randomly selected as experimental group, using PBL method, at the same time another 5 classes ( total 151 students) were also randomly selected as control group, using lecture-based learning ( LBL) mode in 2010 grade. The scores of the experimental group were compared with control at the end of term. ln addition, students and teachers were respectively interviewed using self -administered questionnaire to obtain their evaluation for PBL practice.
RESULTS:The mean scores of PBL group (78. 35±7. 63) were significantly higher than control group (71. 68±6. 37) (P<0. 001). Most of students thought that their ability of referring, synthesizing and analyzing information was enhanced by PBL, and their skills both in written and oral were also improved. PBL made it easier to understand the contexts of course. lt was the best way to improve the effect of teaching in ophthalmology based on the increase of quality in novitiate that gives more chance to students of contacting with practice, developing the ability of clinical thinking and verifying the theory in clinical novitiate. Lots of teachers considered that the classroom atmosphere was more active, students were becoming more and more proactive on their classes and the relationship between students and teachers were more harmonious when PBL was used.
CONCLUSlON:Using PBL teaching mode can highly improve the teaching effectiveness of clinical epidemiology, which is worth popularizing.

BACKGROUND:Epidural scar after laminectomy is one important reason for the secondary spinal stenosis, and local application ofSanqi sodium hyaluronate gel can prevent epidural scar adhesion after laminectomy. OBJECTIVE: To study the effects ofSanqisodium hyaluronate gel on α-smooth muscle actin expression in the process of rabbit's epidural scar formation. METHODS: In this study, there were ninety-six rabbits which were randomized into four groups and given 0.5 mL normal saline, 0.5 mLSanqi concentrated solution, 0.5 mL sodium hyaluronate and 0.5 mLSanqisodium hyaluronate gel around the dura. At 1, 2, 4, 8 weeks after treatment, immunohistochemistry staining was employed for analysis of α-smooth muscle actin expression. RESULTS AND CONCLUSION:At the end of weeks 1 and 2, the expression of α-smooth muscle actin antibody in the normal saline group was significantly higher than that in the other three groups (P < 0.01 orP < 0.05), but there were no significant differences among the Sanqi, sodium hyaluronate andSanqisodium hyaluronate gel groups (P> 0.05). At weeks 4 and 8, the expression of α-smooth muscle actin antibody in theSanqi sodium hyaluronate gel group was significantly lower than that in the other three groups (P < 0.01 orP < 0.05), and there was no significant difference among the latter three groups (P > 0.05). These findings suggest thatSanqi sodium hyaluronate gel can inhibit the expression of α-smooth muscle actin, and thus ease scar contracture.

U plus DHA.

Objective To observe the clinical efficacy of Jianpi Huatan Decoction plus Zhongwan (RN12) moxibustion on patients of mild to moderate stable chronic obstructive pulmonary disease (COPD) with syndrome of qi deficiency of lung and spleen, and analyze the related influencing factors. Methods With prospective randomized clinical trial, 140 cases of mild to moderate stable COPD were randomized into two groups (70 cases for each group). Treatment group was treated by Jianpi Huatan Decoction plus Zhongwan moxibustion based on western medicine, and control group was only treated by western medicine. Both groups were treated for 12 weeks and followed up for 12 weeks. Scores of clinical symptoms and quality of life questionnaire were examined, and multiple logistic regression analysis was used to find possible impacting factors on the effect. Results Symptoms were significantly alleviated after treatment (P<0.01) in both groups. The clinical effects and quality of life in treatment group were significantly improved than the control group (P<0.01). There were no significant changes in life quality of control group ( P>0.05). Multiple logistic regression analysis showed that different therapies and severity of COPD were the major influencing factors of clinical effect (P<0.05, P<0.01). Conclusion Jianpi Huatan Decoction plus Zhongwan moxibustion had significant therapeutic effect on mild to moderate stable COPD patients with syndrome of qi deficiency of lung and spleen by alleviating symptoms and improving quality of life. Treatment style and severity of COPD are the main influencing factors.

Objective To further investigate the association among clinical pathology,complement activation and renal secretory IgA (SIgA) deposition in patients with IgA nephropathy (IgAN).Methods The activation of serum complements were detected by immunoturbidimetry and ELISA.Renal deposition of SIgA and activation of complements were detected by immunofluorescence.Then the association among clinical pathology,complement activation and renal SIgA deposition were analyzed in IgAN patients.Results In all 201 patients with IgAN,59 patients had SIgA deposition with higher incidences of mucosal infection history and hematuria (P ＜ 0.05),lower levels of serum cystatin C,β2 microglobulin and lower tubulointerstitial lesion grades and T-grade in the Oxford classification (P ＜ 0.05),when compared with patients without SIgA deposition.Both alternative and mannose binding lectin (MBL) pathways were activated in patients with or without SIgA deposition.Patients with MBL pathway activation had lower estimate glomerular filtration rate (P ＜ 0.01),higher serum creatinine,higher proportion of glomerulosclerosis and S-grade in the Oxford classification,more severe tubulointerstitial lesion (P ＜ 0.05).Conclusions Compared with patients without SIgA deposition,patients with SIgA deposition have a stronger link to mucosal immune.The deposition of SIgA is associated with different clinical and pathological manifestations;however,the complement activation is similar in both groups of patients.Patients with MBL pathway activation show more severe kidney injury.

Aim To study the changes of the biological behavior of dermal fibroblasts in Ⅲ skin burns wound in rats using chitosan.Methods Wistar rats were randomly divided into 5 groups as follows:1% chitosan(W/V)group,2% chitosan(W/V)group,4% chitosan(W/V)group,bFGF(basic fibroblast growth factor) group and the control group.Rats were made for Ⅲ skin burns.The wound healing time was recorded,and the wound healing rate was calculated.Then the cell cycle and apoptotic dermal fibroblasts were determined and the amount of Hydroxyproline(HOP) in the skin tissue was analyzed.Results The wound healing rate of 4% chitosan(W/V) group was higher and the wound healing time of 4% chitosan(W/V) group was shorter than that of the control group.On the 7th,14th day post-injury,the content of protein of 4% chitosan(W/V) group was higher than that of the control group.The content of HOP of 2% and 4% chitosan(W/V) group was highest on the 7th day post-injury. Compared with that in control group,the percentage of cells of S stage in 4% chitosan(W/V) group was aboundant,and was reduced in apoptotic dermal fibroblasts.Conclusion The changes of cellular biological behaviors might be one of the mechanisms of that Chitosan could promote the wound healing of Ⅲ skin burns in rats significantly.

Aim To investigate changes of MAP2 expression level in rat hippocampal pyramidal cells induced by chronic stress, and to explore effects of tianeptine on them. Methods 25 rats were divided randomly into three groups:Control group,Stress group and Stree-tianeptine group. The forced-swimming was performed to rats in stress group and stress-tianeptine. Using the immunohistochemistry and the computerized image technique, expression levels of phosphorated MAP2 and the number the Positive cells were assayed quantitatively in each group. Results Compared with control group (149.34?1.81), the phosphorated MAP2 average gray degree in pyramidal cells of stress group (144.99?4.40) was significantly lower, that of the stress-tianeptine group (148.84?2.73) was significantly higher than that of stress group; The number of phosphorated MAP2 positive cells in stress group (40.36?1.35) was significantly less compared withthat of control group (42.73?1.56); that of stress-tianeptine group (42.14?1.62) was significantly more than that of stress group. Conclusion It is suggested that tianeptine could inhibit the enhancement of phosphorated MAP2 expression in hippocampal pyramidal cells induced by chronic stress.

ObjectiveTo observe the effect of mild hypothermia on vital signs of the elderly patients with anterior circulation brain infarction (massive hemispheric infarction) and hyperpyrexia.Methods46 elderly patients with massive hemispheric infarction and hyperpyrexia within the first 24 hours after onset were randomly divided into the control group and the hypothermia group with 23 cases in each group. The patients of the hypothermia group were treated with mild hypothermia therapy (33℃～35℃). Those of the control group were treated with routine hypothermal treatment. The temperature and heart rate of all patients were measured after 10 days; the prognosis was evaluated according to mortality and scores of Neurological Deficit Scale (NDS).ResultsFor patients of the hypothermia group, the temperature and heart rate significantly reduced, death rate was significantly lower, the neurological function distinctly improved and prognosis was better than the control group after 10 days treatment ( P<0.05).Conclusion Mild hypothermia is safe and effective to elderly patients with massive hemispheric infarction and hyperpyrexia.

Objective To investigate the pathogenesis of gallbladder chaotic dynamics after partial gastrec-tomy. Methods 140 cases operated by partial gastrectomy after 6 months were randomly examined, they in-cluded one group of 40 cases by Billroth type and the other 100 cases by Eiselsberg type. The ultrasonograph was applied to evaluate the function of gallbladder dynamics and radio-immunity method to determine the content of CCK at the time of having no food and 30 minutes after med. Results BV and RV of Eiselsberg group were bigger than Billroth Ⅰ obviously P<0.05. Gallbladder contraction rate displayed not well obvi-ously as too. The plasm level of CCK had no manifested distinctions in empty stomach cases of the 2 groups, but the increasing gradient plasm level of CCK in Billroth Ⅰ exceeded Eiselsberg type. Conclusions The pathogenesis of gallbladder chaotic dynamics after partial gastrectomy was correlated with the alterative type of partial gastrectomy, the reduction of CCK plasm level, the damage of anterior vagal trunk hepatic branches during the operations and so on led to the disorder of gallbladder emptying and induced cholecystolithiasis.