Clinical teaching of Neurology is one of the courses offered for medical students with more speciality and abstract contents,in which also exist many realistic problems during practice.The quality of clinical teaching of neurology would be improved continually by finding out and solving these realistic problems.

Objective To study the clinical effects of delayed surgery for Maisonneuve fractures.Methods Between January 2006 to June 2011,we treated 21 patients with Maisonneuve fracture by delayed surgery.They were 18 men and 3 women,aged from 17 to 63 years (average,36.8 years).Rupture of inferior tibiofibular ligaments was complicated in all,lateral malleolus fracture in 17 cases,medial malleolus fracture in 14 cases,rupture of deltoid ligament in 7 cases,and posterior malleolus fracture in 15 cases.None of them got timely surgery due to complicated injuries,poor skin condition or missed diagnosis.Six patients had surgery after 2 weeks,11 after 3 weeks and 4 after 4 weeks.The interval from injury to surgery ranged from 14 to 32 days,averaging 21.3 days.Fractures of lateral,medial and posterior malleolus were treated with open reduction and internal fixation.Ruptures of deltoid ligament and anterior ligament of inferior tibiofibula were repaired and reconstructed.Functional recovery of the ankle joint was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) scoring system.Results The patients were followed up for 10 to 18 months (average,12.3 months).All the fractures healed after an average time of 12.4 weeks (from 10 to 22 weeks).No infection or implant failure was observed in this group.The affected ankle restored inflexion basically to the range of the contralateral 6 months post-surgery,but was limited in the ranges of varus and valgus.Pain was extensively experienced.At the last follow-up,10 patients (47.6％) showed obvious disparity between the 2 sides,and 5 ones had lateral displacement of the talus and widened ankle mortise.AOFAS results were excellent in 5 cases,good in 9,fair in 4 and poor in 3,yielding a good to excellent rate of 66.7％.Conclusion Because delayed surgery increases the difficulties in surgery and functional recovery,early diagnosis and early surgery are crucial for treatment of Maisonneuve fractures to achieve satisfactory outcomes.

Objective To explore the distribution and drug resistance of pathogens causing bloodstream infection in patients in a general intensive care unit (GICU),and provide reference for the prevention of bloodstream infection and rational use of antimicrobial agents.Methods From January 2011 to December 2013,clinical data of patients who were diagnosed with bloodstream infection were reviewed retrospectively,detected pathogens and drug resist-ance were analyzed statistically.Results The major pathogens isolated from 385 patients with positive blood culture were gram-negative bacilli,which accounting for 62.34%;isolation rate of gram-positive cocci and fungi was 27.01 % and 10.65% respectively.The top five pathogens were Escherichia coli (18.18%),Pseudomonas aerugi-nosa (16.10%),Staphylococcus aureus (15.59%),Acinetobacter baumannii (13.25%),and Klebsiella pneumoni-ae (9.09%).The detection rate of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase negative Staphylococcus was 72.55% and 68.34% respectively.Gram-negative bacilli was most sensitive to imipen-em and amikacin (resistant rate was 0 -35.65%).Conclusion Gram-negative bacilli are the main pathogens in blood culture from GICU in this hospital,and drug-resistant rates are high.It’s important to strengthen blood cul-ture of patients with suspected septicemia,use antimicrobial agents rationally and control infection effectively.

Objective To explore the effects of puerarin on proliferation ,invasion ,migration and tube formation in human endo-thelial cells and its possible mechanism .Methods The effect of puerarin on cell proliferation was determined using methyl thiazolyl tetrazolium(MTT) assay .Invasion was evaluated with transwell chamber .Migration was performed by the wound healing method . Endothelial tube formation was performed by tube formation assay .The expressions of phosphorylase Akt(p-Akt) and phosphoryl-ase nitric oxide synthase(p-eNOS) protein were determined by western blot .Results Puerarin promote the proliferation ,invasion , migration and tube formation of human endothelial cells(P<0 .05) .The expression of p-Akt and p-eNOS were increased signifi-cantly(P<0 .05) .Conclusion Puerarin can promote the proliferation ,invasion ,migration and tube formation of human endothelial cells .Up regulation of p-AKT and p-eNOS protein may be one of its mechanisms .

Objective To compare the effect of different analgesia methods on the treatment of pain after total knee arthroplasty (TKA),and find the ideal analgesia way for peri operation period of TKA.Methods A total of 79 patients was randomly divided into three groups:cocktail,spinal,and multimodal analgesia groups.A comparative study among three groups was conducted on the postoperative visual analogue scale (VAS) of pain score,range of motion,and adverse reaction.Results The motion pain score of using multimodal analgesia patients 24 hours after operation and the resting pain scores 48 hours after operation were less than the other two groups.The postoperative joint range of motion in 1 ～ 2 weeks of multimodal analgesia group was significantly better than the other two groups.Conclusions Multimodal analgesia was an effective way to treat pain after knee arthroplasty.

Objective:To explore the communication problems among nursing students in early clinical prac-tice, and to provide reference for clinical nursing education .Methods:Introspecting diary of the clinical communi-cation in nursing students were classified and analyzed by using qualitative research method .Results:5 themes were extracted as following: barriers for communication between nurses and patients , reflection on patient , nurse occupation , clinical teaching and critical reflection on public opinion .Conclusion:Introspecting diary is important to help teachers in teaching , to guide and cultivate nursing students to develop their interpersonal communication competence .

Calcineurin ; metabolism ; Cardiovascular System ; growth & development ; metabolism ; Humans ; NFATC Transcription Factors ; metabolism ; Signal Transduction

The fluctuation of medical staff thoughts and hospital rapid action during SARS epidemic, we name it "hospital phenomenon during SARS", has its specific characteristics. We analyzed this phenomenon from the following points: the conflict between panic response and the duty of the profession, the contradiction between the need to control infection and the available conditions, the special following phenomenon post - diagnosis of SARS and the hospital routine activity and SARS prevention and cure. We conclude that at least three fields should be improved, that is to strength education of duty morals, to normalize the medical procedure, and to build the dual system of hospital' s routine run and rapid action, in order to constructing hospital credit ethic.

Objective To survey the relationship between myocardial damage of chronic and latent Keshan disease with A360P missense mutation in desmin gene exon6. Methods By clinical epidemiology method,30 cases had been collected randomly among chronic Keshan disease patients and 30 cases equally among healthy adults (inner control groups) in Diantou town,Huangling county,Shaanxi province,a Keshan disease area,and 30 cases among health adults(outer control group) in Chang'an district,Xian city,a normal area. Genome DNA had been extracted from 90 blood samples. Different restriction sites had been analyzed by the methods of PCR,digested by restriction endonuclease and electrophoresis. By virtue of Bsp1286 Ⅰ enzyme,122 bp and 60 bp strap could be found in control group from exnn4,showing that Bsp1286 Ⅰ enzyme was active. By virtue of Bsp1286 Ⅰ enzyme,desmin gene exon6 was digested to 184 bp and 66 bp strip when A360P missense mutation site exited in exon6. Results One hundred and twenty two bp and 60 bp strap could be found in control group from exon4 digested by Bsp1286 Ⅰ ,which showed Bsp1286 Ⅰ enzyme was active. Two hundred and fifty bp strips can only be found in digest products of exon6. One hundred and eighty-four and 66 bp strips which were the products of DNA digested by Bsp1286 Ⅰ could not be found. A360P missense mutation site of desmin gene exon6 had not been found among chronic and latent Keshan disease patients and tow control groups in Keshan disease area and in normal area. Conclusions A360P missense mutation site of desmin gene exon6 has not been found among chronic and latent Keshan disease patients. A360P missense mutation of desmin gene exon6 probably is not predisposing genes of chronic Keshan disease.

Objective To observe the protective and repairing effects of bone mesenchymal stem cells(BMSCs) transplantation on cerebral infarction in rats and to study the different effect of transplantation at different time points. Methods Middle cerebral artery occlusion(MCAO) models were set up,and the rats were divided into a control group,a group with PBS transplantation and five groups with BMSCs transplantation 3,6,12,24 and 72 h after MCAO,respectively.The volume of infarction area and the neurological severity score(NSS) in all the groups were compared. Results Twenty-eight days after MCAO,the TTC staining indicated that the volume of infarction area in the groups with BMSCs transplantation decreased remarkably compared with the control group and the group with PBS transplantation(P