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 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 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 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 .

OBJECTIVETo investigate the reproducibility of Gleason scores for prostate cancer.

METHODSBased on the revised Gleason Scoring System of the International Society of Urological Pathology ( ISUP) , we analyzed the reproducibility and difference of Gleason scores in 49 cases of prostate cancer using the methods of combination and grouping.

RESULTSThe total reproducibility of Gleason scores among 15 pathologists was good (κ = 0.642), 62.2% by the combination method, the highest in Gleason 5 + 5 (81.2%) and 5 +4 (73.3%), then in Gleason 4 + 4 (67.5%), 3 + 3 (64.0%), 4 +3 (61.3%), and 3 + 4 (44.0%), and the lowest in Gleason 4 + 5 (38.9%) and 3 + 5 (33.3%). The total reproducibility of Gleason scores by the grouping method was 71.4%, the highest in Gleason 9-10 (84.9%) , then in Gleason 7 (76.7%) and 6 (64.0%), and the lowest in Gleason 8 (60.7%).

CONCLUSIONThe reproducibility of Gleason scores remains to be further improved in prostate cancer, mainly concerning the understanding of Gleason 3 and 4 carcinoma.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Oculomotor Nerve Diseases ; therapy ; Young Adult

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

Src is a non-receptor protein tyrosine kinase activated by a number of extracellular signal moleculars. It is recruited to peripheral sites through myristoylation and the SH3 domain. Src initiates intracellular signal trandsduction pathways that influence cell adhesion, migration, growth, differentiation and survival though catalytic domain. Src is normally maintained in an inactive conformation because of carboxy terminal Src kinase, but can be activated transiently during cellular events such as mitosis or constitutively by abnormal events such as mutation and some cancers. In additions, c-Src protein is found to be highly activated and the Src gene is frequently over-expressed in many cancers. These findings suggest that the relationship between c-Src activation/over-expression and cancer progression appears to be significant.