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.

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.

Objective To discuss the clinical therapeutic effect of tibia fracture treated by intramedullary nail using limited incision or close reduction.Methods We treated 54 tibia transverse fracture cases,93 oblique fracture cases, 7 1 fragmental fracture cases by intramedullary nail using open with limited incision or close reduction.We then compared operation time,X-ray time,hospital stay duration,infection rate,nonunion rate, and postoperative function restoration between patients with different fractures.Results There was no different operation time in transverse fracture group,but longer for close reduction in oblique fracture group and for open reduction in fragmental fracture group.X-ray time did not differ for open or close reduction in transverse fracture group.Long X-ray time was used in close reduction in oblique and fragmental fracture groups.There was no significant difference in nonunion rate for open and close reduction in both transverse and fragmental fracture groups.The oblique fracture nonuinon rate was higher in close reduction group than in open reduction group.No difference was found in infection rate or function recovery whether for open or close reduction in all types of fractures.Conclusion Different therapy methods should be determined by different fracture types.Open reduction with minimal incision should be used for oblique fracture cases and fragmental fracture cases with reduction difficulty.

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.

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

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.