The construction of a network resource data base for clinical skill teaching aiming at sharing excellent teaching resources was completed by integrating all kinds of teaching resource including characters,eourseware,pictures,cartoons,videos and examination questions,etc.In view of the generally weak situation of the current domestic education resource data base construction,the contents,guiding ideology,principle,object,orientation,function and the management mechanism of the network resource data base construction were devised for clinical skills teaching.Suggestions for specific ideas and construction problems were proposed to promote the construction and optimization of the network resource database for clinical skills teaching.

Objective To compare the outcomes of total hip replacement and minimally invasive dynamic hip screw in treating osteoporotic femoral intertrochanterie fractures.Methods Retrospectively analyze the clinical data of 56 patients with osteoporotic femoral intertrochanteric fractures who came to our hospital from July,2008-June,2012.Twenty eight cases who accepted minimally invasive dynamic hip screw were divided into the control group while 28 cases who accepted total hip replacement were divided into the experimental group.The blood loss and postoperative drainage,operative time,situation of implant loosening,the occurrence of postoperative complications and the clinical curative effect were compared between two groups.Results The differences in operative time,blood loss,and postoperative drainage flow,limited weight-bearing after operation was statistically significant between two group[(96.37 ± 20.42)min,(529.85±73.82) ml,(7.46±1.23) dvs (66.84±18.63)min,(152.79±37.35) ml,(14.32±2.62)d,t=5.653,24.117,12.542,P＜0.05].The differences in FRS score and Harris score between twogroups was not statistically significant [(27.75±3.59),(89.84±4.17) vs (26.41±3.16),(88.68±3.92),P＞ 0.05].The incidence in internal fixation loosening varied significantly with different degree of osteoporosis in the control group (66.7％vs18.8％,x2 =4.745,P ＜ 0.05) but not in the experimental group (11.1％ vs 10.0％,P＞0.05).Complication rate of the experimental group was significantly lower than the control group (3.6％vs 28.6％,x2 =4.766,P ＜ 0.05).Conclusions For the elder patients with osteoporotic femoral intertrochanteric fractures,the selection of surgical approach should be based on the patient's individual circumstances and the degree of osteoporosis.In the same time,attention should be paid to anti-osteoporosis therapy after operation.

Objective To investigate the effect of improved bone plate fixation and bone grafting in the treat ment of intra-articular calcaneal fracture.Methods 80 patients with intra-articular calcaneal fractures were randomly divided into the two groups.The non-bone graft group(47 feet in 40 patients)was given improved bone plate fixation.The bone graft group(50 feet in 40 patients)was given improved bone plate fixation and bone grafting.Results The incidence rate of complication in the non-bone graft group was 25.0％ and that in the bone graft group was 19.1％.The difference between the two groups was not significant(x2 =0.21,P ＞ 0.05).Postoperative Bhler's angle and calcaneal height between the two groups had significant differences (t =14.5,16.99,all P ＜ 0.05).The excellent rate of Maryland functionality in non-bone graft group was 66.0％,which was significantly lower than 86.0％ in the bone graft group(x2 =5.38,P ＜ 0.05).The average full weight bearing time between the two groups had significant difference (t =11.17,P ＜ 0.05).Bhler's angle after 1 year and forwa rd Bhler's angle loss of the non-bone graft group had significant differences compared with the bone graft group (t =29.76,9.81,all P ＜ 0.05).Conclusion Improved bone plate fixation and bone grafting in the treatment of intra-articular calcaneal fracture can obtain better results and avoid the long-term loss of reduction.

Objective To investigate the distribution of arterial stenosis in patients with ischemic cerebrovas-cular disease and its risk factors .Methods 224 patients with ischemic cerebrovascular disease were divided into four groups according to DSA results .Patients showed no stenosis or mild stenosis were selected as control group ( 43 ca-ses),the other patients were divided into pure extracranial stenosis group (41 cases),simple intracranial stenosis group (93 cases) and extracranial stenosis group (47 cases).The results of laboratory test were analyzed .The ques-tionnaire was designed and the indicators including name ,age,long-term smoking,drinking,hypertension and diabetes were collected .Results Of all the subjects , there were 181 cases with artery stenosis .Single factor results showed that gender,age,long-term smoking,long-term drinking,hypertension,diabetes,high homocysteine,high level of lyso-phosphatidic acid were the independent risk factors of cerebral artery stenosis (χ2/t =8.744, 5.562, 10.736, 11.032,9.812,10.002,9.083,2.576,all P<0.05).Multivariate analysis showed that high homocysteine ,long-term smoking and drinking were the risk factors of simple intracranial artery stenosis .High homocysteine and high fibrino-gen were risk factors of simple extracranial stenosis .Age,hypertension,long-term smoking and drinking ,high homocys-teine and fibrinogen were risk factors of intracranial and extracranial stenosis .Conclusion In patients with ischemic cerebrovascular diseases ,the simple intracranial artery stenosis is most common .The incidence of cerebral artery ste-nosis has age characteristic ,with the increase of age ,the incidence rate of intracranial and extracranial artery stenosis is rising.High homocysteine,long-term smoking and drinking,hypertension,diabetes,high lysophosphatidic acid are independent risk factors of cerebral artery stenosis .

Objective To explore the effects of nursing intervention under community family responsibility doctor contract mode on insulin therapy knowledge, compliance, self-management ability and glucose control in elderly diabetic patients. Methods From June 2015 to May 2016, 100 elderly diabetic inpatients of Endocrinology Department in Shangqiu First People's Hospital of He'nan Province were selected by convenience sampling. All of the patients were randomly divided into observation group and control group, 50 cases in each group. Patients of control group accepted routine community intervention post discharge. On the basis of control, patients of observation group were treated with signing family responsibility doctor service agreement and community nursing intervention. The follow-up was carried out for six months post discharge. The insulin therapy knowledge, injection compliance of insulin and score of self-management behavior, changes of fasting blood-glucose of patients in two groups were compared. Results Three and six months after intervention, the scores of insulin therapy knowledge and injection compliance of patients in observation group were higher than those in control group; the scores of insulin therapy knowledge and injection compliance of patients in two groups six months after intervention were lower than those three months after intervention with significant differences (P< 0.05). There was an interaction effect between the group factor and time factor in fasting blood-glucose between two groups with a significant difference (F=6.943,P< 0.001). There was an interaction effect between the group factor and time factor in total score of self-management behavior of elderly diabetic patients in two groups with a significant difference (F=6.243, P<0.001). Conclusions The nursing intervention under community family responsibility doctor contract mode for elderly diabetic patients is conducive for patients to mastering insulin therapy knowledge, improving injection compliance of insulin and self-management ability as well as glucose control.