Osteochondral lesions of the talus are rare.The factors leading to them include trauma,chronic fatigue,family history,and idiopathic necrosis.The patients present with ankle pain,swelling,bruise,limited mobility and limp at an early stage while joint stiffness and walking and moving pain at a late stage.Normal check is likely to overlook them,resulting in delayed diagnosis and treatment.If an osteochondral lesion of the talus is suspected with negative X-ray manifestations,further radionuclide bone scan or MRI is indicated for definite diagnosis.As there is no blood supply to the talar cartilage which is relatively too small,it is difficult to treat osteochondral lesions of the talus.Early mild lesions can be treated by conservative therapy.If conservative treatment fails or the lesions deteriorate,surgery is required.This paper reviews the research progress in the treatment of osteochondral lesions of the talus.

Objective To investigate the clinical characteristics and prognosis of acute myocardial infarction (AMI) combined with ventrical septal perforation (VSP).Methods Fifty-seven AMI + VSP patients were retrospectively analyzed their clinical characteristics and outcomes who were treated in the Fourth People' s Hospital of Shenyang and the First Hospital Affiliated to China Medical University from June 2000 to May 2014.Results Of all patients,43 (75.4％) VSP occurred anterior wall AMI,and 14 (24.6％) were not.Echocardiogram show the end diastolic diameter of left ventricle was (53.7 ± 9.5) mm,left ventricle ejection fraction was (48.5 ± 11.8)％,VSP diameter was (9.8 ±7.9) mm,and 37(64.9％) were with near apex.The level of cardiactroponin I,C-reactive protein,and N terminal of B type natriuretic peptide of patients were (16.7 ± 12.9) μg/L,(99.7 ± 31.40 mg/L,(3 051.2 ± 879.7) μg/L.Total mortality was 71.9％ (41/57) in 30 days and 78.9％ (45/57) in 1 year.The mortality of operation group was 73.9％ (17/23) in 30 days and 91.3％ (21/23) in 1 year.The mortality of consecutive therapy was 64.7％ (22/34) in 30 days and 76.5％ (26/34) in 1 year.Conclusion The mortality of AMI + VSP is higher and operation is the most effective therapeutic method.

ObjectiveTo explore the influence of cognitive behavioral intervention on hospitalized patients with schizophrenia.Methods100 hospitalized schizophrenia patients were randomly divided into experimental group and the control group.Routine treatment given to the patients in the control group and cognitive behavioral intervention was applied to the patients at the same time based on routine treatment in experimental group.The patients were assessed with the mini-mental state examination( MMSE),activities of daily living(ADL) and WHO battery of cognitive assessment instrument(WHO-BCAI) pre-and post-cognitive behavioral intervention.ResultsThe expenrentcl geoup and ntrol group before and after the intervention the average MMSE score was(21.8 ± 3.9),(24.4 ± 4.7 ),(21.5 ±3.4),(22.9 ±3.8) ;ADL score an average of(28.8 ±7.9),(25.1 ±4.5),(27.9 ±7.1),(25.2 ±4.8) (t =6.89,11.13,all P ＜ 0.05 ) ; cognitive function in the auditory vocabulary learning,language skills,visual identification,the connection test and cancellation tests were different ( P ＜ 0.05 or P ＜ 0.01 ).ConclusionCognitive behavioral intervention had positive influence on cognitive function in hospitalized patients with schizophrenia.

Flipping the classroom is a new teaching mode in which the students learn some-thing through the network autonomous learning before class, in classroom students interact with teach-ers, internalized and absorb what they have learned, and then consolidate it after class. So it can resultin real-timeevaluation of learning effect by different means, different objects and form and can ef-fectively give secondary feed back comments, which has important significance for the improvement of teaching and learning effects at all levels. Article discusses how to effectively use formative assess-ment method to conduct effective monit oringand feed back to improve the flipped classroom activi-ties. It also explore show to strengthen and exercise their student's ability in the application process.

Objective To establish the disease-syndrome integrated animal models suitable for the studies of TCM through differen- tiating the property of TCM syndromes of spontaneous diseased animal models.Methods With the observation on general behaviors, irritable degree,turning endurance time,pain threshold,urine and stools,luster of hair,growing speed of hair,body weight,tongue condition,degree of eyeball protruding,conjunctiva chroma,blood pressure,heart rate,etc.of spontaneous hypertension rats(SHR) and the comparison with normal rats,the study was carried out on the macroscopic description of property of TCM syndrome of SHR (14～18 weeks of age)and their ethology.Results The blood pressure of SHR at the early stage tended to raise with age growing. Compared with the normal group,the heart rate of SHR rats was obviously quicker(P

Nationally and internationally,there is an growing emphasis on formative assessment for medical education.Teachers are enabled to apply the reflective teaching methods in their classes through careful theoretical trainings and practical guidance.By the application,shortcomings of students are found effectively,so that teachers can adjust their teaching plans and reach a higher teaching quality.

Objective To explore the related factors of the influence of persistent pulmonary hypertension( PPH) after neonatal resuscitation. Methods Tow hundred and fifty?six cases asphyxia patients who were treated in the Maternal and Child Care Service Center of Shangluo from March 2012 to March 2015 were retrospectively analyzed. One hundred and thirty?six newborns asphyxia of persistent pulmonary hypertension were selected as the observation group. One hundred and twenty newborns asphyxia without persistent pulmonary hypertension were selected as the control group. Medical records of children of two groups were retrospectively analyzed. Apgar scores of all observed objects. Before resuscitation blood pressure, blood glucose, body temperature,blood pH value of children in the two groups were recorded. Results In admission, the systolic blood pressure,diastolic blood pressure,body temperature,blood sugar,blood pH value in the observation group ((49. 27±8. 08) mmHg,(22. 25±5. 17) mmHg,(34. 40±0. 41)℃,(2. 78±0. 65) mmol/L,(7. 11±0. 79)) were lower than that in the control group((51. 23±4. 17) mmHg,(23. 87±2. 18) mmHg,(36. 80±0. 85)℃, (3. 55±0. 33) mmol/L,(7. 33±0. 17)),the differences were statistically significant(t=2. 480,3. 334,28. 169, 12. 155,3. 166;P<0. 05) . Hypoglycemia,hypothermia,low systolic blood pressure,low diastolic blood pressure were identified as the impact factors that can cause neonatal resuscitation after persistent pulmonary hypertension ( OR=3. 660,1. 930,8. 903,4. 543;95%CI=1. 061-12. 631,1. 399-2. 661,1. 166-67. 962,1. 636-12. 613;P<0. 05). Conclusion Hypoglycemia,hypothermia,low systolic blood pressure and low diastolic blood pressure are impact factors can cause neonatal resuscitation after persistent pulmonary hypertension.

Objective To evaluate the efficacy and safety of combined intrapleural therapy with bevacizumab and cisplatin in controlling malignant pleural effusion(MPE)caused by non?small cell lung cancer(NSCLC). Methods A total of 63 NSCLC study subjects with MPE were randomly assigned to one of two groups(A and B). Group A(bevacizumab,n=32)received intrapleural bevacizumab(5 mg/kg)with cisplatin(40 mg/m2) therapy once a week for a total of three cycles. Group B(cisplatin,n=31)received intrapleural cisplatin therapy alone with the same dose and cycle. Pleural fluid was collected from both groups prior to and after treatment. The levels of VEGF in the pleural fluid were determined by ELISA. The cura?tive effect and adverse reaction were observed and follow?up was conducted. Results In 63 evaluable study subjects,the curative efficacy in the be?vacizumab group was significantly higher than that found in the cisplatin group(84.3%vs 61.3%,respectively,P<0.05). But the overall survival (OS)of the two groups showed no statistically significant difference(13.0 months vs 12.0 months,P>0.05). After treatment,The VEGF levels in the MPE were significantly decreased in both groups. In the bevacizumab group,the levels of VEGF in the pleural fluid were significantly lower com?pared to those of the cisplatin group after treatment,showing greater efficacy(P<0.05). The VEGF levels of the two groups whose treatment was in?valid had no statistically significant difference(P=0.079). There was no significant difference in gradeⅢ/Ⅳadverse events between the two groups. All procedures were well tolerated by the patients. Conclusion Combined intrapleural therapy with bevacizumab and cisplatin was effective and safe in managing NSCLC?mediated MPE. The patients showed high tolerance to the therapy. For prediction of local treatment efficacy of bevaci?zumab using the VEGF expression levels in MPE,further research was needed.

[Objective]To analyze the clinical features of spinal fracture of the injured in Wenchuan Earthquake and to summarize the medical rescue.[Method]The clinical data of 94 injured cases with spinal fracture in the earthquake were collected and analyzed,including the general condition,injury mechanism,associated injuries and the rescue measures.[Result]The incident rate of the male was much higher than that of the female,the incidence of spinal fracture was high in 21~60-years old;the associated injuries were found in 54 cases,taking up 57.4%.The spinal fracture typing showed that 89 cases had flexion-compression fracture and burst fracture,taking up 94.7%.[Conclusion]Earthquakes cause a large amount of the injured with spinal fracture,who are evacuated within a concentrated time,the injuries are severe with many associated injuries.Scientific organization and reasonable division are critical in the immediate medical rescue of the injured in large quantity within the shortest time.

[Objective]To investigate the possibility of percutaneous minimally invasive technique in treating patients with type C1 pelvic fracture injured in the earthquake.[Method]Thirteen patients with Type C1 pelvic fracture determined by Tile Classification received reduction with external fixation frame for pelvic anterior ring and with cannulated lag screw for pelvic posterior ring fixation guided under C-arm X-ray.[Result]The cannulated lag screw was successfully implanted percutaneously guided under C-arm X-ray,and post-operation X-ray showed satisfactory reduction.[Conclusion]It is an optimum choice for treating C1 pelvic fracture with external fixation frame combined with cannulated lag screw percutaneously implanted under C-arm X-ray.