Objective To evaluate the clinical significance of anatomic reduction and internal fixation of posterior malleolar fracture in ankle fracture surgical treatment. Methods Fifty-four patients with posterior malleolar fracture were treated with anatomic reduction and internal fixation from March 2005 to June 2010. The patients groups consisted of 36 males and 18 females. According to CT scan classification,the group was made up of 36 type Ⅰ cases, 10 type Ⅱ and 8 type Ⅲ cases. All patients were evaluated with modified Baird-Jackson scoring system. The relationship between final result and fracture pattern , fixation methods, the time of exercise initiation fitted operation were analyzed respectively. Results The followedup period varied from 6 months to 36 months, with an average of 18 months. The number of patients whose result was excellent, good, fair and poor was respective 29,18 ,5 and 2. The total percent age of good to excellent clinical result was 87. 03%. There were 4 patients who had only slight pain after long time walking ,the remainder patients were completed with no pain. Conclusion Operative treatment may provide satisfactory fracture anatomic reduction and internal fixation for posterior malleolar fracture. Correct fracture pattern estimation and proper internal fixation are important to achieve and improve reduction quality, and to ameliorate better long term results.

ObjectiveTo analyze the influential factor of anxiety and depression scores in patients with broken limb(finger),and find the effective nursing interventions.MethodsThe international general hospital anxiety and depression scale research studies on the 100 patients with broken limb(finger) were conducted.ResultsThe patients' age,education level,the nature and size of the company,pre-service training,the level of income and the patients' family economic conditions had a significant impact on scoring a high level of anxiety and depression in patients with broken limb (finger).The differences between the various influencing factors were statistically significant (F =2.926,2.722,t =5.701,4.117,3.311,2.837,3.021,2.947,4.106,3.199,5.286,4.310,5.129,4.152,all P ＜0.05 ).Then the patients' gender,marital status,work experience,the time of injury for overtime and the injured situations do not constitute the relevant factors affecting the patients' anxiety and depression scores.ConclusionPatients with broken limb(finger) have a high incidence of anxiety and depression.The patients' age,education level,the nature and size of the company,pre-service training,the level of income and the patients' family economic conditions have significant impact on scoring a high level of anxiety and depression in patients with broken limb (finger).Clinical care for such patients,should be thought their background,in order to take appropriate nursing intervention.

Missing data plagues almost all surveys and researches. The occurrence of missing data will cause losses of original sample information and undermine the validity of the research results to some extents, so researchers should attach great importance to this problem. In this article, we introduced 3 kinds of missingness mechanism, namely missing completely at random, missing at random, and not missing at random. We summarized some common approaches to deal with missing data, including deletion, weighting approach, imputation and parameter likelihood method. Since these methods had its pros and cons , we should carefully select the proper way to handle missing data according to the missingness mechanism.

Objective To probe the reasons of failure of caged cervical intervertebral fusion and define the indications, operative techniques and short term results of the revision surgery. Methods Twenty-seven cases of caged cervical fusion were revised. The indication for fusion was cervical disc herniation in four cases and cervical spondylotic mylopathy in 23 cases. Of the 27 cases, there were 8 single levels, 15 double levels, 4 three levels. The intervals from revision to primary fusion were 2-25 months, 10.3 months in average. Patients presented discomfort (22 cases) and local pain of neck and shoulder (9 cases) or paralysis (19 cases) preoperatively. JOA grade was mean 11.6 points before revision. Radiographic examination showed the mean lordosis loss was 7.1 mm, the mean interbody height loss was 3.9 mm. 24 patients presented kyphosis. Occluded neighboring cages were found in multilevel cases. Nonunion was founded in 6 cases, unstable in 9 cases, compression still existed in 19 cases. Removal of cages and then decompression, bone grafting and anterior plating fixation were performed in 23 cases (29 cages). 16 patients underwent further posterior fixation. Posterior revisions underwent in another 4 cases (9 cages), including laminectomy and reshaping the lordosis and lateral mass screw plating fixation. Results All the cases were followed-up from 4 to 26 months, 11.7 months in average. The local symptoms released in 81% patients. Nerural deficit symptoms improved in 58% patients. Mean JOA grade was 14.2 points after revision. In 23 cases of anterior approach revisions, 17 cases obtained bone healing within 3 months, while 6 cases got delayed union. The kyphosis was corrected, and the intervertebral height increased 3 mm in average. There were no nerural impaction or failed internal fixation. Conclusion Deficient decompression, sinking of the cage into the cancellous bone of the vertebral body and subsequent kyphosis and bone graft nonunion consist of the main causes for revision surgery. The indications of revision are aggressive neurologic symptom, unstable or deformity of the cervical spine. Cage removal, completely decompression, bone grafting and secure fixation are major steps of revision procedure. In case of more than 3 fusion levels, further posterior fixation is advised.

Based on the review of literature, the evaluation method and application of medication and functional exercise compliance of patients with stroke were summarized, to provide reference for nursing staff about the effective evaluation of medication and exercise compliance of patients with stroke, as well as the early and accurate judgment of patient′s compliance, further taking nursing intervention measures, to provide a basis for improving the medication and functional exercise compliance of patients with stroke and their rehabilitation effect.

Objective To investigate the roles of the cytokine and chemokine in protective immunity of tuberculosis(TB) patient. Methods The RANTES( CCL5) and MIP1-?( CCL3) content of the Supernatant from PBMC stimulated with IL-4、TNF-?、MIP1-?and LPS in TB patients and normal control subjects was assessed using commercially available ELISA kit. Results The RANTES secretion was increased significantly in both TNF-?plus LPS groups[ (1 731. 86?925. 60) ng/L ] and IFN-?plus LPS [(2 120.78?1 120.72)ng/L] compared with LPS group[ (1 102. 56?873. 44) ng/L] in TB patients (P 0. 05). The MIP1-?secretion in response to IL-4、TNF-?、IFN-?was unchanged significantly in PBMC of TB patients and normal subjects. Conclusion TNF-?、IFN-?and RANTES may play important roles in protective immunity of TB patient

Objective To explore the relationship among professional commitment, learning burnout and academic self-efficacy of undergraduate nursing students. Methods 506 undergraduate nursing students were investigated with the three Questionnaires of college students: professional commitment questionnaire, learning burnout inventory and academic self-efficacy scale. Results The scores of affective commitment, ideal commitment, normative commitment and continued commitment of the undergraduate nursing students were (28.229 ± 5.327), (20.348 ±4. 507), (19. 405 ± 3. 730), (18. 148 ± 2. 954) and( 86. 130 ± 13. 421), respectively. And the scores of depression, misconduct, low sense of accomplishment, total bumrnut of the undergraduate nursing students were(21.733 ±5.338), (18.459 ±3. 918) , (17.083 ±3. 596)and(57. 275 ±9. 766) , respectively. As well as the scores of learning ability of self-efficacy, learning behavior of self-efficacy and total self-efficacy were(35.765 ±5.835), (35.247 ±4.840)and (71.012 ±9.659), respectively. The affective commitment,ideal commitment and normative commitment of professional commitment were negatively correlated with the dimensions of learning bumout. And the continued commitment was significant correlated with the low sense of accomplishment. Otherwise, the dimensions of professional commitment were positive correlated with the dimensions of academic self-efficacy. However, the dimensions of academic self-efficacy were significant negative correlated with the dimensions of learning burnout (P＜ 0. 01). Conclusions The professional commitment, learning bumout of undergraduate nursing students are closely related with the academic self-efficacy of undergraduate nursing students. The higher the levels of professional commitment and academic self-efficacy are, the lower the level of learning bumout is.

Objective To investigate the relationship between the staging of endoscopic ultrasonography(EUS) and the expression of carcinoma metastasis associated genic in the patients with gastric carcinoma.Methods Sixty-three patients with gastric cancer were diagnosed by electric gastroscopy and EUS.The preoperative staging of gastric cancer was measured by EUS and compared by pathologic staging and MMP-9 expression.MMP9 level of peripheral serum was measured by enzyme-linked immunosorbent assay,while the expression of MMP-9 protein was tested by immunohistochemistry and hybridization in situ in the gastric carcinoma tissue.Results The total accuracy rate of EUS in estimating invasive depth of gastric cancer was(80.95)%,while that of lymphatic metastasis was(73.02)%.The expression level of MMP-9 in serum was consistent with the expression of MMP-9 protein and MMP-9 mRNA in tissue,which was closely correlative with invasive degree,staging with EUS,lymphatic metastasis in gastric cancer(P

Objective To evaluate endoscopic ultrasonography in preoperative diagnosis and staging of gastric cancer, and to study the molecular biologic basis of its ultrasonic manifestation. Methods Gastric cancer patients were diagnosed by electric gastroscopy and endoscopic ultrasonography. Gastric cancer was preoperatively staged by EUS and results were compared with pathologic staging and VEGF expression. Results The diagnostic accuracy of gastric cancer by gastroendoscopy combined with biopsy in 63 patients was 94%,the accuracy of EUS was 92%,while that of gastroendoscopy combined with EUS was 100%.The total diagnostic accuracy of EUS in estimatating invasive deepth of gastric cancer was 81%,that for stage T_1,T_2,T_3,T_4 was 78%,79%,82%,83%,respectively.The total diagnostic accuracy of lymphaden metastasis was 73%.The positive expression rate of VEGF protein in cancer tissue was 56%,which was closely associated with EUS staging and lymphatic metastasis. Conclusions The accuracy of gastroendoscopy combined with EUS in the diagnosis of gastric cancer was high. The preoperative staging with EUS has a high correspondence with postoperative pathological staging. The VEGF protein expression is positively correlated with preoperative EUS staging.

Objective To study whether Bay 11-7082,a nuclear factor-kappa B (NF-KB) inhibitor,could enhance the treatment efficacy of 131I on DTC in nude mice.Methods Total thyroid ablation nude mice models were prepared by intraperitoneal injection of 37 MBq 131I.The xenografted mice were divided into4 groups (18/group):131I group,Bay 11-7082 group,combination of 131I and Bay 11-7082 group and control group.Drug dosages were given as:intraperitoneal injection of 37 MBqT31I on day 1 in the 7th week in the 131I group; intraperitoneal injection of 10 mg/kg Bay 11-7082 on day 1,2 and 3 in the 7th week in the Bay 11-7082 group; intraperitoneal injection of both 131I and Bay 11-7082 as above-mentioned in the combined treatment group; injection of saline in the control group.The xenografted tumor volume curves were drawn every 7 days.Pertechnetate imaging was performed before thyroid ablation.Post-ablative and post-therapeutic 131I whole body imaging was conducted.On day 7 in the 7th week,6 mice in each group were sacrificed and apoptotic staining was performed on excised xenograft tumors.Apoptosis index was determined as positive cells over total ceils × 100％.One-way analysis of variance and q test were performed for statistical analysis.Results Thyroid and stomach could be visualized on pertechnetate imaging before thyroid ablation.Post-ablative 131I imaging showed increased uptake by the thyroid gland.Post-therapeutic 131I imaging showed increased uptake by the malignant tumor lesions in both the 131I and combined groups.Tumor volume curves showed significant differences in volume changes among different methods of therapy from the end of the 8th week (F =11.91-246.56,all P ＜ 0.01).Combined treatment was more effective than single-therapies (q =3.36-14.99,all P ＜ 0.01).Apoptosis indices for the control group,131I group,Bay 11-7082 group and combined group were (0.28 ±0.15)％,(5.49 ±0.69)％,(6.82 ±0.72)％ and (16.21 ± 1.57) ％,respectively (F =304.40,P ＜ 0.01).Apoptosis index in the combined group was significantly higher than those in each single therapy group (q =15.33 and 13.33,both P ＜ 0.01).Conclusion NF-κB inhibition by Bay 11-7082 could effectively enhance the treatment efficacy of 131I on DTC.