Objective To investigate the clinical results and related key points of surgical treatment for Hawkins Ⅲ talus neck fractures.Methods From March 2005 to March 2010,26 patients with Hawkins Ⅲ talus neck fracture were treated and 21 of them were followed,including 13 males and 8 females,with an average age of 37.6 years.The fractures occurred on the left side in 11 patients and on the right side in 10patients.The mechanism of injury included high falling injury in 13 patients,traffic accident injury in 7 patients and rolling down injury in 1 patient.Five cases were closed fractures and 6 cases were open fractures.A bilateral approach,the medial and lateral approaches,was used to perform the operation with cannulated screw fixation in emergency.After external fixation in functional position for 6 weeks without loading,ankle joints were allowed to take exercise with hinge brace and to bear partially basing on plain radiograph 12-16weeks later.The weight-bearing should be adjusted with follow-up.Functional results were assessed according to AOFAS (American Orthupaedic Foot and Ankle Society,AOFAS)score.Results The average duration of follow-up was 36.6 months (range,6-60 months).All fractures gained union and the average union time was 4.5 months.The average AOFAS score was 78.6.There were 4 cases in excellent results,10 in good,5 in fair and 2 in poor.The overall excellent and good rate was 67.8％.Traumatic arthritis occurred in 13 cases and avascular necrosis in 5 cases.Conclusion The effect of surgical treatment for Hawkins Ⅲtalus neck fracture via a bilateral approach is satisfactory.

Objective To explore the effect of extracurricular activities based on specialist nursing clinic. Methods Thirty-four undergraduate nursing students of grade 2013 in the Capital Medical University were enrolled in the study. After learning of nursing theories for senile dementia, the extracurricular activities based onspecialist nursing clinicwere carried out. Before and after the second class activities, the caring ability inventory scale and self scale-rating for self-directed learning (SRSSDL) were used to assess 34 students. Result After the activities, students' caring ability and self-directed learning ability were statistically significantly improved (P<0.01). Conclusion The extracurricular activities based onspecialist nursing cliniccan stimulate the learning interest of nursing students and improve their self-directed learning ability and humanistic care ability.

Objective To explore the imaging characteristics of common malignant sinonasal tumors for improving the diagnostic accuracy of the disease. Methods Radiological and clinical data of 78 patients with sino-nasal malignant tumors confirmed by pathological examination were retrospectively analyzed. Results Sinonasal malignant tumors lacked imaging specificity. Most of CT showed uneven soft tissue densities with unclear boundary and destruction of bone which invaded the soft tissue outside of the cavity including orbit or intra-cranium. There was moderate to remarkable enhancement of the lesion. T1WI in MR demonstrated homo-and hypo-intense signal , while T2WI revealed homo- and hyper-intense signal ,and post contrast MR imaging displayed heterogeneous con-trast enhancement. There was no significant statistical difference between CT and MRI in the detection rate of ma-lignant tumors(P > 0.05),but CT in combination with MRI improved the positive rate of detection(P < 0.05). Conclusions The imaging of sinonasal malignant tumors is complicated and lacks specificity. For complicated si-nonasal malignant tumors,enhanced CT in combination with MRI should be used to determine the nature and limi-tation of the tumor,and its relationship with the surrounding structures,resulting in improvement of the diagnostic accuracy of the disease.

To explore influence of interventional closure on heart rate in patients with atrial septal defect . Methods : A total of 63 patients with atrial septal defect undergoing percutaneous interventional closure in our hospi‐tal were selected. Heart rate was compared before and after surgery ,and correlation among heart rate ,age ,occlude size and preoperative pulmonary artery pressure was analyzed .Results : Compared with before surgery ,there was significant reduction in heart rate [(75.22 ± 8.23) beats／min vs. (64.87 ± 10. 65) beats／min] after percutaneous in‐terventional closure of atrial septal defect , P＝0.001 ;Pearson correlation analysis indicated that postoperative heart rate change was not correlated with age ,occluder size and pulmonary artery systolic pressure (PASP ) ( r＝0.017－0.182 , P＞0.05 all) . Compared with patients without preoperative pulmonary artery hypertension ,there was sig‐nificant rise in postoperative reduction amplitude of heart rate [ (2.28 ± 9.81) beats／min vs. (11. 35 ± 10.73) beats／min] in those with preoperative elevated pulmonary systolic pressure (≥25mmHg) , P＝0.038 .Conclusion : After percutaneous interventional closure ,heart rate significantly decreases in patients with atrial septal defect .Presence of preoperative pulmonary artery hypertension can be regarded as a risk predictor for postoperative heart rate reduction .

Objective To study the function of interleukin (IL)-25 for rheumatoid arthritis (RA) fibroblast-like synoviocytes (FLS) differentiation as well as on the expression of extracellular regulating protein kinase (ERK) and matrix metalloproteinases-3 (MMP-3).Methods The differences on ERK1/2 and MMP-3 protein levels were tested in RA-FLS of RA patients and healthy controls,then IL-17A (10 ng/ml) was tested when the RA-FLS were co-stimulated with different concentrations of IL-25 (0.01,0.1,1 and 10 ng/ml) and IL-17A(10 ng/ml) for 24 hours respectively.The expression of ERK1/2 and MMP-3 protein was detected by the Western blot.T test was used for the comparison between different groups.Results The expression of ERK1/2 (1.71±0.17) and MMP-3 (0.50±0.13) proteins in RA-FLS was higher than the healthy controls (0.50±0.15,0.17±0.05) (t=-9.13,P＜0.01 and t=-4.10,P＜0.05),after stimulated with IL-17A,the expression of ERK1/2 (0.77±0.22) and MMP-3 (0.59±0.13) proteins in RA-FLS were increased compared with the untreated groups (0.18±0.35,0.04±0.03) (t=-4.69,P＜0.01 and t=-7.47,P＜0.01).With increase of the concentration on IL-25,the level of ERK1/2 (0.54±0.26,0.48±0.18,0.48±0.23,0.23±0.06) and MMP-3 (0.58±0.09,0.59±0.14,0.21±0.04,0.04±0.02) in RA-FLS which were stimulated by IL-17A was decreased slowly (t=4.22,P＜0.05 and t=4.95,P＜0.01 and t=7.47,P＜0.01).Conclusion IL-25 can inhibit the stimulation of IL-17A on ERK1/2 and MMP-3 fractionally,which implies that it may take part in the development of RA through this pathway and may be a target for the RA treatment.

Objective: To observe the effects of electroacupuncture (EA) at Neiguan (PC6) on arrhythmia during acute myocardial ischemia-reperfusion and the expression of connexin 43 (Cx43) in rats. Methods: A total of 40 Sprague-Dawley male rats were used. Ten rats were randomly selected as the blank group, and the remaining 30 rats were randomly divided into a model group and an EA group, with 15 rats in each group. Before modeling, rats in the EA group received one session of EA intervention at bilateral Neiguan (PC6) for 30 min; the other groups were treated with the same grasping and anesthesia for 30 min without intervention. PowerLab physiological recorder was used to record electrocardiograph within 30 min of infarction. After the experiment, cardiac tissue and serum were collected from rats. Hematoxylin-eosin (HE) staining was used to observe the morphological changes of myocardial tissue in the ventricular infarction area of rats in each group. The expression of Cx43 protein in the myocardium of each group was detected by Western blotting (WB). Enzyme-linked immunosorbent assay (ELISA) was used to determine the activity of Na+-K+-ATPase in myocardial tissue and the serum content of endogenous digitalis-like factor (EDLF) in rats. Results: There was no statistical difference in arrhythmia score between the EA group and the model group, but the total duration and average duration of arrhythmia in the EA group were decreased (P<0.01). HE staining showed that compared with the blank group, myocardial cells in the model group were disorganized and seriously damaged. The pathological changes in the EA group were similar to those in the model group, but the damage was relatively minor. The results of WB showed that compared with the blank group, the Cx43 expression in myocardial tissue of the model group was decreased (P<0.01); compared with the model group, the Cx43 expression in the EA group was increased (P<0.01); compared with the blank group, the Na+-K+-ATPase activity in myocardial tissue of the model group was significantly decreased (P<0.01); compared with the model group, the Na+-K+-ATPase activity in the EA group was increased (P<0.01). ELISA results showed that compared with the blank group, the serum EDLF content in the model group was significantly increased (P<0.01); compared with the model group, the EDLF content in the EA group was decreased (P<0.01). Conclusion: EA at Neiguan (PC6) can delay and reduce the onset of arrhythmia during myocardial infarction in the rat model of myocardial ischemia-reperfusion. Its mechanism of action may be related to the regulation of the Cx43 expression in myocardial tissue, improvement of the activity of Na+-K+-ATPase in myocardial tissue, and increase in the content of serum EDLF.

Objective To prepare Zishen pills as gel plaster according to the prescription,and investigate its transdermal absorption characteristics in vitro.Methods Based on preliminary experiments,the matrix prescription of the gel plaster was optimized by single-factor tests and the Box-Behnken design.Evaluation indicators included initial viscosity,viscosity retention and sensory scores.The modified Franz diffusion cell was used to investigate the effect of penetration enhancers on the transdermal characteristics of gel plaster in vitro,with the permeability of neomangiferin,phellodendrine hydrochloride,mangiferin and berberine hydrochloride as evaluation indicators.Results The prescription dosage of the preferred matrix for the Zishen gel plaster was sodium polyacrylate NP700 2.55 g,glycerin 11.04 g,polyvinylpyrrolidone K90 1.13 g,tartaric acid 0.1 g,glycyrrhizin 0.1 g,kaolin 0.3 g,and distilled water 15 g.Among different types and concentrations of permeation enhancers,5%aminoketone showed the best permeation performance.The permeation rates for neomangiferin,phellodendrine hydrochloride,mangiferin,and berberine hydrochloride were 1.5338,1.7809,2.3247 and 20.0899 μg·(cm2)-1·h-1,and the penetration rates were 2.4319,1.9408,1.9604 and 1.4701,respectively.The percutaneous absorption curve of the drug conformed to the zero-order kinetic equation.Conclusion The preparation process of the obtained gel plaste is stable and feasible,with good adhesive properties,sustained drug release,and favorable in vitro percutaneous permeability,indicating potential clinical application value.

Continuous nursing plays an important role in patients discharged from hospital with peripherally inserted central catheter (PICC) . This article summarizes the current status, models and effect evaluation indicators of continuous nursing for discharged patients with PICC in China, and explores the existing problems and prospects of PICC continuous nursing, so as to provide a reference for medical institutions to effectively implement localized continuous nursing models.

Objective To explore the effect of the second class on improving teaching results in "Geriatric Nursing".Methods A total of 53 junior college nursing students of Capital Medical University were selected by purposive sampling from September 2014 to February 2015. They were randomly divided into observation group (n=28, traditional teaching method + the second class teaching) and control group (n=25, traditional teaching method). The learning effects were evaluated with the self-rating scale for self-sirected learning (SRSSDL) and the theoretical achievements of "Geriatric Nursing".Results The theoretical achievements of "Geriatric Nursing" all improved. The average of the theoretical achievements was (80.28±6.15) in observation group and (72.33±9.78) in control group with a significant difference (t=4.43,P<0.05). The scores of SRSSDL in learning awareness, learning behavior, learning strategy, learning evaluation, interpersonal relations skills in observation group were all better than those in control with significant differences (t=4.198, 8.314, 10.237, 12.639, 5.109;P<0.05).Conclusions The second class in "Geriatric Nursing" provides a platform for innovation, demonstration, practice and knowledge aftertaste. It can effectively inspire students' learning interest in the major, be in favor of cultivation in humanistic concern and improve the self-directed learning capacity of junior college nursing students.

Spinal cord injury is a serious disabling disease and its pathological and physiological processes mainly consist of primary and secondary injury. Primary injury is mainly caused by instantaneous mechanical injury while secondary injury is chiefly triggered by long-term inflammatory cascade reactions. With myelin sheath damaged in primary mechanical injury and secondary inflammatory injury, there was a large amount of cholesterol-rich myelin debris in the damaged area, which is mainly swallowed by bone marrow-derived macrophages (BMDMs). Owing to the limited capacity for processing cholesterol and insufficient efflux pump function of BMDMs, a large number of intracellular lipid droplets composed of neutral fat will be formed, as a result of which BMDMs show a"foamlike"shape and develop into foam cells. Foam cells further aggravate the local inflammation of the injury, prolong the inflammation and promote the formation of local scars, thus hindering nerve regeneration and recovery of sensory and motor functions. Currently, there has been no comparatively complete summary concerning the formation, mechanism of action, intervention of foam cells in spinal cord injury. To this end, the authors reviewed the research progress on the influence and regulation of foam cells on the pathological process of spinal cord injury, hoping to provide new ideas for the related basic research and clinical treatment of spinal cord injury.