Objective To analyze the cause of constipation of elderly patients with thighbone fracture in order to reduce the incidence of constipation.Methods We gave psychological nursing,activity instruction to 42 elderly patients with thighbone fracture and helped them to form a habit to defecate at fixed time.Results Twelve patients defecated one time every one to two days,Ten patients began to defecate on the second day.26 patients defcated at fixed time.Four patients(9.5%)showed constipation and the symptoms alleviated after use of glycerine enema.Conclusions Selective nursing could settle the problem of constipation for elderly patients with thighbone fracture.It could reduce the pain of patients and promote their rehabilitation.

Objective To research the clinical outcome of atypical glandular cell (AGC)according to various subtypes of HPV infection and histological pathology results.Methods The data of the liquid-bases cytology (LBP),HPV infection and histology in 102 cases of AGC at the gynecology outpatient department of our hospital from January 1 ,2009 to February 28,2014 were collected and performed the analysis on their clinical outcomes.Results Among 67 218 cases of LBP detection,102 cases were AGC with the total incidence rate of 0.15%.In the cases of AGC-NOS,67 cases were normal or benign lesions,11 cases were precancerous lesion and malignant lesions;in the cases of AGC treading to tumor,the benign,precancerous and malignant lesions were in 7,14 and 3 ca-ses respectively.At the same time in the cases of AGC-NOS,HPV infection was in 64 cases,in which 57 cases were high risk infec-tion(type 16,52,45)and 7 cases were low risk infection(type 6,11 ).The single infection,double infection and multiple infection were in 54,6 cases respectively;in the cases of AGC trends to neoplasm,HPV infection was in 19 cases,in which 18 cases were high risk infection(type 52,16,18)and 1 case was low risk infection(type 6),single infection and double infection were in 15 cases and 4 cases respectively.Conclusion AGC may play an important role for the forecast of cervical malignant lesions.The results of differ-ent HPV subtypes infection in AGC related tumors also play a certain role in the prediction of cervical neoplasia.Their combined a-nalysis is the important signal for judging the occurrence of gynecological cervical precancerous lesion and malignant tumor,i.e., AGC combining with the corresponding HPV subtype infection not only can make a judgement for the cervical lesions,but also pro-vides the basis for predicting the high risk existence of gynecological malignant tumor and provides constructive suggestions for Chi-na regional cervical carcinoma vaccine manufacturing and promotion.

Objective:To explore the anatomical and clinical effects of lateral-perineal approach in treating the fracture of inferior ramus of pubis-ischium ramus.Methods:The lateral approach of the perineum was simulated on 10 side of 5 intact wet adult cadavers to determine the surface symbols of incision design and to expose the operative field of the approach and to observe the anatomical characteristics of the perineal branch of the posterior femoral cutaneous nerve and the incision of the surgical approach. Five points were selected at the incision of the approach. The distance (L 1-L 5) between each point and the body surface projection of the perineal branch of the posterior femoral cutaneous nerve was measured. A total of 11 patients, including 5 males and 6 females with an average age of 41.55±14.32 years, ranging from 18 to 62 years, were treated by this approach in clinical practice. All patients had a reduction and fixation to the fracture of inferior ramus of pubis-ischium ramus. The operation duration, incision length, intraoperative blood loss and surgical complications were recorded. The quality of fracture reduction was evaluated according to Matta radiographic criteria. The strength of the adductor was measured. The pelvic function was evaluated according to Majeed Pelvic Score at the last follow-up. Results:Anatomical studies shown that the line between the two points. One point was 4 cm lateral to the level of the apex of the pubic arch. Another point was 4 cm from the ischial tubercle on the line from the ischial tuberosity to the point that 4 cm lateral to the level of the apex of the pubic arch was the axis of the approach lateral of the perineum. Anatomical studies showed that the lateral-perineal approach could expose the range from pubic symphysis to sciatic tuberculum. The distance between the points selected at the incision of the approach and the body surface projection of the perineal branch of the posterior femoral cutaneous nerve: L 1 was 19.40±1.17 mm, ranging from 18 to 21 mm; L 2 was 16.60±2.76 mm, ranging from 10 to 20 mm; L 3 was 18.30±1.89 mm, ranging from 16 to 21 mm; L 4 was 19.20±1.93 mm, ranging from 16 to 22 mm; L 5 was 14.70±1.83 mm, ranging from 13 to 18 mm. All patients were followed up for 17.91±4.09 months, ranging from 13 to 26 months. The incision length was 8.18±0.98 cm, ranging from 7 to 10 cm. The operation duration was 59.64±12.17 min, ranging from 43 to 85 min. The intraoperative blood loss was 100 ml, ranging from 50 to 130 ml. All incisions were healed in all patients. The fractures were healed in 13.36±2.06 weeks, ranging from 10 to 16 weeks. According to Matta radiographic criteria, the quality of fracture reduction was excellent in 6 cases, good in 4 cases and fair in 1 case. At the last follow-up, the adductor muscle strength reached grade 4 in 4 patients and grade 5 in 7 patients. Furthermore, according to the Majeed Pelvic Score, the score of every patient was 86.55±9.59, ranging from 66 to 100, and 8 cases were excellent, 3 cases were good at the last follow-up. The heterotopic ossification occurred in 2 patients, the pain during intercourse occurred in 2 patients. No patient had sensory disturbance or pain in the perineal area. Conclusion:A certain safe distance is between the lateral to the perineum and the perineal branch of the posterior femoral cutaneous nerve with limited risk of injuring posterior femoral cutaneous nerve via the lateral approach of the perineum. The advantages in treating the fracture of inferior ramus of pubis-ischium ramus by this approach have concealed incision, short operation duration and less bleeding with satisfied short-term clinical effects.

Objective: To explore the clinical and pathological features and mutational types and their relations with WT1 mutation-associated nephropathy (WT1MAN). Methods: The clinical and pathological data and the results of WT1 mutation analysis of the cases from Nanfang Hospital of Southern Medical University, Sun Yat-sen Memorial Hospital and The First Affiliated Hospital of Sun Yat-sen University whom we recruited recently and reported during the last ten years were analyzed. Results: Totally, 20 cases (6 males and 14 females), included 5 newly diagnosed cases, were recruited. (1) Ten children were diagnosed with Denys-Drash syndrome (DDS): The median onset age of proteinuria was 1 year and 7 months. Diffuse mesangial sclerosis (DMS) were revealed in 3 cases, minimal lesions (MCD) in 4 cases, and focal segmental glomerulosclerosis (FSGS) in 1 case; renal pathology was not available in the other 2 cases. Glomerular basement membrane (GBM) thickening was observed in 2 cases. Calcineurin inhibitors (CNIs) were administered in 5 cases, complete remission of proteinuria was observed in 3 cases, partial remission in the other 2 cases. Genetic analysis revealed that six cases had WT1 missense mutation, 3 had nonsense mutation, and 1 had frameshift mutation. (2) Two cases were diagnosed with Frasier syndrome (FS): proteinuria was observed at 1 year and 1 month of age and 1 year and 9 months of age, respectively. FSGS with GBM layering were observed in both cases. They progressed to ESRD at 1 year and 6 months of age and 6 years and 6 months of age, respectively. CNI was tried in 1 case with partial proteinuria remission. Both patients were detected to have WT1 splice mutation. (3) Isolated nephropathy (IN) was observed in 8 cases: three had splice mutation, 5 had missense mutation. Of the 3 patients with splice mutation, one was found to have nephropathy and renal failure at the age of 5 months. The other two cases (1 was FSGS and another MCD), both had GBM layering. CNIs were tried on both of them, one got partial remission with normal renal function at the age of fourteen years, the other one had no response and entered ESRD at the age of 6 years and 9 months. Of the 5 cases with missense mutation, 3 had DMS, 2 of them entered ESRD within 6 months of age, another case had DMS entered ESRD at 9 years of age. One case with FSGS, was treated with CNIs and got complete remission. Conclusions Slow progression (7/10) nephropathy was observed in DDS patients. Missense mutation (11/20) was the most common type of WT1 variants, followed by splice mutation (5/20) in this group of patients. Early onset nephropathy (4/5), rapid progression (4/5) and GBM layering (4/4) wereobserved in patients with splice mutation. CNI was effective in reducing or even eliminating proteinuria in WT1 MAN patients (8/9).

Objective:To explore the characteristics of Lowe syndrome, as well as OCRL1 gene mutation and its relationship with phenotype. Methods:Children diagnosed with Lowe syndrome during their visit to Nanfang Hospital of Southern Medical University (4 cases) and the First Affiliated Hospital of Sun Yat-sen University (3 cases) from January 2009 to January 2019 were included. The clinical data and peripheral blood samples were collected, and the sequence analysis of OCRL1 was performed after genomic DNA extraction. Then the clinical features of the children and the relationship between OCRL1 mutation and clinical phenotype were analyzed. Results:Seven patients from 6 families who presented with Lowe syndrome were included. All of them had different degrees of ocular-neural-renal symptoms. Six cases from 5 families had congenital cataract and neonatal hypotonia, one case from another family only had a thin lens without cataract. Four cases had nystagmus and 2 cases had glaucoma. Six cases from 6 families had psychomotor retardation and had proximal tubular impairment, included low-molecular-weight proteinuria (LMWP). Serum aspartate transaminase (AST), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase-MB (CK-MB) were increased in all 6 patients who were tested. Mutations of OCRL1 were detected in all the 6 families, which located in exon 10, 13, 16, 18, 22 and 23 respectively. The mutations of c.891 G>T, c.1682_1683insAA and c.2564_2567del are novel. Conclusions:Three OCRL1 novel mutations in 6 Chinese Lowe syndrome families are identified. The clinical manifestations in different mutations of OCRL1 are heterogeneous. The mutations of c.891 G>T in exon 10 without congenital cataract is rare in clinical.