Objective To explore the relationship between restoring Gissane angle and prognosis in calcaneal fracture surgery. Methods Forty patients with single side calcaneal fracture (SandersⅡ-Ⅲ), Gissane angle changed more than 15°and having performed open reduction and internal fixation with steel plate were enrolled. In them, 25 patients (experimental group) recovered Gissane angle in surgery referencing the healthy side with X-rays. Another 15 patients (control group) didn't recover Gissane angle. The ratio of calcaneum height and length was measured at 1 week after surgery. At 6 and 12 months after surgery, the function were valued by Maryland score. Results The ratio of calcaneum height and length in experimental group was significantly higher than that in control group:0.60± 0.04 vs. 0.55±0.05, and there was statistical difference (P<0.05). All the patients were followed up. At 6 and 12 months after surgery, the Maryland score in experimental group were significantly higher than those in control group:(88.9± 5.7) scores vs. (80.5±7.3) scores and (89.5 ±5.5) scores vs. (82.5 ±6.4) scores, and there were statistical differences (P<0.05). Conclusions Restoring Gissane angle is benefitial for prognosis. So in calcaneal fracture surgery, the Gissane angle should be recovered as much as possible referencing the healthy side.

Rifaximin as a representative of the non-absorbable antibiotics,has special effects and wide application prospects in treatments of acute intestinal tract infections,irritable bowel syndrome,inflammatory bowel disease,diverticulosis of colon,hepatic encephalopathy and so on.This paper reviews the advances on clinical efficacy and safety of rifaximin to provide reference for clinical use.

AIM:To evaluate the effectiveness and safety between trabeculectomy with collagen matrix versus trabeculectomy with mitomycin C(MMC) for patients with primary open-angle glaucoma(POAG).METHODS:In this prospective randomized comparative study from January 2015 to December 2016.Thirty-two eyes presented with POAG were included in this study, 14 eyes treated by trabeculectomy with subconjunctival implant of collagen matrix (study group) and the other 18 eyes treated by trabeculectomy with mitomycin C.Postoperative IOP, the success rate of operation, number of postoperative glaucoma medications and postoperative complications were recorded.Each patient was followed up at least 6mo.RESULTS:The mean postoperative IOP was statistically different between the study group and the control group after 1d (P<0.05), while not statistically different at 1 and 1mo follow-up (P>0.05), and the mean postoperative IOP was statistically different between the two groups (P<0.05) at 3 and 6mo after surgery.There was no significant difference in the success rate of operation between the two groups at 6mo after operation (P>0.05).The IOP decreased at 1d after openations compared with before, kept stable at 1wk to 6mo.IOP of study group was lowen than control.IOP was controlled by glaucoma medications in the study group by 28% compared to control group by 33% at 6mo after operation, but there was no significant difference.There was no significant difference between the study group and the control group in complications (P<0.05).CONCLUSION:Trabeculectomy with collagen matrix implant is comparable to the use of MMC with a similar success rate in open-angle glaucoma and the range in reducing intraocular pressure was significantly higher than that of MMC and it can significantly avoid the occurrence of low IOP postoperatively, transient anterior chamber, conjunctival wound leakage complications has no advantages compared with the use of MMC.

Objective To investigate the effect of all-trans retinoic acid (ATRA) on transforming growth factor β1 (TGF-β1)/Notch signaling pathway in injured podocytes induced by adriamycin (ADR) in vitro.Methods Podocytes cultured in vitro were randomly divided into normal group,model group,ATRA treatment control group,12-hour ATRA intervention group and 24-hour ATRA intervention group.Morphological changes were observed by using light microscope.The expressions of TGF-β1,podocin,Notch 1,Jagged 1 mRNA were evaluated through real-time polymerase chain reaction (RT-PCR) and the corresponding proteins were detected by using Western blot.Results (1) No obvious changes between normal group and ATRA treatment control group were revealed as the plump podocytes and distinct outline were found in light microscope,while podocytes in model group showed disordered arrangement,fuzzy boundary,atrophy,hypertrophy and increased cellular debris.Of note,the podocytes in 12-hour ATRA intervention group and 24-hour ATRA intervention group almost returned to normal.(2) In contrast with those in model group,the amounts of TGF-β1,Notchl,Jaggedl mRNA levels decreased in 12-hour ATRA intervention group (1.34 ±0.43 vs.4.16 ±0.31,1.67 ±0.2 vs.4.21 ±0.92,2.08 ±0.27 vs.5.14 ±0.63,q =23.83,11.45,19.67,all P ＜0.05) and 24-hour ATRA intervention group (1.22 ± 0.16 vs.4.16 ± 0.31,1.73 ± 0.53 vs.4.21 ± 0.92,2.08 ± 0.29 vs.5.14 ± 0.63,q =24.85,11.18,19.67,all P ＜ 0.05),and the differences were significant;similar trend was detected in the protein levels (1.04 ± 0.03 vs.4.31 ± 0.10,1.06 ± 0.04 vs.4.47 ± 0.24,1.07 ± 0.04 vs.4.20 ± 0.16,1.06 ±0.03 vs.4.31 ±0.10,1.07 ±0.03 vs.4.47 ±0.24,1.09 ±0.03 vs.4.20 ±0.16,q =163.50,69.61,90.36,162.50,69.40,89.78,all P ＜ 0.05),and the differences were significant;whereas the level of podocin mRNA (1.13 ±0.05 vs.0.40 ± 0.06,1.16 ± 0.03 vs.0.40 ± 0.06,q =36.50,38.00,all P ＜ 0.05) and protein (1.01 ± 0.01 vs.0.44 ±0.01,1.02 ±0.01 vs.0.44 ±0.01,q =180.25,183.41,all P ＜0.05) increased,and the differences were sig nificant.(3) The expressions of Notch1,Jagged1 mRNA were positively correlated with TGF-β1 mRNA (r =0.84,1.00,all P ＜ 0.05),but negatively correlated with podocin mRNA (r =-0.95,-0.94,all P ＜ 0.05) in model group.Conclusions ATRA might alleviate podocyte injury through cutting the expressions of TGF-β1,Notch1,Jagged1 and raising the expression of podocin in injured podocytes induced by ADR.

Objective To study the relationship between the cancer patients'right to know the true diagnosis and their satisfaction degree with nursing service. Methods We randomly selected 746 patients from the tumor center, the circulation department,the respiration department and surgery department.Questionnaires were designed according to patients'right to know the true diagnosis and the results were analyzed. Results Cancer patients who don't know the true diagnosis wanted to acquire the true information about their diseases but nurses were supposed to keep secret of the actual diagnosis.This contradiction led to the impediment of communication between patients andf nurses compared with other department(P<0.05). Conclusion The right to know their true diagnosis proved to be important for cancer patients in that it could increase the compliance of patients and promote communications so that patients would accept nursing service and the satisfaction degree with nursing service would improved.

Objective To investigate the incidence and occurrence time of PICC-related upper extremity asymptomatic and symptomatic venous thrombosis in cancer patients;to explore the risk of asymptomatic venous thrombosis' developing into symptomatic venous thrombosis.Methods A total of 246 cancer patients who were scheduled to receive PICC between April and October 2014 were prospectively studied and divided into 2 groups by random digits table method.The time-phased follow-up observation on PICC cathertering cancer patients was conducted by Doppler ultrasound.The follow-up visiting inspection on the cathering upper limb vein by Doppler ultrasound at the 2nd,7th,14th,21st,28th,35th,42nd day were arranged after insertion of the catheter in experimental group (127 cases) to understand the incidence and occurrence time of asymptomatic venous thrombosis,while the control group (119 cases) were investigated for inspecting whether there were venous thrombosis through clinical symptoms or not.Once the clinical symptoms occurred,the incidence and time of occurrence of symptomatic venous thrombosis would be diagnosed by Doppler ultrasound and recorded.Results The incidence rate of asymptomatic thrombosis in the experimental group was 48.82％(62/127),the median time was 3 days,and there was no symptomatic thrombosis.Among them,85.48％(53/62) of the asymptomatic thrombosis occurred within 1 week,11.29％ (7/62) occurred in 2-3 weeks,and 3.23％ (2/62) occurred in 4-6 weeks after catheter insertion.Meanwhile,the incidence and median time of symptomatic thrombosis was 23.53％(28/119) and 12 days respectively in the control group.And 32.14％ (9/28) of these cases occurred within 1 week,50.00％ (14/28) occurred in 2-3 weeks,and 17.86％ (5/28) occurred in 4-6 weeks after catheter insertion.Conclusions The incidence of PICC-related upper extremity venous thrombosis in cancer patients is relatively high,and most cases have no symptoms and occur in an early time.Cancer patients are high-risk patients of venous thrombus.We should take early preventive intervention and treatment to reduce the incidence of venous thrombosis after catheter insertion.

Objective To study patients experience in and needs for vaginal douching in the department of gynecology.Method Using semi-structured interviews,10 patients undergoing vaginal douching in the hospital were selected,and then the interviews were analyzed and described with the content analysis method.Results Before vaginal douching,the patients had some psychological states of tension,fear,shyness,fear and calmness.In the process of vaginal douching,the patients experienced comforts,pain,fear,shyness and dissatisfaction with water temperature and skin preparation.After vaginal douching,the patients experienced worries of different sorts like vaginal infections,sexual life and pregnancy.The patients needed for the douching-related knowledge and the improvement in hygienic situations and they had some questions about urination and defection,operative effect and bathing and infection.Conclusion Medical staff should provide the corresponding services for patients during vaginal douching according to their needs and individual situations so as to enhance the nursing service quality.

Objective To evaluate the changes of platelet aggregation rate and short-term prognosis after the application of colopidgrel with booster doses or replaced by ticagrelor for ACS patients with CYP2C19 medium-metabolized genotype). Method A total of 302 patients with medium-metabolized genotype were randomly divided into colopidgrel group (75 mg/bid) and ticagrelor group (90 mg/bid). Patients in both groups accepted other conventional treatments of coronary heart disease and accompanied diseases. The platelet aggregation rates and platelet inhibition rates were observed before and after the treatment. The incidence of adverse events was followed up within 1 m. Results After one-week treatment, the platelet aggregation rates of the inducement with 5 μmol/L ADP had statistical significance between colopidgrel group and ticagrelor group ( P = 0 . 019 ) and the platelet inhibition rates had statistical significance difference between the two groups (P = 0.000). No severe adverse events occurred within one-month follow-up and 10 dyspnea patients were all in ticagrelor group. Conclusions Compared with booster doses of clopidogrel, ticagrelor presents obvious inhibitory effect on platelet of patients with medium-metabolized of ACS but it increases the incidence of dyspnea.

Objective To describe a new classification of pelvic obliquity secondary to poliomyelitis,and investigate the operative indications and effective surgical modes. Methods Fifty-six adult pelvic obliquity secondary to polio were reviewed. The pelvic obliquity was divided into two types and three kinds according to the causes of deformity, X－ ray films of pelvic and gait. Six surgical methods were chosen respectively to correct the deformities. Results All the patients were followed-up for 10 to 80 months(mean 28 months). Complete correction of pelvic obliquity was obtained in 11 patients and major correction in 45 patients. The average corrective rate was 78.3％ . Conclusion Not all the patients with pelvic obliquity after polio need surgical treatment. This new classification has great help to surgical planning and to improve the operative effects.

[Objective]Through the analysis of 82 cases of spondylolisthesis treated with surgery,the different types of surgical procedures were evaluated.[Method]Patients with spondylolisthesis were divided into 4 groups based on their pathology and different surgical procedures were used accordingly.Group Ⅰ consisted of 18 patients with degenerative spondylolisthesis with back pain(3 cases)and isthmic spondylolisthesis(13 cases)and traumatic spondylolisthesis(2 cases)of Ⅰ degree;They were treated with posterior interlaminar and interspinous process fusion;Group Ⅱ consisted of 31 cases with degenerative spondylolisthesis(2 cases)and isthmic spondylolisthesis(23 patients)and traumatic spondylolisthesis(6 cases)of Ⅰ degree(11 cases)and Ⅱ degree(20 cases);They were treated with reduction of sliding vertebra and posterior interlaminar and interspinous process fusion;Group Ⅲ consisted of 19 cases with degenerative spondylolisthesis(2 cases)and isthmic spondylolistbesis(17 cases)of Ⅰ degree(2 cases),Ⅱ degree(13 cases)and Ⅲ degree(4 cases);They were treated with laminectomy and decompression,with reduction of sliding vertebra and transverse process fusion;Group Ⅳ consisted of 14 cases with isthmic spondylolisthesis of Ⅰ degree(1 case),Ⅱ degree(10 cases)and Ⅲ degree(3 cases);They were treated with laminectomy and decompression,with intervertebral body fusion,with reduction of sliding vertebra and transverse process fusion.[Result]In group Ⅰ,solid fusion were in 15 cases giving a fusion rate of 83%,0.03% rate of reduction,52.69% rate of improvement;In group Ⅱ,solid fusion were in 30 cases giving a fusion rate of 96%,56.20% rate of improvement,83% rate of reduction;In group Ⅲ,fusion rate,reduction rate and improvement rate reached 89%,90%,59.85% respectively;In group Ⅳ,the fusion rate,reduction rate and improvement rate were as high as 100%,92%,61.08% respectively.[Conclusion]Different operative methods have different operative indications.Operative methods differ from different patients.