OBJECTIVE: To evaluate the safety and effectiveness of reducing posterior malleolar fractures via the modified Rammelt transfibular approach. METHODS: A retrospective analysis was conducted on 26 patients with ankle fractures who met the selection criteria and were admitted between September 2023 and May 2024. There were 13 males and 13 females, aged from 14 to 59 years (median, 43.5 years). Causes of injury included traffic accident (1 case), falls (7 cases), and sprains (18 cases). Time from injury to operation ranged from 1 to 13 days (mean, 3.9 days). According to the Lauge-Hansen classification, there were 5 supination-external rotation type Ⅲ fractures and 21 supination-external rotation type Ⅳ fractures. According to the Bartoníček classification for posterior malleolar fractures, there were 12 type Ⅱ fractures, 10 type Ⅲ fractures, and 4 type Ⅳ fractures. During operation, the fracture was exposed via the modified Rammelt transfibular approach; then, the fracture reduction was achieved under direct vision using techniques such as towel clip traction, posterolateral compression, and lifting with a posterior transverse periosteal elevator; finally, the fracture was fixed using anteroposterior cannulated screws or Kirschner wires. The incision healing was observed after operation. At 4 months after operation, X-ray film and CT were reviewed to evaluate the quality of fracture reduction. The medial clear space, tibiofibular clear space, and the anterior/posterior tibiofibular syndesmotic distances were measured. At last follow-up, the ankle function was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the range of motion. RESULTS: The marginal necrosis occurred in 2 lateral malleolar incisions, and superficial infection occurred in 1 lateral malleolar incision; the remaining incisions healed by first intention. All 26 patients were followed up 13-21 months (mean, 15.6 months). X-ray films showed that fractures in 25 patients achieved clinical union within 3-8 months (mean, 5.4 months); 1 case had delayed union of the lateral malleolus. At 4 months after operation, no significant difference was found between the injured and healthy sides in the medial clear space, tibiofibular clear space, or the anterior/posterior tibiofibular syndesmotic distances ( P>0.05). No malreduction of the posterior malleolus or the tibiofibular syndesmosis occurred. At last follow-up, the AOFAS score ranged from 80 to 100 (mean, 91.9). The range of motion ranged from 17° to 22° (mean, 21.0°) in active ankle dorsiflexion and from 40° to 49° (mean, 44.6°) in plantar flexion. Internal fixator was removed in 12 patients at 1 year after operation, with no ankle instability occurring. Ankle joint degeneration was observed in 1 patient at last follow-up. CONCLUSION The modified Rammelt transfibular approach is a safe and reliable technique. It enables precise reduction under direct vision, improves the quality of reduction for the distal tibial articular surface and the tibiofibular syndesmosis, and provides satisfactory ankle functional recovery in short-term follow-up.
Humans ; Male ; Female ; Adult ; Ankle Fractures/diagnostic imaging* ; Middle Aged ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Adolescent ; Treatment Outcome ; Young Adult ; Bone Screws ; Ankle Joint/surgery* ; Fibula/surgery* ; Range of Motion, Articular

Objective: To explore the roles of self efficacy and smoking rationalization tendency in the relationship between college students physical activity and smoking cessation beliefs, in order to provide a basis for the positive effects of college students physical activity on smoking cessation beliefs. Methods: From May 6 to 23 in 2023, 3 048 students from 10 colleges in Jiangxi Province were recruited and surveyed using the Physical Activity Participation Scale, the Smoking Cessation Self efficacy Scale, the Smoking Rationalization Tendency Scale and the Smoking Cessation Belief Scale. The Harman one way test was adopted for common method bias test. Bias correction was unfolded by Bootstrap method, and 95% confidence intervals of parameter estimates were analyzed using repeated sampling 5 000 times. Results: The results of the sequential mediation model analysis showed that physical activity was positively associated with college students beliefs about smoking cessation ( β =0.17), and physical activity, self efficacy and smoking rationalization tendency were positively associated with each other ( β =0.41, 0.08, 0.19) ( P <0.05). Both self efficacy and smoking rationalization tendency positively predicted smoking cessation beliefs ( β =0.19, 0.17, P <0.01). Self efficacy and smoking rationalization tendency mediated the relationship between physical activity and smoking cessation beliefs, with a mediating effect value of 0.09, accounting for 62.82% of the total effect value (0.15). Conclusions Self efficacy and smoking rationalization tendency have a serial mediating effect between physical activity and smoking cessation beliefs among college students. Interventions should be actively used to enhance college students beliefs about smoking cessation, promote smoking cessation behaviors.

Objective To observe the clinical efficacy ofWuzi Yishen Oral Liquid for female stress urinary incontinence.Methods Ninety patients were randomized into treatment group (45 cases) and control group (45 cases). The treatment group was treated byWuzi Yishen Oral Liquid, while control group was treated bySuoquan capsule. After three-month treatment, the clinical efficacy was observed by 1 h pad-test and urinary incontinence questionnaire scores.Results Compared with before treatment, the quantity of fluid loss of 1 h pad-test of the two groups was reduced significantly, and the symptom scores of urinary incontinence questionnaire were improved after treatment (P<0.05). The symptom scores of urinary incontinence questionnaire of the treatment group were higher than the control group (P<0.05).ConclusionWuzi Yishen Oral Liquid has obvious clinical efficacy for the treatment of female stress urinary incontinence.

The paper reviews the background and current situation of medical disputes and puts forward the concept of the reaction chain of medical disputes in view of their high occurrence rate and the difficulty in handling them. It discusses the framework, chief content, basic principles and major features of the reaction chain of medical disputes and argues that as a commonly used tool for handling medical disputes, the reaction chain renders it possible to check from the angje of the interests of the patients whether each party involved in the dispute has fulfilled its duties. Intended to improve the professional ethics of the physicians and the quality of medical care and calling on the patients to rebuild their confidence in the physicians, the reaction chain indicates that it is necessary to scientifically analyze the entire process and various influencing factors of medical disputes and bring into play the advantages of integration so as to successfully resolve medical disputes.

The authors first expound the connotations of hospital credibility and then set forth a number of viewpoints. They hold that hospital credibility refers to the hospital's fulfillment of its commitments and obligations in its medical practice, that the hospital should attach importance to the value of credibility in advancing the medical cause, and that hospital credibility plays an indispensable role in the medical and health cause. Lastly, the authors give a detailed account of the principles for establishing hospital credibility, the standards and methods for evaluating hospital credibility, the system for cataloguing hospital credibility files, and the measures for enhancing hospital credibility.