Objective:To evaluate the fixation with a locking fibular intramedullary nail for treatment of extra-articular distal tibial fracture complicated with fibular fracture (AO/OTA 43A).Methods:A retrospective study was conducted to analyze the data of 31 patients who had been treated by fixation with a locking fibular intramedullary nail for extra-articular distal tibial fracture complicated with fibular fracture at Department of Orthopaedics, The 909th Hospital of Joint Logistics Support Force between January 2018 and December 2021. There were 20 males and 11 females; (41.5±15.7) years in age; AO classification of the distal tibial fractures: 10 cases of type 43A1, 10 cases of type 43A2, and 11 cases of type 43A3; 11 open fractures and 20 closed fractures. Fracture healing, fibular alignment, tibiotalar angle, and incidence of complications were regularly followed up and recorded after surgery. At the last follow-up, the ankle joint function was assessed using the Olerud Molander ankle score (OMAS) and the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All the 31 patients were followed up for (17.5±3.3) months after surgery. All of them achieved fine fracture union. The union time was (3.9±0.8) months for tibial fractures, and (3.6±0.9) months for fibular fractures. No internal fixation failure was observed. The last follow-up revealed the following: the fibular alignment was 1.8°±1.3° and the ankle tibiotalar angle 9.1°±2.3°; no fibular rotation, shortening, or separation displacement happened; the OMAS score was (88.3±6.2) points, and the AOFAS ankle-hindfoot score (87.4±6.0) points. Two patients required removal of the distal locking screw of the fibular intramedullary nail due to soreness around the lateral malleolus caused by screw loosening. There were no other related complications.Conclusion:Fixation with a locking fibular intramedullary nail is an effective treatment for extra-articular distal tibial fracture complicated with fibular fracture, demonstrating advantages of firm fixation, limited complications, minimal trauma and soft tissue irritation, and good clinical efficacy.

Objective To deeply analyze the problems of public hospitals in medical service satisfaction,construct a more applicable and explanatory service satisfaction evaluation model,and provide reference for the improvement path of patients'medical service satisfaction.Methods Based on the ESCI model,this paper puts forward a research hypothesis,compiles the"Medical Service Satisfaction Evaluation Scale of Public Hospitals in S City",selects S public hospitals as the research object,and evaluates medical service satisfaction from the perspective of patients.Results At present,the main problems affecting the improvement of patients'satisfaction with medical service management in public hospitals in S city are as follows:it is urgent to improve the diagnosis and treatment technology in terms of hardware quality and optimize the environmental hygiene of public hos-pitals,and it is an urgent task to shorten the waiting time for medical treatment in software quality.The score of medical service satisfaction evaluation of S public hospitals was 3.76,and the satisfaction of patients in S public hospitals with their medical serv-ices was at a moderately low level.Conclusion In view of the above problems,it is recommended to strengthen the construction of key specialties,strengthen the construction of talent team,optimize the medical process,open digital linkage services,and strengthen service management,so as to promote the improvement of patients'satisfaction with medical services.

OBJECTIVE: To investigate the effectiveness of compression screw combined with Buttress plate through direct axillary approach for Ideberg typeⅡ scapular glenoid fractures. METHODS: A retrospective analysis was conducted on 11 patients with Ideberg type Ⅱ scapular glenoid fractures treated with compression screws combined with Buttress plate fixation through the direct axillary approach between January 2014 and June 2022. There were 7 males and 4 females, aged from 34 to 75 years, with an average of 56.0 years. The causes of injury included 4 cases of falling from height injury, 4 cases of heavy object injury, and 3 cases of traffic accident injury. The time from injury to operation was 2-5 days, with an average of 3.8 days. The operation time, intraoperative blood loss, hospital stay, complications, and fracture healing time were recorded. The Constant-Murley score, American Society of Shoulder and Elbow Surgeons (ASES) score, and shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion were used to evaluate shoulder joint pain and function. RESULTS: The operation time was 45-105 minutes, with an average of 79.0 minutes; the intraoperative blood loss was 80-200 mL, with an average of 99.2 mL; the hospital stay was 3-8 days, with an average of 5.8 days. One patient had poor wound healing after operation, and the wound healed after strengthening dressing change; the rest wounds had primary healing, and no axillary nerve paralysis occurred. Except for 1 patient lost follow-up, the remaining 10 patients were followed up 10-54 months, with an average of 26.4 months. The postoperative X-ray film examination showed that the fractures healed well within 8-15 weeks, with an average of 11.0 weeks. There was no complication such as fracture displacement, internal fixator failure or fracture during follow-up. At last follow-up, the patient's shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion, Constant-Murley score, and ASES score significantly improved when compared with those before operation ( P<0.05). CONCLUSION Compression screw combined with Buttress plate through direct axillary approach is an effective way to treat Ideberg typeⅡ scapular glenoid fracture, with advantages of small trauma, concealed incision, and good effectiveness.
Male ; Female ; Humans ; Retrospective Studies ; Blood Loss, Surgical ; Fracture Fixation, Internal ; Treatment Outcome ; Shoulder Fractures/surgery* ; Bone Screws ; Bone Plates

Objective: To evaluate the effectiveness of varicella vaccine in varicella outbreaks and to analyze the influencing factors, and to provide a reference for making the targeted prevention and controlling measures. Methods: A total of 3 888 students with no history of varicella were selected from 2 schools with varicella outbreak in Guangdong Province in 2021, a retrospective cohort study was conducted by using questionnaire survey, rate ratio ( RR ) and vaccine effectiveness ( VE ) values were calculated and Logistic regression was uses to analyze the factors influencing the protective effect of varicella. Results: There were 138 confirmed cases of varicella among the participants. There was no significant sex difference in the vaccination rate( χ 2=1.36, P =0.51), but there was significant difference in the vaccinattion rate of different age groups( χ 2=555.82, P <0.01). The overall protective effect of VarV was 66.94%(95% CI =56.17%-77.71%), and the protective effect of 2 doses of vaccine( VE = 90.02% , 95% CI =83.13%-96.90%) was higher than that of 1 dose( VE =49.40%, 95% CI =32.36%-66.44%)( χ 2=24.93, P < 0.01 ). The high fever rates in the vaccinated and unvaccinated groups were 7.69% and 25.81%, with significant difference( χ 2= 6.29 , P <0.05). The rates of moderate and severe skin lesions of vaccinated and unvaccinated groups was 20.00% and 50.00%, respectively, and the difference was statistically significant( χ 2=11.32, P <0.01). The protective effects of varicella vaccine against high fever and moderate to severe rash were 70.19%(95% CI =42.11%-98.27%) and 60.00%(95% CI =38.15%-81.85%). Stratified analysis showed that there were significant differences in different years of vaccination( χ 2=37.87, P <0.05), while there were no significant differences in age of vaccination and vaccine manufacturer ( P >0.05). Conclusion Varicella vaccination can prevent chickenpox infection and reduce the severity of the disease. However, the efficacy of varicella vaccine was affected by vaccination years. It is recommended to improve the vaccination coverage of varicella vaccine to prevent the outbreak of the epidemic.

Objective:To evaluate the efficacy and safety of SPOT (GI Supply, USA), a new carbon-based permanent marker approved by the Food and Drug Administration (FDA), in the endoscopic marking for gastrointestinal lesions.Methods:A total of 115 patients with gastrointestinal lesions who underwent endoscopic treatment or surgery in Beijing Friendship Hospital or Beijing Chao-Yang Hospital from April 2019 to November 2019 were enrolled in the study. SPOT was used to mark the lesions, and marking points were found during endoscopic treatment or surgery to calculate the effective marking rate by single-group target value method. Adverse events after marking were recorded, and the changes of blood routine test, liver and kidney functions before and after marking were compared.Results:The effective rate of endoscopic marking with SPOT was 99.13% (114/115). The longest marking time was 57 days. There was no puncture of intestinal wall or injection into abdominal cavity during the marking process. One patient developed mild fever after marking. The incidence of adverse events was 23.48% (27/115), which were all unrelated to the test equipment. There was no significant difference in blood routine tests or liver and kidney functions before and after marking ( P>0.05). Conclusion:SPOT produced by GI Supply can effectively mark gastrointestinal lesions without serious adverse events, which meets the requirements of clinical use.

New immune checkpoint targets such as lymphocyte activation gene-3, T-cell immunoglobulin mucin-3, T cell immunoglobulin and ITIM domain, V-domain immunoglobulin suppressor of T cell activation, B7 Homolog 3, B and T lymphocyte attenuator play an important role in tumor treatment. Blocking them can delay tumor growth, enhance the anti-tumor effect of immune cells, and improve the survival rate of the host. Although these new immune checkpoints are in the early stages of research, with the continuous development of science and technology, they will play an increasingly important role in tumor immunotherapy.

Objective: To explore the effect of different midwifery methods on the pelvic floor function of parturients and nursing experience. Methods: From January 2018 to December 2018, 200 cases of vaginal delivery in Enze Obstetrics and Gynecology Hospital of Taizhou Hospital were selected as study objects.According to the random number table method, they were divided into non-invasive midwifery group and traditional midwifery group, with 100 cases in each group.The non-invasive midwifery group adopted non-invasive midwifery, while the traditional midwifery group adopted traditional midwifery.The pelvic floor muscle strength, pelvic floor muscle dysfunction and postpartum hemorrhage were observed in the two groups. Results: There was no statistically significant difference in pelvic floor muscle strength between the two groups in grade 0, grade Ⅰ, grade Ⅱ, grade Ⅲ and grade Ⅳ(all P>0.05). The pelvic floor muscle strength of the observation group in grade Ⅴ (45.00%) was higher than that of the control group (31.00%), the difference was statistically significant (χ²=4.160, P<0.05). The incidence of sexual dysfunction (15.00%) and stress urinary incontinence (28.00%) in the observation group were significantly lower than those in the control group (41.00%, 54.00%) (χ²=16.766, 13.973, all P<0.05). The amount of bleeding 2 hours after delivery in the observation group [(245.93±19.89)mL] was less than that in the control group [(297.42±24.21)mL] (t=16.433, P<0.05). Conclusion Non-invasive midwifery has little effect on the pelvic floor function of parturients, and the incidence rate of sexual dysfunction and stress urinary incontinence is low, and the amount of bleeding is small, which is worthy of clinical reference.

Objective To analyze the clinical diagnosis and treatment data of 20 children with hypophosphatemic rickets (HR) in order to improve the clinical diagnosis and treatment of HR.Methods The retrospective analysis of clinical data of 20 cases with HR who were hospitalized at Children's Hospital of Nanjing Medical University from May,2010 to April,2016 was performed to summarize the clinical characteristics.All patients were analyzed for the phosphate regulating gene with homologies to endopeptidase on the X chromosome(PHEX) gene by direct sequencing.If no mutations were detected,multiplex ligation-dependent probe amplification analysis was performed.Results All of the 20 cases with HR showed different degrees of growth retardation and typical X-ray rickets.After treatment,the clinical features were improved.Height standard deviation score (HSDS) was improved significantly with longer treatment time,and the difference was statistically significant(P =0.027).There was a correlation between the blood phosphorus fluctuation and secondary hyperparathyroidism(P ＜ 0.05).Nineteen cases had PHEX gene mutations.Truncating mutations was the most frequent mutation type,and 4 new mutations were found.Conclusions Clinical characteristics,laboratory test results and X-ray examination are important clinical index for the diagnosis of HR,and PHEX gene test can be used as an important auxiliary diagnostic tool.Early diagnosis and treatment can significantly improve the clinical manifestations of the patients.

Objective To investigate the effect of Shenfu injection preconditioning on ventilator-induced brain injury in rats.Methods Sixty healthy adult male Sprague-Dawley rats,weighing 300-320 g,were divided into 3 groups (n=20 each) using a random number table:control group (group C),ventilator-induced brain injury group (group VIBI) and Shenfu injection group (group SF).Rats were mechanically ventilated for 6 h with tidal volume of 40 ml/kg in VIBI and SF groups.Rats were mechanicaliy ventilated for 6 h with tidal volume of 10 ml/kg in group C.Shenfu injection 20 ml/kg was injected intraperitoneally at 30 min before ventilation in group SF.Blood samples were collected at 2 and 6 h of ventilation for measurement of the concentrations of serum S100β protein (by enzyme-linked immunosorbent assay).Then the rats were sacrificed at the end of ventilation,and brains were removed for determination of the contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-o) (by enzyme-linked immunosorbent assay) and expression of glutamate decarboxylase (GAD) and γ-aminobutyric acid type A (GABAA) receptor in brain tissues (by Westem blot).Results Compared with group C,the serum concentrations of S100β protein at each time point of ventilation and contents of IL-1β and TNF-α in brain tissues were significantly increased,and the expression of GAD and GABAA receptor was down-regulated in VIBI and SF groups (P＜0.05).Compared with group VIBI,the serum concentrations of S100β protein at each time point of ventilation and contents of IL-1β and TNF-α in brain tissues were significantly decreased,and the expression of GAD and GABAA receptor was up-regulated in group SF (P＜0.05).Conclusion Shenfu injection preconditioning can relieve ventilator-induced brain injury in rats,and the mechanism may be related to inhibiting inflammatory responses and activating GABA signaling pathway.

Objective To compare the effects of two kinds of lidocaine gel indwelling catheter on male patients with general anesthesia during recovery period. Methods A total of 90 cases of male patients with general anesthesia were selected and divided into experimental group and control group by random digits table method,45 cases in each group. The experimental group was given lidocaine gel injection indwelling catheter urethral surface anesthesia, the control group will lidocaine gel evenly to the catheter indwelling catheter. The incidence of catheter related bladder irritation and restlessness were observed during the recovery period of general anesthesia. Results The incidence of catheter related bladder irritation in grade 0, I, II, III during the recovery period of general anesthesia were 28, 14, 3, 0 cases in the experimental group and 7, 23, 12, 3 cases in the control group, there was significant difference between 2 groups (Z=1500, P<0.01). The incidence of restlessness in grade 0, I, II and III during the recovery period of general anesthesia were 27, 18, 0 and 0 cases, respectively in the experimental group and 7, 20, 9, and 9 cases in the control group, respectively. The difference between the 2 groups was statistically significant (Z=1435.5, P<0.01). Conclusions Lidocaine gel injection into the urethra surface anesthesia can effectively improve the comfort of male patients during the recovery period of general anesthesia.