Objective To compare the clinical efficacy of intramedullary pin versus plate fixation for displaced mid-shaft clavicle fractures.Methods The databases,PubMed,CENTAL and CBM,were searched according to the standards of the Cochrane Collaboration for all the randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing intramedullary pin with plate fixation for treatment of displaced mid-shaft clavicle fractures.In addition,hand search was also conducted in relevant journals.Time limit for search was from the beginning till December 2013.Trial quality was assessed using the modified Jadad scale and effective data were pooled for Meta analysis with software RevMan5.2.7,including wound infection,hospital stay,wound size,intraoperative blood loss,operation duration,implant irritation,implant problems,delayed union,malunion,nonunion,total complications and Constant scoring.Results Three RCTs and 7 CCTs with 697 patients were included in our study.The modified Jadad scoring showed fine quality of the 10 trials.Intramedullary fixation was significantly superior to plate fixation in wound size,intraoperative blood loss,operation duration,hospital stay,wound infection,and symptomatic hardware (P ＜ 0.05),but led to a significantly higher rate of implant problems (P ＜ 0.05).However,no significant differences were identified in total complication rate,delayed union,nonunion,malunion or Constant score (P ＞ 0.05).Conclusions The superiority of intramedullary fixation for displaced mid-shaft clavicle fracture lies in its advantages of minimally invasion,such as limited incision,less intraoperative bleeding,shorter operation time and hospital stay,less wound infection and implant irritation.Ahhough intramedullary fixation may lead to a higher rate of implant problems,it shows no significant differences from plate fixation in bone healing and functional recovery.

AlM: To compare the effects of external approach microsurgery and conventional external approach surgery for retinal detachment ( RD) .METHODS: From January 2010 to January 2013, 60 patients (60 eyes) in our hospital were randomly divided into experimental group (29 cases, 29 eyes) and control group ( 31 cases, 31 eyes ) , the external approach microsurgery and conventional external approach surgery were performed respectively ( by the same skilled doctor ) . Retinal reattachment rate, visual acuity improvement rate and operative time were compared between two groups.RESULTS:lt cost shorter time for the external approach microsurgery than that of conventional external approach surgery ( P = 0. 0087 ). The once successful retinal reattachment rate in experimental group was 93% ( 27 cases ) , which was higher than that in control group (90%, 28 cases), there was no statistical difference. The vision improvement rate in control group was 86% ( 25 cases ) , compare to 90% ( 28 cases ) in experimental group, there was no statistical differences. CONCLUSlON: No statistical differences showed in visual acuity improvement and the once retinal reattachment rate between the two groups for rhegmatogenous retinal detachment. However, it is believed that external approach microsurgery could be faster, easier to learn with satisfactory effect.

OBJECTIVE:To observe the clinical efficacy and safety of Qingkailing injection combined with naloxone in the ad-juvant treatment of chronic obstructive pulmonary disease (COPD) with pulmonary encephalopathy. METHODS:80 COPD pa-tients with pulmonary encephalopathy were randomly divided into control group and observation group. Control group was treated with conventional treatment,including bi-level noninvasive positive pressure ventilation,conventional oxygen inhalation,anti-infec-tion,resolving sputum and relieving asthma,etc;based on the treatment of control group,observation group was additionally treat-ed with Qingkailing injection 40-60 ml by intravenous infusion,30-40 drops/min,qd+Naloxone hydrochloride injection 0.8 mg by intravenous infusion,and then Naloxone hydrochloride injection 2 mg by microinfusion pump for continuous 24 h. After 3 d,the clinic data was observed,including clinical efficacy,and pO2,pCO2,pH,CO,CI,GCS coma score before and after treatment,av-erage hospitalization time,endotracheal intubation rate and incidence of adverse reactions. RESULTS:The total effective rate in ob-servation group was significantly higher than control group,average hospitalization time and incidence of adverse reactions were significantly lower than control group(P<0.05). After treatment,pO2,pH and GCS scores in 2 groups were significantly higher than before,observation group was higher than control group,pCO2 was significantly lower than before,observation group was lower than control group(P<0.05). There were no significant differences in the CO and CI before and after treatment and endotra-cheal intubation rate between 2 groups (P>0.05). CONCLUSIONS:Based on the conventional treatment,Qingkailing injection combined with naloxone has good efficacy and safety in the adjuvant treatment of COPD with pulmonary encephalopathy.

Child ; Esophagus ; pathology ; Foreign Bodies ; diagnosis ; Humans

Objective To observe the subarachnoid space the epidural space joint block labor analgesia (CSEA) changes of T lymphocyte subsets.Methods 100 cases of full-term mothers were randomly divided into two groups,analgesia group and the control group.The analgesic group row CSEA childbirth analgesia.Two groups of maternal cervix large 2 to 3cm (T1),when the baby was delivered (T2),24h (T3),blood was colleoted after childbirth,detected by radioimmunoassay of cortisol.Flow cytometry assay was wsed to test T lymphocyte subsets CD3+,CD4+,CD8+,CD4+/CD8+,And the birth process,Apgar score,Labor pain visual analogue score (VAS) were recoroded.Results (1) Active phase of the first stage of childbirth analgesia group was significantly shorter than the control group (t =2.182,P ＜ 0.05).The second and third stage of Childbirth and neonatal Apgar score difference between the two groups was not statistically significant.(2)Serum cortisol concentration at T2 analgesia group was significantly lower that of than the control group (P ＜ 0.05).(3) The two groups in maternal blood of CD3+,CD4+,CD4+ / CD8+ were reduced to varying degrees,T3 was reduced significantly (P ＜ 0.05),Analgesia group was significantly lower than that of the control group (all P ＜ 0.05).Conclusion CSEA analgesia in Childbirth can shorten the first stage of Childbirth active period,has no significant effect on the Apgar score,can alleviate the pain and stress reactions such as the suppression of the maternal immune function.

Objective The purpose of this study was to examine the status quo of the perceptions of professional benefits in the clinical teachers of nursing,analyze the influencing factors and put forward effective measures to improve it.Methods A convenience sample of 117 nurse preceptors in 4 teaching hospitals participated by completing a two-part questionnaire the Preceptor's Perception of Benefits and Rewards Scale and a demographic questionnaire.Results The total average score of benefits and rewards to the preceptor role was(63.64±9.93) points,low than the study done by Hyrkas(2007) in American.Nurse preceptors in different nursing unit felt different benefits and rewards to the preceptor role.Medicine unit and surgical unit were higher than Pediatrics unit.The longer time of being preceptor,the higher score of benefits and rewards to the preceptor role.Conclusions The score of benefits and rewards to the preceptor role is low.Hospitals should increase support for clinical teaching program,particularly pediatrics.Nurse managers should adjust promotion opportunities,workload,rewards of nurse preceptors to meet the needs of nurses in clinical teaching and to improve teaching effectiveness.

Objective To investigate the clinical features, diagnosis and treatment of acute mesenteric isehe-mic disease. Methods Clinical data of 15 patients with acute mosenteric ischemic disease were analyzed retrospective-ly. Results Operation was performed on 14 patients and 1 patient received conservative treatment, 9 cases recovered and 5 died postoperatively. Conclusion Color ultrasound and selective angiography are effective examinations for early diagnosis of acute mesenterie ischemic disease. Early resection of necrotic bowel and application of anticoagulant post-operatively are effective to reduce the mortality. Conservative treatment is still effective for elective patient.

Adult ; Craniotomy ; methods ; Humans ; Male ; Nasal Cavity ; pathology ; Paranasal Sinuses ; pathology ; Skull Base Neoplasms ; surgery ; Teratoma ; surgery

Asbestos ; adverse effects ; Environmental Exposure ; GPI-Linked Proteins ; metabolism ; Humans ; Population Surveillance