With the improving of people's living quality and medical technology, the demand for breast reconstruction after mastectomy is increasing. Transverse rectus abdominis muscle (TRAM) surgery is an important way of autologous tissue breast reconstruction. This article introduced the anatomy and blood supply of TRAM flap, the indications and contraindications of TRAM surgery, procedure and complications of the surgery. This article also discussed some problems in surgery. TRAM reconstruction, as a way of autologous tissue reconstruction, can avoid the implant related complications because the implant is not used in the surgery. In addition, compared to the implant recon-struction, the appearance and softness of autologous tissue reconstruction are closer to natural breasts, and the result of this surgery is better. In the meantime, pedicled TRAM reconstruction, which does not need microvascular anastomosis technique and close postoperative monitoring of the flap, is easy to be mastered by surgeons and could be performed at more medical centers. Therefore, the TRAM flap still has its own application prospect.

Objective To establish an evaluation index system for breastfeeding after cesarean section,and supply evidence for systematic evaluation of nursing quality for breastfeeding for the post-cesarean primipara.Methods The evaluation index system was preliminarily established by literature review,and experts survey investigation,telephone counseling and field investigation were used to selected evaluation indexes.The indexes were tested with statistical methods according to results of 252 questionnaires.Results This scale has high reliability(internal consistency)and validity (content validity).Conclusions The opinions of the specialists were consistent.The scale is highly objective,reliable and applicable.

BACKGROUND:Chronic ankle instability affects normal life severely. Therefore, chronic ankle instability causes more and more attention of experts, and choice of reasonable and effective diagnosis and targeted treatment method for chronic ankle instability in early stage has become an important issue in the clinic.
OBJECTIVE:To review literature research on the diagnosis and treatment of chronic ankle instability in recent years, and to provide reference and evaluation criteria for the diagnosis and reasonable and effective treatment of chronic ankle instability in clinical practice.
METHODS:We searched PubMed database, China National Knowledge Infrastructure, Wanfang database and VIP database for clinical and basic experimental research on chronic ankle instability. Keywords were“chronic ankle, instability, diagnosis, rehabilitation exercises, surgery methods, research progress”in Chinese and“chronic ankle, instability, diagnosis, rehabilitation exercises, surgical methods, research”in English. Total y 40 literatures were analyzed.
RESULTS AND CONCLUSION:Because of the special anatomical features and biomechanical advantages of the ankle, we should first consider the early diagnosis and effective treatment in chronic ankle instability patients. The treatment should focus on the anatomic characteristics, biomechanic characteristics, etiology of chronic ankle and diagnostic methods of the ankle joint. Conservative treatment and rehabilitation exercises after surgery play a major role in the recovery of chronic ankle instability. The use of balance board, tilting board, and climbing machines is an effective rehabilitation exercises for chronic ankle instability. The application of AOFOS-hind foot and ankle fibula reaction time is important for the assessment of functional recovery of the ankle joint. The emergence of arthroscope is an important clinical research direction of ankle surgery. This plays a significant effect on the treatment of chronic ankle instability.

OBJECTIVE:To explore the ways of preventing errors in the process of drug treatment.METHODS:Related overseas literatures were consulted;causes of errors in the drug treatment were analyzed,which combined with prac-tice.RESULTS&CONCLUSIONS:Errors can be found effectively and reduced by establishing independent checking and error reporting system.

AIM: A novel approach to generate reference fingerprint, named principal component analysis method(PCA), was proposed in this paper. METHODS: Chromatographic finerprint of Tongbiding Injection and multi-wavelength chromatographic fingerprint of Fructus Gardenia were served as examples. Their corresponding reference fingerprints were yielded via PCA, and by comparison with average method and median method were also performed. RESULTS: Reference fingerprint, yielded by PCA based on least-squares principle, was essentially the linear combination of original chromatographic fingerprints. It had a better capability of maintaining and summarizing the data information of original chromatographic fingerprints and optimized properties, and was very similar to one generated by average method or median method. Abnormal fingerprints, if were possibly present in population of fingerprints, would be conveniently found via PCA method, and treated by using appropriate methods to eliminate the effects on reference fingerprint yielded. CONCLUSION: PCA method can be served as an effective approach to produce the reference fingerprint.

Objective To discuss treatments of femoral intertrochanteric fractures by external fixators which can prevent complications caused by lying in bed for long periods after operation. Methods After proper closed reduction had the fragments maintained in good position, the fracture was fixed by external fixators through closed pinning under the roentgenoscopy. After the operation the patients with femoral intertrochanteric fractures could conduct early exercises to recover the functions of the fractured limb. Results Compared with traction or inner fixation, this method to treat femoral intertrochanteric fractures showed significant superiority in trauma, healing time, expenditure, functional recovery and complications for the majority of the patients. Conclusion The external fixators are recommendable for patients with femoral intertrochanteric fractures when their bone matrix and physical conditions are good enough.

Objective To analyze the clinical characteristics of brucellosis presenting as fever of unknown origin in non-endemic area.Methods Clinical data of 11 patients with fever of unknown origin,who were admitted in a general hospital of non-endemic area from Jan 2013 to Jan 2017 and diagnosed as brucellosis by blood culture,were retrospectively analyzed.Results There were 8 males and 3 females aged 40-70 years.The patients were admitted with or without accompanied symptoms.The patients were initially presented in rheumatology (1 case),neurology (1 case),emergency (4 cases),hematology (1 case),orthopedics (2 cases) and pneumology (2 cases) departments,respectively.The time from onset to presentation was 0.5-7.0 months.The clinical manifestations were nonspecific,and blood cultures of Brucella were positive between 2 to 5 weeks with a mean of 3 weeks.Time to diagnosis was 1 to 9 months with a mean of 4 months.All patients were transferred to infectious hospital when the diagnosis was confirmed.The telephone follow-up showed that none of the patients had fever after discharged.Conclusion Brucellosis should not be neglected in the differential diagnosis of FUO in non-endemic area,and blood culture is important for a definitive diagnosis.

Objective To observe the clinical efficacy of LiQiDingChuan pill combined with Dexamethasone on the treatment of patients with acute asthma.Methods 93 patients with acute asthma from July 2015 to September 2016 were randomly divided into the observation group(47 cases)and the control group(46 cases).The control group were received dexamethasone, and the observation group were given LiQiDingChuan pill combined with Dexamethasone.The main symptoms disappeared time, forced expiratory volume in 1 second, peak expiratory flow rate value, hs-CRP, TNF-α and clinical efficacy were recorded and analyzed.Results ①After treatment, wheezing cough, chest tightness and wheezing disappeared time were(4.71±0.59)d,(2.85±0.49)d,(4.93±0.70)d in the observation group, which were shorter than(7.76±1.02)d,(5.16±0.74)d,(8.67±1.12)d in the control group, and the differences were statistically significant(P<0.05).② After treatment, FEV1 and PEF levels were(65.69±3.74)V/L,(218.92±16.09)L/s, which were better than(57.45±3.62)V/L,(176.34±15.14)L/s in the control group, and the differences were statistically significant(P<0.05).③ After treatment, hs-CRP and TNF-α levels were(6.76±0.78)mg/L,(7.99±1.87)pg/mL, which were better than(6.76±0.78)mg/L,(7.99±1.87)pg/Ml in the control group, and the differences were statistically significant(P<0.05).④The total effective rate in the observation group was 91.49%, which was significantly higher than 71.74% in the control group, and the differences were statistically significant(P<0.05).Conclusion Liqidingchuan pills combined with dexamethasone treatment has a good therapeutic effect on acute phase of asthma, which can reduce asthma related symptoms, reduce the inflammation level in the patients, optimize the forced expiratory volume in 1 second and peak expiratory flow rate.The combination is better than the single drug.

Pancreatic cystic lesions are being recognized increasingly due to the development of computed tomography and magnetic resonance imaging.Differential diagnosis between pseudocysts and cystic tumors is the key point for pancreatic cystic lesions.Patients with pancreatic pseudocysts generally have a history of acute or chronic pancreatitis,whereas patients with cystic tumors did not have such a history.Some pancreatic cystic lesions did not have typical imaging presentations,and they were difficult to be diagnosed.Pancreatic cystic lesions could be divided into unilocular cysts,microcystic lesions,macrocystic lesions and cysts with a solid component according to the presentations under computed tomography and magnetic resonance imaging.This typing system is helpful for the diagnosis and differential diagnosis of pancreatic cystic tumors,as well as for the guidance of therapy.