BACKGROUND:Bennett fracture repair is one of the problems for orthopedic surgeons, although there are a variety of clinical treatment for Bennett fracture, no treatment strategy is widely accepted. ＜br> OBJECTIVE:This study aims to provide evidence for developing an effective treatment strategy for Bennett fracture. ＜br> METHODS:A computer-based retrieval of PubMeb database (http://www.ncbi.nlm.nih.gov/PubMed), CNKI China Journal Ful-Text database (http://www.cnki.net/) and Wanfang database (http://g.wanfangdata.com.cn/) between January 2004 and July 2014 was performed by the first author. Meantime, Campbel ’s Operative Orthopaedics, Shiyong Guke Xue and other orthopedic monographs were manual y retrieved, to analyze research progress about Bennett fracture. ＜br> RESULTS AND CONCLUSION:A total of 37 literatures associated with Bennett fracture were involved in this study. Conventional closed reduction plaster or Kirschner wire fixation is characterized by low cost and easy operation, but it fails to achieve anatomical reduction. AO principle for fracture treatment has been widely accepted in recent years, the application of AO screw and AO plate is increasing in treatment of Bennett fracture, it can not only repair bone fracture but also repair and reconstruct the damaged ligament, but the cost is very high and secondary surgery is needed to remove the implant. Traditional Chinese orthopedics and integrated traditional and western medicine are experienced methods for treatments of Bennett fracture, and Chinese herbs have obvious symptomatic treatment effect and effectively improve the symptoms of patients. As the thumbs play a crucial role in the hand movement, the optimal treatment strategy for Bennett fractures has important clinical significance.

Objective To study the feasibility, superiority and experience of minimally invasive laparoscopic-assisted surgery of the thyroid using ultrosonic scalpel. Methods In a period from January, 2006-August, 2008, 56 patients of the department of general surgery, the hospital of Heilongjiang Province were diagnosed as thyroid node. The size of the nodes ranged from 5.0 cm×4.2 cm to 3.5 cm×2.0 cm in uhrosonography. An incision of about 1.5-2.0 cm was made 1.0 cm above the suprasternal notch and the operation was performed with ultrosonic scalpel assisted with laparoscope. Partial thyroideetomy of lateral thyroid was performed in 20 cases, subtotal thyroidectomy in 25 cases, subtotal thyroidectomy of unilateral thyroid and partial thyroidectomy of contralateral thyroid respectively in 1 case, partial thyroidectomy of bilateral thyroid in 10 cases. Results All 56 cases have undergone minimally invasive laparoscopic-assisted surgery successfully in 50-146 min and no complications occurred. Fifty five cases were confirmed to be benign lesion pathologically. Conclusion Laparoscopic-assisted surgery of the thyroid is an effective with a good cosmetic result.

Objective To investigate the effect of the treatment of children with mycoplasma pneumonia and the level of inflammatory factors in the serum of children with mycoplasma pneumonia. Methods 180 cases of mycoplasma pneumonia in our hospital from July 2015 to June 2016 were randomly divided into observation group and control group,90 cases in each group. The control group were treated with azithromycin,and the observation group were treated with combination of hydrochloric acid and bromine on the basis of control group. The course of the two groups were all 12 days.The efficacy of the treatment, fever subsided time, the disappearance time of cough and pulmonary rales, before and after treatment serum inflammatory factor interleukin-6 (IL-6),interleukin-10 (IL-10),interleukin-17 (IL-17) and procalcitonin (PCT) levels between two groups were compared,and the incidence of adverse reactions. Results The observation group treatment efficiency 93.33% was higher than the control group 82.23% (P<0.05); The observation group dissipated time of fever,cough disappeared time and pulmonary rales disappeared faster than the control group (P<0.05);After treatment,the levels of serum IL-6, IL-17 and PCT in two groups were decreased,the level of IL-10 increased,the difference was statistically significant (P<0.05); the level of serum IL-6, IL-17 and PCT in observation group were lower than the control group, while the level of IL-10 was higher than that of the control group, the difference was statistically significant (P<0.05);There were no significant differences in the adverse reactions between the two groups . Conclusion The curative effect of bromhexine hydrochloride combined with azithromycin in treatment of mycoplasma pneumonia in children, and can reduce the serum inflammatory cytokines IL-6, IL-17 and PCT level and increase the level of IL-10 and lessen inflammatory reaction, has important research significance.

Objective To clarify weather or not lymph node dissection can achieve the requests of gastric carcinoma radical degrees under laparoscopic operation for advanced gastric careinoma. Methods Sixty-five cases of advanced gastric carcinoma with under 1/3 stomach lesions and three cases with middle 1/3 stomach lesions. were randomly divided into tow groups: assisted laparoseopic group(n=33)and conventional gastric carcinoma D2 radical surgery group(n=35).The number of lymph node dissection, and the incidence of positive lymph nodes oecnred in damaged capsule. the margin necrosis analyzed. Results The average lymph node dissection of the laparoscopic group were 20.79±5.21 were ohscrved. the positive oases were 9.63±4.64.The average lymph nnde dissection of the control group were 21.20±5.04.the positivecases were 9.63±4.64. The two groups had no significant difference f (P>0.05)1. Positive-margin lymph node in the control gmup was 6 and 14 in the experimenl group ( P>0.05). The experlment gnmp margin appeared necrosis under eletronic microseope and the control group appeared degeneratinn. Conclusions Laparoscopic advanced gastric carcinoma lymph node dissectinn can D2 radical of advanced gastriC carcinoma demands(D>N), have significant difference with conventional surgery. Positive lymph node dissection margin of treatment is better than traditional surgery.

Cardiomyopathy, Dilated ; etiology ; genetics ; Humans

Objective To evaluate the efficacy of decortication by video-assisted thoracic surgery (VATS) in pa﹣tients with tuberculous empyema, and discuss its indications. Methods 60 patients with tuberculous empyema who underwent decortication by VATS for surgical management from December 2010 to December 2015 were included. Under a thoracoscope, we cleaned up the pus, separated adhesions, scraped granulation tissues and caseous necrosis on the inner wall of the abscess cavity, and stripped the thickened fiberboard of the parietal and visceral pleurae. Af﹣ter the procedure, sufficient drainage and antituberculosis therapy were carried out. Results All the patients in this group were operated successfully. All the patients were cured without perioperative death and complications. No re﹣currence of empyema was observed at the follow-up examination from 2 months to 5 years, and suffered pulmonary reexpansions were better. Conclusions The decortication by VATS for tuberculous empyema is safe, effective, mini﹣mally invasive. The imaging manifestations of pleural thickening in 1 cm, no obvious calcification, no serious lesions in the lungs are the indications for the operation.

Objective To evaluate the therapeutic efficacy of neoadjuvant chemotherapy in cervical carcinoma. Methods TAC(DDP, EPI and BLM) was applied in 68 patients with cervical carcinoma. Therapeutic efficacy and side effects were documented. Results After 1～3 cycles of neoadjuvant chemotherapy, clinical symptoms remission rares reached 100% ,response rate were 100% (40/40) in Ⅰ b～Ⅱ a,90.9% (20/22) in Ⅱ b and 50% (2/4)in Ⅲ a, respectively. Radical resection reached 91.2 %, and only 6 patients of advanced disease failed to radical resection and turned to radiotherapy. Conclusion Neoadjuvant chemotherapy is a safe and effective therapeutic option which could alleviate clinical symptoms, decrease tumor size, down-staging and increase the radical resection rate.

Objective:To explore the optimal postpartum nursing intervention method of elderly second-birth parturient based on the best evidence and evaluate its effect so as to improve the quality of clinical nursing.Methods:Based on the best evidence obtained from the previous study, the optimal nursing examination index of the elderly second parturient was established, and the evidence of best practice was obtained by using the evidence-based nursing method, and the 2017 revised version (the third edition of) Johns Hopkins evidence-based nursing practice model) was used to guide nurses to apply the evidence to clinical practice. During the period from March to May 2019, the baseline review was completed, including 82 pregnant women and 43 nurses. The evidence was incorporated into clinical practice in June 2019. From July to October 2019, the same indicators and inclusion and exclusion criteria were used to evaluate the effectiveness of evidence application in 43 nurses (including midwives) and 85 elderly second-child parturients in obstetric wards (including baby-friendly areas). The anxiety, depression, maternal satisfaction and nurses' correct implementation rate of the best evidence were compared before and after the application of evidence.Results:After the use of evidence-based intervention, the implementation rate of nurses was above 80%. The anxiety score of parturient decreased from 55.29±10.11 to 41.74±10.35, the difference was statistically significant ( t value was 8.55, P<0.001), and the depression score decreased from 57.77 ±8.32 to 47.86 ±9.33, the difference was statistically significant ( t value was 7.23, P<0.001). Maternal satisfaction increased from 92.68% (76/82) to 98.82% (84/85), the difference was statistically significant ( χ2 value was 3.92, P< 0.05). Conclusion:The result of practice shows that through evidence-based nursing intervention, we can further standardize the postpartum optimal nursing paradigm of elderly second-child parturients in China. Reduce postpartum anxiety and depression and improve maternal satisfaction. And quality review still needs to be continuously promoted and implemented in clinical practice in order to continuously improve the quality of nursing and ensure sustainability.

Objective:To explore the application of self-teaching model based on PBL teaching combined with flipped classroom in standardized residency training of orthopedics.Methods:There were 102 cases of residents who received standardized residency training from March 2017 to February 2018 in orthopedics department of Yueyang Hospital of Traditional Chinese and Western Medicine, among whom 55 were randomized into the observation group and 47 were divided into the control group. Traditional teaching was applied in the control group and self-teaching model was applied additionally in the observation group. At the end of the month, the teaching effect was evaluated by the department graduation examinations and questionnaire survey. SPSS 19.0 was used for t test. Results:The ability of history inquiry, diagnosis and physical examination of the residents in the observation group were higher than those in the control group. The self-study and data access ability, confidence in presenting, and satisfaction with teaching in the observation group were better than those in the control group.Conclusion:The self-teaching mode can arouse the learning initiative of residents, and increase residents' literature retrieval ability and their learning satisfaction.

ObjectiveTo investigate whether early goal-directed therapy (EGDT) could improve the mortality rate in patients with severe sepsis or septic shock.Methods Articles were retrieved from PubMed, Cochrane Library, Embase data, Wanfang data, and CNKI from January 1980 to May 2015. Inclusion criteria included the subjects concerning patients with severe sepsis or septic shock reported as randomized controlled trial (RCT), clinical controlled trial (CCT), case-control studies, cohort studies with complete data, which endpoints were the short-term mortality [in-hospital, intensive care unit (ICU) or 28-day] and long-term mortality (60-day, 90-day or 1 year). RevMan 5.2 software was used for Meta analysis of effect of EGDT on mortality rate in patients with severe sepsis or septic shock, and funnel plot was drawn to evaluate the quality of enrolled literature.Results There were 12 studies meeting inclusive criteria including 5 528 patients, 4 RCTs, 3 case-control studies, 4 cohort studies, and 1 quasi-experimental research. It was shown by Meta analysis that EGDT was associated with significant decrease in the short-term mortality [relative risk (RR) = 0.72, 95% confidence interval (95%CI) = 0.64-0.80,P< 0.000 01], but not associated with decrease of long-term mortality (RR = 0.99, 95%CI = 0.92-1.06,P = 0.81). The funnel plot showed that there was no publication bias. EGDT was recommended as grade C.Conclusions EGDT was associated with significant improvement in short-term mortality but not with long-term mortality in patients with severe sepsis or septic shock. Grade C was recommended by our study.