Objective To evaluate efficacy of healthy canteen based-nutritional health promotion so as to provide evidence for popularization and application.Methods A total of 429 college professors and administrative staffs with a healthy canteen were selected as the intervention group in 2012 in Changzhou,and another 947 counterparts without a healthy canteen were selected as the control group.Those of the intervention group was further assigned to the ≥2 times/week and＜2 times/week subgroups.Blood pressure,fatty liver,serum triglycerides,blood glucose,total cholesterol,uric acid,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol and body mass index(BMI)were tested before and after the intervention.Results After the intervention,the mean serum glucose[(5.06±0.62)mmol/L],uric acid[(310.57 ± 71.79)μmol/L],total cholesterol[(4.88 ± 0.86)mmol/L],triglycerides[(1.39 ± 0.67)mmol/L]and low-density lipoprotein cholesterol[(2.51 ±0.62)mmol/L]of the intervention group were significantly decreased(t values were 7.513,2.126,2.062,3.731 and 8.891,respectively; all P＜0.05),and mean high-density lipoprotein cholesterol[(1.43±0.34)mmol/L]were significantly increased(t=-2.309,P＜0.05).After the intervention,mean serum glucose and uric acid of the control group were significantly increased(t values were-3.491 and-7.703,respectively; both P＜0.05),although there was no statistically significant difference of mean serum triglycerides,total cholesterol,low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in the control group before and after the intervention(all P＞0.05).The abnormality rates of serum glucose,uric acid,total cholesterol,triglycerides,low-density lipoprotein cholesterol and BMI as well as the incidence of hypertension of the intervention group were significantly decreased after the intervention(x2 values were 4.202,3.940,4.031,7.305,59.422,4.273 and 7.385,respectively; P＜0.05).In the control group,although the abnormality rate of serum uric acid and the incidence of fatty liver were significantly inclined after the intervention(x2 values were 23.740 and 7.408,respectively; both P＜0.05),there were no significant difference of abnormal serum triglycerides,glucose,total cholesterol,low-density lipoprotein cholesterol and BMI as well as the incidence of hypertension before and after the intervention(all P＞0.05).Mean serum triglycerides[(1.15 ±0.68)mmol/L]and low-density lipoprotein cholesterol[(2.4 1±0.60)mmol/L]in the ≥2 times/ week subgroup were significantly lower than those of the＜2 times/week subgroup(t values were-4.884 and-2.513,respectively; both P＜0.05),and mean high-density lipoprotein cholesterol[(1.46±0.33)mmo]/L]of the ≥2 times/week subgroup was significantly higher than that of the＜2 times/week subgroup(t=2.032,P＜0.05).The abnormality rates of serum total cholesterol,triglyceride and low-density lipoprotein cholesterol in the ≥ 2 times/week subgroup were significantly lower than those in the＜2 times/week subgroup(x2 values were 3.963,9.947 and 4.589,respectively; all P＜0.05).Conclusion Healthy canteen based-nutritional health promotion model may provide an effective method to prevent and control the development of noncommunicable chronic diseases.

Objective To explore the curative efficacy of treating tibial transport gap fracture after bone transport by external fixation with locking compression plate(LCP) and autologous iliac grafting.Methods From February 2015 to January 2016,9 patients who had sustained tibial transport gap fracture after bone transport were treated by LCP external fixation and autologous iliac grafting.They were 7 men and 2 women,aged from 26 to 56 years (average,40.2 years).One of them received bone transport because of limb shortness after replantation and others did because of traumatic osteomyelitis.The distances of tibial transport averaged 9.2 cm (from 7 to 12 cm);the time for external fixation averaged 20.1 months (from 13 to 25 months);the time from removal of external fixator to gap fracture averaged 1.8 weeks (from 1 to 3 weeks).Two patients were complicated with docking site fracture.The durations from gap fracture to operation averaged 4.1 days (from 3 to 5 days).Five patients sustained angular deformity of various severities which could not be corrected by surgery.The curative efficacy was evaluated according to conventional criteria for fracture healing.Results The 9 patients were followed up for 11 to 15 months (average,13.1 months).The time for LCP external fixation averaged 9.0 months (from 8 to 10 months);the time for fracture union averaged 4.6 months (from 4 to 5 months).The 5 patients with angular deformity obtained fracture malunion which did not obviously affect their limb appearance.One case suffered extensive cellulitis at the leg which responded to intravenous administration of antibiotics.No pin track infection happened.The knee and ankle functions after removal of LCP external fixation were not significantly different from those after removal of external fixator following bone transport.Wounds at the iliac donor site and bone graft area all healed well.Conclusions LCP external fixation is an effective treatment for tibial transport gap fracture after bone transport,due to its stable fixation,limited injury to soft tissues,positive curative efficacy and miniature size as well.However,it requires sophisticated operative skills and demanding postoperative care.

To investigate the effect and application value of transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft for the treatment of antibrachial chronic osteomyelitis of Cierny-Mader type IV. Methods From August, 2013 to May, 2017, 12 cases of ulna or (and) radius chronic osteomyelitis of Cierny-Mader type IV were treated by transplantation of the free cutaneous fibu-lar flap combined with antibiotic-loaded calcium sulfate artificial bone graft. There were 7 males and 5 females, with an average age of 36.3 (21-47) years.Pure ulnar osteomyelitis in 7 cases, radius osteomyelitis in 4 cases, and both ul-nar and radius osteomyelitis in 1 case. The average range of osteomyelitis lesions was 6.3 (3.0-9.0) cm. The area of soft tissue defect (including bone scar) ranged from 8.0 cm×2.0 cm to 15.0 cm×5.0 cm. The area of the flap was 10.0 cm×3.5cm-17.0 cm×7.0 cm.The average length of the fibular flap was 8.8 (5.0-12.0) cm.Locking plate internal fixa-tion was used in 9 cases, external fixator in 2 cases, and plate combined with external fixator in 1 case. Vancomycin/gentamicin, an effective component of calcium sulfate artificial bone, averaged 0.64 g/102.7 kU (0.4 g/64 kU-1.0 g/160 kU).Routine postoperative treatment.And monthly outpatient review in the first half year after operation, and outpatient review every 3 months after half a year.One year after operation, comprehensive evaluation of elbow, forearm and wrist function with Mayo Elbow Function Index, Anderson Forearm Double Fracture Evaluation System and Cooney Wrist Function Score. Results Vascular crisis occurred in 1 case after operation, prompt surgical exploration, and ultimately all flaps survived completely.The donor sites healed well in all cases.The lower extremity functions of donor sites had no change compared with that before operation.Followed-up of an average of 22.7 months, there were 2 cases who had sen-sory disturbance in the ulnar nerve innervation area and returned to normal 3 months after operation. The fibular flaps healed satisfactorily with an average healing time of 4.7 (3-6) months.No calcium sulphate artificial bone granules were seen on X-ray at 3 months after operation.One year after operation, bone healing, forearm appearance and wrist function recovered well, but elbow and forearm motor function recovered unsatisfactorily. Conclusion On the basis of master-ing the applied anatomy and vascular anastomosis techniques of microsurgery, this method of transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft for the treatment of an-tibrachial chronic osteomyelitis of Cierny-Mader type IV has achieved satisfactory results.The recipient area is beautiful. The bone healing is reliable.And it has little influence on the recipient area and the donor area.It is worthy of clinical application.

Objective To investigate the clinical efficacy of tissue flap combined with antibiotic-loaded calcium sulfate and autogenous iliac bone grafting at stage Ⅰ for infected nonunion of long bone.Methods A retrospective case series study was conducted to analyze the clinical data of 51 patients with infected nonunion of long bones admitted to Tongde Hospital of Zhejiang Province from January 2013 to December2017.There were 42 males and nine females,aged 19-71 years,with an average age of 36.3 years.There were 43 patients with bone nonunion at tibia,six at femur,one at humerus,and one at ulna and radius.The range of bone defect area was 1-9 cm,with an average of 2.9 cm.On the basis of thorough debridement,tissue flaps combined with antibiotic-loaded calcium sulfate and autologous iliac bone graft were performed at stage Ⅰ treatment.The survival of skin flaps,infection control,nonunion healing and complications were recorded.Johner-Wruhs joint function assessment criteria were used to evaluate limb function.Results All patients were followed up for 10-35 months,with an average of 18.3 months.All flaps survived eventually.Except for one patient with infection recurrence,the other 50 patients with infection obtained primary cure.All nonunions were healed,with an average healing time of 6.4 months ranging from 4 to 15 months.Complications included venous crisis of skin flaps in five patients,anterolateral femoral cutaneous nerve injury in 20 patients,recurrence of infection in one patient,and infection of external fixator nail tract in three patients.Function evaluation results by Johner-Wruhs criteria were excellent in 34 patients,good in 14,and moderate in three patients,with an excellent and good rate of 94％.Conclusion On the basis of thorough debridement,tissue flap combined with antibiotic-loaded calcium sulfate and autogenous iliac bone graft can control the infection effectively,promote the bone union and improve the limb function.

Objective: To study the treatment of huge empyema with free vastus lateralis muscle flap. Methods: From May 2015 to December 2015, 3 cases of empyema were treated with free vastus lateralis muscle flaps, (unilateral vastus lateralis muscle flap, n=2; bilateral vastus lateralis muscle flaps with Flow-through technique, n=1). The volumes of defects were 12.4 cm×5.1 cm×6.4 cm, 11.8 cm×6.9 cm×5.6 cm, and 14.4 cm×7.6 cm×9.4 cm, respectively. Result: All flaps was survived after 23-29 months follow-up. The pus cavities were filled well. There was no empyema reoccurred. The patients felt good, without chest distress. The donor site of flap healed well. The function of lower limb was not affected. Conclusions Vastus lateralis muscle can fill the pus cavity of empyema successfully, without the sacrifice of chest shape. Free vastus lateralis muscle flap is an ideal choice to repair large empyema defection. For young patient, bilateral free vastus lateralis muscle flap can be used if the cavity is too large to fill with one flap.

At present,the quality and safety management of multiple districts of hospital still has problems such as low informatization level,inconsistent quality and safety management mode,and insufficient quality and safety management concept.It takes an orthopedic hospital of Traditional Chinese Medicine as an example to explore the quality and safety management practice of multiple districts of hospital under the homogenization strategy.A three-level quality control management system composed of leadership,executive level and guidance level was constructed,and the general framework of the integrated quality management system and the specific work contents of quality management in each hospital were proposed,in order to provide a standardized and operable management mode for medical institutions to carry out medical quality management.

At present,the quality and safety management of multiple districts of hospital still has problems such as low informatization level,inconsistent quality and safety management mode,and insufficient quality and safety management concept.It takes an orthopedic hospital of Traditional Chinese Medicine as an example to explore the quality and safety management practice of multiple districts of hospital under the homogenization strategy.A three-level quality control management system composed of leadership,executive level and guidance level was constructed,and the general framework of the integrated quality management system and the specific work contents of quality management in each hospital were proposed,in order to provide a standardized and operable management mode for medical institutions to carry out medical quality management.

At present,the quality and safety management of multiple districts of hospital still has problems such as low informatization level,inconsistent quality and safety management mode,and insufficient quality and safety management concept.It takes an orthopedic hospital of Traditional Chinese Medicine as an example to explore the quality and safety management practice of multiple districts of hospital under the homogenization strategy.A three-level quality control management system composed of leadership,executive level and guidance level was constructed,and the general framework of the integrated quality management system and the specific work contents of quality management in each hospital were proposed,in order to provide a standardized and operable management mode for medical institutions to carry out medical quality management.

At present,the quality and safety management of multiple districts of hospital still has problems such as low informatization level,inconsistent quality and safety management mode,and insufficient quality and safety management concept.It takes an orthopedic hospital of Traditional Chinese Medicine as an example to explore the quality and safety management practice of multiple districts of hospital under the homogenization strategy.A three-level quality control management system composed of leadership,executive level and guidance level was constructed,and the general framework of the integrated quality management system and the specific work contents of quality management in each hospital were proposed,in order to provide a standardized and operable management mode for medical institutions to carry out medical quality management.

At present,the quality and safety management of multiple districts of hospital still has problems such as low informatization level,inconsistent quality and safety management mode,and insufficient quality and safety management concept.It takes an orthopedic hospital of Traditional Chinese Medicine as an example to explore the quality and safety management practice of multiple districts of hospital under the homogenization strategy.A three-level quality control management system composed of leadership,executive level and guidance level was constructed,and the general framework of the integrated quality management system and the specific work contents of quality management in each hospital were proposed,in order to provide a standardized and operable management mode for medical institutions to carry out medical quality management.