Objective To summarize the clinical effects of retrograde intramedullary nail in treating distal femora| fracture. Methods Retrospectively analysed 52 cases of intereondyiar and supracondylar fracture of femur treated with retrograde intrameduUary nail. Results All cases were followed up for 6 to 24 months. All fracture were union except 2 reoperations cases had delay union. Conclusion Retrograde intrameduUary nail has supreme biological stability and allowed early exercise. It also can shorten operation time, reduce damage of periosteum and reduce delay union rate.

Objective To investigate the operative indications and the therapeutic effect of the pedide screw fixation used for treating multiple fractures of the thoracolumbar spine. Methods 16 cases of multiple fractures of the thoracolumbar spine were chosen to be treated by open reduction through posterior approach and pedicle screw fixation. 10 cases were the fractures involved adjacent segments,4 cases were the fractures with one intact vertebral segment between them,2 cases were the fractures with two intact vertebral segments between them. Results The patients were followed up for 12～36 months,with an average of 21.5 months. After the operations,function of moat of the injured nerves had beeu improved or restored. The vertebral height of the fractured segment showed no signifi-cant loss. The materials of internal fixation found no loosening or fracturing at the end of follow-up. Conclusion Fractures of multi-segment of thoraeolumhar vertebrae can cause serious instability and are required for timely treat- ment. The method of the internal fixation with pedicle screw-rod fixation system through posterior approach, fol- lowed by limited decompression, can reconstruct the stability of the vertebrae and promote the recovery of the im- paired neurological functions.

Objective Summarize the clinical experience on the improved intramedullary nail therapy for the fraction of femurand tibia,to improve the skill. Methods The modified intramedullary nail has been used for frac-tion-cure on 64 cases of which 29 are femur fraction and 35 tibin fraction through the period. Results All the pa-tients were recovered within 4 months without any joint malfunction or syndromes. Conclusion The far-end aiming of the modified intrameduUary nail could maintain a 100 % precision, which out down the surgery operation time and reduce bleeding. Remain the advantage of previous intrarnedullary nail is beneficial to bone fraction concrescence and function recovery.

Objective To investigate the clinical effect of interbody cages combined with pedicle screw system in treatment of spondylolisthesis. Methods Of 20 patients with spondylolisthesis, interbody cages combined with 10pedicle screw system was performed in 10 patients and spinal decompression combined with intervertebral bone grafting in another 10. Results All the patients were followed up for 8-12 months (average 10 months), which showed significant improvement in the syndrome. Of 10 patients treated with interbody cages combined with pedicle screw system, seven patients were evaluated excellent, two good and one fair. Of 10 patients treated with spinal decompression combined with intervertebral bone grafting, five patients were evaluated excellent, two good and three fair. Conclusion Interbody cages combined with pedicle screw system is an safe and effective surgery for spondylolisthesis.

Abstract The aging process is increasingly accelerating in China, and the improvement of health literacy is a prerequisite to achieving health for all, and is an important strategy to promote healthy aging. Based on recent studies pertaining to health literacy among the elderly, this review, from the perspective of aging, summarizes the level and common influencing factors of health literacy among Chinese elderly populations, and discusses the health literacy promotion strategies among the elderly, so as to provide insights into improving the health literacy surveillance and promotion quality and health literacy levels among the elderly.

Objective: To investigate the prevalence of cigarette and electronic cigarette ( e-cigarette ) use among adults in Zhejiang Province, so as to provide insights into tobacco control. Methods : Thirty study sites were randomly sampled from Zhejiang Province in 2020 using a multi-stage stratified random sampling method, and permanent residents at ages of 15 to 69 years were selected as study subjects. A questionnaire was designed based on the questionnaire for the China Adult Tobacco Survey to collect subjects' demographic characteristics, cigarette and e-cigarette use, smoking cessation and exposure to secondhand smoke ( SHS ). The weighted prevalence of smoking, current smoking, current e-cigarette smoking, smoking cessation and exposure to SHS was estimated based on the Seventh National Population Census in 2020. Results : A total of 19 200 questionnaires were recovered, and 19 180 were valid, with an effective recovery rate of 99.90%. The respondents had a mean age of ( 50.30±12.90 ) years, with a male to female ratio of 1∶1.06 and an urban/rural population ratio of 1∶1.31. Among all the respondents, there were 6 033 smokers ( 31.45% ), 4 163 current smokers ( 21.70% ), 201 current e-cigarette users ( 1.05% ), 146 cigarette and e-cigarette dual users ( 0.76% ), 1 870 respondents quitting smoking ( 31.00% of smokers ) and 7 189 respondents with exposure to SHS ( 47.87% of non-smokers ). The weighted prevalence of smoking, current e-cigarette use, cigarette and e-cigarette dual uses, smoking cessation and exposure to SHS was 20.49%, 1.34%, 0.94%, 29.56% and 49.53% in Zhejiang Province, respectively, and the prevalence of current smoking, current e-cigarette use, cigarette and e-cigarette dual uses and exposure to SHS was 40.39%, 2.39%, 1.86% and 55.31% among males and 0.35%, 0.28%, <0.01% and 46.02% among females, respectively. The highest prevalence of current smoking was seen among respondents at ages of 55 to 64 years ( 24.24% ), while the highest prevalence of current e-cigarette use and cigarette and e-cigarette dual uses was seen in adults at ages of 25 to 34 years ( 2.18% and 1.58% ). Conclusions The prevalence of current e-cigarette use was higher among adults in Zhejiang Province in 2020 than the nationwide level in China. The prevalence of cigarette use was lower among adults in Zhejiang Province in 2020 than the nationwide level in China; however, improving the management of tobacco control in public places and the capacity building of smoking cessation services is still required to reduce the use of cigarettes and e-cigarettes.

Objective To explore the curative effect of fibular flap with limbs composite soft-tissue.Methods From February,2013 to February,2016,13 cases with body severe trauma patients were treated,which including 5 cases of upper limbs and 8 cases of lower limbs,and all existed bone defect,soft tissue defect and trunk vessel defect.Three cases with limbs distal non blood supply were emergency treated with debridment and flow-through fibular flap transplantation renovation,peroneal artery repairing defective blood vesscls to rcstorc limbs distal blood supply,fibular flap repairing bone defect,skin flap repairing soft tissue defect.The limb blood supply for other 10 cases were in good condition,but one case with main artery defect did the second phase of fibular flap transplantation and repaired defective blood vessels,bone and skin soft tissue synchronously according to wound condition.According to the postoperative observation for flap survival and appearance,X-ray films to observe fracture healing after 6 weeks,three months and 6 months of operation as well as evaluating limb function recovery,then analyzed the results.Results Flaps survived successfully for 11 cases,and flaps for the other 2 cases were partial necrosis.One Case was edge flap necrosis,heal scabby after dressing,and the other case was necrosis for 1/3 of the area,but the deep fascia survival,and the skin graft healing after dressing.One case with forearm rolling was in vascular crisis after operation,but tbe crisis was relieved after detection,and fingers blood supply was recovered.All the patients were followed up for 6 to 36 months(mean,14 months).All flaps were survived,fractures healed well and limbs distal blood supply was good.Bone healing time was 8 to 24 weeks,and patients with lower limbs injury could bear load after 3 to 8 months.Lower limbs restored walking function.Upper limbs and hands restored rotation function.Transplant flapshad good elasticity and satisfactory appearance.Conclusion Using fibular flap to repair defective blood vessels,bone and soft tissue synchronously,not only can rescue the limbs on the verge of amputation,but also can repair defective composite tissue and get a good prognosis.It is an effective method for open injuries severely treatment in clinic.

Objective To survey the resistance profile of clinical isolates to antibiotics across the hospitals in Dongguan,Guangdong Province during 2015.Methods Kirby-Bauer method or automated system was used to test the susceptibility of clinical isolates to selected antimicrobial agents.Results were analyzed according to CLSI 2015 breakpoints.The susceptibility data were analyzed using WHONET 5.6 software.Results A total of 29 665 strains of microorganisms were isolated,of which gram positive cocci accounted for 32.1％ (9 509/29 665) and gram negative bacilli accounted for 67.9％ (20 156/29 665),respectively.The prevalence of methicillinresistant Staphylococcus was 23.3％ (705/3 024) in S.aureus and 43.6％ (1 054/2 419) in coagulase-negative Staphylococcus.No vancomycin-resistant staphylococcal strain was found.ESBLs-producing strains accounted for 36.4％ (2 554/7 020) in E.coli and 24.5％(792/3 227) in Klebsiella isolates.The prevalence of carbapenem-resistant Enterobacteriaceae was 0.2％ (30/13 077).The prevalence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB) was 16.0％ (500/3 116) and 53.9％ (827/1 533),respectively.The prevalence of penicillin-resistant S.pneumoniae (PRSP) strains was 10.1％ (142/1 404).Beta-lactamase was produced in 30.6％ (276/902) of the H.influenzae strains.The prevalence of vancomycin-resistant Enterococcus (VRE) strains was 0.7％ (10/1 441).Conclusions Periodic surveillance of antimicrobial resistance is valuable for rational antimicrobial therapy,formulation of treatment guidelines and infection control and prevention measures,as well as preventing the spread of drug-resistant strains.

ObjectiveTo explore the predictive effect of serum TC/HDL-C ratio on ischemic and hemorrhagic stroke incidence in middle aged Chinese population.MethodsA prospective study was conducted based on the PRC-USA Collaborative Study on Cardiovascular and Cardiopulmonary Epidemiology. A total of 10 121 individuals (4921 men and 5200 women), aged 35—59 years were selected from 4 cohorts, in Beijing and Guangzhou, urban and rural. The average following up time was 15.9 years. During the follow-up period, 277 ischemic and 125 hemorrhagic stroke cases were diagnosed.ResultsThe age adjusted incidence rate of ischemic stroke was 144.1,169.4,166.7,226.9 and 282.2 in the group of TC/HDL-C ratio

Objective To analyze the serotypes and antimicrobial susceptibility profile of Group B Streptococcus (GBS) in perinatal pregnant women.Methods The vaginal and rectal specimens were collected from pregnant women at 35 to 37 weeks of pregnancy for culture and identification.The serotypes were analyzed using agglutination assay.Antimicrobial susceptibility testing was conducted by using Kirby-Bauer method,and interpreted according to 2009 CLSI breakpoints.The data were analyzed via WHONET 5.6 software.Results The prevalence of GBS was 10.4％ (264/2 533) in the 2 533 perinatal pregnant women.Serotype Ⅲ,Ⅰa and Ⅰb was identified in 54.9％ (84/153),17.6％ (27/153) and 13.1％ (20/153) of the GBS,respectively.All the GBS isolates were susceptible to penicillin,cefiriaxone and vancomycin.But 32.9％,68.1％ and 62.1％ of the isolates were resistant to levofloxacin,erythromycin and clindamycin,respectively.The antibiotic resistance rate of serotype Ⅲ isolates to the above three antibiotics was significantly higher than the other serotypes.Conclusions GBS may colonize both vagina and rectum of pregnant women.Vaginal and rectal secretions should be sampled simultaneously for better screening GBS.GBS serotype Ⅲ was the predominant serotype.Penicillin can be used as the first-choice treatment for GBS infections in pregnant women and newborns.GBS-positive pregnant women should be given the intervention treatment immediately to ensure the health of perinatal infants.