Objective: To analyze the effects of health literacy on overweight and obesity among primary school students and their parents in terms of salt, oil and sugar reduction (referred to as the "three reductions"), so as to provide a theoretical basis for the development of obesity control measures. Methods: From March to April 2024, a total of 1 022 fourthgrade primary school students and 913 parents were surveyed in 24 classes in six counties in Shandong Province using multistage cluster random sampling, and physical measurements of primary school students were conducted. Pearsons correlation analysis and ordered multivariate Logistic regression were used to investigate the associations between health literacy of primary school students and their parents with overweight and obesity among children. Results: The detection rates of overweight and obesity primary school students in Shandong Province were 14.87% and 24.66%, respectively, with significant sex difference in obesity rate (29.46% for boys and 19.76% for girls) (χ2=12.93, P<0.01). In addition to students reducing oil scores, parental reducing salt,reducing oil,reducing sugar, comprehensive health literacy scores and students reducing salt,reducing sugar and comprehensive health literacy scores showed a negative relationship with students overweight and obesity (r=-0.10, -0.08, -0.07, -0.10, -0.04, -0.07, -0.03, P<0.05). The overweight and obesity rates among primary school students with high parental reducing salt,reducing oil,reducing sugar and composite health literacy scores were lower (OR=0.69, 0.69, 0.71, 0.63, P<0.05); and the overweight and obesity rate among students with high parental and low parental and high and low parental health literacy scores were lower (OR=0.68, 0.57, P<0.05). Conclusion Improving health literacy regarding "three reductions" for parents and children, especially parents, can effectively reduce the risk of childhood overweight and obesity.

Objective:To investigate the clinical effect of the giant deep inferior epigastric artery paraumbilical perforator flap in repairing the circular high-voltage electric burn wounds on the wrist.Methods:A retrospective observational study method was used. From September 2016 to October 2021, thirteen male patients (aged 20-43 years) with annular high voltage (10-100 kV) electrical burns on the wrist were admitted to the Beijing Jishuitan Hospital. At the early stage after injury, the patient's wrist was subjected to incision, tension reduction and debridement, with the wound area after debridement being 27 cm×16 cm-32 cm×19 cm; in 12 patients with vascular injury, the radial or ulnar artery was reconstructed by great saphenous vein transplantation, with the length of 15-25 cm; the wrist wound was repaired by free transplantation of the deep inferior epigastric artery paraumbilical perforator flap (if the wound was giant, the lower abdominal flap carrying other perforators was used), with the area of 30 cm×19 cm-35 cm×20 cm. The donor site was repaired by direct suture+skin grafting or relay flap transplantation. After surgery, the survival of flap in recipient area, as well as survival of the skin or flap in donor site were observed. During follow-up, the appearances of the flap in recipient area and the recovery of hand function, as well as the healing of donor site, occurrence of abdominal wall hernia, and scar in skin graft area were observed.Results:After surgery, all the 13 patients' paraumbilical perforator flaps survived. Among them, 3 patients had subcutaneous fat necrosis at the distal end of the wrist flap, and the wound had mild infection, which healed after re-expansion and dressing change. All the skin grafts in the donor site of 10 patients survived, and the flaps in the donor site of 3 patients survived well. The patients were followed up for 6 months to 3 years. The flaps in recipient area were in good shape, 8 cases had partial recovery of hand function, and 5 cases had loss of finger flexion function; the donor site of abdominal flap healed well with no abdominal hernia occurred, and the skin graft site had no obvious scar hyperplasia and was soft in texture.Conclusions:Early vascular reconstruction after injury, together with free transplantation of the giant deep inferior epigastric artery paraumbilical perforator flap are effective in repairing circular high-voltage electrical burn wounds on the wrist.

Objective:To explore the application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing various destructive wounds.Methods:The retrospective observational study method was applied. From January 2015 to December 2020, 28 patients (21 males and 7 females, aged 25 to 66 years) with destructive wounds in various body parts were admitted to Beijing Jishuitan Hospital. The wound areas of patients ranged from 17 cm×8 cm to 35 cm×22 cm after debridement. Pedicled or free paraumbilical perforator flaps with inferior epigastric vessels were used to repair the wounds respectively. The areas of flaps were from 18 cm×10 cm to 37 cm×24 cm, and the lengths of vascular pedicles were 13.0-17.0 (15.1±2.3) cm. For type Ⅲ high-voltage electric burn wounds of wrist, two methods were used to reconstruct the blood flow of hand, one is to bridge the radial artery with saphenous vein grafting and the other one is to design blood flow-through flap. The strength of abdominal wall in the donor site was strengthened by polypropylene patch, and then the wounds were directly sutured. If the wounds could not be sutured directly, then allogenic acellular dermal matrix (ADM) was applied to strengthen the abdominal wall first, and then autologous medium-thickness skin graft was taken from the thigh to cover the wounds. The flap transplantation, hand blood flow reconstruction, the repair of donor site, the flap survival, the wound and donor site healing after operation, the appearance of flaps, and the wound and donor site recovery during follow-up were observed.Results:Among the patients in this group, 13 patients were treated with pedicled flap grafting, while 15 patients were treated with free flap grafting. The hand blood flow of 7 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed by bridging radial artery with saphenous vein grafting. The hand blood flow of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist was reconstructed with blood flow-through flap. In 16 patients, the strength of abdominal wall was strengthened using patch in the donor site,and then the donor sites were sutured directly. In 12 patients, the strength of abdominal wall was strengthened using allogenic ADM, and then the donor sites were covered by skin grafting. All the transplanted flaps survived completely. The wounds of 24 patients were healed, while the wounds of 3 patients with type Ⅲ high-voltage electric burn wounds of wrist and 1 patient with chronic radiation ulcer of ilium failed to heal because of there were still some necrotic tissue and purulent secretion under the flaps. The wounds were healed eventually after debridement and dressing changes. During the follow-up of 6 months to 3 years, the flap survived well with good appearance in all patients, and there was no recurrence, or no abdominal wall hernia occurred in the donor site.Conclusions:Paraumbilical perforator flap with inferior epigastric vessels has flexible design, long vascular pedicle, large area for cut. It can be pedicled or freely transplanted, which is a good choice for repairing destructive wounds in various areas.

Objective: To explore the excellent methods for aesthetic repair of the donor sites of flaps. Methods: From January 2013 to March 2018, 120 patients (94 males and 26 females, aged from 3 to 60 years) were admitted to the Department of Burns of Beijing Jishuitan Hospital. Wounds areas after debridement or removing scar were ranged from 8.0 cm×3.5 cm to 24.0 cm×18.0 cm. Twenty patients with facial and neck scar were repaired with expanded flaps, including 4 scalp flaps, 8 supraclavicular flaps, 4 deltoid flaps, and 4 trapezius myocutaneous flaps. The flaps in ideal donor sites were selected to repair the wounds in 40 patients, including 20 cases of hand wounds or scars repaired with inguinal flaps, 10 children of foot skin defects or scars repaired with cross inguinal skin flap, 10 cases of knee joint wounds repaired with medial or lateral thigh flaps. The optimal flap design was used to repair wounds in 50 patients. Among the patients, wounds of 36 patients were repaired with relaying flaps, including donor sites of free anterolateral thigh flaps of 8 patients repaired with anteromedial thigh perforator flaps and donor sites of free anterolateral thigh flaps of 8 patients repaired with ilioinguinal flaps or superficial abdominal artery flaps, and donor sites of flaps of 20 patients repaired with peroneal perforator relaying flaps. Besides, wounds of 9 patients were repaired with free lobulated anterolateral thigh flaps, and wounds of 5 patients were repaired with modified V-Y propelling latissimus dorsi myocutaneous flaps. The donor sites of flaps were repaired with allogenic acellular dermal matrix combined with autologous split-thickness skin grafts in 10 cases. The areas of the flaps or myocutaneous flaps were ranged from 6.0 cm×4.0 cm to 30.0 cm×20.0 cm. The survival of flap, myocutaneous flap, or skin graft and the repair of donor site after operation and during follow-up were observed. Results: Blood flow obstacle at 0.5 cm to the distal margin of the flap occurred in 1 patient repaired with expanded flap, which were healed after dressing change. Blood supply disorder occurred at the tip of the anteromedial thigh perforator flap of 1 patient repaired by optimal flap design, which were healed completely after second debridement and restitching. The other flaps or myocutaneous flaps survived well. The allogenic acellular dermal matrix and the autologous split-thickness skin graft survived with good color and texture. During follow-up of 3 months to 4 years, the donor sites of flaps had good appearance, only with linear scar and the function recovered well. The donor sites of skin grafts had no scar hyperplasia, only with scattered pigmentation. Conclusions According to the characteristics of donor sites of flaps, individualized and reasonable design before the operation such as pre-expanding of the flaps, selecting the ideal donor sites, optimization of the flap design or allogenic acellular dermal matrix combined with autologous split-thickness skin graft to repair donor sites of flaps can minimize the damage for function and appearance of donor sites of flaps and achieve aesthetic effects of donor sites of flaps.

Objective: To explore the limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation. Methods: From January 2003 to March 2019, 61 patients with high voltage electric burns of extremities on the verge of amputation were treated in our hospital. All of them were male, aged 15-58 years, including 49 cases of upper limbs and 12 cases of lower limbs. The wound area after thorough debridement ranged from 15 cm×11 cm to 35 cm×20 cm. Emergency surgery for reconstruction of the radial artery with saphenous vein graft under eschar was performed in 5 cases. The arteries of 36 patients (including 7 cases with simultaneous ulnar artery and radial artery reconstruction) were reconstructed with various forms of blood flow-through after debridement, among them, the radial artery of 13 cases, the ulnar artery of 8 cases, the brachial artery of 8 cases, and the femoral artery of 2 cases were reconstructed with saphenous vein graft; the radial artery of 3 cases and the ulnar artery of 7 cases were reconstructed with the descending branch of the lateral circumflex femoral artery graft; the radial artery of 2 cases were reconstructed with greater omentum vascular graft; the reflux vein of 3 cases with wrist and forearm annular electric burns were reconstructed with saphenous vein graft. According to the actual situation of the patients, 12 cases of latissimus dorsi myocutaneous flap, 6 cases of paraumbilical flap, 28 cases of anterolateral thigh flap, 10 cases of abdominal combined axial flap, 5 cases of greater omentum combined with flap and/or skin grafts were used to repair the wounds after debridement and cover the main wounds as much as possible. Some cases were filled with muscle flap in deep defect at the same time. The area of tissue flaps ranged from 10 cm×10 cm to 38 cm×22 cm. For particularly large wounds and annular wounds, the latissimus dorsi myocutaneous flap, the paraumbilical flap, the abdominal combined axial flap, and the greater omentum combined with flap and/or skin grafts were used more often. Donor sites of three patients were closed directly, and those of 58 patients were repaired with thin and medium split-thickness skin or mesh skin grafts. The outcome of limb salvage, flap survival, and follow-up of patients in this group were recorded. Results: All the transplanted tissue flaps survived in 61 patients. Fifty-six patients had successful limb salvage, among them, 31 limbs were healed after primary surgery; 20 limbs with flap infection and tissue necrosis survived after debridement and flap sutured in situ; 5 limbs with flap infection, radial artery thrombosis, and hand blood supply crisis survived after debridement and radial artery reconstruction with saphenous vein graft. Five patients had limb salvage failure, among them, 3 patients with wrist electric burns had embolism on the distal end of the transplanted blood vessels, without condition of re-anastomosis, and the hands gradually necrotized; although the upper limb of one patient was salvaged at first, due to the extensive necrosis and infection at the distal radius and ulna and the existence of hand blood supply under flap, considering prognostic function and economic benefits, amputation was required by the patient; although the foot of one patient was salvaged at first, due to the repeated infection, sinus formation, extensive bone necrosis of foot under flap, dullness of sole and dysfunction in walking for a long time, amputation was required by the patient. During the follow-up of 6 months to 5 years, 56 patients had adequate blood supply in the salvaged limbs, satisfied appearance of flaps, and certain recovery of limb function. Conclusions Timely revascularization, early thorough debridement, and transplantation of large free tissue flap, combined tissue flap, or blood flow-through flap with rich blood supply are the basic factors to get better limb preservation and recovery of certain functions for patients with high voltage electric burns of limbs on the verge of amputation.

Salt reduction is the most cost-effective population strategy to prevent and control hypertension and cardiovascular disease. Accurate measurement of salt intake is an important basis for implementing salt reduction interventions, while the urine sodium measurement is the most objective method to evaluate salt intake. According to different time spans, it is mainly divided into 24-h urine, overnight urine and spot urine collection methods. This article reviewed the application and evaluation of these three urine measurement methods, and compared their advantages and disadvantages. According to the accuracy and feasibility of different urine measurement methods, it is suggested that the 24-h urine collection method can be applied to the correlation study with small sample size, and the overnight urine method and the spot urine method can be applied to the daily population salt reduction interventions and monitoring activities.

Salt reduction is the most cost?effective population strategy to prevent and control hypertension and cardiovascular disease. Accurate measurement of salt intake is an important basis for implementing salt reduction interventions, while the urine sodium measurement is the most objective method to evaluate salt intake. According to different time spans, it is mainly divided into 24?h urine, overnight urine and spot urine collection methods. This article reviewed the application and evaluation of these three urine measurement methods, and compared their advantages and disadvantages. According to the accuracy and feasibility of different urine measurement methods, it is suggested that the 24?h urine collection method can be applied to the correlation study with small sample size, and the overnight urine method and the spot urine method can be applied to the daily population salt reduction interventions and monitoring activities.

Salt reduction is the most cost?effective population strategy to prevent and control hypertension and cardiovascular disease. Accurate measurement of salt intake is an important basis for implementing salt reduction interventions, while the urine sodium measurement is the most objective method to evaluate salt intake. According to different time spans, it is mainly divided into 24?h urine, overnight urine and spot urine collection methods. This article reviewed the application and evaluation of these three urine measurement methods, and compared their advantages and disadvantages. According to the accuracy and feasibility of different urine measurement methods, it is suggested that the 24?h urine collection method can be applied to the correlation study with small sample size, and the overnight urine method and the spot urine method can be applied to the daily population salt reduction interventions and monitoring activities.

Objective To report the clinical outcomes of latissimus dorsus flap used to reconstruct severe trauma on lower leg.Methods From May 2011 to September 2016,12 patients were treated for severe trauma on lower leg at Orthopaedic Department,General Hospital of Rocket Force.They were 10 men and 2 women,aged from 22 to 54 years (average,37.5 years).According to the Gustilo classification,their open fractures were of type ⅢA in 2 cases and of type ⅢB in 10.The areas of soft tissue defect ranged from 15 cm × 8 cm to 35 cm × 12 cm.Their wounds were covered with latissimus dorsus flaps;the dorsal expansion of the ankle joint was reconstructed after their bone infection was controlled.Two flaps were anastomosed directly to the anterior tibial vessels and one flap to the femoral vessels.The other 9 flaps were anatomosed to the lateral circumflex femoral artery,bridging with the greater saphenous vein (average length:32 cm).Ten flaps were neuroanatomosed with the motor branch of common peroneal nerve and 2 with the motor branch of vastus lateralis.The therapeutic outcomes were evaluated in terms of repair of soft tissue defects,control of infection and range of active dorsal flexion of the ankle at neutral position.Results The 12 patients were followed up for an average of 3.5 years (from 1 to 6 years).All the 12 flaps survived and infections were eradicated.The fractures were healed with muscle strength of grade 3 to grade 4.Their ankle extension was reconstructed.Their limbs were preserved with satisfactory limb function.The bone exposures of 5 cm × 3 cm and 6 cm × 3 cm in area after debridement respectively in 2 cases of Gustilo type ⅢA were covered with latissimus dorsus flaps.The range of active dorsal flexion of the ankle at neutral position increased from preoperative 10.5° to postoperative 19.1° on average.Conclusion In treatment of severe trauma on lower leg,latissimus dorsus flaps can be used to repair skin wound,control infection and reconstruct ankle function simultaneously,with advantages of reduced operative procedures,a high rate of limb preservation,and better function recovery.

Objective To explore the effect of ilioinguinal flap on reconstruction of perineal obliteration deformity after extensive deep burn.Methods Five patients with perineal obliteration deformity after extensive deep burn were hospitalized from January 2010 to June 2015,with total burn area ranging from 35％ to 55％ total body surface area,depth of full-thickness burn and wound deep to bone,and course of scar from 6 months to 3 years.Scars of patients were involved in bilateral groins,inner thighs,monsveneris,sacrococcygeal region,and central area of perineum.The abduction angles of double lower limbs ranged from 30 to 65°.Anus was narrow,and defecation was difficult.After release of scar tissue in perineal region,the wound area ranged from 23 cm × 12 cm to 28 cm× 24 cm.For wound repair and reconstruction of anus,unilateral ilioinguinal flap was used in 3 cases.Due to large wound in two patients,bilateral ilioinguinal flap was used in one patient,and unilateral ilioinguinal flap combined with anterolateral femoral flap was used in another one patient.The area of unilateral ilioinguinal flap ranged from 23 cm× 12 cm to 30 cm× 20 cm,and the area of anterolateral femoral flap was 21 cm× 12 cm.The abdominal donor site was closed with partial suture and partial skin grafting (harvested from split-thickness skin of autologous head or thin intermediate-thickness skin of autologous back).The femoral donor site was directly sutured.After the operation,the double lower limbs were fixed with plaster on abducent position and strictly immobilized.Results All the flaps survived after operation and the wounds healed well.During the follow-up for 6 to 12 months,the appearance of flaps were good with soft texture and no contracture.Hip joint motion was good,and abduction angles of double lower limbs ranged from 110 to 135°.The appearance of crissum was good without skin inflammation and with normal function of defecation.The appearance of donor site was acceptable to patients or their parents.Conclusions Ilioinguinal flap is a good choice for reconstruction of perineal obliteration deformity after burn.