Chronic osteomyelitis is a serious clinical problem with repeated courses and high disability rate, which seriously affects the physical and mental health of patients. Through continuous learning and summary in the process of using traditional therapies, the innovative improvements and changes had made in the treatment of osteomyelitis: Radical debridement of lesions was performed by applying the basic principles of modern bone tumor surgery. The application of microsurgical technique to transfer composite tissue flap can provide guarantee for tissue defect repair and wound closure without tension. Combined with bone grafting, local antibiotics and bone fixation, an one-stage operation has significantly improve the therapeutic effect of chronic complex osteomyelitis.

Objective:To study the efficacy of different systemic chemotherapy regimens as first-line and second-line therapy and to determine the prognostic factors for patients with advanced biliary tract cancer.Methods:The clinical data of patients with advanced biliary tract cancer who underwent systemic chemotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from January 2011 to December 2018 were studied. The efficacy of chemotherapy on objective response rate (ORR) and disease control rate (DCR) were evaluated. Potential prognostic factors for survival were studied using the Cox proportional hazards models.Results:Of 151 patients enrolled into this study, there were 75 males and 76 females, with ages ranging from 31 to 77 years (median 58 years). Two treatment protocols were used: (1) 104 patients received a gemcitabine-based regimen (combined with platinums or fluorouracils) or a combination of platinums and fluorouracils, while (2) 47 patients received a combination of albumin-bound paclitaxel and S-1. The corresponding ORR for each group were 15.4%(16/104) and 27.6%(13/47), respectively, and the DCR were 65.4%(68/104) and 72.3%(34/47), respectively. Of 58 evaluable patients who received chemotherapy as a second-line therapy, 31 patients received the regimen containing gemcitabine, platinums or fluorouracils with an ORR of 3.2% (1/31) and a DCR of 35.5%(11/31); a total of 18 patients received the taxanes-based regimen with an ORR of 11.1%(2/18) and a DCR of 38.9%(7/18); 9 patients received the irinotecan-based regimen with an ORR of 22.2%(2/9) and a DCR of 44.4%(4/9). Univariate analysis showed positive liver metastasis and elevated carbohydrate antigen (CA)19-9 level to be significantly correlated with worse survival outcomes ( HR=1.540, 95% CI: 1.019-2.328, P=0.040 and HR=1.892, 95% CI: 1.123-3.188, P=0.017). Conclusion:For patients with advanced biliary tract cancer, in addition to the conventional regimens containing gemcitabine, platinums and fluorouracils, the combination of albumin-bound paclitaxel and S-1 was shown to be an effective chemotherapeutic regimen for these patients. Second-line chemotherapy was insufficient and ineffective, and an irinotecan-based regimen deserves to be further investigated. Liver metastasis and elevated CA19-9 level were worse prognosis after chemotherapy for patients with advanced biliary tract cancer.

Objective:To investigate the clinical efficiency of gastrocnemius muscle flap combined with antibiotics loaded calcium sulfate in the treatment of postoperative infection and plate exposure of tibial plateau fracture in elderly patients.Methods:From January, 2015 to May, 2019, 21 elderly patients with postoperative infection and plate exposure of tibial plateau fracture were treated, including 14 males and 7 females with an average age of 72.6 years, ranging from 61 to 82 years. The average course of disease was 22.7 days, ranging from 6 to 91 days. The site of wound infection was at medial in 8 cases, lateral in 9 cases and bilateral in 4 cases. The size of wound ranged from 2.0 cm×3.5 cm to 5.0 cm×12.0 cm. All wounds were implanted with antibiotics loaded calcium sulfate and repaired by gastrocnemius muscle flap combined with skin graft after debridement. Muscle flap survival, wound healing, inflammatory index, fracture healing and knee joint function were recorded. The curative effect was evaluated by McKee infection treatment criteria and the knee joint function was evaluated by HSS scoring criteria.Results:All 21 muscle flaps survived. In 1 case, skin graft necrosis occurred in a small area, and the wound healed well after dressing change. One case had exudation which was clear and the bacterial culturing was negative, and the wound healed after 2 weeks of dressing change. The other incisions were healed in stage I, and the healing rate was 90%. All patients were followed-up for an average of 28.7(16-39) months. The redness and swelling occurred in 1 case without exudation after 2 months which disappeared after anti-infection treatment and didn't recur again. The infection recurred in 1 case after 5 months, and it which was controlled after debridement and plate removal. According to McKee criteria, 19 cases were cured, 1 improved and 1 recurred with an effective rate of 95.2%. The fracture healing time was from 3 to 7 months, with an average of 4.6 months. According to HSS scoring criteria, the knee joint function was excellent in 12 cases, good in 7 cases and moderate in 2 cases.Conclusion:After thorough debridement, gastrocnemius muscle flap combined with antibiotic loaded calcium sulfate can effectively control the infection, repair the wound, promote fracture union and restore limb function in the treatment of postoperative infection and plate exposure of tibial plateau fracture in elderly patients.

Preeclampsia is a multiple system disease in obstetrics, which often leads to adverse pregnancy outcome.Twin pregnancy is a high-risk pregnancy.When preeclampsia occurs, the condition is very serious, and the complications of mother and child are increasing.The pathogenesis of preeclampsia is diversified.The high risk factors of twin pregnancy with preeclampsia are bichorionic, assisted reproductive technology pregnancy, primipara, and advanced age.The timing of termination of pregnancy should be selected according to chorionic nature, and the indications of cesarean section should be relaxed to reduce the adverse pregnancy outcomes.Clinical studies mostly use comprehensive indicators combined with screening to predict preeclampsia.How to prevent preeclampsia still needs further clinical and basic research.

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.

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 analysis causes of the serious complications after the operation of the lower leg perforator pedicle screw flap, and to explore the corresponding countermeasures. Methods From June, 2012 to Au-gust, 2016, 60 cases of soft tissue defect of ankle and foot were repaired with propeller flaps pedicled with perforator of lower legs. with the area were soft tissue defect ranged from 3.0 cm ×2.0 cm to 19.0 cm ×9.0 cm, and all with bone exposure. Two cases of traumatic tissue defect, 7 cases were chronic osteomyelitis of the distal tibia, 13 cases were in-cision infection and necrosis after the operation of ankle joint fracture and Pilon fracture, 10 cases were simple inci-sion necrosis after calcaneal fracture, 18 cases were calcaneal osteomyelitis, 1 case were soft tissue defect after the ankle tumor operation, 6 cases were soft tissue necrosis after the Achilles tendon rupture, and 3 cases were soft tissue defect of the dorsum with infection. The posterior tibial artery perforator pedicled propeller flap was used in 18 cases. The pedicle of the vascular pedicle was 6.0-18.0 cm from the medial malleolus, the flap rotation was 135 °-180° . There were 42 cases of the perforator pedicle propeller flap of the peroneal artery, 5.0-18.0 cm from the pedicle of the vascular pedicle and 120°-180° rotation in the flap. The area of the flap was 9.0 cm ×3.0 cm-34.0 cm ×18.0 cm. There were 32 cases of direct suture in the donor site and 28 cases of free skin grafting. Results The color, swelling, elasticity, capillary reaction and healing of donor site were observed after operation. There was no flap ischemia occurred in 60 patients. Fourteen cases had venous reflux obstruction, all of which had swelling above II degree, 8 cases had swelling above III degree with obvious purple blood stasis, resulting in partial flap necrosis in 4 cases, all necrosis in 1 case, including 4 cases of free skin grafting, 1 case of flap transplantation and repair. There were 3 cases of necrosis after skin grafting in the flap area, all of which were partial necrosis. There was case of necrosis of the wound surface after di-rect suture of the donor site and 1 case of skin disintegration after disassembly, and all wounds healed after the replace-ment of the wound and the external use of the dried blood powder. All the 60 patients were followed-up for 12 to 30 (mean, 24.5)months. The flaps survived and the donor site scars healed well. The range of motion of the ankle was from-10°to 10°(mean, 5.6 °) and the flexion of the plantar was from 20 °to 50 °(mean, 37.8 °). Fourteen patients with venous reflux disorder were followed up for 15 to 28(mean, 22.3)months. The flap and skin graft survived well. Ankle dorsiflexion ranged from-10° to 10 °(mean, 2.4 °) and plantar flexion from 20° to 45 °(mean, 35.6 °). There was no obvious limp in walking. Conclusion Although the overall effect of the lower leg perforator pedicle propeller flap to repair the soft tissue defect of the foot and ankle is satisfactory, there are still various serious complications, which are mainly due to ia-trogenic. Doctors should strictly follow the basic principles of skin flap surgery from preoperative to postoperative, and during operation and postoperative management, so as to reduce the incidence of complications.

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.

Objective? To investigate the present situation of nurse's metabolic syndrome, and explore the correlation between diet, behavior and occupational stress and nurse's metabolic syndrome. Methods? In April to May 2015, using stratified cluster random sampling method, a total of 393 nurses in Fuzhou were investigated by physical examination, blood tests, Nurse Stressor Scale (NSS) and a general information questionnaire for metabolic syndrome and its influencing factors. Totally 393 questionnaires were distributed and 380 valid questionnaires were collected. Results? There were 54 cases of metabolic syndrome among 380 nurses, accounting for 14.21%. Logistic regression analysis showed that age, working age, occupational stress, sleep time, the amount of meat in diet, cooking oil were the risk factors of metabolic syndrome (P＜0.05). The physical exercise and the quantity of vegetables in diet were the protective factors of metabolic syndrome (P＜0.05). Conclusions? Unreasonable diet, inadequate exercise and occupational stress are the factors that affect the metabolic syndrome in nurses, which are related to their professional characteristics.

Objective To prepare biomimetic bone material by reconstructing type Ⅰ collagen combined with polyaspartic acid. Methods By acid hydrolysis,rat tail type Ⅰ collagen was decomposed into collagen fibers,which were then placed in the calcium phosphate mineralization solution. Under the cross-linking of glutaraldehyde,the collagen fibers were reconstructed and assembled into collagen fibers,and the calcium phosphate crystals were wrapped in the inner side of the collagen fibers for biomineralizationin. After poly aspartate acid was added,calcium hydroxyapatite calcium precursor was added into the collagen fibers to simulate thebiomimetic biomineralizationin the human body. After mineralization for 3-9 days,the bone mineralization process was observed by transmission electron microscopy and electron diffraction. Results Transmission electron microscopy and electron diffraction displayed that,after 3 days of mineralization,calcium hydroxyapatite precursor was wrapped in the collagen fiber gap,and the collagen fiber was partially mineralized. After 9 days of mineralization,calcium hydroxyapatite precursor completely infiltrated into the collagen fiber,and the amorphous calcium phosphate was transformed into hydroxyapatite calcium crystal. Thus,the simulation of bone mineralization was completed,and collagen type Ⅰ collagen/hydroxyapatite calcium biomimetic bone material was formed. Conclusion Reconstruction of type Ⅰ collagen combined with polyaspartic acid can prepare biomimetic bone material that has close chemical composition and molecular structure to the human bone tissue.