Impacted femoral neck fractures should be treated operatively as displaced fracture. Many authors suggested emergency operation. The principle of treatment of femoral neck fractures is anatomic reduction, fragmental compression,and rigid fixation. Closed reduction must be done in most cases. When close anatomic reduction can not be achieved, open reduction should be considered.Implants used recently consist of pins , screws,hook pins and gliding screws with side plate. Every implant has its own advantages, disadvantages and indications. The principle of treatment of femoral neck fractures in young patients is emergency operation (within 12h after trauma), anatomic reduction (open reduction when necessary), and rigid fixation with screws. Some authors stated the necessity of anterior capsularoctomy.

Osteoporosis is considered as the most important factor which causes the fracture of the femoral neck. Comminution of fracture and rigidity of fixation are greatly affected by the degree of osteoporosis. Femoral neck fractures in young patients are mainly caused by severe trauma. Although Garden classification is widely accepted in classifying femoral neck fractures, in the recent decades some doctors have found out some shortcomings in Garden classification in practical application. It has been suggested to classify the femoral neck fractures simply into displaced and undisplaced ones. Arthroplasty used to be thought as the choice of treatment of femoral neck fractures in the elderly. Application of arthroplasty must accord with the indications, not only with the age of the patient or the degree of the displacement of the fracture. There is no X ray diagnosis specially for the avascular necrosis of femoral head secondary to femoral neck fracture, other than Ficat Arlet grade system. MRI is considered to be the only method to diagnose the avascular necrosis of femoral head at an early stage and to defect its extent and location.

Employment ; Humans ; Japan ; Surveys and Questionnaires

Background Suprachoroidal hemorrhage (SCH)is a rare but devastating complication of ophthalmic surgery,and it is crucial to be aware of the risk factors and select effective treatment. Objective Present study was to assess the treatment and risk factors of SCH induced by intraocular surgery. Methods Retrospective case series were carried out to investigate the clinical data of 15 eyes from 15 patients with SCH at Peking Union Medical College Hospital.The risk factors of SCH were analyzed.Written informed consent was obtained before any medical examination and treatment.SCH was occurred in 10 eyes during intraocular surgery,while the SCH was diagnosed in other 5 eyes 1-3 days after operation.Surgical drainage was carried out in 8 eyes,of which 3 eyes combined with vitrectomy besides surgical drainage and other 5 eyes were treated with medication alone.Results SCH was completely removed and absorbed in 12 eyes.The visual acuity was improved in 6 eyes,unchanged in 6 eyes and decreased in 3 eyes.Nine eyes complicated with retinal detachment and reattached in 6 eyes after treatment.Seven eyes combined with hypermyopia,6 eyes combined with glaucoma,and 1 eye was aphakia.Four patients combined with hypertension,and 2 patients had diabetes mellitus. Conclusions SCH induced by intraocular surgery develops rapidly and violently,and it can result in vision loss without effective treatment.Suturing surgical incision immediately,applying hypertonic agents and sclerotomy drainage are the urgent approaches to treat SCH.Medicines and/or sclerotomy could be optional according to the amount of bleeding and other ocular complication.The risk factors of SCH include myopia,glaucoma and the instantly dropping of intraocular pressure.

RhoA, a small GTPase, is involved in a wide array of cellular functions in the central nervous system, such as cell motility, cytoskeleton rearrangement, transcriptional regulation, phagocytosis and cell growth. It is not known how spinal cord injury (SCI) affects the expression of RhoA in different nerve cells. In the present study, we investigated the changes of RhoA expression in remote areas of the injury at the 3rd, 7th and 30th day after SCI, which was established by T10 contusion method. Moreover, we examine its expression profile in neurons, astrocytes and microglia. RhoA was found to be weakly expressed in these nerve cells in normal spinal cord. Western blotting showed that, after SCI, the total RhoA expression was up-regulated, and the RhoA expression was increased and peaked at the 7th day. Double immunostaining revealed specific and temporal expression patterns of RhoA in different nerve cells. The expression of RhoA in neurons started to increase at day 3, peaked at day 7 and then decreased slightly at day 30. Expression of RhoA in astrocytes increased moderately after SCI and peaked at day 7. There was no obvious change in RhoA expression in microglia after SCI in remote areas. This study demonstrated that, after SCI, RhoA expression exhibited different patterns with different nerve cells of spinal cord. RhoA expression patterns also changed with time after SCI, and among different nerve cells in the injured spinal cord. These findings can help us better understand the roles of RhoA in SCI.

Objective To develop a quantitative assessment of the severity of femoral neck fractures with CT scan.Methods The preoperative X-ray and CT data were reviewed of 229 patients with femoral neck fracture who had been treated in our department from December 2008 to April 2012.Posterior fracture fragment,posterior angulation,longitudinal maximum displacement,location of fracture line,and difference in neck-shaft angle were measured in the 3-D reconstruction images of CT scans.The severity of the fracture was categorized as slight,(score ≤5,grade Ⅰ),moderate (score 6 to 8,grade Ⅱ) and severe (score ≥9,grade Ⅲ) according to the measurements of the above 5 indexes.A comminuted fracture was categorized into grade Ⅲ.Results Posterior comminutions were found in 35 cases (15.3％),but not in the other 194 ones (84.7 ％).No posterior angulation was observed in 27 cases (11.8％).Posterior angulation ≤30° was found in 44 cases (19.2％),that from 30° to 60° in 115 cases (50.2％),and that ≥60° in 43 cases (18.8％).Twenty patients(8.7％) had no displacement.Fracture displacement ≤ 10 mm was observed in 96 cases (41.9％),that from 10 to 20 mm in 96 cases (41.9％),and that ≥20mmin 17 cases (7.4％).The facture line was located below the head in 131 cases (57.2％),at the head-neck in 88 cases (38.4％),and across the neck in 9 cases (3.9％).The difference in neck-shaft angle was 0° in 12 cases (5.2％),≤ 10° in 105 cases (43.4％),10° to 20° in 84 cases (35.3％) and ≥20° in 28 cases (17.6％).In the 229 cases,our severity scores were related to Garden classification in the following manners:all Garden Ⅰ cases belonged to grade Ⅰ; Garden Ⅱcases contained grade Ⅰ in 15 cases (45.5％) and grade Ⅱ in 18 cases (54.5％);Garden Ⅲ cases included grade Ⅰ in 6 cases (3.1％),grade Ⅱ in 123 cases (64.7％) and Grade Ⅲ in 61 cases (32.2％); all Garden Ⅳ cases were Grade Ⅲ.Conclusion In assessment of the severity of femoral neck fractures,CT scans can be more accurate,objective and reliable,and can be quantified as well.

Objective To investigate the sensitivity of the real-time fluorescence PCR technique and the bacterial culture for detecting the colonization of group B Streptococcus(GBS)in late pregnant women.Methods 2 specimens were collected from preg-nant women genital tract-rectal secretions swabs,one specimen for conducting the bacterial culture and another for conducting the real-time PCR technique to detect genital GBS.The accuracy and rapidness were compared between the two methods.308 cases of pregnant women were divided into the GBS positive group and the GBS negative group according to the detection results of the real time real-time fluorescence PCR technique.The relation between the occurrence of premature rupture of membranes with GBS was investigated by the comparative analysis.Results Among 308 pregnant women with GBS detection,18 cases were positive by the ordinary bacterial culture with the positive rate of 5.8%(18/308),while 28 cases were positive by the real-time fluorescent PCR with the positive rate of 9.4%(29/308).In the GBS positive group detected by PCR,the premature rupture of membranes occurred in 9 cases with the positive rate of 31%,while in the GBS negative group detected by PCR,which occurred in 33 cases with the pos-itive rate of 11.83%.Conclusion This survey shows that the positive detection rate of the real-time fluorescent PCR technique is significantly higher than that of the bacterial culture method,the application of this detection technique for detecting GBS provides the basis for rapidly diagnosing GBS and conducting the prophylactic use of antibacterial drugs more accurately and more effectively.

Objective To explore the molecular mechanism of inhibition of LPS-induced inflammation by fenoterol, a β2 adrenoceptor agonist in monocyte. Methods Concentrations of interleukin 1β (IL-1β), tumor necrosis factor α (TNF-α) and MCP-1 from cell supernatants from THP-1 cells and wild type or MyD88- / - mice peritoneal macrophages stimulated by LPS in the presence or absence of fenoterol were determined by use of an ELISA system. Expression of MyD88 (myeloid differentiation factor 88) stimulated by LPS in the presence or absence of fenoterol were determined by Western blot. Results Fenoterol inhibited LPS-induced activation of MyD88 and secretion of inflammatory cytokines (TNF-α, MCP-1, and IL-1β). The reaction of MyD88- / - mice peritoneal macrophages to LPS was much lower than that of the wild type mice peritoneal macrophages. Conclusions MyD88 plays an important role in inflammation induced by LPS. The inhibition of LPS-induced expression of MyD88 by fenoterol is associated with its anti-inflammatory effect.

Objective To investigate incidence and onset of deep vein thrombosis (DVT) in elderly patients with hip fracture, and to evaluate the laboratory tests of plasma levels of D-Dimer, fibrinogen(FIB)and platelet(PLT) in diagnosing DVT. Methods From January, 2005 to December, 2006, 112 patients, 47 men and 65 women, aged 65 and over, were recruited into this study. Their mean age was 75.5 (range, 65 to 90) years. D-Dimer, FIB and PLT, as high specific fibrin degradation products, were detected via laboratory testing. The incidence, onset and distribution of DVT in these cases were observed. Univariate analysis was used to determine the associations between laboratory values and DVT. Influences of sex and type of hip fracture on the concentration of D-Dimer were studied as well. Results DVT was detected in 18 patients by means of B-mode ultrasonography and venography. The incidence rate of DVT in the elderly was 16. 1%. The onset of DVT took place between the second day and sixth day of hospitalization (average, 5.4 days), apparently earlier than the time of surgery (11. 6 days). Serum D-Dimer level was found significantly higher in the DVT group (P ＜ 0. 05) whereas levels of plasma FIB and PLT showed no significant influence on DVT(P ＞ 0. 05) . The D-Dirmer level was strongly influenced by type of fracture but not by sex.Conclusions Elderly patients with hip fracture have a high incidence of DVT. Since the onset of DVT usually happens before surgery, emergent operation is strongly indicated. A normal level of serum D-Dimer may be clinically significant in excluding the onset of DWT, but a simple rise in plasma D-Dimer level may not indicate DWT. The plasma levels of FIB and PLT may have no clinical significance in diagnosing DVT.D-Dimer level is not associated with sex of patients but with type of fracture.

Apoptosis ; Apoptosis Regulatory Proteins ; genetics ; Genetic Vectors ; Humans ; K562 Cells ; Transfection