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.

Hypertensive renal damage is based on the extent and duration of hypertension, renal damage caused by varying severity. Hypertensive renal damage due to various causes imbalance of vascular active substances, renal arteriosclerosis, so that the abnormal renal hemodynamic, renal ischemia, low specific gravity of urine, low osmotic pressure and urine. The rapidly increasing incidence of hypertensive renal damage has become one of the most important reasons of end stage renal disease (ESRD). Effective treatment of hypertension is limited by poor compliance and significant adverse reaction of antihypertensive drugs. Therefore, some patients have turned to Chinese medicine (CM), hoping that such treatments might improve the efficiency. The author reviews relevant theory and the latest researches, on the basis of combining diseases and syndrome, discusses state and achievement of hypertensive renal damage with Chinese herbal medicines from fundamental and clinical research and action mechanism from standpoints of Chinese herbal compound and herbal effective chemical composition to take future research for important reference.
Antihypertensive Agents ; therapeutic use ; Disease Progression ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Hypertension, Renal ; diagnosis ; drug therapy ; Kidney ; drug effects ; Medicine, Chinese Traditional ; methods

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.

Objective To evaluate the outcome of the old patients who were treated for femoral neck fractures in our hospital during 2000-2007. Methods A retrospective study was conducted to evaluate outcomes of the 139 old patients who had received internal fixation for femoral neck fractures in our department during 2000-2007. The mechanism of injury, duration between injury and hospitalization, severity of fracture, anamnesis, time of hospital stay, anaesthesia, operation, postoperative complications, fracture healing, in-cidence of avascular necrosis of femoral head, failure of fixation, and functional restoration of the patients were documented. Results Fracture healing was found in 126 cases (90.6%). Time to healing ranged from 2 to 20 months (average, 6.2 months). Failure of fixation and nonunion were found in 13 cases (9.4%). Avascular necrosis of femoral head occurred in 9 cases (6.5% ). Of them, 81 patients(58.3%) restored their gait as normal as before whereas 50 patients(36.0%) walked with crutches. Conclusions Internal fix-ation can be suggested for old patients with femoral neck fracture, considering a high rate of fracture healing and a low rate of avascular necrosis of the femoral head. Early operation is recommended if the general con-dition of the patient has been well controlled.

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

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.