There has still been controversy on selection of approapreate treatments for elderly patients with acetabular fracture who are rapidly increasing in number. Although the treatment principle for them is anatomical reduction, effective fixation and early mobilization, choice of a proper treatment has turned to be a new hot spot for clinical research because the physical status, bone quality and fracture type of the elderly population are special. With unceasing achievements in medicine, surgical techniques and implants, the management ideas and strategies for elderly acetabular fractures have become gradually mature and diversified. The current major protocols include conserverative treatment, open reduction and internal fixation and total hip arthroplasty. In order to enhance the surgeons'knowledge of elderly acetabular fractures and summarize the cilinical experiences in management of them, we present this review to illustrate the current achievements and new development trends.

Objective:To investigate the management of pelvic injury associated with complete anterior sacroiliac joint dislocation.Methods:In the study, 6 cases of pelvic injury associated with complete an-terior sacroiliac joint dislocation treated in Beijing Jishuitan Hospital from February 2008 to June 2014 were analyzed.We described the history and severity of injury, emergency treatment, and fracture radio-logy.In all the cases, the surgical treatment and postoperative functional exercise were performed.We followed up all the cases on an average of 1.6 years, assessed the postoperative recovery and summed up the treatment experience.Results:All the 6 patients with fractures recovered without infection and nerve symptoms after surgery.Their X-rays showed good reduction of sacroiliac joints.All the cases were followed up on an average of 1.6 years.Six months after surgery, the Majeed scores were perfect in 2 cases, good in 2, fair in 1, and poor in 1.The patients with poor scores suffered persistent pain, and decreased physical activity, and when walking long distances, they needed a walking stick.The 2 patients with low scores could not resume the original work.Conclusion:Pelvic injury associated with complete anterior sacroiliac joint dislocation is a special type of the pelvic injury since the managements during the emergency phase are difficult.The surgery should be done as early as possible, and the anterior approach is available for the reduction and fixation.

Objective To evaluate the clinical effect of early total care (ETC) for treatment of unstable pelvic fractures.Methods This retrospective case series study included eighteen patients with unstable pelvic fractures treated surgically from May 2013 to May 2015.There were 11 male and 7 female patients,aged (45.1 ± 13.1)years.Eleven patients were injured due to road traffic accidents and 7 due to fall from height.Tile B type pelvic fractures were seen in 8 patients and Tile C type in 10 patients.All patients were treated with ETC method and received open reduction and internal fixation within 24 to 48 hours after the primary treatment.Data were collected,such as operation time,intraoperative blood loss,hospital length of stay and perioperative complications.Majeed score and EuroQol 5 dimension (EQ-5D) were used for evaluation of clinical outcome and quality of life respectively.Excellent and good rate of operation was assessed using the Matta clinical evaluation standard.Results Three patients died and fifteen patients survived.Operation time was (120.1 ± 22.2)minutes,amount of intraoperative blood loss was (355.9 ± 56.4) ml,and hospitalization was (8.5 ± 1.6) days.Incidence of perioperative complications was 56％,including 3 patients with acute respiratory distress syndrome,1 pneumonia,2 acute lung injury,1 incisional wound infection,2 multiple organ failure and 1 diffuse intravascular coagulation.All patients were followed up for (15.1 ±2.4)months (range,12-21 months).Majeed score was decreased from preoperative (93.7 ± 6.1) points to final follow-up of (74.1 ± 9.2) points,and the EQ-5D index was decreased from preoperative 0.96 ± 0.04 to final follow-up of 0.74 ± 0.19 (both P ＜ 0.05).Excellent and good rate of operation was 80％.Conclusions ECT provides satisfactory short-term outcome for treatment of unstable pelvic fractures,but the incidence of complications is high.Doctors should choose reasonable treatment plan according to the surgical indications.

Objective To report a group of uncommon cases, and discuss t he impact of distal tibiofibular synostosis on the patients and its clinical sig nificance. Methods At a mean follow-up of 22.8 months(11 to 54 months), 14 pati ents with distal tibiofibular synostosis after ankle fracture were evaluated wit h Philips and Schwartz clinical scoring system of ankle. Results 3 patients comp lained of transient pain after strenuous activities. The others complained of no discomfort. All of them had no trouble in normal working and daily activities. The mean degree of plantar flexion was 47.9?, with 3.5?(0 to 10?)less than the normal side. The mean degree of dorsiflexion was 20?, with 8.6?(0 to 20? )less than the normal side. There were no degenerative changes in all ankles. T he mean Philips and Schwartz score was 90.8(82 to 98). The excellent rate was 71 .4%, and the excellent and good rates were 100%. Conclusion Distal tibiofibul ar synostosis after an ankle fracture usually gives rise to few symptoms and nee ds no specific treatment.

Objective:To study the risk factors for contralateral hip fracture within 2 years after primary hip fracture surgery in elderly patients.Methods:A retrospective study was conducted of the 1,962 elderly patients who had been surgically treated for hip fractures at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from May 2015 to April 2018. They were 573 males and 1,389 females; the median age of primary hip fracture was 81 (75, 86) years. They were divided into 2 groups according to whether a contralateral hip fracture occurred or not within 2 years after primary hip surgery: 134 patients in the contralateral fracture group and 1,828 ones in the contralateral fracture-free group. The duration from primary hip fracture to secondary contralateral fracture was recorded. The χ2 test and Mann-Whitney U test were used to compare between the 2 groups their gender, age, walking ability, laboratory indexes upon admission, concomitant internal diseases, Charlson comorbidity index (CCI), duration from admission to surgery, duration from admission to discharge and complications during follow-up. The risk factors for contralateral hip fracture within 2 years after primary hip surgery were determined by the Cox's proportional hazard regression model. Results:In the elderly patients with hip fracture, the 2-year cumulative incidence of secondary contralateral hip fracture was 6.83%(134/1,962) and the median duration from primary surgery to secondary contralateral hip fracture was 365 (189, 611) d. The risk factors for contralateral hip fracture were female ( RR=2.081, 95% CI: 1.351 to 3.207, P=0.001), concomitant peripheral vascular disease ( RR=5.876, 95% CI: 2.922 to 11.818, P< 0.001), concomitant chronic obstructive pulmonary disease ( RR=3.750, 95% CI: 1.897 to 7.413, P< 0.001), progressively higher CCI ( RR=1.363, 95% CI: 1.223 to 1.519, P<0.001), complicated pneumonia ( RR=3.606, 95% CI: 2.054 to 6.332, P<0.001), complicated urinary infection ( RR=7.670, 95% CI: 4.441 to 13.248, P<0.001), and complicated deep venous thrombosis (DVT) ( RR=7.389, 95% CI: 3.992 to 13.677, P<0.001). Conclusions:The risk factors for contralateral hip fracture within 2 years after primary hip fracture surgery in elderly patients may be female, concomitant peripheral vascular disease and chronic obstructive pulmonary disease, progressively higher CCI, and complicated pneumonia, urinary infection and DVT.

Although internal fixation is still a standard treatment for geriatric Garden Ⅰ/Ⅱ femoral neck fractures, it is reported to lead to a high rate of reoperation. Therefore, identification of risk factors for internal fixation failure can help a sensible decision-making in initial treatment. In recent years, many studies have suggested that posterior tilt of the femoral head before surgery may affect the rates of internal fixation failure and reoperation. Some studies have even recommended hip arthroplasty for geriatric Garden Ⅰ/Ⅱ femoral neck fractures. However, different studies adopted different measurement methods and thus obtained inconsistent results. By literature review, this article expounds on various measurement methods for femoral head tilt and correlation between posterior tilt of femoral head and prognosis after internal fixation, and compares therapeutic efficacy between internal fixation and hip arthroplasty, hoping to provide useful information and data for clinical treatment of geriatric Garden Ⅰ/Ⅱ femoral neck fractures.

ObjectiveTo summarize the experience of managing portal hypertension( PHT) complicated with hyperthyroidism. Methods5 patients with hyperthyroidism complicated PHT were performed with splenectomy plus pericardial devascularization after preoperative management, and the experience of pre- and postoperative management was summarized. Results1 patient occurred postoperative thyroid crisis and was cured with tranquilizing, prenisone and sodium iodide;the other 4 went through perioperation safely. The preoperative WBC,RBC,Hb and Pt were(2.018±0.536)×109/L,(2.97±0.42)×1012/L,(87±15.6)g/L and (38.4±13.24)×109/L, respectively, which rose to (6.54±0.398)×109/L, (3.636±0.387)×1012/L, (108.6±9.633)g/L and (240.4±84.54)×109 /L, respectively after operation. WBC and platelets of all patients reached normal level postoperatively. ConclusionProper perioperative management ensures that patients with hyperthyroidism complicated PHT survive the splenectomy plus pericardial devascularization, which renders opportunity for treating hyperthyroidism with medicine or surgery.

Objective:Glutamine is the main oxidative fuel of the enterocyte which enters the enterocyte primarily via amino acid transporters.The aim of the test was to study the distributions and functions of glutamine transporters in IEC-6 cell line.Methods:The rat intestinal epithelial cell line(IEC-6) was incubated in vitro.The mRNA expression of different glutamine transporters,protein expression of system ASCT2,and the [3H]-L-glutamine uptake were measured.Results:The mRNA of system ASCT2,SN1,ATA1,LAT1,LAT2 was expressed and the protein expression of ASCT2 was also validated in IEC-6.In Na+-containing buffer,the velocity of Na+-dependent glutamine uptake was(164.07?37.94) fmol/(mg protein?10min).In Na+-free buffer,the velocity of glutamine uptake was(58.71?10.51)fmol/(mg protein?10min).With the saturate dosage of MeAIB,the velocity of glutamine uptake was(81.02 ?19.59) fmol/(mg protein?10min).Conclusion:There may be five kinds of glutamine transporters(ASCT2,SN1,ATA1,LAT1,and LAT2) in IEC-6 cell.The Na+-dependent transporter was the major contributor(64.22%) to glutamine total uptake in IEC-6.The contributions of system A and the remainder were 50.62% and 13.60%,respectively.The Na+-independent transporter was the lesser contributor(35.78%).

Objective Combination of nanoparticle with p53 and Rb gene therapy by gene targeting was applied to investigate its curative effect and safety evaluation on colorectal rabbit hepatic VX2 metastasis for tumor eradication and survival enhancement. Methods Recombinant expressing plasmids harboring wild type p53 and Rb were cotransferred or transferred separately to the rabbit hepatic VX2 metastasis by the emulsion of PLL-nHAP nanoplex and lipodiol through the hepatic artery in a tumor target manner. Subsequent co-expressions of p53 and Rb protein within the treated tumors were detected by Western blot and in situ analysis of confocal laser scanning microscope. The therapeutic effect was evaluated by the tumor growth velocity and the survival time of animals. Eventually, investigations of liver function were applied to evaluate the safety of the process. Results With safe procedure for the rabbits liver function, both p53 and Rb local nano-therapy showed favorable anti-tumor effects and increased animal survival time. p53+Rb local nano-therapy could significantly inhibit hepatic VX2 metastasis and enhance the animal survival time compared with p53 local nano-therapy or Rb local nano-therapy. Local nano-therapy showed no significant influence to animal liver function. Conclusions Rb can work synergistically with p53 in the combined therapy mediated by PLL-nHAP nanoplex to augment the anti-tumor effect. The local nano-therapy with p53 and Rb is likely to be an effective and safe anti-tumor therapy for hepatic colorectal metastasis.

Objective: This study was designed to investigate the variations of endotoxin,glutamine and TNF-? concentration in septic rats. Methods: A total of 90 adult male SD rats were divided as follows: control group(normal),experimental group(CLP).They were killed on hour 6,12,24,48,72 after surgery.Plasma,liver,small intestine and skeletal muscle were collected to measure the concentrations of glutamine in plasma and tissues,the levels of endotoxin and TNF-? in plasma. Results: In septic rats,plasma concentrations of endotoxin and TNF-? increased on hour 6,significantly increased on hour 12,attained the peak on hour 24,and decreased evidently on hour 48 and 72.Glutamine concentration in plasma elevated on hour 6 and 12,elevated significantly on hour 24 and 48,and decreased on hour 72.Glutamine concentration in liver increased on hour 6～12,increased significantly on hour 24,and decreased significantly on hour 48 and 72.Glutamine concentration in small intestine and skeletal muscle decreased on hour 6 and 12,and decreased significantly after 24 hour. Conclusion: During the early stage of sepsis,the plasma levels of endotoxin and TNF-? are increased significantly,the glutamine concentration in plasma and liver is also increased significantly,however,it was decreased evidently in skeletal muscle and small intestine.