Intertrochanteric fractures occur mostly in the elderly population. Direction of fracture line, lesser trochanteric fracture, comminution and displacement are the chief concerns in radiological diagnosis of intertrochanteric fractures. Interchanteric fractures can be classified by Evansgrading, Jensens modification of Evansgrading, AO classification, and so on, which are to judge the stability of the fracture. Currently, the basic priciple of management is operation and fixation. The common implants of internal fixation consist of two basic kinds: gliding compression screws with lateral plate, such as dynamic hip screws (DHS), and intramedullary nail fixation, such as Gamma nails and proximal femoral nails. Exteranl fixators are only applied in cases of severe multiple trauma and elderly patients, and artificial joint replacements in those of serere comminuted fractures combined with high osteoporosis.

Objective To evaluate the independent effect of premorbid statins on incident ischemic stroke severity and outcome at discharge.Methods We included consecutive patients with ischemic stroke and recorded demographic data,vascular risk factors,Oxfordshire Classification,the method of treatment National Institutes of Health Stroke Scale(NIHSS)score,previous statins treatment,and outcome discharge.We analyzed the data using univariate methods and a logistic regression with the dependent variable of good outcome(Barthel Index,BI 95 to 100).Results A total of 185 individuals met study criteria:57 patients were on statins agents prior to admission and 128 were on no statins.Pretreatment with statins was associated with lower presenting median NIHSS(6.0 vs 13.0,P

BackgroundAllogenic immunological rejection is still the common cause of keratoplasty failure.Organ culture is a good choice for gradually attenuating corneal antigeniciy.However,the complicated regulatory mechanism of such allogenic rejection with organ culture gratts is unclear until now.ObjectiveTo investigate the changes of several Thl/Th2 cytokines and T lymphocyte subsets in the rat corneal allogenic transplantation rejection with organ culture grafts.MethodsThirty-six SPF Wistar rats served as donors,and 72 SPF SD rats served as recipients in this study.Seventy-two SD rats were divided into two groups randomly.Organ culture and fresh grafts from Wistar rats were performed on 36 recipients SD rats,respectively.Six normal SD rats were served as the normal control.After transplantation,graft survival time was observed ; Aqueous humor levels of IL-2,IFN-γ,IL-4 and TNF-α were measured by enzyme linked immunosorbent assay.Immunohistochemistry was performed to examine CD25 expressions in grafts.Levels of TNF-αmRNA,IFN-γmRNA,IL-4mRNA and CD25mRNA in grafts were detected by using reverse transcription polymerase chain reagction.The levels of CD28subsets in peripheralblood were determined by Flow Cytometry.The use of experimental animals followed the Statement of ARVO.Results The mean rat graft survival time was longer in the organ culture grafts group( 13.78 d) than that with fresh gratts( 10.56 d)(t=14.945,P =0.000 ).The aqueous humor levels of IL-2,IFN-γ,IL-4 and TNF-α were higher in two allograft groups at day 6,day 13 and day 24 after transplantation than that in the normal control,which peaked at day 13,and the fresh grafts group had the highest level( F=324.891,416.416,240.661,364.533,P=0.000).At day 13,CD25 was weakly expressed in frozen section of two operation groups.The expression of TNF-α and IFN-γmRNA in organ culture grafts group was markedly less than in fresh grafts group at day 13 after surgeries (t =2.464,P =0.039;t=5.438,P=0.001 ),whereas there was no significient difference in IL-4 and CD25 mRNA levels between them (t=-0.782,P =0.457,t =0.712,P =0.497).The percentages of CD28 of the fresh graft group increased significantly and more weakly expressed in organ culture grafts group (P =0.016 ). Conclusions Th1/Th2 cytokines and CD28 lymphocyte subsets may play important roles during corneal allograft rejection with organ culture grafts.

ObjectiveTo establish a comprehensive evaluation method on sensitivity of Yersinia pestis to different antibiotics, then use the method to evaluate the sensitivity of Yersinia pestis to 6 antibiotics. Methods Through literature review, related articles were consulted and sensitivity testing data to antibiotics were collected,and the sensitivity of Yersinia pestis to the 6 antibiotics was assessed with analytic hierarchy process. The sensitivity of Yersinia pestis to the 6 antibiotics(Cefotaxime penicillin, Ampicillin, Cefazolin, Ciprofloxacin, Ciprofloxacin Buddha's, and Streptomycin) was evaluated comprehensively with analytic hierarchy process from the antibacterial situation of the antibiotics to Yersinia pestis of 141 strains of virulent, attenuated EV76paris strains and isolates of the bacteria of Yunnan. Results The evaluation showed that the sensitivity of Yersinia pestis to antibiotics was different. The rank of the sensitivity of Yersinia pestis to the 6 antibiotics was: Ceftazidime, Ampicillin, Cefazolin,Ciprofloxacin, Norfloxacin and Streptomycin. Composite score index were 1.730 77, 1.631 77, 1.581 95, 1.567 80,1.449 48, and 0.999 99, respectively. Conclusions Analytic hierarchy process evaluation can be a reasonable,objective and more accurate evaluation on the sensitivity of Yersinia pestis to different antibiotics. This method could provide some references for screening feasible pharmaceuticals against plague.

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.

Radiotherapy has been proven to enhance tumor-specific immune response and provide targets for immune drugs. Immune checkpoint inhibitors represented by PD-1/PD-L1 combined with radiotherapy can enhance anti-tumor activity and exert abscopal effect. In this article, research progress on the basic study and clinical trials and challenges of radiotherapy combined with PD-1/PD-L1 inhibitors in the treatment of breast cancer were reviewed.

Objective:To provide the scientific reference basis in order to establish a perfect cost controlled system for medical consumable. To analyze game factors, such as main resource, the price-off influence and price-off aspiration and so on, from different views, such as medical institutions, patients, manufacturers and other stakeholders and so on, based on game theory and situation of medical consumables management.Methods: To collect the management information of medical consumables cost from a tertiary referral center hospital in Fujian in recent 3 years, and adopt descriptive study to analyze the income situation of medical consumable, medical consumable proportion and medical consumable cost per capita.Results: The medical consumable proportions from 2013-2015 were 14.44%, 16.27% and 18.75%, respectively. Medical consumable cost per patient from 2013-2015 were 3547.95RMB, 4122.3 RMB and 5059.02RMB, respectively. All of these datum contained the drug information.Conclusion: It is obvious that the medical consumable proportions and medical consumable cost per patient were enhancement from 2013 to 2015. The necessity of medical consumable leaded to the direct influence on medical cost. On the other hand, the artificially high price and unreasonable implement of medical consumable are the urgent problems and must be resolved as soon as possible.

BACKGROUND: Studies have shown that chitosan can improve the proliferation and migration of fibroblasts, promote the synthesis of extracellular matrix, and create a favorable environment for defect healing.OBJECTIVE: To observe the effect of highly simulated chitosan scaffolds in repairing abdominal wall defects in rats.METHODS: Sixty adult Sprague-Dawley rats were used to make animal models of abdominal wall defects, and then model rats were randomly divided into two groups: experimental group and control group followed by implantation with the highly simulated chitosan scaffold and polypropylene mesh, respectively. At 2, 4 weeks after repair, gross, adhesion and histopathological observations of the repair part were performed.RESULTS AND CONCLUSION: Gross observation: in the control group, omental adhesion was found at 2 weeks after repair; and at 4 weeks after repair, the mesh was thickened and exhibited clear boundaries with the surrounding tissue, but common color and integration. In the experimental group, there was mild adhesion between the scaffold and the defect site at 2 weeks after repair, and the mesh was thickened, but the wound healed well with no prominence, swelling, and infection at 4 weeks after repair. Kadata adhesion score in the experimental group was lower than that the control group at 4 weeks after repair (P < 0.05). Pathological observation showed that at 4 weeks after repair, there were a large number of infiltrated inflammatory cells, capillary growth, and a large number of fibroblasts at the defect site in the control group; and meanwhile, a small amount of infiltrated inflammatory cell infiltration and a large number of collagen fibers and capillaries, with better granulation tissue maturity,were found in the experimental group. To conclude, the highly simulated chitosan scaffold can promote the repair of abdominal wall defects and reduce inflammatory reactions.

Paternity testing has to be cautiously practiced,since it involves issues coming from all aspects including ethics,legislation,family and society.If the educational backgrounds of the litigants prevent them from fully understanding the ethical and legal issues involved in paternal testing,it would thus be impossible to achieve a real "informed consent" for the litigants.It is our point of view that in these cases,and when no alternative solutions are available,it is the responsibility of those who perform paternity testing to advise the litigants give up the application for paternity test.Besides,it is time for judicial departments to place on the agenda the establishing of a technique standard for paternity testing and relevant judicial procedures,in order to protect the basic rights of informal consent and autonomy of litigants in paternity testing practices.It is in this article that some ethical and legal issues commonly involved in paternity testing are discussed.