BACKGROUND:There is controversy on the treatment of old femoral neck fracture with hemiarthroplasty.
OBJECTIVE:To observe the clinical effect of cementless hemiarthroplasty in the treatment of old femoral neck fracture, and to compare with total hip arthroplasty.
METHODS:A retrospective analysis was performed on the clinical data of 23 old femoral neck fracture patients treated by artificial joint replacement from January 2009 to June 2010. Among the 23 patients, 11 cases were treated with cementless hemiarthroplasty, and 12 cases were treated with total hip arthroplasty. The time for off-bed activity, Harris score and the incidence of perioperative complications were compared between cementless total hip arthroplasty and hemiarthroplasty.
RESULTS AND CONCLUSION:Al the patients were fol owed-up for 12-18 months. The active straight leg raising angle, time for off-bed activity, incidence of early postoperative complications and Harris score at 1 week after treatment of the cementless hemiarthroplasty group were better than those of the total hip arthroplasty group;there were no significant differences in Harris score at 6 weeks, 3 and 6 months between two groups;the incidence of forward hip pain of the cementless hemiarthroplasty group was higher than that of the total hip arthroplasty group. So, we general y think that cementless hemiarthroplasty has better short-term effect in the treatment of old femoral neck fracture, but the long-term integrated efficacy needs to be further identified.

The clinical data of a child with anti-(α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid, AMPA2) receptor antibody encephalitis after herpes simplex encephalitis was retrospectively analyzed.The child was a 9-year-old female developing abnormal mental behavior after fever.The auxiliary examination of the first hospital displayed, cerebrospinal fluid: sugar qualitative (+ ), white blood cell count 32×10 6/L, albumin measurement (immune turbidity method) 317.00 mg/L, immunoglobulin IgG 45.80 mg/L.Herpes simplex virus (+ ). Skull magnetic resonance imaging showed: abnormal signal at the top of the frontal frontotemporal, considering intracranial infection.Video electroencephalogram: the background is diffuse slow wave, a small amount of multifocal spikes, sharp waves, spine slow wave release, left frontal, and temporal sacral protrusions.One partial seizure may be detected during the awake period.The diagnosis was " herpes simplex virus encephalitis" , and the body temperature of the child returned to normal after anti-infection and hormone therapy.However, there were still cognitive impairments, irritability, and no language communication.After 2 years, there was no abnormality in routine biochemical and viral cerebrospinal fluid examination.Serum and cerebrospinal fluid autoimmune encephalitis-related antibody spectrum: anti-NMDA, AMPA1/2, GABAB receptor antibody and anti-CASPR2, LGI1 antibodies were negative in serum.The anti-AMPA2 receptor antibody in the cerebrospinal fluid was weakly positive, and the final diagnosis was anti-AMPA2 receptor antibody encephalitis.After the application of hormones, the children′s cognition improved, mood was more stable than before, and language communication improved as well.Anti-AMPA2 receptor antibody encephalitis can be observed in children, and may be related to immune response after viral infection.For patients of viral encephalitis with poor treatment or disease relapse and progression, the possibility of autoimmune encephalitis should be considered.

Objective To analyze the effects of 25-hydroxyvitamin D[25(OH)D]on the result of the HCV RNA and the FIB-4 in the patients with hepatitis C.Methods 255 serum samples were random collected from the patients with hepatitis C and 218 serum samples were random collected from the healthy people.The 25(OH)D,HCV RNA,aspartate aminotransferase (AST),alanine aminotransferase (ALT)and blood platelet (PLT)were detected.Then,compared the results of the 25 (OH)D in the patients with hepatitis C and the healthy group.Analyzed the relevance between the concentration of 25(OH) D and HCV RNA.According to the quartile concentration of the 25(OH)D,the patients with hepatitis C were categorized to four groups.The relationship of FIB-4 between HCVRNA and 25(OH)D was analyzed.Results The average concentration of the 25(OH)D in the patients with hepatitis C and healthy people were 48.16±1.41 nmol/L vs 60.42±1.34 nmol/L, with a significant difference (t=4.682,P<0.01).There were 38 patients (14.90%)had severe deficiency of 25(OH)D (<25 nmol/L)in 255 patients with hepatitis C.And there were 8 patients (3.67%)had severe deficiency of 25(OH)D (<25 nmol/L)in 218 healthy people,with a significant difference (t=5.216,P<0.01).Then found no relevance between the log-arithmic of the HCV RNA and the concentration of the 25(OH)D (r2=0.018 8,P=0.412)and there was significant differ-ence between the proportion of FIB-4 in the highest quartile concentration of the 25(OH)D and the lowest quartile concen-tration of the 25(OH)D (χ2=8.190,P=0.042).Conclusion The patients with hepatitis C were easier to have a severe de-ficiency of 25(OH)D than the healthy people.The hepatitis C patients should been suggested to supply the vitamin D.FIB-4 has a significant difference with 25(OH)D and no great effects on the result of the HCV RNA.

Objective: To observe the eff ect and mechanism of chronic high-fat diet on predation behavior in rats. Methods: Ten female SD rats with 4-week-old were randomly divided into a normal control group (NC group,n=5) and a chronic high-fat diet group (HF group,n=5). The rats in the NC group received the regular diet while rats in the HF group were fed with high-fat diet. Fitf een weeks later, the predation behavior of rats was evaluated by open if eld test and food foraging tests. At the end of experiments, the rats were killed and brain tissues were collected for evaluation of c-Fos protein expression in anterior cingulate cortex by immunohistochemical assay. Results: hT e predation behavior of rats in the HF group was signiif cantly impaired in the competitive or non-competitive food foraging test compared with the control rats (P<0.001). hT e c-fos protein expression in anterior cingulate cortex of rats from the HF group was signiif cantly decreased (P<0.001). Conclusion: Long time high-fat diet can aff ect the predation behavior of rats, which is related todysfunction of neuron in anterior cingulate cortex.

The clinical data of a child with paroxysmal kinesigenic dyskinesia (PKD) and being diagnosed and treated in the Department of Pediatrics of the First Affiliated Hospital of Zhengzhou University in October 2018 were analyzed retrospectively.The male patient was 13 years old.The clinical manifestation was the change of body position, and the temporary movement cannot appear.The manifestations included the turning of head to one side, the falling back of neck, head shaking, swinging, the tightly hugging of hands in front of the chest, the touching of two tiptoes to the ground, numb sole, and ache.Gene detection: chromosome 16p11.2 (chr16: 29594293-30189789) had about 595.5 kb heterozygosity deletion.A total of 8 cases of 16p11.2 microdeletion in children with PKD were reported in details.16p11.2 microdeletion is another form of gene expression that causes PKD.16p11.2 microdeletion should be screened for genetic evaluation in patients with PKD.

Objective To explore the expression of miRNA-181a (miR-181a) in patients with multiple myeloma (MM) and its effect on biological features of MM cells. Methods CD138+cells of bone marrow from 25 MM patients and 10 patients with hematological non-malignancies were purified by using immunomagnetic separation, and the expression of miR-181a in CD138+cells and MM cell lines including RPMI 8226, H929 and U266 were detected by real-time quantitative PCR. The effects of down-regulation and up-regulation of miR-181a expression on the biological characteristics of MM cells were studied with miR-181a antagomir and agomir. Results Compared with patients with hematological non-malignant diseases, the expression of miR-181a in CD138+ cells was upregulated in MM patients. Compared with CD138+ cells in hematological non-malignancies, high expressions of miR-181a were observed in RPMI 8226 and U266 myeloma cell line, while low expressions of miR-181a were observed in H929 cells. Down-regulation of miR-181a with 100 nmol/L miR-181a antagomir could inhibit the proliferation of U266 cells at 24,48 and 72 h [(67.1 ± 3.3) %vs. (50.5 ± 4.1) %, (71.5 ± 3.6) % vs. (52.3 ± 2.2) %, (78.1 ± 5.4) % vs. (69.5 ± 4.3) %, P < 0.05 respectively], whereas up-regulation of miR-181a with 100 nmol/L miR-181a agomir could significantly promote the proliferation of H929 cells at 24 h and 48 h [(21.2 ± 2.4) %vs. (38.5 ± 3.6) %, ( 61.3 ± 5.4) %vs. (82.2 ±6.9)%, P<0.01 respectively]. Cell cycle analysis showed that miR-181a antagomir made U266 cell cycle arrest in the G0/G1 phase. Meanwhile, susceptibility test results indicated that the apoptosis of U266 cells induced by doxorubicin, paclitaxel and 5-fluorouracil was increased when the proliferation of miR-181a expression was down-regulated with miR-181a antagomir. In migration assay, the data showed that down-regulation of miR-181a with miR-181a antagomir could inhibit the migration of U266 cells, and the proportion of migrated cells in the experimental group (62 ± 10) %was lower than that in the control group (89 ± 12) %(P< 0.05), whereas up-regulation of miR-181a with miR-181a agomir could improve the migration of H929 cells, and the proportion of migrated cells in the experimental group (242 ± 9) % was higher than that in the control group (98 ± 8)%(P<0.01). Conclusions The high expression of miR-181a expressed highly by MM cells may promote the proliferation, migration and drug resistance of myeloma cells, indicating that miR-181a could be an important prognostic biomarker candidate, and the application of gene silencing may improve the prognosis of MM.

Objective:To evaluate the effectiveness of integrated pediatric training course of extracorporeal membrane oxygenation(ECMO)based on simulation teaching.Methods:The instructors of ECMO team of Children′s Hospital of Fudan University developed the teaching curriculum.Team members as a unit were recruited to study simulation-based courses, whose theoretical knowledge, skills and teamwork were assessed, and feedback from the trainees were gathered.Results:Since May 2018, 22 teams of pediatric specialized hospitals or general hospitals have taken part in our ECMO simulation, with totally 132 participants, including 45 ICU doctors(34.1%), 60 ICU nurses(45.5%), 23 thoracic surgeons(17.4%) and four anesthesiologists(3.0%). Twelve of them(9.1%)had a little ECMO experience.After training, the trainees had a high evaluation on each part of the course, with average score more than four, of which the theoretical score was lowest.Their self-evaluation on the theory, skills, teamwork and confidence in the implementation of ECMO had been significantly improved.Most(80.3%)of the trainees were confident to carry out ECMO in their local hospitals.The trainees′ baseline score of theoretical knowledge was 55.2±7.6, and increased to 67.1±7.3 after training( P<0.001). The average teamwork score of the 22 teams was 70.2±8.2, and the qualified rate was up to 86.4%.The most prominent skill problems in operation assessment were no albumin and blood priming(90.9%), non-skill problems were extremely anxious during the overall assessment(84.8%)of the participants, poor team work(74.2%), poor leadership(68.2%). For the feedback of the whole course, 97.0% and 94.7% of the trainees thought that integrated training and simulation teaching were the highlights of the course.At present, 13(59.1%)units have successfully developed ECMO technology after the course, and the number of children treated has been up to 83, with a survival rate of discharge of 54.2%.However, it was found that the skill level of some participants decreased about 2 weeks after the course. Conclusion:As a new attempt of ECMO teaching, this curriculum has achieved certain efficiency in both teaching and clinical practice.At the same time, our study also plays a role in promoting the development of ECMO in pediatrics.

Objective To investigate the therapeutic effect of post-traumatic complex posterior urethral stricture in the male patients.Methods Clinical data of 479 male patients with post-traumatic complex posterior urethral stricture were reviewed.One-stage resection of the stenosis and end-to-end anastomosis was performed in 422 patients and scrotal flap with blood pedicle posterior urethroplasty in 57.Results The mean operation time was 115 minutes(range,90-140 minutes).The mean blood loss was 225 ml(range,100-300 ml).No intraoperative blood transfusion was needed.The mean follow-up time was 15 months(range,12-24 months).Among the 422 patients performed end-to-end anastomosis,386 patients had good voiding and 36 had dysuria because of the formation of anastomotic stoma valve(21 patients)or stricture ring(15 patients).The problem was resolved by transurethral valve/stricture ring resection.Among 57 patients undergone posterior urethroplasty,45 patients had good voiding nine patients were found with anterior urethra-skin tube anastomotic stoma stricture,of which four patients were treated by urethral dilatation and five by endourethrotomy; three patients were found with posterior urethra-skin tube anastomotic stoma stricture,of which one patient was treated by urethral dilation and two by endourethrotomy.Conclusions One-stage resection of the stenosis and end-to-end anastomosis is the main treatment for post-traumatic complex posterior urethral stricture.If the condition of the patients does not allow the end-to-end anastomosis,posterior urethroplasty can be an alternative.

Objective To study the clinical value of neonatal arterial blood pH,base excess and lactate levels within 72 h after birth in assessing early brain injury in asphyxia neonates.Method From June 2015 to November 2016,a retrospective study was performed on the asphyxia newborn admitted to newborn department of Children's Hospital of Fudan University.The data of brain magnetic resonance imaging (MRI),video electroencephalogram (VEEG),and artery blood gas analysis (within 12 h and 72 h) were all collected.The neonates were assigned into brain injury group (severe or moderate injury) and control group (normal or mild injury) according to MRI and VEEG results.The differences of arterial blood pH,base excess and the level of lactate between the two groups were analyzed and indicators of brain injury were evaluated using ROC curves.Result A total of 63 cases were included in the study.Thirty patients were in the control group and 33 patients the brain injury group.The pH within 12 h was lower [(7.32 ±0.09) vs.(7.38 ±0.08)],and the lactic acid level in 12 h and at 24-72 h were significantly higher in the brain injury group than the control group [(7.9 ±4.2) mmol/L vs.(4.9 ±2.4) mmol/L and (3.7 ±3.2) mmol/L vs.(2.2 ± 1.1) mmol/L].The differences were statistically significant (P ＜0.05).The areas under the ROC curve of pH,lactate within 12 h and at 24-72 h were 0.323,0.715,0.643 (P =0.016,0.003,0.051).The cut-off value of lactic acid within 12 h in assessing of brain injury was 7.5 mmol/L,with the sensitivity of 0.46 and the specificity of 0.97.Conclusion The artery lactate level within 72 h after birth can be used to evaluate the severity of brain injury in neonatal asphyxia infants.

Objective To explore the feasibility of Guardian real-time continuous monitoring system (GRT) in high-risk infants with hypoglycemia.Methods The glucose of 72 infants admitted to Neonatal Intensive Care Unit (NICU) of Children's Hospital of Fudan University between May 2015 and December 2016 were detected by GRT (provided by Medtronic),there were 43 males and 29 females with gestational age [(35.25 ± 4.45) weeks],and birth weight [(2 385.69 ± 1 062.63) g].At the same time,the capillary glucose was monitored intermittently detected by using ACCU-CHEK(R).Results A total of 1 134 paired glucose levels were collected.A good correlation between the paired capillary[(5.23 ± 1.96) mmol/L] and GRT continuous monitor measurements [(5.19 ± 1.99) mmol/L] was found(r =0.88,P ＜ O.05),and the value of mean absolute difference (MAD) was 11.88％.Through the Clarke error grid analysis,there were 98.24 ％ points located in region A and region B,only 20 paired(1.76％) glucose located in region D.Hypoglycemia was defined as glucose concentration ＜ 2.6 mmol/L,while hyperglycemia was defined as glucose concentration ＞ 7.0 mmol/L.A high/low blood glucose detected by peripheral blood glucose monitoring is a high/low blood glucose event,and a high/low blood glucose detected by GRT in a continuous period is a high/low blood glucose event.Twelve cases of hypoglycemia,26 episodes of hypoglycemia,29 cases of hyperglycemia,and 151 episodes of hyperglycemia were detected by using fast blood glucose meter.Twenty-six cases of hypoglycemia,88 episodes of hypoglycemia,38 cases of hyperglycemia,and 229 episodes of hyperglycemia were detected by using GRT.Sixty-two episodes of hypoglycemia were not detected by the fast blood glucose meter,with 14 episodes lasting longer than 30 min,4longer than 60 min,and 5 longer than 90 min.There were 78 hyperglycemic episodes that were not detected by the fast blood glucose meter,with 44 episodes lasting longer than 30 min,15 longer than 60 min,and 70 longer than 90 min.There were significant differences in the testing of hypoglycemia and pathoglycemia(x2 =7.00,18.60;all P ＜ 0.05),but,there was no significant difference in the testing of hyperglycemia between the 2 kinds of detection(x2 =2.26,P ＞0.05).GRT was acceptable to parents,medical staffs and children as only 3 infants bled when the continuous glucose sensor was imbedded,but there was no progressive increase in blood loss.There was no redness,edema,infections,or effusions at the insertion sites.Conclusions The use of GRT continuous monitoring system in high-risk infants of hypoglycemia was feasible.Compared with the conventional intermittent peripheral blood glucose monitoring,more abnormal blood glucose events and their duration could be detected.