Objective:To explore the related risk factors contributing to re-fracture after hip surgery in elderly patients.Methods:This retrospective analysis was conducted on the clinical data of 2 415 elderly individuals who underwent surgical treatment for hip fractures and were discharged from Shanghai Sixth People's Hospital between January 2016 and December 2021.Patients were grouped into re-fracture and non-re-fracture cohorts based on whether a second fracture occurred within three years after surgery.Demographics, clinical data, and postoperative functional rehabilitation outcomes of the two groups were collected, and univariate and multivariate logistic regression analyses were applied to identify the independent risk factors for re-fractures after surgery.Results:A total of 2, 000 patients who completed follow-up were included in the final analysis, aged 60~91 years, with a mean age of (75.4±8.2) years.Among them, 855 were male(42.75%), and the postoperative re-fracture incidence was 28.25% (565/2 000). Univariate analysis indicated that advanced age, fracture type at first onset, lower Harris scores, insufficient rehabilitation training, osteoporosis, diabetes, cerebrovascular disorders, visual impairment, and syncope were all significantly associated with re-fracture (all P<0.05), while gender differences were not statistically significant ( P>0.05). Multivariate regression confirmed the following as independent risk factors: age ≥75 years, postoperative Harris score <80, non-standard rehabilitation training, combined osteoporosis, diabetes, cerebrovascular disease, visual impairment, and syncope ( OR、 RR>1). Conclusions:Elderly patients are prone to re-fracture after hip surgery, and its occurrence is closely related to advanced age, inadequate functional rehabilitation, osteoporosis, and multiple internal medical comorbidities.In clinical practice, attention should be paid to standardized postoperative rehabilitation, systematic anti-osteoporotic therapy, and active intervention of comorbidities to reduce the incidence of re-fracture and improve the long-term prognosis of patients.

Objective:To explore the related risk factors contributing to re-fracture after hip surgery in elderly patients.Methods:This retrospective analysis was conducted on the clinical data of 2 415 elderly individuals who underwent surgical treatment for hip fractures and were discharged from Shanghai Sixth People's Hospital between January 2016 and December 2021.Patients were grouped into re-fracture and non-re-fracture cohorts based on whether a second fracture occurred within three years after surgery.Demographics, clinical data, and postoperative functional rehabilitation outcomes of the two groups were collected, and univariate and multivariate logistic regression analyses were applied to identify the independent risk factors for re-fractures after surgery.Results:A total of 2, 000 patients who completed follow-up were included in the final analysis, aged 60~91 years, with a mean age of (75.4±8.2) years.Among them, 855 were male(42.75%), and the postoperative re-fracture incidence was 28.25% (565/2 000). Univariate analysis indicated that advanced age, fracture type at first onset, lower Harris scores, insufficient rehabilitation training, osteoporosis, diabetes, cerebrovascular disorders, visual impairment, and syncope were all significantly associated with re-fracture (all P<0.05), while gender differences were not statistically significant ( P>0.05). Multivariate regression confirmed the following as independent risk factors: age ≥75 years, postoperative Harris score <80, non-standard rehabilitation training, combined osteoporosis, diabetes, cerebrovascular disease, visual impairment, and syncope ( OR、 RR>1). Conclusions:Elderly patients are prone to re-fracture after hip surgery, and its occurrence is closely related to advanced age, inadequate functional rehabilitation, osteoporosis, and multiple internal medical comorbidities.In clinical practice, attention should be paid to standardized postoperative rehabilitation, systematic anti-osteoporotic therapy, and active intervention of comorbidities to reduce the incidence of re-fracture and improve the long-term prognosis of patients.

Objective To explore the effects of TRAF6 inhibition on autophagy,myocardial inflammation and cardiac function in septic mice.Methods Twenty-four male Kunming mice were randomly divided into 4 groups:sham,sham + C25-140(sham+C),cecal ligation and puncture(CLP),and cecal ligation and puncture+C25-140(CLP+C)group.Sham+C group and CLP+C group were intraperitoneally injected with C25-140 after operation.LVEF and LVFS were evaluated by ultrasound 24 hours after operation.Serum TNF-α and IL1-β were measured by ELISA.HE staining was used to evaluate myocardial inflammatory response.Autophagosomes and mitochondrial microstructure of cardiomyocytes were observed by transmission electron microscopy.TRAF6 mRNA in myocardial tissue was detected by qPCR.The expression of TRAF6,P62,Beclin-1 and LC3B protein was detected by W-B.The effect of C25-140 on myocardial injury in the septic mice was observed by inhibiting autophagy with 3-MA.Results Compared with the sham group,the levels of TRAF6 mRNA and TRAF6 in the myocardial tissue in the CLP group were significantly increased(P<0.05)and the serum TNF-α and IL1-β concentrations were signifi-cantly increased(P<0.05).Meanwhile,the myocardial tissue HE staining showed inflammatory cell infiltration and the LVEF and LVFS levels were significantly decreased in the CLP group(P<0.05).Compared with CLP group,the CLP+C group showed that the expression of TRAF6 mRNA and TRAF6 protein decreased(P<0.05),serum TNF-α and IL1-β decreased(P<0.05),myocardial histopathological myocardial inflammatory cell infiltration decreased,the LVEF and LVFS levels increased(P<0.05).Electron microscopy showed that the mitochondrial swelling decreased,autophagosomes increased,expression of Beclin-1 and LC3Ⅱ/Ⅰ increased,and P62 expression decreased(P<0.05).As compared with CLP+C group,the CLP+C+3-MA group showed that obvious inflamma-tory cell infiltration in the myocardial pathology and the LVEF and LVFS levels decreased after 3-MA inhibited autophagy(P<0.05).Conclusion Inhibition of TRAF6 can not only ameliorate myocardial inflammatory injury and cardiac dysfunction in septic mice,but promote the involvment of cardiomyocyte autophagy in provention from sepsis-induced myocardial injury.

Objective:To determine the influences of structural changes after valgus impacted femoral neck fracture on hip range of motion (ROM) so as to provide evidence for clinical judgment of whether reduction is necessary or not in the internal fixation of such fractures.Methods:1. 3D reconstructions of the CT hip scans were performed for the 73 patients who had been treated at Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University for valgus impacted femoral neck fractures from January 2019 to April 2019.The femoral neck-shaft angle, anteversion angle, femoral offset, axial alpha angle, lateral center edge angle (LCEA), anterior center edge angle (ACEA) and center displacement were measured and compared between the affected and healthy sides to determine the influences of the fracture on the above indexes. 2. Hip motions (flexion and MIR-90°) were simulated on bilateral sides to determine the influences of structural changes after fracture on hip ROM using stepwise regression and Logistic regression. 3. The distribution of femoral-acetabular contact points on the femoral side was observed in simulation of hip flexion to detect the potential area for femoracetabular impingement (FAI) induced by the fracture displacement.Results:1. The valgus impacted femoral neck fractures had significant influences on femoral neck-shaft angle, anteversion angle, femoral offset and axial alpha angle. Compared with the healthy side, on average, the femoral neck-shaft angle increased by 5.1°, anteversion angle decreased by 6.5°, femoral offset decreased by 8.2 mm and axial alpha angle increased by 9.7° on the affected side, showing significant differences ( P<0.05).The displacements of the femoral head center averaged 9.2 mm. There was no significant difference in LCEA or ACEA between the affected and healthy sides ( P>0.05). 2. Compared with the healthy side, on average, the simulated hip flexion decreased significantly by 27.0° and the hip MIR-90° decreased significantly by 20.3° on the affected side after fracture ( P<0.05). Regression analysis showed that femoral anteversion angle, ACEA and displacement of the femoral head center had a significant influence on hip ROM, especially the anteversion angle. When the anteversion angle decreased by more than 7.1°, the hip flexion would decrease by at least 20%. 3. The points of FAI distributed more widely on the fracture side. Compared with the healthy side, the impact points extended outward and upward in hip flexion and extended inwardly in hip MIR-90° on the affected side. Conclusions:After a valgus impacted femoral neck fracture, if the femoral anteversion angle has been decreased by more than 7.1°, the hip ROM can be greatly influenced and the points of FAI can be distributed more widely. Therefore, reduction should be recommended before internal fixation of the fracture.

Femoral neck fractures are not common in young patients,accounting for merely 3％ of all these fractures.However,since the young femoral neck fractures are mostly caused by high energy violence,they usually jeopardize local blood supply and mechanical environment,resulting in higher risks of non-union and avascular necrosis.Besides,young patients often make a greater demand for functional recovery.Consequently,young femoral neck fracture is always a clinical challenge.In this article,we introduce in details the latest techniques and standards for reduction of young femoral neck fracture,compare advantages and drawbacks of various internal fixations,illustrate up-to-date progress in treatment methods and concepts for delayed and nonunited femoral neck fractures,and lastly put forward some unsolved issues open to dispute.In treatment of young femoral neck fractures,it is necessary for us to get familiarized with their anatomy and biomechanical characteristics,grasp the principles of treatment on the whole,and choose operational and internal fixation methods based on the clinical evidence before we can improve therapeutic efficacy,accelerate rehabilitation progress and restore function of the hip joint as much as possible.

Objective To investigate the safety and effectiveness of endovascular treatment and surgical clipping for the treatment of intracranial ruptured aneurysms. Methods From January 2012 to December 2017, patients with ruptured intracranial aneurysm treated at the Department of Neurosurgery, the Second People's Hospital of Taizhou were enrolled retrospectively. The demographics, baseline clinical data,outcomes, and complications were compared between the endovascular treatment group and the surgical clip group. Results A total of 220 patients were enrolled, they aged 55. 1 ±11. 8 years. There were 117 patients in the endovascular treatment group and 103 in the surgical clipping group. There were no significant differences in perioperative complications (26. 2％ vs. 19. 6％; χ2 = 1. 340, P = 0. 247), in-hospital mortality (6. 0％vs. 4. 9％; χ2 = 0. 135, P = 0. 713), and good outcomes at discharge (85. 5％ vs. 81. 6％; χ2 =0. 614, P = 0. 433) between the two groups. Multivariate logistic regression analysis showed that age (odds ratio [OR] 1. 072, 95％ confidence interval [CI] 1. 025-1. 124; P < 0. 001), smoking (OR 6. 325, 95％ CI 2. 367-16. 901; P < 0. 001 ), and high World Federation of Neurosurgery Societies (WFNS) grade (OR 5. 218, 95％ CI 1. 881-14. 449; P < 0. 001) had significant independent correlation with the poor clinical outcome at discharge. The imaging follow-up data in 155 aneurysms (81 in the endovascular treatment group and 74 in the surgical clipping group) were available. The follow-up time was 14. 3 ± 6. 9 months (range, 6-36 months); 20 aneurysms (12. 9％) had recurrence. There was no significant difference in the recurrence rate of the endovascular treatment group and surgical clipping group (17. 3％ vs. 8. 1％; χ2 =2. 900, P = 0. 089). The clinical follow-up data of 188 patients (95 in the endovascular treatment group and 93 in the surgical clipping group) were available. The follow-up time was 15. 5 ± 6. 8 months (range, 6- 36 months). There was no significant difference in the good outcome rate between the endovascular treatment group and surgical clipping group (95. 8％ vs. 90. 3％; χ2 = 2. 182, P = 0. 140 ). Multivariate logistic analysis showed that smoking (OR 4. 872, 95％ CI 1. 719-13. 872; P < 0. 001 ) and high WFNS grade (OR 3. 512, 95％ CI 1. 446-8. 583; P < 0. 001) were the independent risk factor for long-term poor outcome. Conclusion The efficacy and safety of surgical clipping for ruptured intracranial aneurysms were comparable to endovascular treatment. Age, smoking, and WFNS grade were the important factors affecting the outcomes of patients.

Objective To quantitatively assess the liver fat content by Nav IDEAL-IQ and compare with conventional breath-hold IDEAL-IQ and magnetic resonance spectroscopy (MRS).Methods Twenty volunteers,twenty fatty liver patients and twenty patients with other liver diseases were enrolled in this study.IDEAL-IQ,Nav IDEAL-IQ and MRS imaging were performed and fat fraction (FF) were measured respectively.The results were compared by t-test to explore whether there were differences between these groups. Spearman correlation analysis was also used to test the correlation.Results No significant differences in the FF measured by IDEAL-IQ,Nav IDEAL-IQ and MRS in normal volunteers [(4.09±0.82)%,(3.94±0.83)%,(3.92±0.85)%],fatty liver [(15.5±6.1)%,(11.8±6.5)%,(1 2 .4 ± 7 .2 )% ] and other liver lesions patients [(4.20±0.84)%,(4.00±0.94)%,(3.97±0.96)%]were found between these groups (P>0.05). There was a significant positive correlation between Nav IDEAL-IQ and MRS,and the correlation coefficients of these groups were 0.959,0.786 and 0.945,respectively.Conclusion The results of Nav IDEAL-IQ of fat quantification are consistent with MRS results and it increases the success rate of fat quantitative testing.In a word,it is a noninvasive,convenient and accurate way to measure fat fraction.

AIM:To investigate the effect of activation of retinoid X receptor (RXR) on transforming growth factor β1 (TGF-β1) induced collagen synthesis under hypoxic environment in rat cardiac fibroblasts (CFs) and underlying molecular mechanisms .METHODS: CFs were cultured using myocardial tissue with dry method .Hypoxic environment was established for CFs by continuous nitrogen supplement .Type I and type III collagens in supernatants were detected by ELISA.Nuclear and cytoplasmic extractions were prepared using NE-PER nuclear and cytoplasmic extraction reagents .The protein levels of Smad2 and p-Smad2 were determined by Western blot and immunocytochemical staining .RESULTS:Un-der hypoxic condition , TGF-β1 (0.01~10 μg/L) increased the synthesis of type I and type III collagens in a dose-de-pendent manner in the CFs .At the concentration of 5μg/L, the synthesis of collagen I and III was significantly increased as compared with control group (P<0.01).RXR agonist 9-cis-retinoic acid (9-cis-RA;10 -9 ~10 -6 mol/L) decreased TGF-β1 (5μg/L)-induced synthesis of type I and III collagens in a dose-dependent manner in the CFs under hypoxic con-dition.The synthesis of type I and type III collagens was significantly inhibited by 9-cis-RA (P<0.01).Smad2 inhibitor ( 20 nmol/L) showed similar inhibitory effect on the synthesis of type I and III collagens induced by TGF -β1 under hypoxic condition.Compared with TGF-β1 intervention group, the cytoplasmic level of p-Smad2 in the CFs was significantly in-creased in TGF-β1+9-cis-RA group, but the nuclear p-Smad2 level was significantly decreased (P<0.05).CONCLU-SION:Retinoid X receptor agonist 9-cis-RA inhibits TGF-β1-induced synthesis of type I and type III collagens in the CFs by repressing p-Smad2 nuclear translocation under hypoxic condition .

AIM:To explore the effects of atorvastatin (Atorv) on atherosclerosis in streptozotocin (STZ)-in-duced diabetic apolipoprotein E knockout ( ApoE-/-) mice with fat-rich diet and the possible mechanism .METHODS:C57 mice served as control.ApoE-/-mice (n=34) fed with high-fat diet were randomly divided into ApoE-/-group, STZ-ApoE-/-group and STZ-ApoE-/-+Atorv group.Intraperitoneal injection of streptozotocin was performed to create di-abetic animal model .Blood glucose was determined by glucose oxidase method .Blood lipid levels were detected by enzymic method or selective homogeneous method .The plaque area in the thoracic aorta was measured by HE staining .The protein level of nicotinamide-adenine dinucleotide phosphate ( NADPH) oxidase subunit gp91phox in the thoracic aorta was deter-mined by Western blotting .The levels of reactive oxygen species ( ROS) in blood and thoracic aorta homogenates were de-tected by Fenton reaction and Griess reagent .Human umbilical vein endothelial cells ( HUVECs ) were isolated from healthy umbilical cords by collagenase I and cultured .ROS production was detected by flow cytometry .NADPH oxidase ac-tivity was measured using lucigenin assay .Effects of retinoid X receptor α( RXRα) on inhibition of oxidative stress by ator-vastatin were evaluated by RNA interference and plasmid transfection .RESULTS: (1) Compared with C57 group, the plaque areas of the thoracic aorta in ApoE-/-group were increased .No difference of the fasting glucose between the 2 groups was observed.The levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), thoracic aorta gp91phox protein and ROS in blood and thoracic aorta homogenates were higher in ApoE-/-group than those in C57 group.(2) Compared with ApoE-/-group, the plaque areas of the thoracic aorta in STZ-ApoE-/-group were further enlarged [(314.13 ±35.72) μm2 vs (215.88 ±34.19) μm2, P<0.05].The levels of blood glucose, TG, TC and LDL-C, thoracic aorta gp91phox protein and ROS in blood and thoracic aorta homogenates were higher in STZ-ApoE-/-group than those in ApoE-/-group (P<0.05).(3) Compared with STZ-ApoE-/-group, the plaque areas of the thoracic aorta in STZ-ApoE-/-+Atorv group were reduced [(217.47 ±24.56) μm2 vs (314.13 ±35.72) μm2, P<0.05].The levels of blood glucose , LDL-C, TC, HDL-C and TG showed no significant difference between the 2 groups.Thoracic aorta gp91phox protein level and ROS production in blood and thoracic aorta homogenates were lower in STZ -ApoE-/-+Atorv group than those in STZ-ApoE-/-group (P<0.05).(4) High glucose-induced increases in NADPH oxidase activity and gp91phox expression were significantly inhibited by atorvastatin (10-6 mol/L) in HUVECs.The inhibitory effects of atorvasta-tin on high glucose-induced ROS production and NADPH oxidase activation were largely impaired when the cells were trans -fected with RXRαsiRNA.However , the effect of atorvastatin was significantly strengthened when RXRαwas over-expressed in the HUVECs transfected with RXRαplasmid.CONCLUSION: Atorvastatin inhibits atherogenesis by depressing high glucose-induced oxidative stress in diabetic ApoE-/-mice with fat-rich diet.The anti-oxidative stress effect of atorvastatin is mediated by RXRα.

Objective To explore the effect of retinoid X receptor (RXR) agonist bexarotene on atherosclerosis and the potential mechanism in streptozotocin (STZ) induced diabetic apolipoprotein E knockout (apoE-/-) mice.Methods Eight C57BL/6 mice served as control,46 apoE-/-mice were randomized into 4 groups:apoE-/-group (n =10),STZ + apoE-/-group (n =12),STZ + apoE-/-+ Bex 10 (10 mg · kg-1 · d-1)group (n=12),STZ+ apoE-/-+Bex 30 (30 mg · kg-1 · d-1)group (n=12).Diabetic apoE-/-animal model was established by intraperitoneal injection of STZ.Blood glucose was determined by glucose oxidase method.Patch area in thoracic aorta was measured by HE staining.Western blotting was used to determine the RXR and gp91 phox protein level in thoracic aorta.Reactive oxygen species (ROS) level in blood and thoracic aorta homogenates was detected by Fenton and Griess method.Results (1) Patch areas of thoracic aorta were larger in apoE-/-group than in C57BL/6 group[(38.40 ± 8.95) μm2 vs.(0.10 ±0.01) μm2,P ＜0.01],further increased in STZ + apoE-/-group [(94.06 ± 8.04) μm2,P ＜0.05 vs.apoE-/-group] and significantly reduced in STZ + apoE-/-+ Bex 10 group [(78.72 ± 4.62)μm2,P ＜0.05 vs.STZ + apoE-/-group] and further educed in STZ + apoE-/-+ Bex 30 group[(46.13 ±7.56) μm2,P ＜ 0.05 vs.STZ + apoE-/-+ Bex 10 group].(2) Blood glucose level,TG,TC,LDL-C,thoracic aorta gp91 phox protein level and ROS level in blood and thoracic aorta homogenates were significantly higher in STZ + apoE-/-group than in apoE-/-group (all P ＜ 0.05).Blood glucose level and TG,TC,LDL-C levels were similar between STZ + apoE-/-+ Bex10 and STZ + apoE-/-group.Thoracic aorta gp91 phox protein level and ROS level in blood and thoracic aorta homogenates were lower in STZ + apoE-/-+ Bex 10 group than in STZ + apoE-/-group (P ＜ 0.05).Blood glucose level,TG,TC,LDL-C levels,gp91 phox expression in thoracic aorta,ROS level in blood and thoracic in STZ + apoE-/-+ Bex 30 group were lower than in STZ + apoE-/-group (all P ＜ 0.05).Conclusion Bexarotene treatment could attenuate arteriosclerosis progression in STZ induced diabetic apoE-/-mice,the underlying mechanism might be related to suppressing oxidative stress and decreasing blood glucose level and improving lipids metabolism.