Treatment of adult femoral neck fracture is still a great challenge faced by trauma orthopedists. As treatment effects can be infleunced by multiple factors, like age, gender and preoperative physical condition, they may vary with different treatment schemes. Classification of femoral neck fractures plays an important guiding role in choosing a proper treatment scheme and judging the prognosis. The current classic clinical classification systems for femoral neck fractures include Garden, AO/OTA and Pauwels classifications. Since the recent progress in science and technology has put more advanced technologies into clinic application, such as CT, MRI and Digital Subtraction Angiography (DSA), new ways of classification have appeared. However, each classification has its own shortcomings which need to be improved. This paper reviews the research progress in classification of adult femoral neck fractures and their treatment principles.

Objective:To evaluate internal fixation via only the modified Stoppa approach in the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall.Methods:A retrospective study was conducted in the 13 patients with central hip dislocation and fracture of the posterior acetabular wall who had been treated at Department of Orthopedic Trauma, Nanfang Hospital between February 2015 and February 2018. They were 10 men and 3 women, aged from 31 to 65 years (average, 46.7 years). All patients were treated with internal fixation via only the modified Stoppa approach. The reduction of double-column and posterior wall fractures was evaluated according to the X-ray Matta scoring system, as well as to the Wiberg central-edge (CE) angles between the vertical line of the center point of the femoral head and the lateral edge of the acetabulum and acetabular tolerance on the normal and affected sides immediately after operation; the hip function was evaluated by the modified Merle d'Aubigne and Postel scoring system at 12 months after operation.Results:All patients were followed up for 16 to 52 months (average, 25.6 months). In all of them, reduction and fixation of central hip dislocation and acetabular fracture was completed successfully, and indirect reduction of posterior wall fracture and acetabular tolerance were satisfactory. Operation time ranged from 130 to 270 min, averaging 155.5 min; intraoperative blood loss from 600 to 5,600 mL, averaging 1,150.5 mL; intraoperative infusion of concentrated red blood cells from 2 to 12 U, averaging 6 U. By the X-ray Matta scoring system immediately after operation, anatomical reduction was achieved in 4 posterior wall fractures and satisfactory reduction in 9 ones. There was no significant difference between the normal and affected sides in the CE angle (43.53°±3.46° for the affected side versus 43.19°±3.28° for the normal side) or in the acetabular tolerance (76.56%±15.50% for the affected side versus 75.32%±16.24% for the normal side) ( P>0.05). The modified Merle d'Aubigne and Postel scores at 12 months after operation ranged from 12 to 18 points, averaging 16.5 points; the hip function was assessed as excellent in 9 cases, as good in 3 and as fair in one. By the last follow-up, none of the 13 patients lost fracture reduction, and their internal fixation was firm with no loosening or breakage. Conclusion:In the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall, internal fixation via only the modified Stoppa approach can lead to satisfactory fracture reduction, firm fixation, good hip joint tolerance, and fine clinical efficacy.

Objective To study the epidemic characteristics of hand foot mouth disease (HFMD) and the influence of meteorological factors on the incidence of HFMD in Beijing from 2010 to 2019, and to provide scientific evidence for the warning, prediction, prevention and control of HFMD. Methods Descriptive statistical analysis was conducted to analyze the epidemic characteristics of HFMD in Beijing from 2010 to 2019 using R4.0.2 software, and the relationship between meteorological factors such as daily average temperature, daily average relative humidity, daily average precipitation, daily average air pressure, and daily average wind speed and HFMD incidence from 2015 to 2019 was analyzed by using distribution lag nonlinear model. Results In 2010-2019, a total of 324 864 HFMD cases were reported in Beijing, with an average incidence rate of 155.10/100,000. May to July was the annual peak of HFMD. The average daily temperature, relative humidity and precipitation were positively correlated with the incidence of HFMD (Rs=0.66, 0.45 and 0.24, P=0.0000, 0.0000 and 0.0000, respectively). The average daily wind speed and pressure were negatively correlated with the incidence of HFMD (Rs=-0.14 and -0.3, P=2.22×10^-9 and 0.0000, respectively). The RR was the highest when the air temperature was 25℃ and at the lag of 10 day, which was 1.41 (95%CI:1.12-1.77). Humid weather conditions were the risk factors of HFMD, and the influence time was relatively long. The RR was the highest when the relative humidity was 84.5% and the lag was 15 days, which was 1.51 (95%CI:1.34-1.70). When daily average wind speed was 3m/s, and the lag was 14 days, the RR was the highest, which was 1.22 (95%CI:0.86-1.73). The RR was the highest when the daily average pressure was 842.5 hPa and the lag was 5 day, which was 1.20 (95%CI:0.66-2.07). When the daily average precipitation was 166.5 mm and the lag was 7 days, the RR was the highest, which was 4.37 (95%CI:1.61-11.84). When the above meteorological conditions were met, the risk of HFMD was the highest. Conclusion Meteorological factors such as daily average temperature, daily average relative humidity, daily average precipitation, daily average pressure and daily average wind speed are closely related to the incidence of HFMD, which is nonlinear and has certain lag. It can be used to predict the risk and epidemic intensity of HFMD, and to provide a scientific basis for the prevention and control, early warning, and prediction of infectious diseases.

Femoral neck fracture in children is usually caused by high-energy trauma. This relatively rare injury characterized by skeletal immaturity is different from that in adult patients in proximal femoral anatomy and blood supply. Currently, a variety of fixation methods have been used for paediatric femoral neck fractures but their overall goal is anatomical reduction and stable fixation. Femoral neck fractures in children are usually associated with a high incidence of complications (e.g. femoral head necrosis, premature epiphyseal closure, coxa vara and nonunion) even after appropriate treatment. This review addresses the anatomic characteristics, treatment strategies and complications in the treatment of paediatric femoral neck fractures.

Objective To clarify the function of LIM and SH3 domain protein-1 (LASP1) and ferritin in rhBMP2-induced osteogenic differentiation of beagle bone marrow mesenchymal stem cells (BMSCs).Methods After BMSCs from 3-18-month-old C57BL/6J mice were cultured adherently for 24 hours,they were subjected to osteogenic differentiation for 7,14 and 21 days in 3 groups.BMP2 (100 μg/L) and osteogenic differentiation medium was added in the experimental group,only osteogenic differentiation medium was added in the control group,and nothing was added in the blank group.Osteoblast differentiation was determined by examining marker genes (Runx2,OSX,OCN and OPN) using qRT-PCR.The protein expression of both LASP1 and ferritin was investigated using western blotting.After LASP1 and ferritin were silenced in the cells in the experimental group after transfection of shRNA to target LASP1(m),rhBMP2-induced osteogenesis was repeated to verify the roles of LASP1 and ferritin in osteoblast differentiation.Results The qRT-PCR showed successful osteoblast differentiation in the experimental group.Western blotting verified significant down-regulation of LASP1 and up-regulation of ferritin in the experimental group.After the LASP1 gene was silenced,the expression levels of osteoblast differentiation marker genes in the experimental group were higher than those in the control group.Conclusions rhBMP2 can induce mouse BMSCs to differentiate into osteoblasts in a significant manner.Combined with our preliminary research,the present study may confirm that LASP1 and ferritin,which play an important role in regulating cytoskeleton activity and iron metabolism,are critical in the osteogenic differentiation of mouse BMSCs induced by rhBMP2.

Objective To explore the clinical efficacy of medial iliosciatic plating via the Stoppa approach for complex acetabular fractures involving the posterior column.Methods Between February 2015 and February 2016,a total of 16 complex acetabular facture cases treated by the medial iliosciatic plate via the Stoppa approach were retrospectively analyzed in this study.This approach provided good exposure to a large region of the pelvis and acetabulum including pubis symphysis,pubic ramus,anterior and inner wall of acetabulum,quadrilateral surface,inner surface of posterior column,true pelvic margin,greater sciatic notch and sacroiliac articulation.The anterior and column was reduced and fixed by the anterior column plate and the medial ilioseiatie plate.The screw direction and angle were adjusted according to the intraoperative X-ray.Surgical time,amount of bleeding,and relevant complications were recorded.The reduction of the posterior column fracture was evaluated by Matta scoring system on the plain X-ray of the pelvic post-surgery,and functional outcomes of the hip joint affected were evaluated one year post-surgery by the Merle d'Aubigne-Postel scoring system.All the cases were followed for at least 12 months.Results The reduction and fixation of the posterior column was accomplished in all the 1 6 patients.The average surgical time was 165.5 min (range,130-270 min).The average blood loss was 1 245.6 ml (range,600-5 600 ml).Thc intraoperative infusionof concentrated red blood cells averaged 6 units.According to the Matta scoring system,anatomical reduction was achieved in 12 cases,satisfactory reduction in 3,and poor reduction in one.The patients were followed from 12 to 22 months.According to the Merle d'Aubigne-Postel scoring system,there were 11 cases of excellent and 3 cases of good,yielding a good or excellent rate of 87.5％.The average Merle d'Aubigne-Postel score was 15.8 (range,8-18).There were 1 case of external iiiac vein rupture and 1 case of bladder rupture.Both were repaired during surgery.Superior gluteal artery rupture was found in 1 case and surgical ligation of the artery was performed during surgery.Conclusion In the treatment of complicated acetabular fractures involving the posterior column,the medial iliosciatic plating via the Stoppa approach is safe and effective,because it can provide a safe and sufficient operative field for surgeons to reduce and fix the posterior column fractures,and it leads to satisfactory recovery of the patients with limited complications.

BACKGROUND:Whether continuous passive motion improves osteoarthritis by enhancing the proliferation ability of chondrocytes is rarely reported.
OBJECTIVE:To analyze the therapeutic outcomes of continuous passive motion in rabbits with osteoarthritis and the underlying mechanism.
METHODS:Thirty-six New Zealand white rabbits were randomly al otted into three groups (n=12 per group). Rabbits in control group only underwent capsulotomy with no harm to the cartilage;osteoarthritis models were established in the rabbits of model and treatment groups using Hulth method. At 1 day after modeling, the treatment group rabbits were treated with continuous passive motion, 8 hours daily for consecutive 8 weeks. Interleukin-1 and tumor necrosis factorαlevels in the synovial fluid were detected by ELISA;col agen type II expression and the proliferation ability of chondrocytes were detected by MTT assay;Erk signaling pathway activation was determined using western blot assay.
RESULTS AND CONCLUSION:In the model group, interleukin-1 and tumor necrosis factorαlevels in the synovial fluid were significantly increased, and the expression level of col agen type II mRNA was remarkablely down-regulated. Continuous passive motion significantly downregulated interleukin-1 and tumor necrosis factorαlevels and up-regulated the col agen type II mRNA level (P<0.01). The model group showed significantly decreased proliferation ability of chondrocytes and down-regulated Erk signaling pathway activation, while after continuous passive motion, al above indicators were significantly improved (P<0.01). These results indicate that the continuous passive motion can al eviate osteoarthritis probably by influencing interleukin-1 and tumor necrosis factorαlevels, proliferation ability of chondrocytes, and col agen type II expression, as wel as regulating Erk signaling pathway activation.

Objective To explore the association between the polymorphism rs671 site of the acetaldehyde dehydrogenase 2 (ALDH2) gene and H-type hypertension in the elderly in Han nationality in Qingdao.Methods Totally 406 patients aged 60-90 years with primary hypertension were randomly selected in the study.Serum levels of homocysteine(Hcy),folate and vitamin B12 were determined and all patients were divided into H-type hypertension group and non H-type hypertension group.Gene chip technology was used to analyze the ALDH2 (rs671) polymorphism,and the association between ALDH2 gene and H type hypertension was evaluated.Results Of all hypertensive participants,82.0％ (333/406) were in H-type hypertension,87.4％ (221/253) in male and 73.2％ (112/153) in female.The GA/AA genotype and A allele frequency were higher in H-type hypertension group than in non H-type hypertension group [37.2 ％ (124/333) vs.16.4 ％ (12/73) and 21.3％(71/333) vs.9.6％(7/73),P=0.001and 0.021].Serum Hcyleveland the prevalence of H type hypertension were higher in GA/AA genotype group than in GG genotype group(both P＜ 0.05).Logistic regression analysis showed that GA/AA genotype,gender (male),drinking,folate deficiency and increased systolic pressure were the risk factors for H-type hypertension (OR=3.17,2.14,2.37,0.75,1.03,respectively,all P＜ 0.05).Conclusions The genetic variation of ALDH2(rs671) may increase Hcy level by decreasing the levels of folate and vitamin B12.GA/AA genotype is a risk factor for H-type hypertension,and it contributes to H-type hypertension together with gender,drinking history,folate levels and systolic pressure.

In this study,the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated.From March to August,2009,17618 women,from Wufeng area of Hubei province,China,were recruited to screen breast diseases by using breast infrared diagnostic apparatus.Other diagnostic methods,such as B-mode ultrasound,X-ray mammography,needle biopsy and pathological examination were,if necessary,used to further confirm the diagnosis.The screening showed that 5990 of 17618 cases (34.00％) had breast diseases,5843 (33.16％) had mammary gland hyperplasia,48 (0.27％) had breast fibroadenoma,ll (0.06％) had breast carcinoma,and 88 (0.50％) had other breast diseases.The peak morbidity of breast cancer was found in the women aged 50-0 ages.The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8,0.157％) in comparison with that in the subjects younger than 50 years old (n=3,0.024％) (u=2.327,P＜0.05).It was shown that the occurrence of breast diseases was concentrated in women aged 20-40 years,while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40.Compared with the patients elder than or equal to 40 years old (n=3289,27.46％),the morbidity rate of breast diseases was significantly increased in women less than 40 years old (2648 cases,47.18％; P＜0.001).However,there was no significant difference in the morbidity of breast diseases between the age group of 20-29 years and that of 30-39 years (P=0.453),and both of them were high.There was no significant association between the morbidity of breast diseases and cervical cancer.Since the morbidity of breast diseases was higher among young women,more attention should be paid to the screening of breast diseases among young women for early diagnosis.

Objective To observe the change of MR perfusion value in patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE). Methods A total of 22 patients with HCC underwent MR perfusion weighted imaging (MR PWI) before TACE and 3-10 days after TACE. The mean time to enhance (MTE), negative enhancement integral (NEI), time to peak (TTP) and maximum slope of decrease (MSD) before and after TACE were acquired and compared. Results The time intension curve (TIC) of HCC region was observed to descend rapidly before TACE, while descended slowly after TACE. The value of MTE and TTP after TACE were lower than those before TACE (P<0.05), and the value of NEI after TACE was higher than that before TACE (P<0.05). The value of MSD after TACE were lower than that before TACE, but no statistical significance was found (P>0.05). Conclusion MR PWI is a very sensitive imaging technique that be used to monitor blood flow changes of HCC before and after TACE and evaluate efficacy of TACE.