Volume 85  ·   Issue 46  ·  2005

With the coming of aging society, the incidence of hip fracture has increased, and there are some divergent opinions about the treatment of fresh femoral neck fracture in the elderly. At present, there is a trend of one-sided expansion in the selection of indications for prosthesis replacement, and some complications that should not occur after surgery appear. If we can obtain a more consistent opinion on the treatment principle after discussion, the occurrence of complications will be reduced, and it is possible to further improve the treatment results of fresh femoral neck fracture in the elderly.

Every country in the world is entering the elderly society to varying degrees. Morocco, which has the most serious population aging, has more than 22% of the population over 65 years old. In 2000, the population over 65 years old in Korea accounted for 7.3% of the total population of the country. In 2000, the population over 65 years old in China accounted for 7.13% of the total population, and it is expected that it will reach 8.38% by 2010 and 11.83% by 2020. With the increase of the elderly, the focus of medical care will shift to geriatric medical care.

Femoral neck fracture refers to the hip fracture located from the base of the femoral neck to the junction of the head and neck of the femoral neck. With the aging of the population, hip fracture, including femoral neck and intertrochanteric fracture, has gradually become a serious disease that threatens the health and life of the elderly. According to statistics, there are 250,000 hip fracture patients in the United States every year, and the direct economic loss is 20 billion US dollars. It is estimated that the number of patients will rise to 500,000 in 2010.

With the aging of society, the incidence of osteoporosis and femoral neck fracture caused by osteoporosis is gradually increasing. Clinically, the fracture of the elderly femoral neck fracture is generally regarded as the elderly femoral neck fracture. The elderly femoral neck fracture patients are often accompanied by many complications, such as hypertension, heart disease, cerebrovascular disease, diabetes, etc. If such patients are not treated in time, they cannot quickly recover their preoperative activity as much as possible. Long-term bed rest will rapidly deteriorate the general health status of the patients, and serious complications such as accumulated pneumonia, bedsores, deep phlebitis, pulmonary embolism, urinary system infection and even death will occur.

Objective to investigate the effect and mechanism of cigarette smoke aggregate (CSC) on the expression of rate-limiting enzyme r-GCS in alveolar epithelial cells (CCL149). Methods CCL149 cells were treated with different concentrations of CSC for 1, 4, 8, 12, 24 and 48 h, and the mRNA and protein levels of r-GCS expressed in CCL149 cells were detected by reverse polymerase chain reaction and West blotting at different time points of CSC. The effects of CSC on the function of the 5'-terminal promoter region of rat gamma-GCS heavy chain (GCLC) gene were determined by liposome transfection and luciferase activity detection; Results CSC could stimulate the expression of gamma-GCS in CCL-149 cells. At a certain concentration (>1 μ g/ml), there was no significant difference in the expression level of gamma-GCS in CCL-149 cells 1, 4 and 8 h after CSC treatment. The expression level of γ-GCS mRNA in the 12, 24 and 48 h groups was significantly higher than that in the control group (1.71±0.12 vs. 0.67±0.06, P<CSC could also enhance the activity of luciferase with the full-length luciferase reporter gene at the 5'-end of GCLC. Compared with the empty vector control group without promoter, the activity of luciferase was significantly enhanced and the activity of γ-GCS was increased in the group at 12, 24 and 48 h after CSC stimulation (0.63±0.24 vs. 1.75±0.27, P<Conclusion CSC upregulates the expression of r-GCS in CCL-149 cells by activating the oxidative stress-sensitive transcription factor AP-1.

Objective to explore the clinical characteristics of medial temporal lobe epilepsy (MTLE) caused by hippocampal lesions, especially tumor. Methods 21 patients with MTLE were treated by surgery. Preoperative EEG monitoring and head MRI examination were performed, and postoperative pathological examination of hippocampal resection was performed. Results the clinical manifestations were mainly complex partial seizures; The preoperative MRI images showed long T2 signal in hippocampus and full volume in 10 cases, enlarged temporal horn, long T2 signal in hippocampus and decreased hippocampal volume in 8 cases, long T1 long T2 signal in hippocampus and obvious space occupation in 1 case, and normal in 2 cases. Postoperative pathology confirmed hippocampal sclerosis in 11 cases, astrocytoma in 6 cases, gangliocytoma in 1 case, dysembryogenic neuroepithelioid tumor in 1 case, atypical hyperplasia in 1 case, and radionecrosis in 1 case. Eighteen patients were followed up, 16 of whom had no seizures. Statistical analysis showed that the difference in imaging changes between hippocampal tumor and hippocampal sclerosis was statistically significant. Conclusion For patients with medial temporal lobe epilepsy, if the hippocampus showed long T2 signal on MRI and the volume was fuller than the contralateral hippocampus, the possibility of hippocampal tumor should be considered, and the treatment strategy should be actively operated.

Objective to investigate whether combined hypothermia after diazoxide pretreatment can further alleviate the damage of rat hippocampal neurons after hypoxia and reoxygenation and its possible mechanism.Methods Rat hippocampal neurons were randomly divided into 4 temperature groups at 37, 34, 30 and 22 ℃, and each temperature group was divided into 2 dose groups of diazoxide 0 μ mol/L and 250 μ mol/L, a total of 8 groups; The survival rate, malondialdehyde content and intracellular calcium concentration of hippocampal neurons in each group were compared at different temperatures after DZ pretreatment at 4 h of hypoxia and 24 h after reoxygenation. Results the survival rates at 250 μ mol/L diazoxide in 22, 30 and 34 ℃ low temperature groups were (94±8) %, (73±9) % and (67±8) %, respectively, and (57±6) % in 37 ℃ group, all P<0.01; The highest survival rate at 22℃ (P<0.01). The concentration of malondialdehyde and the fluorescence value of calcium ion in the 22℃ group were lower than those in other groups (all P<0.01). The survival rate of diazoxide combined hypothermia group was higher than that of hypothermia group (P<0.01), the content of malondialdehyde and the fluorescence value of calcium ion were further decreased compared with those of the low temperature group (all P<0.01). The protective effect combined with diazoxide at 22℃ was the best (P<Conclusion Hypothermia can reduce the injury of hippocampal neurons after hypoxia and reoxygenation by inhibiting lipid peroxidation and calcium overload. Diazoxide combined with hypothermia can further enhance the above protective effects, and diazoxide combined with deep hypothermia has the strongest protective effect.

Objective to investigate the effects of polymorphisms of exons 21 (exon21) and 26 (exon26) of multidrug resistance gene (MDR1) on the plasma concentration of immunosuppressant tacrolimus (FK506) in patients after renal transplantation. Methods MDR1 genotyping was performed by polymerase chain reaction (PCR) and restriction endonuclear fragment polymorphism (RFLP) in 86 patients after renal transplantation. The plasma concentrations of FK506 were determined by enzyme-linked immunosorbent assay (ELISA) at different postoperative times. The differences of plasma concentration of FK506 to dose ratio per kilogram of body weight were compared between different genotypes. Results Among 86 patients, 26 (30.2%) were GG type, 35 (40.7%) were GT type and 25 (29.1%) were TT type in exon21. There were 26 (30.2%) CC type, 37 (43.0%) CT type and 23 (26.8%) TT type in exon26. There was a significant linkage disequilibrium between MDR1 exon26 C3435T and MDR1 exon21 G2677T. The ratio of GG type patients was significantly lower than that of CT type and TT type patients, and the difference was statistically significant (all P<0.05); Conclusion MDR1 gene polymorphism is correlated with plasma concentration of FK506 in renal transplantation patients. GG type and CC type patients should take higher dose of FK506 than GT type or TT type and CT type or TT type patients. Knowing the MDR1 genotype of patients is beneficial to the individualized application of FK506 after renal transplantation.

Objective to detect the positive rate of anti-endothelial cell antibody (AECA) in systemic vasculitis and explore its possible pathogenic mechanism.Methods 113 patients with systemic vasculitis were selected in the experimental group, 57 patients with systemic lupus erythematosus (SLE), 15 patients with rheumatoid arthritis (RA) and 20 normal subjects in the control group.The protein of EA.hy926 endothelial cell line was extracted, and the positive rate of AECA in the serum of the above groups was detected by immunoblotting, and then the target antigen of AECA was isolated and identified by two-dimensional electrophoresis combined with immunoblotting, liquid chromatography-electrospray ion trap mass spectrometry (LC-ESI-MS/MS). Results The results of immunoblotting showed that the positive rate of AECA in patients with systemic vasculitis and SLE was significantly higher than that in RA patients and normal controls (P<0.01): The positive rate of AECA was 69.0% (78/113) in the systemic vasculitis group, 66.7% (38/57) and 6.7% (1/15) in SLE and RA patients, respectively. The relative molecular mass of the main proteins recognized by AECA in patients with systemic vasculitis is 26 000~125 000, and the relative molecular mass of the main proteins recognized by SLE is 15 000~97 000.47000-AECA is commonly found in the sera of different patients with AECA positive systemic vasculitis and SLE, and its component is α-enolase. Conclusion The positive rate of AECA is high in the sera of different patients with systemic vasculitis and SLE. AECA is a group of heterogeneous antibodies that bind to various proteins of endothelial cells; AECAs in patients with different systemic vasculitis and SLE may have a common target antigen (47 000 endothelial cell proteins), whose component is alpha-enolase.

Objective to analyze the clinical, endocrine and metabolic characteristics of obese patients with polycystic ovary syndrome (PCOS). Methods: 70 obese patients with PCOS (group A), 122 non-obese patients (group B) and 104 patients with infertility due to fallopian tube factors (including 25 obese patients in group C, 79 normal weight patients in group D) were used as controls. The clinical signs and endocrine and metabolic indexes of the above subjects were measured. Androgen index (FAI) was used to assess androgenism, insulin sensitivity was assessed by steady state model index (HOMA IR) and area under the insulin curve (IAUC), and islet β cell function was assessed by HOMA-IS and Δ I30/Δ G30. Results (1) The FAI of patients in group A (3.40±1.84) was higher than that in group B (1.75±1.20) and group C (1.65±0.90).<0.01. The ratio of luteinizing hormone (LH) /follicle stimulating hormone (FSH) in group B (2.41 ± 1.13) was higher than that in group A, C and D<0.01. (2) The total incidence of insulin resistance in 192 patients was 43.23%,82.86% and 20.49% in group A and B, respectively. The incidence of acanthosis nigricans, fasting insulin, IAUC, HOMA IR and triglyceride levels in group A were higher than those in group B (P all<There was no significant difference in HOMA IS, Δ I30/Δ G30 between groups A, B and D (P>0.05). (3) Body mass index and waist-hip ratio were positively correlated with FAI and HOMA-IR (P<0.01); It was negatively correlated with LH/FSH ratio (r = -0.345, -0.260, P<Conclusion Obese patients with PCOS have more severe endocrine and metabolic disorders than non-obese patients, and the function of pancreatic islet β cells is in compensatory stage, so the prevention and treatment of long-term complications should be highly paid attention to.

In the past ten years, the reform of medical and health system has been uncertain and difficult between public welfare and marketization, and the deepening of hospital reform has also been confused and stagnant in the contradictions of many societies, industries and hospitals. On the premise of defining the position of public non-profit medical institutions, it will become an important part of the reform of medical and health system to return to research and promote hospital reform rationally and scientifically. This paper starts with the analysis of the economic characteristics of hospitals, puts forward that the reform of hospital organizational structure and organizational operation is an important topic in the current hospital reform, and expounds the ideas, methods and performance of hospital organizational structure reform with cases.

Objective to investigate the results of traction therapy in elderly patients with hip fracture who could not undergo surgical treatment due to other systemic factors.Methods A total of 102 elderly patients with hip fracture underwent traction therapy from November 2000 to January 2005.Among them, 37 cases of femoral neck fracture and 65 cases of femoral intertrochanteric fracture, aged 48-98 years, with an average of 75.8 years, all cases received traction therapy at home.Results 9 cases died within 1 year, with a mortality rate of 8.8% (9/102). Other complications were bedsores in 30 cases, with an incidence rate of 29.4% (30/102), pulmonary infection in 6 cases, with an incidence rate of 5.9% (6/102), deep vein thrombosis in lower limbs in 2 cases, pulmonary embolism in 1 case and urinary tract infection in 1 case. The healing rate of femoral neck fracture was 51.7% (15/29) in 15 cases, and the healing rate of femoral intertrochanteric fracture was 97.6% (40/41) in 40 cases. Compared with the Harris score before injury, the average decrease was 23.1 points in femoral neck fracture group and 15.6 points in femoral intertrochanteric fracture group. Conclusion Traction treatment can obtain good results for undisplaced or stable femoral neck fracture and partial intertrochanteric fracture, and its cost is low.

Objective to retrospectively analyze the treatment of unstable intertrochanteric fractures in elderly patients with artificial femoral head replacement. Methods 86 cases in this group, 35 males and 51 females, aged 80-98 years, with an average of 87 years, were classified according to Evans, 31 cases were type ⅢA, 35 cases were type ⅢB and 20 cases were type Ⅳ. Most of the patients were operated within 3 days after injury. The large trochanter was reconstructed with "∞" wire fixation, and the small trochanter was fixed with wire cerclage close to the proximal femoral cortex. The bone defect at the femoral distance was remodeled with bone cement. Some cases were transformed into intertrochanteric fractures after femoral neck osteotomy, and the femoral distance was preserved. Results The operation time of 86 cases was 45-70 min, with an average of 55 min.73 cases were transfused with blood transfusion volume of 400-800 ml, with an average of 450 ml. 33 cases got out of bed within 3 days after operation; 4~7 d 43 cases got out of bed; 8 cases got out of bed more than 8 days; 2 cases failed to get out of bed.Hospitalized for 13~27 days, mean 16.8 d.2 cases mild deep vein thrombosis; 5 cases of mental disorders; Three cases of bacterial imbalance gradually improved after symptomatic treatment, but did not affect the therapeutic effect.2 cases died during hospitalization, died of multiple organ failure.59 cases were followed up for 6~48 months, and the excellent and good rate was 88.1%.1 case died of other diseases 5 months after discharge, and there were no cases of artificial joint dislocation, loosening and late infection. Conclusion Artificial femoral head replacement for the treatment of unstable intertrochanteric fracture of femur in elderly patients is simple, less trauma, short hospital stay, low complications, low mortality, and can significantly improve the quality of life of patients.

Objective to analyze the correlation factors and prevention methods of femoral head avascular necrosis after cannulated nail internal fixation for femoral neck fractures. Methods the data of 212 cases of fresh femoral neck fractures treated with cannulated nail were summarized. The age of the patients was 13-70 years old, with an average age of 45.2 years old. The Garden classification of fractures was: 3 cases were type Ⅰ, 32 cases were type Ⅱ, 107 cases were type Ⅲ and 53 cases were type Ⅳ. The follow-up period was 12-101 months, with an average of 32.7 months. Results the fracture nonunion occurred in 9 cases, and the fracture healing rate was 95.8%. 70 cases (33.0%) had avascular necrosis of femoral head, and 30 cases (14.3%) developed late collapse of femoral head. The discovery time of avascular necrosis of femoral head was mostly within 3 years after injury (95.7%). The main correlation factor of avascular necrosis and late collapse of femoral head was Garden classification (P =0.0002).<On 14 days after reduction, patients with Garden's index in both lateral and anteroposterior positions of 155~180 degrees had lower rates of avascular necrosis and late collapse of femoral head. Conclusion Garden's classification is the most important factor affecting the occurrence of avascular necrosis and late collapse of femoral head. Emergency surgery and good fracture reduction can help to reduce the occurrence of avascular necrosis of femoral head.

Objective to investigate the causes and countermeasures of the main complications of peritrochanteric fractures in the elderly.Methods the preoperative, postoperative and postoperative conditions of 261 cases (265 hips) of peritrochanteric fractures in the elderly over 75 years old were retrospectively analyzed.The average age of the patients was 79.5 years old (75~96 years old), and the average preoperative diseases were 2.6. 230 hips of intertrochanteric fractures and 35 hips of subtrochanteric fracture.The average operation time was 73 min. 224 cases (227 hips) were followed up for more than 6 months, the follow-up rate was 86%, the average follow-up was 13.2 months (6-58 months), 206 cases were healed (92%), and the excellent and good functional rate was 81% at 6 months after operation. Intraoperative and postoperative complications included cardiovascular and cerebrovascular accidents, pulmonary infection, respiratory failure, nutritional disturbance, deep venous thrombosis, etc. Conclusion Different surgical methods should be selected for different types of peritrochanteric fractures in the elderly.

The patient was a 42-year-old female with repeated dry cough and loss of taste for more than 3 years, accompanied by difficulty in defecation, diplopia for 8 months, and dyspnea for 30 days. The treatment effect was not good in the local hospital, so she asked our hospital for consultation. Three years ago, the patient sought medical treatment for repeated dry cough and loss of taste, and found thymoma (lymphocyte-dominant type), which was an operation to remove the tumor and preserve the thymus (28 times of postoperative radiotherapy). The dry cough and loss of taste did not improve after operation, and the mouth was dry when eating.

At present, the three conventional therapies-surgery, chemotherapy and radiotherapy are insufficient in the treatment of tumors, which often cause damage to normal tissues and organs. Immunotherapy can produce specific reactions against tumors, even remove residual tumor lesions, and produce immune memory, which is obviously complementary to the three conventional therapies. Vaccines are usually used to prevent the invasion of pathogenic microorganisms, while tumor vaccines are mainly therapeutic vaccines, which are a way of active immunotherapy.

Previous studies suggest that epithelial-mesenchymal transition (EMT) is a basic physiological phenomenon, which is involved in organ shaping during embryonic development. In recent years, it has been found that EMT also plays an important role in the invasion and metastasis of malignant tumors derived from epithelial cells [1]. At present, the role of EMT in tumor invasion and metastasis and its regulatory mechanism are receiving more and more attention.

On November 22, in Jena, Thuringia, eastern Germany, the Fritz-Lipmann-Institut was officially established. This research institute, named after a German-American biochemist and Nobel Prize winner, is dedicated to the molecular mechanisms of aging and geriatric diseases. It can receive about 20 million euros per year.

Recent studies have shown that the abnormality of ribosomal protein gene (RPG) is related to the occurrence and development of tumors.Our study found that the expression of RPS13 and RPS26, members of RPG family, is significantly down-regulated in human nasal NK/T cell lymphoma.In this study, the expression of RPS13 and RPS26 gene in a group of non-Hodgkin's lymphoma samples with different histological types was detected by real-time fluorescence quantitative PCR.

In this study, platelet-derived growth factor (PDGF) -BB was applied to ovariectomized rats to observe the effect of PDGF-BB on osteoarthritic cartilage.

stress urinary incontinence is a common disease in middle-aged and elderly women, which seriously affects the quality of life of patients [1]. Surgery is the most effective treatment for stress urinary incontinence (SUI) accompanied by overactive bladder. There are hundreds of surgical methods for female stress urinary incontinence, goebell-stoeckel fascia lata sling operation and tension-free vaginal tape (TVT) are the most commonly used surgical methods at home and abroad in recent years.

The tumors in the middle and posterior cranial fossa mainly include trigeminal schwannoma and meningioma, which are difficult to resect and have many postoperative complications due to the special location of growth [1]. At present, there are many surgical approaches for this site, but how to choose a reasonable surgical approach according to the growth characteristics of tumors is a difficult point in surgical treatment. Between March 2002 and May 2005, we resected 17 cases of tumors in the middle and posterior cranial fossa through temporal floor and tentorial approach, including 10 cases of meningioma and 7 cases of trigeminal schwannoma, and achieved good therapeutic results.

A 20-year-old female was admitted to the hospital on April 27, 2005 due to paroxysmal vomiting for 5 months and aggravated for 1 month. The patient developed vomiting without obvious trigger 5 months ago, and the vomit was stomach contents, accompanied by acid reflux and belching. He was admitted to another hospital and underwent gastroscopy twice. The pathology showed: (1) severe inflammation of pyloric mucosa, accompanied by edema and congestion and polypoid hyperplasia of partial mucosal epithelium in the surface layer; (2) Ectopic glands and polyps of the stomach angle or stomach body. The diagnosis was "gastric ulcer with pyloric obstruction". After acid suppression and intravenous nutrition treatment, the symptoms were not relieved. The past was healthy.

A 58-year-old male was admitted to the Department of Urology of Peking University First Hospital as a kidney transplant donor. No abnormalities were found in physical examination and auxiliary examination. The renal arteriography is shown in Figure 1.