Age is Not the Most Important Factor in the Prognosis of Femoral Neck Fracture: An Analysis of Long-Term Clinical Follow-Up.

Objective: The prognosis of femoral neck fractures is affected by factors including age and type of fracture. This study aimed to explore the associations among postsurgical outcomes of internal fixation for femoral neck fracture (healing rate, necrosis rate, and joint function score) and age and type of fracture. Methods: We retrospectively analyzed 297 cases of femoral neck fracture treated with internal fixation between February 2008 and October 2018. The postoperative femoral neck nonunion rate (a measure of healing) and femoral head necrosis rate were determined by x-ray and computed tomography. The Harris hip score (a measure of joint function and pain) was calculated. The effects of age and fracture type on these factors were analyzed. Results: There was no significant difference in the rate of femoral head necrosis and postoperative joint function scores among the different age groups. There was a significant difference in the postoperative rate of femoral head necrosis by Garden (P = .001) and Pauwels (P = .01) fracture types. No significant differences were noted for the Harris hip score for fractures characterized by the Pauwels classification (P = .09). However, the Harris hip scores differed significantly among groups for fractures categorized by the Garden classification (P = .001). Conclusions: Fracture type but not age is closely related to femoral head necrosis and Harris hip score after internal fixation of femoral neck fractures.

Moderately decreasing fertilizer in fields does not reduce populations of cereal aphids but maximizes fitness of parasitoids.

Examination of the tradeoff between the extent of decreasing nitrogen input and pest suppression is crucial for maintaining the balance between essential yield and an efficient, sustainable pest control strategy. In this study, an experiment with four manipulated nitrogen fertilizer levels (70, 140, 210, and 280 kg N ha-1 = conventional level) was conducted to explore the effects of decreasing nitrogen on cereal aphids (Sitobion avenae and Rhopalosiphum padi) (Hemiptera: Aphididae), Aphidiinae parasitoids (Hymenoptera: Braconidae: Aphidiinae), and body sizes of parasitoids. The results indicated that nitrogen application, in the range of 70-280 kg N ha-1, has the potential to impact the populations of cereal aphids and their parasitoids. However, both differences between densities of cereal aphids and their parasitoids in moderate (140-210 kg N ha-1) and those in high nitrogen input (280 kg N ha-1) were not significant, and the parasitism rate was also unaffected. A higher parasitism rate reduced population growth of the cereal aphid (S. avenae). Additionally, a moderate decrease of nitrogen fertilizer from 280 to 140-210 kg N ha-1 maximized the body sizes of Aphidiinae parasitoids, indicating that a moderate decrease of nitrogen fertilizer could facilitate biocontrol of cereal aphid by parasitoids in the near future. We conclude that a moderate decrease in nitrogen application, from 280 to 140-210 kg N ha-1, does not quantitatively impact the densities of cereal aphids or the parasitism rate but can qualitatively maximize the fitness of the parasitoids.

Outcomes of Femoral Neck Fractures Treated with Cannulated Internal Fixation in Elderly Patients: A Long-Term Follow-Up Study.

OBJECTIVES: To evaluate the long-term efficacy of cannulated internal fixation in patients who sustain femoral neck fracture (FNF) and risk factors influencing the outcomes. METHODS: This retrospective study analyzed data from 73 elderly patients aged ≥60 years old, hospitalized for FNF and treated with cannulated internal fixation between August 2008 and July 2016. The inclusion criteria were: (i) patients aged ≥60 years; (ii) patients with recent femoral neck fracture, with times of injury ranging from 12-72 h; and (iii) patients who underwent Garden II-IV closed reduction and internal fixation. Patients were classified based on the Garden fracture type and Pauwels angle. Clinical data and radiographs before and after the surgery were collected. Subsequently, surgery was performed with the patient in supine position, under general or lumbar epidural anesthesia. Closed reduction was performed until satisfactory fracture reduction quality was achieved. The weight of all included patients were <75 kg, and thus, minimal internal fixation was performed. The ischemic necrosis of the femoral head was diagnosed by considering the symptoms, signs, and radiological findings. Harris hip scores were used to evaluate postoperative recovery of hip function. Furthermore, relationships between Garden fracture type and necrosis rate of the femoral head, Pauwels angle and necrosis rate of the femoral head, Garden fracture type and Harris hip score, and age and Harris hip score were analyzed. RESULTS: The mean duration of surgery was 1 ± 0.17 h and blood loss for all the patients was approximately 15 mL. The included patients were followed up for 13-128 months, with an average follow-up of 61 months. Among the included 73 patients, 65 (89.0%) exhibited satisfactory union, seven (9.6%) had femoral head necrosis, and one (1.4%) had nonunion. For seven patients with femoral head necrosis, there were two, two, and three patients classified as Garden IV, Garden III, and Garden II, respectively, and two and five patients classified as Pauwels II and Pauwels III, respectively. Among the seven cases, four underwent hip replacement. Garden fracture type was not significantly associated with femoral head necrosis (χ2 = 0.44, P > 0.05) or Harris score (χ2 = 1.43, P > 0.05). Patients with Pauwels I (0%) and II (4.3%) fractures exhibited a significantly lower necrosis rate than those with Pauwels III fractures (41.7%) (P < 0.05). CONCLUSIONS: Cannulated internal fixation was more suitable for older Chinese patients with Pauwels I/II fractures than those with Pauwels III fractures.

A flap based on the plantar digital artery arch branch to improve appearance of reconstructed fingers: Anatomical and clinical application.

AIM: To investigate blood supply features of the flap based on the plantar digital artery arch and arch branch artery, and the treatment of outcomes of reconstructed fingers by the plantar digital artery arch branch island flap. METHODS: Eight fresh foot specimens were employed with red emulsion infusion and microdissection. The vascular organization was observed in the second toe, such as initiation site, the course, and the number of the plantar digital artery arch branch. There were 15 fingers of 13 patients (8 males and 5 females) with finger defects accompanied by toe transfer, using the plantar digital artery arch branch flap inserted in the neck of the second toe to correct the appearance defect caused by a narrow "neck" and a bulbous tip. RESULTS: The intact plantar digital arches were identified in all specimens. The plantar digital artery arch had 5 branches. The range of external diameter of the arch branch was 0.4-0.6 mm. All the plantar digital artery arch branch island flaps and the reconstructed fingers survived. These cases were conducted with a follow-up period for 3-18 months (average, 9 months). All the plantar digital artery arch branch island flaps and reconstructed fingers demonstrated a satisfactory appearance and favorable sense function. The reconstructed finger-tip characteristic was good, with no obvious scar hyperplasia. The range of flexion and extension of reconstructed fingers was favorable as well. CONCLUSIONS: The plantar digital artery arch and arch branch artery possess regular vasa vasorum and abundant vascularity. A flap based on the plantar digital artery arch branch is an ideal selection for plastic surgery of reconstructed fingers.

Androgen alleviates neurotoxicity of ß-amyloid peptide (Aß) by promoting microglial clearance of Aß and inhibiting microglial inflammatory response to Aß.

AIMS: Lower androgen level in elderly men is a risk factor of Alzheimer's disease (AD). It has been reported that androgen reduces amyloid peptides (Aß) production and increases Aß degradation by neurons. Activated microglia are involved in AD by either clearing Aß deposits through uptake of Aß or releasing cytotoxic substances and pro-inflammatory cytokines. Here, we investigated the effect of androgen on Aß uptake and clearance and Aß-induced inflammatory response in microglia, on neuronal death induced by Aß-activated microglia, and explored underlying mechanisms. METHODS: Intracellular and extracellular Aß were examined by immunofluorescence staining and Western blot. Amyloid peptides (Aß) receptors, Aß degrading enzymes, and pro-inflammatory cytokines were detected by RT-PCR, real-time PCR, and ELISA. Phosphorylation of MAP kinases and NF-κB was examined by Western blot. RESULTS: We found that physiological concentrations of androgen enhanced Aß42 uptake and clearance, suppressed Aß42 -induced IL-1ß and TNFα expression by murine microglia cell line N9 and primary microglia, and alleviated neuronal death induced by Aß42 -activated microglia. Androgen administration also reduced Aß42 -induced IL-1ß expression and neuronal death in murine hippocampus. Mechanistic studies revealed that androgen promoted microglia to phagocytose and degrade Aß42 through upregulating formyl peptide receptor 2 and endothelin-converting enzyme 1c expression, and inhibited Aß42 -induced pro-inflammatory cytokines expression via suppressing MAPK p38 and NF-κB activation by Aß42 , in an androgen receptor independent manner. CONCLUSION: Our study demonstrates that androgen promotes microglia to phagocytose and clear Aß42 and inhibits Aß42 -induced inflammatory response, which may play an important role in reducing the neurotoxicity of Aß.

Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly: a systematic review and meta-analysis.

PURPOSE: The best treatment of distal radius fractures (DRFs) in the elderly is uncertain. The purpose of this meta-analysis was to compare the outcomes of surgical and nonsurgical management of DRFs in persons 65 years of age or older. METHODS: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until April 27, 2015 using the following search terms: distal radius fracture, conservative treatment, nonoperative treatment, nonsurgical treatment, surgical treatment, operative, elderly, and older. The primary outcome measure was DASH score, and secondary outcomes were functional and radiological assessments. The standard difference in post-treatment means was calculated for the outcomes to compare the two groups. RESULTS: Of 59 articles identified, eight studies with a total of 440 patients in the surgical groups and 449 in the control groups were included in the analysis. No significant differences in DASH score, VAS pain score, grip strength, wrist extension, pronation, or supination, and ulnar deviation were noted between the groups. The nonsurgical group had significantly greater wrist flexion, radial deviation, and ulnar variance and less radial inclination than the surgical group. CONCLUSIONS: Surgical and nonsurgical methods produce similar results in the treatment of DRFS in the elderly, and minor objective functional differences did not result an impact on subjective function outcome and quality of life.

Repair of a degloving injury of the thumb with a combined dorsal great toenail flap and dorsalis pedis flap: a case report.

Many methods for the repair of degloving injuries of the thumb have been reported, but none are entirely satisfactory. Herein, we report a method in which the injury is divided into the dorsal and palmar area for repair. A great toenail flap is used to repair the dorsal injury to restore the nail defect, and a dorsalis pedis flap is used to repair the palmar injury. The described technique provides good restoration of morphology and aesthetic outcome, good functional and sensory recovery, and is associated with minimal donor-site morbidity.