Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents.

Following the implementation of a long-term care insurance system for the elderly in Korea, many nursing homes have been established and many more patients than ever before have been living at nursing homes. Despite the fact that this is a high-risk group vulnerable to hip fractures, no study has yet been conducted in Korea on hip fracture incidence rates and prognoses among patients residing at nursing homes. We recently studied 46 cases of hip fracture in nursing homes; more specifically, we investigated the most common conditions under which fractures occur, and examined the degree of recovery of ambulatory ability and the mortality within 1 yr. Among those who had survived after 1 yr, the number of non-functional ambulators increased from 8 hips before hip fracture to 19 hips at final post-fracture follow-up. These individuals showed poor recovery of ambulatory ability, and the number who died within one year was 11 (23.9%), a rate not significantly different from that among community-dwelling individuals. It was evident that hip-joint-fracture nursing home residents survived for similar periods of time as did those dwelling in the community, though under much more uncomfortable conditions. The main highlight of this report is that it is the first from Korea on nursing home residents' ambulatory recovery and one-year mortality after hip fracture. The authors believe that, beginning with the present study, the government should collect and evaluate the number of hips fractured at nursing facilities in order to formulate criteria that will help to enable all patients to select safer and better-quality nursing facilities for themselves or their family members.

Clinical and Functional Outcomes of Treatment for Type A1 Intertrochanteric Femoral Fracture in Elderly Patients: Comparison of Dynamic Hip Screw and Proximal Femoral Nail Antirotation.

PURPOSE: We aimed to evaluate and compare the clinical and functional outcomes of dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA) treatment of AO type 1 intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: We retrospectively reviewed 194 consecutive patients with type A1 intertrochanteric femoral fractures who were treated with DHS (n=113) or PFNA (n=81). We evaluated operation time, intraoperative blood loss, and functional outcomes, walking ability, and the Barthel activities index. Fracture union, sliding of hip screw, proximal femur shortening, and presence of complications were assessed radiologically at relevant follow-up intervals. RESULTS: The mean operation time and blood loss were significantly lower for the PFNA group, but walking ability and Barthel index decreased to a similar extent for both groups. However, patients in the DHS group complained of significantly more pain (P=0.049). Although there were no significant differences between the two groups with respect to the time until fracture union was achieved, patients in the DHS group exhibited a higher extent of proximal femoral shortening and sliding of the hip screw. Differences about hip screw sliding and proximal femur shortening within each subgroup were not significant. CONCLUSION: Compared to DHS treatment, PFNA treatment of type A1 intertrochanteric fractures is associated with reduced blood loss, shorter operation time, and less severe pain after surgery. Additionally, sliding of the hip screw and proximal femur shortening are expected to occur more frequently after DHS.

The necessity of bone densitometry for patients taking selective serotonin reuptake inhibitors.

BACKGROUND: To analyze the necessity of bone densitometry for patients long-term taking selective serotonin reuptake inhibitors (SSRI) over a long period of time, which is one of the risk factors of osteoporosis. METHODS: We selected patients from 5 veterans hospitals who took SSRI for more than 2 months while taking bone densitometry on a regular basis. RESULTS: Of the 85 patients from a total of 5 veterans hospitals taking SSRI for more than two months, only 34 patients were under diagnosis and treatment measures of osteoporosis through checking each person's bone mineral density. CONCLUSIONS: It is necessary for patients taking SSRI to check bone density on a regular basis.

Wind-drag estimation in a traffic accident involving a motor scooter and a tractor-trailer.

This case report describes a noncontact traffic accident involving a motor scooter and a tractor-trailer with a focus on the wind-drag effect. We used load cells to measure the drag force acting on a substantially similar motor scooter when a substantially similar tractor-trailer passes by it, taking into consideration various speeds of the tractor-trailer and distances between the two vehicles. A three-dimensional steady-state flow analysis was also performed by using the CFX program for computational fluid dynamics to examine the streamlines and the pressure distribution around the tractor-trailer at various speeds. From the experiment, for a separation distance of 1.0 m (3.28 ft) and a speed of 90 km/h (55.9 mph), the maximum resultant drag force is 124.5 N (28 lb); this constitutes a degree of force that could abruptly disrupt the stability in maneuvering by an operator who is unaware of the approaching tractor-trailer. In addition, a single equation that relates the tractor-trailer speed to the drag force that acts on the motor scooter was derived on the basis of the Reynolds number (Re) and the wind-drag coefficient (C(d)): C(d) = 1.298 × 10(-7) Re.

An explosion of a CNG fuel vessel in an urban bus.

An investigation is presented of the explosion of a CNG (compressed natural gas) fuel vessel, called a liner, in an urban bus. The explosion happened at a gas station 10 min after filling was completed. There were no traces of soot and flames at the failed liner, which would be indicative of explosion by ignition of the gas. The filling process of the station was automatically monitored and recorded in a computer. There was no unusual record of the filling system that indicated excess pressure at the time of the accident. There were cracks on the liner that were initiated at the outer surface of the cylindrical shell located at a point 4 cm above the lower dome where cracks did not originate easily as a result of overload. Chemical analysis was performed on a specimen that was cut from the liner, and there was no peculiarity in the mix. Mechanical analysis was performed on the specimens and showed that the hardness was not in the specified range because of inadequate heat treatment of the metal. The hardness of the liner was strictly controlled in the manufacturing process. All the liners that were manufactured at the same period with the failed liner were recalled for examination.

Rapid exchange of oil-phase in microencapsulation chip to enhance cell viability.

This paper describes a microfluidic device for the microencapsulation of cells in alginate beads to enhance cell viability. The alginate droplet including cells was gelified with calcified oleic acid, using two-phase microfluidics. The on-chip gelation had generated monodisperse spherical alginate beads, which could not be readily obtained via conventional external gelation in a calcium chloride bath. However, the prolonged exposure of encapsulated cells to the toxic oil phase caused serious damage to the cells. Therefore, we proposed the formulation of a rapid oil-exchange chip which transforms the toxic oleic acid to harmless mineral oil. The flushing out of oleic acid after the gelation of alginate beads effected a dramatic increase in the viability of P19 embryonic carcinoma cells, up to 90%. The experimental results demonstrated that the cell viability was proportional to the flow rate of squeezing mineral oil.

A serial dilution microfluidic device using a ladder network generating logarithmic or linear concentrations.

In this paper, we propose a serial dilution microfluidic chip which is able to generate logarithmic or linear step-wise concentrations. These concentrations were generated via adjustments in the flow rate of two converging fluids at the channel junctions of the ladder network. The desired dilution ratios are almost independent of the flow rate or diffusion length of molecules, as the dilution device is influenced only by the ratio of volumetric flow rates. Given a set of necessary dilution ratios, whether linear or logarithmic, a serial dilution chip can be constructed via the modification of a microfluidic resistance network. The design principle was suggested and both the logarithmic and linear dilution chips were fabricated in order to verify their performance in accordance with the fluorescence intensity. The diluted concentrations of a fluorescein solution in the microfluidic device evidenced relatively high linearity, and the cytotoxicity test of MCF-7 breast cancer cells via the logarithmic dilution chip was generally consistent with the results generated with manual dilution.

Multi-well chip for forming a uniform embryoid body in a tiny droplet with mouse embryonic stem cells.

A multi-well chip (MWC) is described by which mouse embryonic carcinoma (EC) stem cells form a comparatively more rapid and uniform embryoid body (EB) over the conventional hanging drop (HD) method. The newly developed MWC consists of an array of extruded through-holes, each of which holds a droplet of the cell suspension. The study found that the small curvature radius of the droplet in the MWC improved the EB formation rate of a hanging drop from 70% to 98%. Furthermore, the EBs formed by the MWC were uniformly round in shape regardless of the number of suspended cells ranging from 0.5 x 10(3) to 20 x 10(3). The ratio of beating colonies from the MWC was over 2-fold larger than that from HD. The experiments demonstrate that the MWC will be a valuable experimental tool for robust and reproducible EB-based differentiation of a defined number of ES cells.

A traffic accident caused by fatigue failure of axle.

An investigation of a traffic accident involving a tractor-trailer and a passenger car that were traveling at high speed is presented. The cause was the fracture of a trailer axle. The investigation showed that the fracture was because of the fatigue failure. In addition, cracks were found in the remaining three trailer wheels. Hardness measurements showed that, because of inadequate heat treatment of the metal, they were prone to failure.