Objective To assess the clinical efficacy of minimally invasive internal fixation combined with percutaneous kyphoplasty (PKP) in treatment of thoracolumbar burst fractures in the elderly.Methods Twenty-one cases of neurologically intact thoracolumbar burst fractures treated by PKP between January 2007 and December 2008 were included in this study.There were 8 males and 13 females at age of 65-78 years (means,70.6 years).Mean period from injury to operation was (3.7 ± 1.1) days (range,3-7 days).The injured segments included Ti1 in two cases,T12 in six,L1 in eight and L2 in five.Kphosis Cobb' s angle,correction degree of kyphosis angle,correction loss of kyphosis,perioperative indicators,visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated after operation.Results All the cases were followed up for a period of 26-56 months (mean 34.2 months).Operation averaged 98.7 minutes (range,80-120 minutes) and showed mean blood loss of 32.8 ml (range,30-85 ml).Ambulation started at mean 18.2 hours after operation (range,8-19 hours).VAS averaged (0.9 ± 0.6) points at postoperative one week.Postoperative X-ray films revealed mean 10.4° correction of kyphotic Cobb angle,followed by mean 1.8 °of loss in the follow-up longer than 24 months.According to hyperextension and hyperflexion radiographies,there was no abnormal activity of fixed segments,implant loosening and breakage or adjacent vertebral fractures.Conclusion Minimally invasive internal fixation combined with PKP can relieve pain and restore function in a short time and is thought to be a preferable treatment option for thoracolumbar burst fractures in the elderly.

Objective To evaluate the clinical effect of interspinous H-shaped bone grafting and bilateral facet interbody fusion in treatment of thoracolumbar fracture with severe disc injury and posterior ligamentous complex (PLC) injury after posterior pedicle screw fixation and its role in prevention of delayed kyphosis.Methods The study involved 19 cases of thoracolumbar fractures with severe disc injury and PLC injury,including 11 males and 8 females,at age of 23-59 years (mean 43.8 years.All cases were treated with posterior pedicle screw fixation (including 11 cases treated with unilateral laminectomy decompression) and C-arm X-ray showed favorable fracture reduction.For prevention of postoperative delayed kyphosis,the interspinous H-shaped bone grafting plus bilateral facet interbody fusion by using the iliac autografts was done.Neurologic recovery was assayed by using Frankel scale and lumbar and iliac pain by visual analogue scale (VAS).Cobb angle was detected as well.Results All cases were followed up for 24-64 months.At final follow-up,all cases showed neurological improvement for at least 1 to 2 Frankel grades except for two cases with Frankel Grade A,with mean Cobb angle of (2.0 ± 3.7) ° (range,-4.9°-8.1 °),mean VAS of lower back pain of (1.1 ± 1.2) points (range,0-4 points) and insignificant angle loss or kyphosis.The thin layer CT scan indicated complete integration of the transplanted bone grafts,with no complications like implant loosening or breakage.Conclusion Interspinous H-shaped bone grafting and bilateral facet interbody fusion is a good choice for prevention of delayed kyphosis after posterior pedicle screw fixation of thoracolumbar fracture with severe disc injury and PLC injury.

ObjectiveTo evaluate the effects of intranasal administration of recombinant interleukin-17A(rIL-17A) on the expressions of β-Defensin-2(Defb2) and macrophage inflammatory protein(MIP) in pneumococcal pneumonia murine models.MethodsTwenty-four BALB/c mice were divided randomly into normal control,pneumococcal pneumonia,and rIL-17A intervention groups ( n =8 ).Before intranasal (i.n) infection with Streptococcus pneumoniae,the mouse was treated with PBS or rIL-17Ai.n respectively.The mRNA levels of Defb2,MIP-1α and MIP-2β expression in lung tissue were detected by real-time quantity PCR.The numbers of bacteria and leukocytes in bronchoalveolar lavage fluid (BALF) were counted as well.And the concentrations of MIP-1α,MIP-2β,IFN-γ and IL-4 in BALF and in supematants of spleen cells and mediastinal lymph node cells were assayed by ELISA.Changes in lung tissue histopathology were observed with HE staining through light microscope.ResultsNeutrophil and macrophage numbers are higher in BALF of rIL-17A group,while the numbers of bacteria were lower,when compared with those in pneumonia group( P＜0.01 ).The expression of Defb2 and MIP-1α mRNA were up-regulated in lung after rIL17A treatment(P＜0.01 ).When compared with rIL-17A non-treated mice,rIL-17A treated mice secretedhigher levels of MIP-1α in lymph node cell culture supernatants( P＜0.01 ),higher levels of MIP-2β were observed in spleen cell and lymph node cell culture supernatants( P＜0.01 ),higher levels of IFN-T were detected in BALF( P ＜ 0.01 ) and culture supernatants of spleen cell ( P ＜ 0.01 ) and lymph node cell ( P ＜0.05),and higher levels of IL-4 were detected in BALF and spleen cell culture supernatant(P＜0.01 ).Comparative analysis have not detect a significant irflammatory cell increases in rIL-17A treated mice lung tissue; however the histopathological lesions were decreased.ConclusionIntranasal inoculation of rIL-17A can promote pulmonary neutrophil and macrophage recruitment and bacterium clearance,Intranasal inoculation of riL-17enhances the host defense against Streptococcus pneumoniae infection partly through increasing the expression levels of defensins,MIP,IFN-T and IL-4 etc.

Objective To explore the value of transthoracic echocardiographic suprasternal view in　the diagnosis of the subtype of the patent ductus arteriosus(PDA).Methods Sixty-five cases with PDA were examined by transthoracic echocardiographic suprasternal view and parasternal great artery short axis view respectively before closure therapy.The diameters of both the aotic and pulmonary side were detected,and subtype diagnoses were made.The results were compared with those from digital subtraction angiography (DSA).Results The demonstrated rates of PDA were 100％ on the parasternal great artery short axis and suprasternal views.Of the 65 cases,12 cases,19 cases and 19 cases were the funnel type of PDA checked on the parasternal great artery short axis view,suprasternal view and DSA respectively.The demonstrated rate of the parasternal great artery short axis view was lower than that of the suprasternal view (x2 =5.14,P ＜0.025 ).The diameter of the aotic side of PDA was (8.31 ± 2.76)mm,(10.87 ± 3.26) mm and (11.15±3.29)mm and the diameter of the pulmonary side of PDA was (5.69± 2.82)mm,(5.75 ± 2.63)mm and (6.09 ± 2.78) mm respectively on the above two views and DSA.Conclusions The diameter of the aotic side of PDA can be accurately detected by using superasternal view,which would be helpful for the diagnosis of PDA subtype.

Objective To express and purify mouse interleukin 17A(mIL-17A) in E. coli and to analyze its ability of stimulating macrophage inflammatory factors expression. Methods The coding gene of mouse mIL-17A mature protein was amplified from mouse spleen cells by RT-PCR. PCR product was cloned into the prokaryotic expressing vector pET28a, and the resulting recombinant plasmid pET28a/mIL-17a was then transformed into the host E. coli strain BL21(DE3) for expression. The mIL-17A protein was identified by SDS-PAGE and Western blot. The recombinant protein was purified by the Ni-NTA affinity chromatography, and was further tested on the stimulation of cytokine and chemokine of RAW264.7 cells by ELISA and real-time quantity PCR in vitro. Results The mIL-17A with bioactivity was over-expressed and purified successfully, and the results of real-time PCR and ELISA showed that recombinant mIL-17A stimulated macrophage mRNA upregulation of IL-6, defensin β2 and Cxcl3 and secretion of defensin β2, Ccl3, Cxcl3,IFN-γ, IL-6 and IL-4. Interestingly, these effects could be blocked by the addition of anti-IL-17A neutralizing antibody partly. After treatment with mIL-17, 74. 87-fold of defensin β2 mRNA expression was increased comparing with that of untreated cells( P ＜0.01 ), while blocking with anti-IL-17A antibody the increase was only 5.4-fold(P ＜ 0.01 ). Conclusion The recombinant mIL-17A has a strong stimulation on secretion of cytokine and chemokine of macrophage, that maybe result to the enhancement of anti-infection ability of macrophage.

Objective:To evaluate the results of butterfly cartilage myringoplasty for anterior quadrant tympanic perforation under endoscope.Methods:Thirty-eight patients with anterior quadrant tympanic perforations who were subjected to endoscopic butterfly cartilage myringoplasty from April 2016 to October 2018 were included in this study, including 16 males and 22 females, with an average age of (34.5±14.2) years. The patients were reviewed retrospectively, and the pre-and post-operative pure tone audiometry (PTA) thresholds, pre-and post-operative air-bone gaps (ABG), post-operative graft success rates and complications were evaluated. SPSS 23.0 was used to analyze data.Results:Mean post-operative follow-up duration was (9.4±3.1) months (range 6-18 months). The graft survival rate was 94.7% (36/38) . The preoperative and postoperative mean PTA was (30.9±8.9) dB HL and (21.4±7.7) dB HL respectively. Preoperative and postoperative mean ABG was (18.4±6.3) dB and (10.8±6.0) dB respectively. There was significant difference between pre-and postoperative PTA and ABG ( t=5.353 and 4.162, P<0.05 for both). A postoperative ABG reduction of (8.3±1.5) dB was reached. Two (4.7%) patients had postoperative myringitis, two (4.7%) had recurrent perforation, and one (2.4%) had lateral healing of transplanted tympanic membrane in the postoperative follow-ups. No intratympanic cholesteatoma was observed. Conclusions:Endoscopic butterfly inlay myringoplasty is a reliable, minimally invasive alternative method to repair anterior tympanic membrane perforations, with high closure rate and low risk of complications.

Objective: To introduce a self-developed bone dust collector designed by the authors and evaluate its efficiency in mastoid obliteration following mastoidectomy. Methods: Consecutive patients, from April 2017 to March 2018, who prepared to receive mastoidectomy were randomly divided into two groups, and in each group the bone dust was harvested by self-developed bone dust collector or by conventional used method respectively in mastoidectomy. The amount of the harvested bone dust and the time consumed in the collecting procedure were compared between two groups. The infection of the bone dust after mastoid obliteration was also evaluated during follow up. Results: 33 patients were recruited in bone dust collector group, and 31 patients in conventional method group.There is no significance of difference between two groups in sex ratio, age and pneumatization of mastoid cells (P>0.05 for all). The median amount of bone dust harvested by bone dust collector was significantly larger than that collected by conventional method (1.8 g vs 1.1 g, P<0.05). The median time spent in bone dust collector group was significantly shorter than that spent in conventional method group (4 minutes vs 6 minutes, P<0.05). No bone dust infection was found in the follow-up in all patients. Conclusion The present self-developed bone dust collector is a easy and useful apparatus which can significantly improve the efficiency of collecting bone dust in mastoidectomy.