Objectives:To evaluate the long-term complications of percutaneous kyphoplasty(PKP) for osteoporotic vertebral compression fractures (OVCF),and to provide evidence for clinical procedure.Methods:Databases including CNK1,CBM,PubMed,The Cochrane Library(lssue 2,2017),Wiley Online Library,ELSEVIER Science Direct(SDOS) were used to collect the randomized controlled trials(RCTs) which compared PKP with conservative treatment in the treatment of OVCF from inception to February 2017.The diagnosis of thoracolumbar vertebral compression fracture was confirmed by X-ray,CT and MRI.The presence of thoracolumbar osteoporotic T which was less than or equal to-2.5,was confirmed by bone mineral density measurement.All the patients were 50 years or older,and disease duration was less than 6 months;postoperative outcomes included at least one of the following indicators:new vertebral fractures,adjacent fractures,serious adverse events,visual analogue score.Cochrane system evaluation manual 5.0.1 was referred to evaluate the quality of the included literatures.Results:Five RCT studies included four English literatures and one Chinese literature.Methodological quality assessment of 4 articles were more than or equal to 4 points,one article scored 3 points.PKP group consisted of 417 cases,conservative treatment group of 458 cases.The results of meta-analysis showed that there was statistical difference in VAS between the two groups after 3 to 6 months' treatment(mean difference=-0.36;95％CI-0.07 to-0.65;P=0.02).However,there was no statistical difference in new vertebral fractures,adjacent fractures or serious adverse events.Conclusions:Application of PKP in OVCF can reduce the patients' long-term (3-6 months) VAS pain score and does not increase the risks of new vertebral fractures,adjacent fractures and serious adverse events.

Objective To observe the impacts of Kechuanning on expression of signal transducer and activator of transcription 6 (STAT 6) in CD4+, CD8+T lymphocytes of athma rats induced by virus, and analyze the mechanism of Kechuanning in treating asthma induced by RSV. Methods The PBMC was isolated from the peripheral blood, CD4+T, CD8+T lymphocyte was separated by immunomagnetic beads. The purity and activity of CD4+T and CD8+T lymphocytes were measured by using flow cytometry, trypan-blue dye exclusion test. The protein expression of STAT6 was detected by fluorescence-activated cell sorting. Results The descending progress of the trial were supported by the purity and activity of CD4+T, CD8+T lymphocyte. CD4+T lymphocyte in the asthma model group were increased (P<0.01), however the increase of CD8+T lymphocyte were not significant (P>0.05). The expression of the protein of STAT6 in the treated group with Kechuanning decoction were decreased than that in the model group (P<0.01). Compared with Dexamethasone and Salbutamol group, there were no significant differences (P>0.05). Conclusion Kechuanning decoction could decrease the protein of STAT6 in CD4+, CD8+T lymphocyte, thereby it could regulate the disorder of Th1/Th2, thus prevent and treat the asthmatic attack induced by virus.

Objective To explore the indications,feasibility and clinical outcome of minimally invasive laminoplasty for cervical spondylotic myelopathy (CSM) using microendoscopic technique.Methods From January 2011 to December 2013,51 patients with CSM treated by this technique in our hospital were reviewed in this study.All these patients were followed up at least 9 months.There were 28 males and 23 females with a mean age of 58 years (range 41-76 years).All patients were found to have cervical disc herniation with spinal cord compression.Among these patients,2 segments (C5-6),3 segments (C3-5/C4-6),4 segments (C3 -6) and 5 segments (C3-7) laminoplasty performed in 5,7,22 and 17 cases respectively.Therapy effect and axial symptom were evaluated according to Japanese Orthopedic Association (JOA) scores and visual analogue scales (VAS) respectively.Cervical curvature index (CCI) and range of motion (ROM) were judged by X-ray.The sagittal diameter of cervical spine,canal enlargement and bony healing were judged by CT scans.Spinal cord signal intensity changes and spinal cord decompression status judged by MRI.Statistical analysis of JOA score,VAS score,CCI and ROM were performed by paired design t test.Results The mean operative time was (1 15±21.9) min,ranging 58-139 min.The mean blood loss was (227.8±73.2) ml,ranging 110-380 ml.The followe-up time ranged 9-36 months with an average of (20±5.9) months..The mean JOA scores had improved from 8.02± 1.69 pre-operatively to 13.02± 1.48 post-operatively.The results were excellent in 17 cases,good in 28 and fair in 4.The VAS scores of axial pain significantly improved to 2.22±0.90 at the final follow-up compared with 4.96± 1.39 preoperatively.Axial symptom were excellent in 18 cases,good in 21 and fair in 12.Pre-operative was 15.40％±4.50％ and postoperative was 15.09％±4.87％,there was no significant difference.ROM of pre-operative was 40.98°±8.27° and postoperative was 38.88°±9.53°,and there was no significant difference.The sagittal diameter of the spinal canal increased 1.3-3.2 mm postoperatively with an average of (2.32±0.42) mm.A total of 204 vertebral lamina were bilaterally slotted and fixed.146 lamina were observed bone healing at the last follow-up.The bone healing rate was 71.6％.Complications such as upper limb motion dysfunction occurred in 1 case muscle strength restored after treatment of methylprednisolone sodium succinate,and little screw looseness in occurred 1 case,and non special treatment was given..Conclusion CMEL is a newsurgical approache which causes less damage to the spinous process-ligament complex and the deep extensor muscles,and the procedure can be used for CSM effectively and safely.

Erchen Decoction is widely used to dampness-phlegm syndrome and it can be flexibly used in clinical application by my supervisor Professor OU Zheng-wu, especially in cough, pneumonia, asthma and influenza, which has obvious efficacy in treatment. This article reviewed five medical cases during the follow-up process with Professor OU in application of Erchen Decoction, with a purpose to share experience of famous doctors and improve TCM diagnosis and treatment level together.

Objective To observe the effect of Kechuanning Oral liquid on the expression of P13K in CD4+and CD8+T cells of asthma rats induced by respiratory syncytial virus (RSV), and explore its mechanism of preventing and treating asthma induced by virus. Methods SD rats were randomly divided into phosphate-buffered saline (PBS) control group, model group, dexamethasone and salbutamol group (positive drug group), and Kechuanning oral liquid group. Ovalbumin asthma rats model was built and induced by RSV. CD4+and CD8+T cells were separated by magnetic beads method. The expressive level of PI3K-110αin T cells was detected by immumofluorescence method with flow cytometry. Results Compared with PBS control group, positive drug group and Kechuanning oral liquid group, the CD4+and CD8+T cells percentage and the expression level of PI3K-110α in CD4+ and CD8+T cells of model group were significantly higher. The differences were statistically significant (P<0.01). The CD4+and CD8+T cells percentage was not associated with the expression level of PI3K-110α in CD4+ and CD8+T cells of each group by Pearson correlation analysis. Conclusion The CD4+ and CD8+T cells involve in the asthma immunity balanced modulation, and the level of PI3K expressed by CD4+ and CD8+T cells increase distinctly. Kechuanning oral liquid can restrain the expression of PI3K in CD4+ and CD8+T cells, which might be one of the immunologic mechanisms of treating asthma.

Objective: To evaluate the composite external fixation in the treatment of children with fracture of lower extremity metaphysis. Methods: A retrospective analysis was conducted of the 42 children with fracture of lower extremity metaphysis who had been admitted to Zhengda Shaoyang Orthopaedic Hospital between September 2016 and September 2018. They were 24 boys and 18 girls, aged from 3 to 14 years (mean, 8.3 years). Open injury occurred in 10 cases, with type Ⅰ in 2, type Ⅱ in 7 and type Ⅲ in one according to the Gustilo-Anderson classification, and closed injury in the other 32 ones. The fracture happened at distal femur in 12, at proximal tibia in 9 and at distal tibia in 21 cases. All the patients were fixated with composite external brackets. Fracture healing, functional recovery of the knee and ankle joints, and complications were recorded. Results: All the 42 patients were followed up for 12 to 18 months (mean, 15.8 months). All fractures healed well by the first intention with no malunion or no alignment change on the full length X-ray films of both lower limbs. Irritant growth within 1.5 cm was observed in 2 cases. No loosening occurred in the external fixation which was removed 3 to 5 months after surgery (mean, 3.8 months). Functional recovery of the knee and ankle joints was good at the last follow-up. For the patients with distal femoral metaphysis fracture, the knee function by the Merchan scoring was excellent in 3 cases, good in 7 cases, fair in one and poor in one; for the patients with proximal tibial metaphysis fracture, the knee function by the Merchan scoring was excellent in 3, good in 4 and fair in 2 cases; for the patients with distal tibial metaphysis fracture, the ankle function by the Kofoed scoring was excellent in 11, good in 7 and fair in 3 cases, giving an excellent and good rate of 83.3%. Of a total of 228 needle channels in the 42 patients, 58 were infected mildly or moderately, giving an infection rate of 25.4%. All the infections responded to active dressing change. Conclusion The composite external fixation brackets are a good choice for the treatment of children with fracture of lower extremity metaphysis, because they are easy in manipulation and stable in configuration, and can reduce the iatrogenic injury to the epiphyseal plate, spare cross-articular fixation and allow early functional exercise.

BACKGROUND:The interaction and mutual influence of intestinal flora in the host intestine with mucosal immune barrier play an important role in the homeostasis regulation within the intestine. OBJECTIVE:To explore the role of intestinal flora in the pathogenesis of irritable bowel syndrome and the mechanism of moxibustion in the treatment of irritable bowel syndrome from the aspects of intestinal flora imbalance and mucosal immune activation. METHODS:With the key words of “irritable bowel syndrome, intestinal flora, intestinal immune, moxibustion” in Chinese and in English, respectively, a computer-based search was performed for articles published in CNKI, VIP and PubMed databases from October 2001 to October 2014. After the initial screening, the reserved articles were further detailed, summarized and concluded. RESULTS AND CONCLUSION:Totaly 37 articles were colected, including 15 in Chinese and 22 in English. The analysis results showed that, the imbalance of intestinal flora and mucosal immune can play an important role in the pathogenesis of irritable bowel syndrome, and the former one can affect the body’s feeling of rectal distension threshold and visceral sensitivity. Moxibustion excels at improvement of the symptoms of irritable bowel syndrome, particularly abdominal pain with high visceral sensitivity, by regulating the body’s physiological balance from multi-link and multi-target aspects.

Objective To analyze the causes for the femoral head osteonecrosis misdiagnosed as lumbar disc herniation.Methods Thirty cases of lumbar disc herniation receiving lumbar CT and MRI were collected,and the causes of misdiagnoses were analyzed.Results Twenty-nine cases with femoral head osteonecrosis were misdiagnosed as lumbar disc herniation.And the diagnosis of femoral head osteonecrosis was missed in a single case of lumbar disc herniation combined with femoral head necrosis.Conclusions The major factors of misdiagnoses and missed diagnosis are the neglect of physical examination,lack of detailed clinical history data collection,excessive reliance on imaging findings,and the absence of necessary differential diagnosis of similar symptoms.

Objective To report the efficacy of closed pry reduction and cross Kirschner wiring in the treatment of refractory flexion-type fracture of supracondylar humerus in children.Methods A retrospective analysis was done of 19 children who had been treated for refractory flexion-type fracture of supracondylar humerus by closed pry reduction and cross Kirschner wiring at Department of Orthopaedics,Shaoyang Orthopaedic Hospital from March 2015 to March 2017.They were 9 boys and 10 girls,aged from 2 to 12 years (mean,6.37 years);10 left and 9 right sides were involved.According to the severity of fracture displacement,11 cases had rotational displacement with their broken ends obviously inserted into one another,and 8 cases complete displacement with no contact of the broken ends.All the fractures were closed,treated with closed reduction by leverage and cross fixation with Kirschner wire.Postoperative complications were recorded and the elbow function was evaluated by the Flynn assessment system at the last follow-up.Results The operation time for the 19 patients ranged from 15 to 60 minutes,with an average of 30 minutes.The patients were followed up for 12 to 24 months (average,18.0 months).All the fractures united after 2 to 4 months (average,2.8 Months).At the last follow-up,according to the Flynn system,the elbow function was evaluated as excellent in 10 cases,good in 7,and fair in 2.No ossifying myositis,cubitus varus or iatrogenic injury to the ulnar nerve was observed in any patient.Nails had to be removed in one case due to implant loosening after pin-hole infection.Conclusion Closed reduction and Kirschner wire cross fixation is an ideal surgical treatment for refractory flexion-type supracondylar fracture of humerus in children,because its intraoperative closed pry reduction can reduce the rate of incision.

Objective:To explore the application effect of four-track teaching mode (LBL: lecture-based learning; CBL: case-based learning; PBL: problem-based learning) in pediatric teaching of integrated traditional Chinese and Western Medicine.Methods:175 integrated traditional Chinese and Western medical students in seven-year program were divided into experimental group and control group. The experimental group was taught by four-track teaching mode, while students in the control group. Were applied with traditional teaching method ("LBL+CBL").Results:Students in the experimental group highly rated the four-track teaching mode and were better than those in the control group in the following aspects: satisfaction with teaching methods, interest in learning, the ability of creative thinking, the thinking ability of clinical diagnosis and treatment, and memorization ( P<0.05). And students' mid-term, final and comprehensive scores in the experimental group were significantly higher than those in the control group ( P<0.05). Conclusion:Compared with traditional teaching methods, the four-track teaching mode can improve the quality of pediatric teaching of integrated traditional Chinese and Western medical students, which should be further integrated and perfected in the teaching practice.