Objective To enhance understanding of the vertebral compressed fracture in old patients so as to reduce its misdiagnosis. Methods 30 aged patients with vertebral compressed fracture were treated from 1998 to 2004 in our department. Their clinic data were retrospectively analyzed. There were 27 males and 3 females, aged from 70 to 90 years (averaging 82.5 years). Results All the patients were diagnosed definitely. There were 2 cases of T11 fracture, 13 cases of T12 fracture, 11 cases of L1 fracture, 3cases of L2 fracture, and 1 case of L3 fracture. At first 1 case was overlooked, and segmental positioning was wrong in 3 cases but the mistakes were corrected later. Conclusion Meticulous review of the history and clinical manifestation in addition to supplemental imageological examination are essential to early diagnosis of the majority of vertebral compressed fractures. As for some difficult early diagnoses, fat suppression MRI and nuclide bone scanning are helpful.

Objective To evaluate efficacy,safety and complication of percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) in≥90 years patients.Methods Clinical data of 56 cases aged ≥ 90 years with osteoporotic vertebral compression fracture undergoing percutaneous kyphoplasty were retrospectively analyzed.Visual analog scale (VAS) score,analgesics administration score,locomotor activity score,bone cement leakage and incidence of refracture were evaluated before and 3 days after treatment,and at the last follow-up.Results The mean follow-up was 18.6 months (6-32 months) in all patients.The mean VAS score was (7.1 ±2.1) before treatment,(2.6±1.1) at 3 days after the procedure,and (1.8±0.7) at last follow-up,respectively (F=455.794,P＜0.001).Analgesics administration score were (2.0±1.7),(1.4±0.5) and (1.1±0.7) respectively before and 3 days after treatment,and at the last follow-up (F=9.631,P＜0.001).Locomotor activity score were (2.5±0.6),(1.2±0.5) and (1.0±0.3)before and 3 days after treatment,and at the last follow-up (F=63.254,P＜ 0.001) respectively.Bone cement leakage occurred in 10 cases(17.9％),recurrent fracture in 6 cases(10.7％),cerebrospinal leak in 3 cases (5.3％),and nerve root stimulation in2 cases(3.6％).Total complication rate was 33.9％(19/56),and all complications were transient and well tolerated.Conclusions Kyphoplasty for osteoporotic vertebral compression fracture in the very elderly is effective and safe.It alleviates fracture-induced pain,reduces analgesic drug use and improves spinal activity,and provides a better choice for minimal invasive treatment for nonagenarian OVCF patients.

Objective To evaluate the surgical results of spinal stenosis in the elderly and to investigate the indications , surgical technique and factors which may contribute to the outcome. Methods A retrospective study was held, 304 patients aged 65 and over who had different kinds of decompression laminectomy for lumbar spinal stenosis between Jan 1990 and Jun 2005 were recruited. The mean patient age at surgery was 70.4 years (65-86 years old). Results One hundred and seventy-five cases had co-existing illnesses, 62 had concomitant degenerative spondylolisthesis, 138 had spinal instrumentation. Functional results were graded as excellent, good, fair and poor: 86. 8% excellent or good, 11. 2% fair and 6 cases poor. Four patients had re-operations because of post operation hematomas. Multivariate analysis revealed that age, sex, co-morbidity score, number of levels decompressed, and degenerative spondylolisthesis did not predict bad outcomes. Conclusions The surgical results of spinal stenosis in the elderly are favourable and comparable to those reported for the general population . Carefully perioperative preparation is very important in the treatment of elderly patient with lumbar spinal stenosis.

Host innate and adaptive immune responses are essential for the clearance of hepatitis B virus (HBV). Patients with chronic HBV infection have defects in innate and specific immune responses against HBV, which cannot effectively eliminate the virus and may result in persistent virus replication and liver inflammation. In addition to direct inhibition of HBV, treatment strategies targeting host immunity, such as stimulating or restoring antiviral immunity, are also important methods to achieve functional cure in patients with chronic hepatitis B. The liver is the target organ for HBV infection, and therefore, the research on the impact of HBV infection on intrahepatic immune microenvironment has become a hotspot for the research and development of new drugs that regulate the antiviral immune response against HBV in the liver. This article reviews the recent research advances in innate immune response associated with HBV infection and the new strategies to activate intrahepatic innate immune response and achieve the cure of hepatitis B.