Objective To explore the operation method and curative effect of small incision minimally invasivepectus excavatum with non thoracoscopic xiphoid.Methods Clinical data of 12 cases with small incision minimally invasive pectus excavatum non thoracoscopic subxiphoid were retrospectively analyzed The index operation time,operation of the surgical bleeding,postoperative complications,postoperative hospitalization time and curative effect evaluation etc,were analyzed.Results 12 patients were successfully completed surgery.The time of operation was (35 ± 8)min;intraoperative blood loss was 5-20 mL,average 10mL;1 patients had pneumothorax postoperative complications;postoperative hospitalization time 3-7day,average 5days;postoperative effect evaluation were excellent in 12 cases.Conclusion Non thoracoscope assisted small incision under xiphoid minimally invasive pectus excavatum surgery is minimally invasive,beautiful appearance,reliable effect and other advantages,and can simplify the operation steps for primary hospital.

Objective:To optimize the extraction process for the total alkaloids of Longzuan Tongbi Fang by central composite design and response surface method.Methods:The independent variables were the ethanol contention,solvent consumption and extraction time,and the dependent variable was the weighted overall desirability of the content of total alkaloids and kukoline.The extraction process for the total alkaloids of Longzuan Tongbi Fang was optimized by central composite design and response surface method.Results:The optimum extraction conditions were as follows:9-fold amount of solvent was used,refluxed for 130 min,extracted twice,and the ethanol concentration was 75%.Conclusion:The central composite design and response surface method used for the extraction optimization for the total alkaloids of Longzuan Tongbi Fang is very simple and highly predictive.

Objective To explore the value of transthoracic echocardiography(TTE) and 64-slice spiral computed tomography(CT) in the diagnosis of complex congenital heart disease(CHD). Methods Ninety-seven patients diagnosed as CHD by TTE underwent 64-slice spiral CT for cardiovascular examination. The results were compared with the results by cardiovascular angiography and from surgery. Results The total diagnosis accordance rated by TEE was 90. 2% and that by spiral CT was 92.5%. There was no difference in diagnosis accuracy rate between TTE and spiral CT. The diagnosis accuracy rate in intracardiae defomities by TTE was 99.2 %, higher than 87.50% by spiral CT. However, the diagnosis accuracy rate in extracardiac defomities and ventricular-arterial connections was 99. 0% by spiral CT, higher than 78. 6% by TTE. The combination of TTE and spiral CT can raise the diagnosis accuracy rate to 99. 1%. Conclusions TTE is of significant value in complex CHD diagnosis,especially in the diagnosis of intracardiac defomities. The combination of TTE and spiral CT can raise the diagnosis accuracy rate of various kinds of complex CHD.

Objective To investigate effects of bone marrow mesenchymal stem cells (MSC) on severe acute pancreatitis (SAP) in rats.Methods A total of 60 rats were randomly divided into normal group (n =10),the model of SAP group (n =10),the transplantation of the MSC group (n =20),the combination of the MSC and the granulocyte colony-stimulating factor (G-CSF) group (n =20).The conversion rate of MSC was detected by using immunofluorescence methods,and the level of amylase in serum was assayed by using biochemical methods.Simultaneously,the level of interleukin-6 (IL-6) in serum was determined by using enzyme linked immunosorbent assay (ELISA).Results The conversion rates of the MSC increased,and consequently,the levels of amylases and interleukin-6 in serum were reduced (P ＜ 0.05).When a small amount of the G-CSF was added to MSC,the therapeutic effects of the two different kinds of cells were synergistically strengthened.In the contrary,when a large number of the G-CSF was added to MSC,the antagonism resulted between these two different kinds of cells gives rise to harmful effects on SAP.Conclusions The bone marrow mesenchymal stem cells have therapeutic effects on SAP.When the number of the bone marrow mesenchymal stem cells increases,the protective effects are enhanced.

Objective To design an intramedullary nail that had the same ends and could be connected to hairline pointer and employ it to fixate mid-shaft clavicular fractures. Methods Sixty adult clavicles and five fresh adult cadaveric clavicles were employed to measure full length, angle between lateral and middle segments, angle between middle and medial segments as well as the narrowest outer and inner diameters of the clavicle. The interlocked intramedullary nail with the same structure of two ends was designed and used to fixate mid-shaft clavicular fractures. The nail was inserted in retrograde manner and locking screws could be inserted at beth ends. Results The full length, angle between lateral and middle segments, angle between middle and media] segments as well as the narrowest outer and inner diameters of the clavicle were (14.82 ± 1.15) cm, 30°, 30°, (1.00±0.16) cm and (0.50± 0. 18) cm respectively. After conversely placing guide pin from the fracture end, expanding medullary cavity and adjusting the nail, the designed nail was inserted into the medullary cavity from the distal or proximal ends of the clavicle, which was locked by interlocked screws. Conclusions Self-made nail takes advantages of less surgical invasion, visible fracture reduction and stable fracture fixation for treatment of mid-shaft clavicular fractures. While the biomechanieal properties of the nail need further investigation.

Objective To investigate the mechanism of acute inflammatory response and tissue repair when rats accepted transplanted bone marrow mesenchymal stem cells (MSC) in severe acute pancreatitis (SAP).Methods A total of 40 rats were randomly divided into 4 groups which included the normal group (n=10),the model severe acute pancreatitis group (n=10),the transplanted bone marrow mesenchymal stem cells group (n =10),and the combination of bone marrow mesenchymal stem cells and granulocyte colony-stimulating factor (G-CSF) group (n=10).To cure the acute severe pancreatic injury caused by SAP,rats were injected with EDU-labeled MSCs and granulocyte colonystimulating factor (Gr-CSF).The conversion rate of MSCs to pancreatic cells or MSCs to endothelial cells was detected to assess the role of MSCs in tissue regeneration and repair.The expression of amylase,interleukin-6 (IL-6),and interleukin-10 (IL-10) in serum was detected to assess the role of MSCs in an acute inflammatory response.Results The concentrations of amylase and IL-6 were reduced and the concentration of IL-10 was increased in MSC and MSC+G-CSF groups after the onset of SAP.Flow cytometry showed a small amount of MSCs converting to endothelial or pancreatic cells,but the conversion rate was relatively low.Conclusions MSCs can play an important role in the antipre-release of inflammatory mediators,reducing acute immune response to control the acute inflammatory response in SAP.Moreover,MSCs can repair a damaged pancreas by converting into both pancreatic and endothelial cells.

Objective To elucidate whether and how injection site diversity influences on the sodium hyaluronate (HA) distribution on cartilage surface of the knee joint.Methods From September 2014 to December 2014, 32 human cadaveric knees were sorted from small to large based on femoral condyle width (FCW) and divided into group Ⅰ (n=16, odd number, the patella medial approach) and group Ⅱ (n=16, even number, injected through the medial joint line approach).Knees of both groups were interfused with a 5％ (mg: ml) methylene blue tracer.Each specimen was then simulated a 5°-45° alternating walking for 2 h in the Electro Force platform.Afterwards, all the knee cavities were cut open to examine the range of HA distribution.Based on the eight-zoning classification law for the knee cartilage surface, the coverage area of HA in each zone was scored and the characteristics of HA distribution was depicted, as well as HA zonal distribution diversity between groups were statistically analyzed.Results HA of both patella medial and medial joint line subgroups showed analogical distribution in all zones except the lateral tibial plateau at the time of FCW ≤ 7.0 cm.However, HA coverage through the patella medial approach showed significantly higher distribution scores in the patella zone and the femoral trochlear zone, but significant lower distribution scores in the antero-lateral/postero-lateral femoral condyle, the medial posterior femoral condyle zone and the lateral tibial plateau zone compared with medial joint line approach at the time of FCW ＞ 7.0 cm.Conclusion When delivered through different injection approaches, HA showed analogical distribution characteristics in most zones of the knee cavity in population with a small bodily shape (FCW ≤ 7.0cm), but significant diverse distribution characteristics in population with a big bodily shape (FCW ＞7.0 cm).When FCW ＞ 7.0cm, HA injected through the medial-patellar approach tended to be distributed mainly over the patella-femoral articulation and the anterior knee cavity, while HA injected through the joint line approach tended to be distributed mainly over the tibio-femoral articulation and the posterior knee cavity.

OBJECTIVETo investigate the distribution of hyaluronic acid (HA) with iohexol tracing in the knee joint cavity of rabbits using CT plain scan, three-dimensional reconstruction and Χ-ray and observe how different injection sites affect HA distribution.

METHODSMixtures of HA and iohexol (tracer) were prepared that contained final iohexol concentrations of 2.5%, 5%, 10%, 20%, or 40%. The HA-iohexol mixtures (0.5 ml) were injected into rabbit knee joints, and the optimal iohexol concentration that allowed clear differentiation of the injected agents from the surrounding tissues was determined using dual-source CT plain scan and three-dimensional reconstruction technique. The HA-iohexol mixture (0.5 ml) containing the optimal concentration of iohexol was then injected into the knees of the rabbits either through the patella medial approach or the medial joint line approach, and HA distribution in the knee joint cavity was observed using CT scan and Χ-ray.

RESULTSThe CT value of HA-iohexol mixture increased progressively with the tracer concentration. After injection of the mixture containing 2.5%, 5%, 10%, 20%, and 40% iohexol, the CT value ratios of the soft tissue, HA-iohexol mixture and bone cortex were 2:7:46, 2:14:44, 2:28:44, 2:60:46, and 2:98:45, respectively, and a iohexol concentration of 5% was determined as optimal for differntiating the injected agents from the surrounding tissues. The HA-iohexol mixutre containing 5% iohexol injected through the medial-patellar approach was distributed mainly over the patello-femoral joint, and that injected through the joint line approach was found mainly over the tibio-femoral joint.

CONCLUSIONHA-iohexol mixture containing 5% iohexol allows clear differentiation of bone cortex and soft tissues in rabit knee joint from the injected agents on CT scan and Χ-ray, and the injection approach can influence HA distribution in the knee joint cavity.

Objective To investigate the clinical efficacy of asymmetric osteotomy via posterior adjacent vertebrae in the treatment of traumatic thoracolumbar kyphotic scoliotic deformity.Methods A retrospective case series study was conducted on the clinical data of 16 patients with traumatic thoracolumbar kyphotic scoliotic deformity admitted to our department from January 2012 to January 2017.There were 10 males and six females,aged (42.5 ±7.6) years (range,20-62 years).According to the location of injured vertebrae,there were two patients with T11,five with T12,six with L1,and three with L2,all of which had scoliosis deformity and obvious low back pain.All patients underwent asymmetric osteotomy via posterior adjacent vertebrae.The operation time and intraoperative bleeding were recorded.The imaging parameters such as kyphosis Cobb angle,scoliosis Cobb angle,distance between C7 plumbline and central sacral vertebral line (C7-CSVL),and distance between C7 plumbline and sagittal vertical axis (SVA) were measured before and after operation.At the same time,the visual analogue scale (VAS),Oswestry dysfunction index (ODI),and SRS-22 scale were used to evaluate the clinical efficacy.The AISA score was used to evaluate the neurological function recovery before and after operation.Results All patients were followed up for (26.3 ± 16.8) months (range,15-65 months).The operation time was (6.0 ± 1.4) hours (range,4.5-9.0 hours),and the intraoperative bleeding was (900.5 ± 360.8)ml (range,800-1600 ml).The kyphosis Cobb angle was improved from (70.3 ± 9.8) °before operation to (12.2 ± 2.9) ° after operation (P ＜ 0.01).The scoliosis Cobb angle was improved from (47.6 ± 11.6) ° before operation to (4.0 ± 0.9) ° after operation (P ＜ 0.01).The C7-CSVL decreased from preoperative (3.1 ±0.8)cm to postoperative (1.2 ±0.4)cm (P ＜0.01),and the SVA decreased from preoperative (5.0 ± 0.9) cm to postoperative (2.9 ± 0.5) cm (P ＜ 0.01).No severe complications such as spinal cord and nerve injury occurred.The VAS decreased from preoperative (6.8 ± 1.0) to (1.9 ± 0.9) points at the last follow up.The ODI decreased from (54.6 ± 4.2) ％ before operation to (8.1 ± 2.5) ％ at the last follow up.The SRS-22 score was increased from (64.6 ±7.5) points before operation to (87.4 ± 3.2) points at the last follow-up.In terms of the ASIA classification,two patients were improved from grade C to grade D after operation,and six patients were improved from grade D to grade E.Conclusion Asymmetric osteotomy via posterior adjacent vertebrae is safe and effective in the treatment of traumatic thoracolumbar scoliosis,with high correction rate of scoliosis and kyphosis at the same time.

Objective:To investigate the efficacy and safety of fecal microbiota transplantation (FMT) in the treatment of irritable bowel syndrome (IBS), and to explore the effects of FMT on the gut microbiota of IBS patients.Methods:From September 2016 to August 2017, at Guangzhou First People′s Hospital, 28 hospitalized IBS patients who underwent FMT treatment were enrolled. Before FMT, four and 12 weeks after FMT, all the IBS patients completed the irritable bowel syndrome quality of life scale (IBS-QOL), irritable bowel syndrome severity scoring system (IBS-SSS) and gastrointestinal symptom rating scale (GSRS). 16S rDNA sequencing was performed before FMT and four weeks after FMT. The effects of FMT on gut microbiota diversity and microbiota structure of IBS patients were analyzed respectively from the level of phylum, family and genus, and linear discriminant analysis effect size (LEfSe) was further used to screen the different bacteria. Paired t test and paired rank sum test were used for statistical analysis. Results:Twelve weeks after FMT, the scores of the six dimensions of IBS-QOL including dysthymia, behavioral disorder, auto imagery, health concerns, eating avoidance, and relationship expansion were all lower than those before FMT (43.750, 22.656 to 56.250 vs. 48.438, 32.031 to 60.938; 37.500, 18.750 to 56.250 vs. 46.429, 21.429 to 62.500; 31.250, 14.063 to 42.188 vs. 31.250, 18.750 to 50.000; 41.667, 27.083 to 56.250 vs. 50.000, 41.667 to 66.667; 54.167, 43.750 to 72.917 vs. 66.667, 58.333 to 83.333; 8.333, 0.000 to 33.333 vs. 16.667, 8.333 to 33.333, respectively), and the differences were statistically significant ( Z=-2.157, -3.429, -2.274, -3.197, -3.042 and -2.329, all P<0.05). Twelve weeks after FMT, the scores of the two dimensions of IBS-QOL including behavioral disorder and relationship expansion were both lower than those of four weeks after FMT (37.500, 18.750 to 56.250 vs. 39.286, 19.643 to 62.500 and 8.333, 0.000 to 33.333 vs. 16.670, 2.083 to 41.667, respectively), and the differences were statistically significant ( Z=-1.998 and -2.110, both P<0.05). Four and 12 weeks after FMT, the scores of IBS-SSS and GSRS were both lower than those before FMT ((190.32±106.51), (201.43±102.48) vs. (245.93±86.10) and 5.50, 4.00 to 9.00 and 5.50, 4.00 to 8.75 vs. 7.00, 6.00 to 9.75), and the differences were statistically significant ( t=4.402 and 3.848, Z=-3.081 and -3.609; all P<0.01). No serious adverse reactions occurred in the patients after FMT. At the phylum level, after FMT the abundance of Verrucomicrobia in the feces of IBS patients was richer than that before FMT (6.74% vs. 0.37%); at the family level, after FMT the abundance of Verrucomicrobiaceae in the feces of IBS patients was richer than that before FMT (6.74% vs. 0.37%); at the genus level, after FMT the abundance of Akkermansia was richer than that before FMT (6.74% vs. 0.37%); and the differences were statistically significant (all Z=-2.589, all P=0.010). The results of LEfSe method indicated that four weeks after FMT the abundance of Akkermansia in the gut microbiota of IBS patients was richer than that before FMT (6.74% vs. 0.37%), and the difference was statistically significant (linear discriminant analysis value=4.5, P=0.049). Conclusions:FMT is safe and effective in the treatment of IBS. The mechanism may be through upregulating the diversity of gut microbiota and changing the structure of gut microbiota of IBS patients.