Objective To establish standard parameters of cervical alignment and cervical range of motion(ROM) in asymptomatic population,and to explore the influential factors such as age,sex and cervical disc degeneration.Methods The cervical standard lateral,flexion and extension plain radiographs of 212 asymptomatic volunteers were analyzed retrospectively.The volunteers,including 128 females and 84 males with ages ranging from 20 to 79 years,were divided into 6 groups from 3rd to 8th decade of life and were divided into 4 groups based on the scoring system of cervical disc degeneration.These plain films were blindly measured by 3 spine surgeons with Mimics software,and each spine surgeon mcasured them for 3 times.Several parameters,including C2-C7 cervical alignment,total ROM,flexion ROM,extension ROM and segmental ROM were measured.The score of disc degeneration were assessed from C2-C3 to C6-C7.Pearson correlation analyses was used to quantify the relation between cervical alignment and total ROM.Multiple linear regression analyses were required to account for influential factors.Inter-and intrarater correlation coefficient was analyzed.Results The C2-C7 cervical alignment was 21.40°± 12.15°,and the total ROM was 63.59°± 15.37°.Sex had a significant impact on the cervical alignment (regression coefficient was-2.472,P ＜ 0.05).Both sex and age had significant impacts on the total ROM (regression coefficient was 3.863 and-6.463 respectively,P ＜ 0.05).Sex had a significant impact on C2,3 and C5,6 segmental ROM; age had a significant impact on all of the five segmental ROM from C2,3 to C6,7; cervical disc degeneration had a significant impact on the C4-5,C5-6 and C6-7 segmental ROM.The cervical alignment had no significant association with both of the extension and total ROM (r=-0.106 and 0.215,respectively,P ＞ 0.05),but had a significantly negative association with flexion angle (r=-0.401,P＜ 0.05).The measurement of cervical alignment,total ROM and segmental ROM showed excellent intra-rater agreement and excellent inter-rater agreement.Conclusion Sex is an influential factor of the cervical alignment.Sex and age are two influential factors of the total ROM.Sex,age and cervical disc degeneration are influential factors of the segmental ROM.The cervical alignments do not have an impact on total ROM.

Objective:To verify the determination method of iodine in serum by inductively coupled plasma mass spectrometry (ICP-MS) and to evaluate the consistency between ICP-MS and As 3+-Ce 4+ catalytic spectrophotometry in determination of serum iodine. Methods:Serum iodine concentration was determined by ICP-MS, 187Re was used as an internal standard, and ralated parameters were optimized. Eighty-eight serum samples were simultaneously determined by ICP-MS and As 3+-Ce 4+ catalytic spectrophotometry, and the evaluation indexes included determination range of standard curve, detection limit, precision, accuracy. In addition, we also evaluated the consistency of the two methods through inter-group correlation analysis, intra-group correlation coefficient analysis, Passing-Bablok regression and Bland-Altman analysis. Results:The linear range of ICP-MS standard curve was 0 - 300 μg/L. There was a good linear correlation between iodine concentration value and iodine response value, and the correlation coefficient range was 0.999 8 to 0.999 9. The detection limit of the ICP-MS method was 1.96 μg/L. The relative standard deviation ( RSD) ranged from 0.2% to 1.4% and from 0.4% to 1.8% for intra and inter-batch precision tests of serum samples. The recovery rate ranged from 90.44% to 108.71%. The correlation analysis of 88 serum samples showed that there was a good correlation between the two methods ( r = 0.934, P < 0.05), and the intra-class correlation coefficient was 0.932. The results of Passing-Bablok regression showed that there was no significant difference between the two methods ( P > 0.05). Bland-Altman diagram suggested that the results of the two methods were consistent. Conclusions:ICP-MS method has low detection limit, high precision and accuracy. ICP-MS method is simple, rapid, easy and suitable for determination of iodine in large quantities of serum samples. The results of the two methods for determining serum iodine are consistent.

Objective To investigate the value of ultrasound in tethered cord syndrome (TCS) in infants. Methods From December 2005 to July 2013, 25 cases TCS were confirmed by surgery in Shenzhen children's hospital. The ultrasonogram and MRI of 25 infants were analysed retrospectively. The diagnostic accuracy of ultra-sound and its clinical significance were evaluated. Results In 25 cases of TCS confirmed by surgery, the coincidence rate of conus level detected by ultrasound [96%(23/24)] was lower than that by MRI (100%(25/25)). Ultrasound showed reduced spinal cord vibration in 4 cases, disappeared spinal cord vibration in 21 cases. Two cases of reduced spinal cord vibration detected by ultrasound were confirmed as disappeared spinal cord vibration by surgery. The coincidence rate of disappeared spinal cord vibration detected by ultrasound was 91%(21/23). The sacral spinal seg-ments form showed by ultrasound were entirely consistent with those of MRI, including 4 cases of enlarged spinal cord, 13 cases of spinal cord without enlargement and 8 cases of spinal cord ended with rat caudate. Twenty-five cases of TCS had malformations:7 cases meningocele (3 cases combined lipoma), 14 cases myelomeningocele (5 cases combined lipoma, 1 case combined hydromyelia), 3 cases spinal canal-epidermis fistula (all combined lipoma) and 1 case solitary lipoma. Compared with the operation findings, ultrasound misdiagnosed 2 cases of myelomeningo-cele as meningocele, missed 1 of case lipoma which combined with meningocele. MRI missed two cases of spinal canal-epidermis fistula. Conclusions Infantile spinal ultrasound examination can accurately locate the position of conus, accurately display the spinal cord. Compared with MRI, ultrasound examination can real-time visually display spinal cord vibration and help to diagnose tethered cord. Ultrasound examination are convenient, repeatable opera-tion with low cost, therefore it can be used as the preferred screening method to diagnose of tethered spinal cord.

Objective To investigate the clinical value of coronary artery Z-scores on echocardiography in diagnosing coronary artery abnormalities. Methods The echocardiography results of 612 patients with Kawasaki disease (KD) at the acute and recovery phase were retrospectively studied. Coronary artery luminal diameters were converted to body-surface-area-adjusted Z-scores. According to coronary Z-scores classiifcation, all the subjects were divided to four groups:415 cases with no dilation (ND), 133 cases with small coronary artery abnormalities (SCAAs), 47 cases with large coronary artery abnormalities (LCAAs), and 17 cases with giant coronary artery abnormalities (GCAAs). Clinical features (gender, age, typical clinical manifestations, fever duration) and laboratory results (CRP, ESR, WBC, PLT) were compared among all the four groups. Coronary artery diameters and the Z-scores were compared between acute and convalescence phase. Results Along with the increase of coronary Z-score, fever duration was prolonged [ND group:(7.75±3.12) d, SCAAs group (8.50±4.12) d, LCAAs group: (8.57±3.58) d, GCAAs group: (11.88±4.33) d, F=22.375, P<0.05]. With coronary Z-score increasing, PLT also increased (F=22.029, P=0.000), and the highest PLT was observed in GCAAs group. There were no significant differences in the CRP, ESR and WBC among all the four groups (F=0.236, 1.116, 0.121, all P>0.05). No significant different coronary diameters were found in ND cases between recovery and acute phase [(2.24±0.34) mm vs (2.33±0.36) mm, t=1.926, P > 0.05]. But there were significant difference in the coronary Z-scores of ND patients between recovery and acute phase (0.41±0.82 vs 1.17±0.75, t=8.332, P < 0.05). The coronary Z-scores in SCAAs group (1.32±0.89 vs 3.40±0.62, t=11.073, P < 0.05), LCAAs group (3.12±2.27 vs 6.20±1.28, t=4.579, P<0.05) and GCAAs group (11.88±6.77 vs 20.4±9.70, t=3.480, P<0.05) at recovery phase were smaller than values at acute phase. Conclusions The KD coronary Z-scores are the body-surface-area-adjusted standard value, and not subject to the influence of children growth and development. Therefore, it may accurately evaluate the severity of coronary artery abnormalities and its recovery process. Accurate quantitative of the coronary artery luminal dimensions is important in KD clinical management and prognosis prediction.

Objective:To investigate the effects of osteocalcin (BGP) on bone growth and development and the expression levels of related hormones in offspring rats under the intervention of sodium fluoride.Methods:Twenty-four clean female SD rats and 24 clean male SD rats were selected, weighing 180-220 g, and the rats were mated in a 1∶1 cage for 10 d. The fluorosis rat model was established by drinking the fluorosis water method, female rats were divided into 3 groups according to body weight by random number table method, each group of 8 rats, including the high-dose, low-dose and control groups, with sodium fluoride of 200, 100, 0 mg/L in drinking water. The female rats were exposed to fluoride from the 0th day of pregnancy to the 3rd week after the offspring rats were born (before weaning). After weaning, 10 male offspring rats were selected from each group and continued to be exposed to fluoride in the same amount and manner until the 12th week after birth. The body weight and length of the offspring rats were measured every week before weaning and every two weeks after weaning. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum BGP, parathyroid hormone (PTH), calcitonin (CT), and alkaline phosphatase (ALP) contents in the offspring rats of each group exposed to fluoride for 12 weeks.Results:In the 2nd week of fluoride exposure, the body weights [(27.25 ± 3.57), (26.27 ± 4.48) g] and body lengths [(6.92 ± 0.46), (6.50 ± 0.54) cm] of the low-dose and high-dose groups were lower than those of the control group [(31.32 ± 3.62) g, (7.19 ± 0.26) cm, P < 0.05], but there were no significant differences in body weights and lengths between the high-dose group and the low-dose group ( P > 0.05). From the 3rd week of fluoride exposure, the body weight and length of the high-dose group were lower than those of the low-dose group and the control group ( P < 0.05). Serum BGP, PTH and ALP contents [(5.42 ± 0.26) mg/L, (157.53 ± 32.21) ng/L, (36.62 ± 6.01) U/L] in the control group were lower than those of the low-dose group [(6.15 ± 0.29) mg/L, (212.26 ± 51.97) ng/L, (50.68 ± 6.11) U/L] and high-dose group [(7.31 ± 0.77) mg/L, (274.21 ± 60.32) ng/L, (74.99 ± 9.08) U/L], and CT content [(182.40 ± 17.39) ng/L] was higher than those of the low-dose and high-dose groups [(135.77 ± 14.06), (70.09 ± 13.49) ng/L], and the differences were statistically significant ( P < 0.05); serum BGP, PTH and ALP contents in the high-dose group were higher than those in the low-dose group, and the CT content was lower than that in the low-dose group ( P < 0.05). Conclusion:Sodium fluoride may be involved in regulating the expression of related hormones by promoting the secretion of BGP, thereby affecting the bone growth and development of offspring rats.

Objective:To explore sagittal parameters change of upper cervical spine after anterior cervical decompression and fusion (ACDF) and analyze the influential factors by comparison between single-, double- and multi-level surgery.Methods:In this retrospective study, 126 patients (include 60 patients with radiculopathy, 41 patients with myelopathy and 25 patients with myeloradiculopathy) who underwent ACDF between December 2016 and December 2018, were followed up at least 1year ranged from14 to 38 months, with the average of 25.6±7.2 months. 20 patients were operated by single-level ACDF, 45 patients were operated by double-level ACDF and 61 patients were operated by 3- or 4-level ACDF. Standing radiographs of cervical spine and the flexion and extension cervical X-rays were obtained in all patients at 1week before, 3 months after and 1year after operation. The Japanese Orthopaedic Association (JOA) Scores, visual analogue scale (VAS) and neck disability index (NDI) were used to evaluate the clinical effectiveness. Cervical sagittal parameters were assessed with the following parameters: the platform angle of axis (C2Slope), the cobb angle and the range of motion (ROM) of C2-7, C0-1 and C1-2.Results:All the patients obtained satisfactory clinical effects. The mean operative time of single-, double- and multi-level group were 86.4±15.5 min, 117.6±15.6 min and 170.2±28.7 min, respectively. The intraoperative blood loss of 3 groups were 16.5±5.2 ml, 37.2±30.5 ml and 63.4±41.5 ml, respectively. There was statistically significant difference between the 3 groups ( P<0.05). In the single- and double-level groups, the changes of the cobb angle and ROM of upper cervical spine between 1 week before operation and 1 year after operation was no significant difference ( P>0.05). In the multi-level group, the ROM of atlantooccipital joint (C0-1) increased significantly from 11.5°±6.1° before operation to 16.1°±13.9° 3 months and 15.3°±4.8° 1 year after operation ( P<0.05). The cobb angle of upper cervical spine and C2Slpoe was decreased significantly from 21.0°±7.6°, 6.1°±6.7° before operation to 18.6°±7.7°, 4.3°±6.9° 3 months and 19.7°±7.2°, 5.6°±6.3° 1 year after operation respectively ( P<0.05). However, there was no significant difference of cobb angle ofatlantooccipital joint between 1 week before operation and 1 year after operation ( P>0.05). Conclusion:Single- and double-level surgery makes a better ability of preserving the restoration of cervical lordosis, with little impact on the upper cervical spine, meanwhile multi-level fusion shows a negative influence on the restoration and limits the range of motion, also increases risk of surgical operation and degeneration of the atlantooccipital joint, with the increased stress distribution and range of motion.

Objective:Applying bibliometrics to analyze the research history, hotspots and trends of Traditional Chinese Medicine (TCM) interventions in edema-related diseases, and to provide reference for the revision of diagnostic and therapeutic criteria for edema in TCM.Methods:The literature about edema treated with TCM was retrieved from CNKI, Wanfang, VIP, CBM from 1 st. Jan 1995 to 25 th. May 2022. CiteSpace and VOSviewer softwares were used to draw the knowledge map, and analyze the co-occurrence relationship and clustering characteristics of the institution, author, keywords and mechanism hotspots. Results:Totally 3 198 articles were included. The annual number of documents issued generally shows a spiral rise trend. Liaoning University of Chinese Medicine published the most articles. Core authors published the most articles were Sun Wei (13 articles); the team with the highest cooperation intensity was Yang Hongtao's team; keywords formed 7 clusters. Hotspot mechanisms included metabolic disorders, immune balance, anti-inflammation, calcium and phosphorus metabolism. Keywords in the past 7 years were membranous nephropathy, chronic heart failure, diabetes, lymphedema etc.Conclusions:The attention paid to the intervention of TCM in the field of edema is generally on the rise, and has decreased in the past two years. The research categories focus on the experience of famous doctors, clinical trials, and mechanistic studies, and nephropathy-related edema has been the focus of research; diabetic nephropathy, chronic heart failure, metabolomics, and immunotherapy are expected to be the focus of attention in the next stage.

Objective:To explore the correlation between cervical curve and ossification of ligaments in cranio-cervical junction and cervical spine in patients with cervical degenerative diseases.Methods:A retrospective study was conducted among 458 patients with cervical degenerative disease who underwent cervical spine X-ray and CT examinations at the Orthopedics Department of Beijing Tiantan Hospital, Capital Medical University between January 2016 and July 2020. There were 265 males and 193 females, with an average age of 57.02±10.41 years (range, 22-87 years). Patients were divided into 5 types (lordosis, straight, S-type degenerative kyphosis, R-type degenerative kyphosis and C-type degenerative kyphosis). Cervical lordosis was defined as C 2-C 7 curve <-4°, cervical kyphosis was defined as >4°, cervical straight was defined as -4° to 4°. C 2-C 7 curve, C 0-C 2 curve were measured respectively, and correlations among these imaging parameters were analyzed. CT images were used to assess the presence of ossification of ligaments in cranio-cervical and cervical spine, including ossification of the posterior longitudinal ligament, nuchal ligament, ligamentum flavum, transverse ligament, apical ligament, diffuse idiopathic skeletal hyperostosis (DISH), as well as capped dens sign (CDS), and correlations between these cervical curve and presence of ossification of ligaments were analyzed. The different grades were based on the length of the ossification of interest with respect to the distance from the posterosuperior rim of the anterior arch of the atlas to the inferior margin of the foramen magnum on mid-sagittal cervical spine CT images, Grade 3 CDS was determined when the length was more than two-thirds. Results:There were 245 patients with cervical lordosis, 114 patients with straight, 53 patients with S-type degenerative cervical kyphosis, 36 patients with R-type degenerative cervical kyphosis and 10 patients with C-type degenerative cervical kyphosis. C 0-C 2 curve showed a negative correlation with C 2-C 7 curve in all enrolled patients ( r=-0.45, P<0.001) and R-type degenerative kyphosis group ( r=-0.58, P<0.001); C 0-C 2 curve showed no correlation with C 2-C 7 curve in lordosis ( r=-0.10, P=0.124), straight ( r=-0.11, P=0.233), S-type degenerative kyphosis ( r=-0.01, P=0.943) or C-type degenerative kyphosis groups ( r=0.03, P=0.946). CDS was detected in 38.4% (176/458) of patients, and Grade 3 was detected in 17.9% (82/458) of patients. The prevalence of CDS was correlated with R-type degenerative cervical kyphosis ( r=0.10, P=0.030). Cervical kyphosis, S-type degenerative kyphosis, C-type degenerative kyphosis, C 2-C 7 curve and C 0-C 2 curve showed no correlation with ossification of the posterior longitudinal ligament, nuchal ligament, ligamentum flavum, transverse ligament, apical ligament, diffuse idiopathic skeletal hyperostosis (DISH) or different grades CDS ( P>0.05). Conclusion:R-type degenerative cervical kyphosis are more likely to correlate with the cranio-cervical curve and CDS, which is an ossification of ligament in cranio-cervical junction.

Based on literature research and Delphi method, the curative effect evaluation criteria of Traditional Chinese Medicine (TCM) edema were revised, in order to promote the standardization construction of the curative effect evaluation of edema and strengthen the research on the revision technology of TCM standards. From January 1, 1994 to July 1, 2021, the China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (Chongqing VIP), Chinese Academic Periodical Database (Wanfang Data) and Chinese Biomedical Literature Service System (SinoMed) were searched, and 221 articles were included. Then the questionnaire item pool was constructed after extracting the contents of the articles. Delphi method was used to conduct two rounds of expert questionnaire survey. And then the concentration degree and coordination degree of expert opinions were counted and analyzed to screen out the content to be revised and the indicators to be included in the revised version, so as to form the revised version of curative effect evaluation criteria of edema. A total of 32 experts participated in this study, and the positive coefficient of experts in the first round was 84.21%, and the positive coefficient of experts in the second round was 78.13%. The mean value ( Xˉ), full score ratio, rank sum, coefficient of variation ( CV), Kendall's coefficient of concordace (Kendall's W) were used to select the questionnaire items. Kendall's W of the second round of expert questionnaire survey was 0.368, P=0.000, higher than that of the first round, and 11 items were finally included in the curative effect evaluation. The CV of the included items in the second round of the questionnaire is lower than that in the first round, and Kendall's W was higher than that in the first round, and the expert opinions tend to be unified. Consensus was reached after the expert discussion meeting, and the revised version of curative effect evaluation criteria of edema has been preliminarily formed.

Objective:To clarify the relationship between interleukin (IL)-6, IL-10 gene polymorphisms and autoimmune thyroid disease (AITD).Methods:Literature search was conducted through databases such as PubMed, Web of Science, CNKI, Embase, Wanfang Database and VIP.com, and domestic and foreign literatures related to IL-6, IL-10 gene polymorphisms and AITD were included in the study. The time limit was from the self-built of the databases to July 2021. Meta-analysis was performed with STATA 16.0 software, the odds ratio ( OR) and 95% confidence interval ( CI) were used as effect indicators, random-effect or fixed-effect model was selected according to the heterogeneity results, and the source of heterogeneity was explored through subgroup analysis. Publication bias was assessed using funnel plots and Egger's test. Results:Finally, 19 literatures were included, all in English. There were 12 studies on IL-6 genes and 11 studies on IL-10 genes, including 4 studies on both IL-6 and IL-10 genes. In the whole population, the loci associated with AITD were IL-6 -174 G/C site (GG vs CC + GC: OR =1.94, 95% CI = 1.01 - 3.76), IL-6 -572 G/C site (GG + GC vs CC: OR = 0.49, 95% CI = 0.29 - 0.84; GG vs CC + GC: OR = 0.76, 95% CI = 0.60 - 0.96; GG + CC vs GC: OR = 0.63, 95% CI = 0.49 - 0.81), IL-10 -819 T/C site (TT + TC vs CC: OR = 1.84, 95% CI = 1.01 - 3.34; T vs C: OR = 1.59, 95% CI = 1.00 - 2.51), and IL-10 -1 082 A/G site (AA + AG vs GG: OR = 0.77, 95% CI = 0.64 - 0.92; AA vs GG + AG: OR = 2.03, 95% CI = 1.16 - 3.58; A vs G: OR = 0.76, 95% CI = 0.61 - 0.94). The results of subgroup analysis showed that in Asian population, the loci associated with AITD were IL-6 -174 G/C site (GG vs CC + GC: OR = 4.61, 95% CI = 1.11 - 19.23; G vs C: OR = 0.65, 95% CI = 0.44 - 0.97); IL-6 -572 G/C site (GG vs CC + GC: OR = 0.64, 95% CI = 0.41 - 0.99; GG + CC vs GC: OR = 0.60, 95% CI = 0.38 - 0.94); IL-10 -819 T/C site (TT + TC vs CC: OR = 2.51, 95% CI = 1.48 - 4.25; T vs C: OR = 1.91, 95% CI = 1.05 - 3.46); and IL-10 -1 082 A/G site (AA + AG vs GG: OR = 0.66, 95% CI = 0.52 - 0.84; AA vs GG + AG: OR = 2.83, 95% CI = 1.54 - 5.21; A vs G: OR = 0.66, 95% CI = 0.53 - 0.82). Conclusion:IL-6 -174 G/C, IL-6 -572 G/C, IL-10 -819 T/C and IL-10 -1 082 A/G polymorphisms are associated with the susceptibility to AITD, especially in Asians.