OBJECTIVESTo summarize the clinical results in the treatment of spinal tuberculosis with debridement, bone grafting and anterior fixation and to evaluate the safety and the value of this procedure.

METHODSFrom June 1997 to May 2001, 18 patients with spinal tuberculosis were treated using anterior debridement, autograft of bone and primary internal instrumentation. They were 8 men and 10 women, aged from 25 to 59 years (mean 41 years). The degree of kyphosis before surgery was 27.0 degrees to 75.5 degrees (mean 47.5 degrees +/- 11.4 degrees ). The involved spines included cervical spine (1 patient), thoracic spine (10), thoracic-lumbar spine (2), and lumbar spine (5). Average 2.8 intervertebral bodies in each patient were afflicted with tuberculosis disease. Spinal fusions were done with iliac bone grafts.

RESULTSAll patients were followed up for an average of 25 months. No deep wound infection and sinus were observed after surgery. The grafted bones were fused in all patients with an average time of 3.6 months. The degree of spine kyphosis correction was 32.7 degrees +/- 8.3 degrees, and 3.2 degrees +/- 2.8 degrees was lost on average in the late stage.

CONCLUSIONAnterior instrumentation for spinal tuberculosis could stabilize the spine, correct kyphosis and fuse the grafted bone.

Adult ; Bone Transplantation ; Debridement ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; Kyphosis ; microbiology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; methods ; Treatment Outcome ; Tuberculosis, Spinal ; surgery

Objective:In general, patients with seropositive rheumatoid arthritis (RA) are considered to show an aggressive disease course. However, the relationship between the two subgroups in disease severity is controversial. Our study is aimed to compare the clinical characteristics and prognosis of double-seropositive and seronegative RA in China through a real-world large scale study.Methods:RA patients who met the 1987 American College of Rheumatology (ACR) classification criteria or the 2010 ACR/European Anti-Rheumatism Alliance RA classification criteria, and who attended the 10 hospitals across the country from September 2015 to January 2020, were enrolled. According to the serological status, patients were divided into 4 subgroups [rheumatoid factor (RF)(-) anti-cyclic citrullinated peptide (CCP) antibody (-), RF(+), RF(+) anti-CCP antibody(+), anti-CCP antibody(+)] and compared the disease characteristics and treatment response. One-way analysis of variance was used for measurement data that conformed to normal distribution, Kruskal-Wallis H test was used for measurement data that did not conform to normal distribution; paired t test was used for comparison before and after treatment within the group if the data was normally distributed else paired rank sum test was used; χ2 test was used for count data. Results:① A total of 2 461 patients were included, including 1 813 RF(+) anti-CCP antibody(+) patients (73.67%), 129 RF(+) patients (5.24%), 245 RF(-) anti-CCP antibody(-) patients (9.96%), 74 anti-CCP antibody(+) patients (11.13%). ② Regardless of the CCP status, RF(+) patients had an early age of onset [RF(-) anti-CCP antibody(-) (51±14) years old, anti-CCP antibody(+) (50±15) years old, RF(+) anti-CCP antibody(+) (48±14) years old, RF(+)(48±13) years old, F=3.003, P=0.029], longer disease duration [RF(-) anti-CCP antibody(-) 50 (20, 126) months, anti-CCP antibody(+) 60(24, 150) months, RF(+) anti-CCP antibody(+) 89(35, 179) months, RF(+) 83(25, 160) months, H=22.001, P<0.01], more joint swelling counts (SJC) [RF(-) anti-CCP antibody(-) 2(0, 6), Anti-CCP antibody(+) 2(0, 5), RF(+) anti-CCP antibody(+) 2(0, 7), RF(+) 2(0, 6), H=8.939, P=0.03] and tender joint counts (TJC) [RF(-) anti-CCP antibody(-) 3(0, 8), anti-CCP antibody(+) 2(0, 6), RF(+) anti-CCP antibody(+) 3(1, 9), RF(+) 2(0, 8), H=11.341, P=0.01] and the morning stiff time was longer [RF(-) anti-CCP antibody(-) 30(0, 60) min, anti-CCP antibody(+) 20(0, 60) min, RF(+) anti-CCP antibody(+) 30(10, 60) min, RF(+) 30(10, 60) min, H=13.32, P<0.01]; ESR [RF(-) anti-CCP antibody(-) 17(9, 38) mm/1 h, anti-CCP antibody(+) 20(10, 35) mm/1 h, RF(+) anti-CCP antibody(+) 26(14, 45) mm/1 h, RF(+) 28(14, 50) mm/1 h, H=37.084, P<0.01] and CRP [RF(-) anti-CCP antibody(-) 2.3 (0.8, 15.9) mm/L, Anti-CCP antibody(+) 2.7(0.7, 12.1) mm/L, RF(+) anti-CCP antibody(+) 5.2(1.3, 17.2) mm/L, RF (+) 5.2(0.9, 16.2) mm/L, H=22.141, P<0.01] of the RF(+)patients were significantly higher than RF(-) patients, and RF(+) patients had higher disease severity(DAS28-ESR) [RF(-) anti-CCP antibody(-) (4.0±1.8), anti-CCP antibody(+) (3.8±1.6), RF(+) anti-CCP antibody(+) (4.3±1.8), RF(+) (4.1±1.7), F=7.269, P<0.01]. ③ The RF(+) anti-CCP antibody(+) patients were divided into 4 subgroups, and it was found that RF-H anti-CCP antibody-L patients had higher disease severity [RF-H anti-CCP antibody-H 4.3(2.9, 5.6), RF-L anti-CCP antibody-L 4.5(3.0, 5.7), RF-H anti-CCP antibody-L 4.9(3.1, 6.2), RF-L anti-CCP antibody-H 2.8(1.8, 3.9), H=20.374, P<0.01]. ④ After 3-month follow up, the clinical characteristics of the four groups were improved, but there was no significant difference in the improvement of the four groups, indicating that the RF and anti-CCP antibody status did not affect the remission within 3 months. Conclusion:Among RA patients, the disease activity of RA patients is closely related to RF and the RF(+) patients have more severe disease than RF(-) patients. Patients with higher RF titer also have more severe disease than that of patients with low RF titer. After 3 months of medication treatment, the antibody status does not affect the disease remission rate.

OBJECTIVETo compare the effects between fast acupuncture and retaining acupuncture for the cervical type of cervical spondylosis.

METHODSSixty patients were randomized into a fast acupuncture group and a retaining needle group, 30 cases in each one. The acupoints in the two groups were Fengchi (GB 20), Jiaji (EX-B 2, C, C, C) and Jianjing (GB 21), Jianjing 1 (Extra) and Jianjing 2 (Extra). The needles in the fast acupuncture group were out afterarrival, while those in the retaining needle group were retained for 30 min, three times a week, once the other day. One week was seen as a course and the treatment was given for 2 courses. The indices were observed before and after treatment, including Northwick Park neck pain questionnaire (NPQ), short-form McGill pain questionnaire (SF-MPQ) [pain rating index (PRI), visual analogue scale (VAS) and present pain intensity (PPI)]. The effects were compared in the two groups.

RESULTSAfter treatment, the NPQ score was lower than that before treatment in the two groups (both<0.01), and that in the fast acupuncture group was better (<0.01). All the items of SF-MPQ decreased compared with those before treatment in the two groups (all<0.01), with the better results of PRI sensation score and PRI total score in the fast acupuncture group (both<0.05). The PRI feeling score, VAS score, and PPI score were not significantly different after treatment between the two groups (all>0.05). The total effective rate in the fast acupuncture group was 83.3% (25/30), not significantly different from 76.7% (23/30) in the retaining needle group (>0.05).

CONCLUSIONFast acupuncture and retaining needle are both effective for the cervical type of cervical spondylosis, which can apparently improve the clinical symptoms. Fast acupuncture is superior to retaining acupuncture.

ObjectiveTo investigate the association between spontaneous portosystemic shunt （SPSS） and hepatorenal syndrome （HRS） in patients with liver cirrhosis. MethodsA retrospective analysis was performed for 93 patients with SPSS from Dezhou Hospital， Qilu Hospital of Shandong University， from January 2015 to January 2022， and the patients were followed up for 12 months with the onset of HRS as the observation endpoint. According to the presence or absence of HRS， the 93 patients with SPSS were divided into HRS group with 38 patients （40.86%） and non-HRS group with 55 patients （59.14%）， and the two groups were compared in terms of clinical data， laboratory data， complication， and shunt diameter. Based on the maximum shunt vein diameter of 1.5 cm， the 93 patients with SPSS were divided into high shunt group with 52 patients （55.91%） and low shunt group with 41 patients （44.09%）， and with the onset of HRS as the observation endpoint， the two groups were compared in terms of the incidence rate of HRS and survival time curve. The independent-samples t test was used for comparison of normally distributed continuous data with homogeneity of variance between two groups， and the chi-square test was used for comparison of categorical data between two groups. The receiver operating characteristic （ROC） curve was used to predict cut-off values， the Kaplan-Meier curve was used for comparison of survival time， and the Log-rank test was used to compare the differences in survival curves. The multivariate Cox regression analysis was used to investigate risk factors. ResultsCompared with the non-HRS group， the HRS group had significant increases in Child-Pugh score， Child-Pugh class， MELD score， serum creatinine， blood urea nitrogen， alanine aminotransferase， aspartate aminotransferase， maximum shunt vein diameter， the incidence rates of hepatic encephalopathy and spontaneous bacterial peritonitis， and the degree of ascites， as well as significant reductions in main portal vein diameter， serum sodium and albumin （all P<0.05）. Compared with the low shunt group， the high shunt group had a significant increase in the incidence rate of HRS （51.92% vs 26.83%， χ²=5.974， P=0.015） and a significant reduction in the time to the onset of HRS （Log-rank P=0.033）. A maximum shunt vein diameter of >1.5 cm （hazard ratio ［HR］=1.123， 95% confidence interval ［CI］： 1.041‍ ‍—‍ ‍1.211， P=0.003）， an increase in MELD score （HR=1.205， 95%CI： 1.076‍ ‍—‍ ‍1.437， P=0.039）， a reduction in serum albumin （HR=0.890， 95%CI： 0.814‍ ‍—‍ ‍0.974， P=0.011）， an increase in the degree of ascites （HR=2.099， 95%CI： 1.066‍ ‍—‍ ‍4.130， P=0.032）， and spontaneous bacterial peritonitis （HR=2.259， 95%CI： 1.020‍ ‍—‍ ‍5.003， P=0.045） were independent risk factors for the onset of HRS in SPSS patients. ConclusionThere is an association between SPSS and HRS， and shunt diameter >1.5 cm was an independent risk factor for HRS in SPSS patients， which should be taken seriously and require early intervention in clinical practice.

Background Fine particulate matter (PM_2.5) in ambient air is an important carrier of heavy metals and polycyclic aromatic hydrocarbons (PAHs), and long-term inhalation of heavy metals and PAHs poses a potential threat to human health. Objective To analyze the ambient PM_2.5 concentrations and the distribution characteristics and sources of heavy metals and PAHs in PM_2.5 in an urban area of Taizhou City, aiming to provide basic data and a scientific basis for local air pollution management and population health prevention. Methods From 9am to 8pm on the 10th to 16th of each month from 2017 to 2022 (23 h·d⁻¹), a monitoring point was set up on the top floor of a building in the main urban area of Taizhou to collect PM_2.5 samples (sampling flow rate: 2.3 m³·h⁻¹) and measure its concentration. The characteristics of 12 heavy metals and 16 priority PAHs in PM_2.5 were analyzed. The pollution sources of heavy metals and PAHs were determined by enrichment factor method and isomer characteristic ratio method, respectively. Results From 2017 to 2022, the average daily concentration of PM_2.5 in this urban area ranged from 4 to 141 μg·m⁻³, and the median annual concentrations were lower than the national secondary standard limit. The seasonal concentration of PM_2.5 was as follows: winter>spring>summer and autumn, and the difference was statistically significant (H=134.077, P<0.01). The concentration of PM_2.5 in 2017.1 to 2020.1 was higher than that in 2020.2 to 2022.12 (Z=−3.989, P<0.01). The main heavy metal pollutants in this area were manganese (Mn), lead (Pb), arsenic (As), nickel (Ni), and chromium (Cr). Except for beryllium (Be) and mercury (Hg), the concentrations of other heavy metals had seasonal differences (P<0.01), higher in winter and spring than in summer and autumn. Except for manganese (Mn) and arsenic (As), the concentrations of other heavy metals were higher from 2017.1 to 2020.1 than from 2020.2 to 2022.12, and the difference was statistically significant (P<0.05). The results of enrichment factor indicated anthropogenic pollution sources of antimony (Sb), cadmium (Cd), and selenium (Se). The average daily concentration of PAHs ranged from 0.88 to 24.56 ng·m⁻³, with a seasonal trend of winter>spring>autumn>summer, and the difference was statistically significant (H=231.387, P<0.01). Among the 16 PAHs, the top pollutants were benzo [b] fluoranthene (BbF) (25.36%), indene [1,2,3-c,d] pyrene (IcdP) (11.22%), and benzo [g,h,i] perylene (BghiP) (9.02%). The results of characteristic ratio method showed that the 16 PAHs pollutants were produced by a combined action of gasoline buring, coal burning, and biomass burning. Conclusion In selected urban area of Taizhou City, the concentrations of PM_2.5, heavy metals, and PAHs all show a downward trend year by year at a relatively low level, and obvious seasonal distributions which are higher in winter and spring. Man-made pollution is the main source of heavy metals, and automobile exhaust emissions, industrial coal burning, and waste incineration may be the main sources of PAHs.