Objective To explore the association between cytotoxic T lymphocyte associated antigen-4 (CTLA-4) gene polymorphism and susceptibility to ankylosing spondylitis (AS). Methods The case-control studies from Chinese Biomedical Database, Chinese National Knowledge Infrastructure, Wanfang, Weipu, PubMed, Cochrane Library, OvidSP, Wiley Online Library, Elsevier Science Direct, Springer Link databases for the association of CTLA-4 gene polymorphism with AS. The association strength was assessed with chi-squared test by Stata 12.0 software. Results Seven references of CTLA-4 gene +49A/G (rs231775) polymorphism were enrolled which included 1119 AS patients and 995 controls (healthy subjects or non-AS patients), which showed that there were no statistical difference between AS and control groups under recessive, dominant, co-dominant, additive and allele gene models. Five references of CTLA-4 gene-318C/T (rs5742909) polymorphism were enrolled which included 635 AS patients and 512 controls, which showed that there were no statistical difference between AS and control groups under recessive and additive gene models; however, there were statistical difference between AS and control groups under dominant model [ OR=1.651, 95%CI (1.052, 2.590), P=0.029], co-dominant model [OR=0.621, 95%CI (0.403, 0.957), P=0.031] and allele model [OR=1.587, 95%CI (1.068, 2.357), P=0.022]. Conclusion The meta analysis reveal that CTLA-4 gene rs231775 single nucleotide polymorphism is not associated with the susceptibility to AS; rs5742909 SNP is associated with the susceptibility to AS, which suggests that C→T mutation increases the risk of AS.

Objectives: To explore the association between the polymorphism in -857 site of tumor necrosis factor (TNF)-α promoter region and the susceptibility to ankylosing spondylitis (AS). Methods: Case-control studies Pubmed, Cochrane Library, Ovid, Chinese Biomedical Database(CBM), Chinese National Knowledge In-frastructure(CNKI), Wanfang and Weipu data bases from inception to October 2013 for the association between TNF-α-857 C/T polymorphism and the susceptibility to AS were collected. Meta-analysis was performed by Revman 5.2 and Stata 12.0 software. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were de-rived from random-effects or fixed-effects models to assess the strength of the association. Results: Nine case-control studies were included in the final meta-analysis, including a total of 933 AS patients and 1094 controls. Statistically significant differences between AS and control groups were observed in the susceptibility to AS and TNF-α-857 genotype CC [OR=0.46, 95%CI (0.26, 0.81), P=0.007], allele C [OR=0.61, 95%CI (0.41, 0.91), P=0.02] and T [OR=1.64, 95%CI (1.10, 2.43), P=0.02]. But, no statistical difference in the fre-quency of genotype TT [OR=1.49, 95%CI (0.95, 2.34), P=0.08] was observed between AS and control groups. There were obvious heterogeneities among the studies of genotype CC(P<0.00001, I2=87%), allele C(P<0.00001, I2=84%) and allele T(P<0.00001, I2 =84%), except genotype TT(P=0.09, I2=42%). Sensitivity analysis was per-formed by leaving out one study at a time, but the heterogeneity remained obvious. It was symmetric of the funnel plots of genotype CC, allele C and T with AS, but genotype TT. There was no statistical significance in genotype CC[Begg′s test(z=0.52, P=0.602), Egger′s test(t=0.23, P=0.825)], genotype TT[Begg′s test(z=0.94, P=0.348), Egger′s test(t=1.26, P=0.248)], allele C[Begg′s test(z=0.31, P=0.754), Egger′s test(t=0.72, P=0.494)] or allele T[Begg′s test(z=0.31, P=0.754), Egger′s test(t=-0.72, P=0.494)]. Conclusions: Genotype CC, allele C and T of TNF-α-857 are associated with the susceptibility to AS, and T-allele carriers have higher risk of AS.

Objective To explore the association between C677T polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene and susceptibility to hyperuricemia and gout.Methods The case-control studies from Chinese Biomedical Database,Chinese National Knowledge Infrastructure,Wanfang,Weipu,PubMed,Cochrane Library,OvidSP,Wiley Online Library,EBSCO,Elsevier Science Direct,Springer Link and Google scholar databases for the association of C677T polymorphism of MTHFR gene with hyperuricemia and gout.The pooled odds ratios (OR) with 95％ confidence intervals (CI) were appropriately derived from randomeffects or fixed-effects models to assess the association strength by RevMan 5.3 and Stata 12.0 software.Results Ten references enrolled 1 899 hyperuricemia patients and 5 403 controls,and 3 references enrolled 209 gout patients and 194 controls in total.The meta analysis showed that carriers of genotype CC [OR=0.42,95％CI (0.29,0.63),P＜0.01] and allele C [OR=0.54,95％CI (0.42,0.71),P＜0.01] had lower risk of hyperuricemia;genotype TT [OR=1.55,95％CI (1.32,1.83),P＜0.01] and allele T [OR=1.84,95％CI (1.38,2.45),P＜0.01] had higher risk of hyperuricemia,carriers of genotype CC [OR=0.32,95％CI (0.15,0.68),P=0.003] and allele C [OR=0.35,95％CI (0.17,0.70),P=0.003] hadlower risk of gout;genotype TT [OR=2.92,95％CI (1.74,4.92),P＜0.01] allele T [OR=2.69,95％CI(1.50,4.84),P=0.0009] had higher risk of gout.Conclusion The meta analysis reveals that C677T polymorphism of MTHFR gene is associated with the susceptibility to hyperuricemia and gout.

Objective To explore the association between the polymorphism in-308 site of tumor necrosis factor (TNF)-α promoter region and ankylosing spondylitis (AS).Methods The case-control studies from PubMed,Cochrane Library,Ovid,Chinese Biomedical Database,Chinese National Knowledge Infrastructure,Wanfang and Weipu databases for the association polymorphism in-308 site of TNF-α promoter region with AS.The pooled odds ratios (OR) with 95％ confidence intervals (CI) were appropriately derived from random-effects models or fixed-effects models to assess the association strength by RevMan 5.2 and Stata 12.0 software.Results Nineteen references enrolled 2 155 AS patients and 2 367 controls in total.The meta analysis showed that the frequencies of GG vs (AA +GA) genotypes was not statistically different between AS group and the control group in total populations [OR=1.20,95％CI (0.85,1.70),P=0.30],in the populations of Asian origin [OR=1.29,,95％CI (0.66,2.52),P=0.45] and in the populations of non-Asian origin [OR=1.16,95％CI (0.78,1.72),P=0.46].The analysis also showed that the frequencies of AA vs (GG +GA) genotypes was not statisticalLY differenT between AS group and the control group in total populations[OR=0.78,95％CI (0.53,1.15),P=0.21],in the populations of Asian origin [OR=1.15,95％CI (0.33,4.00),P=0.82] and in the populations of non-Asian origin[OR=0.69,95％CI (0.42,1.13),P=0.14].The analysis also showed that the frequencies of allele G vs A was not statistically different between AS group and the control group in total populations [OR=1.09,95％CI (0.79,1.50),P=0.61],in the populations of Asian origin [OR=1.17,95％CI (0.65,2.09),P=0.60] and in the populations of non-Asian origin [OR=1.05,95％CI (0.71,1.54),P=0.81].Conclusion The Meta-analysis reveales that all genotypes and alleles of-308 site of TNF-α promoter region may not be associated with AS.

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.

0. 05) . The sensitivity and specificity of NMP-,2 in diagnosing transitional cell carcinoma of bladder were 85. 7% and 60% when the cut-off was set 10 u/ml, In contrast, the sensitivity and specificity of urinec cytology were 32. 1% and 100%. Conclusions: Urinary NMP22 can be used to screen and follow up transitional cell carcinomas of bladder with high sensitivity and high specificity.

In recent years,medical colleges have generally accepted the higher education assessment(evaluation).How to put the good practices and experience we obtained during the educational assessment into the daily teaching management and achieve normalization of teaching evaluation is of great significance to continuously improving the teaching quality.It is the primary condition to establish the evaluation index system for evaluating clinical teaching quality by regular teaching assessment. In this paper,the author constructed a clinical teaching quality evaluation index system through systematic research and exploration.

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.

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 investigate the popularization of cardiopulmonary resuscitation(CPR)knowledge and science popularization needs among urban and rural residents in Tonghai County,Yuxi City,Yunnan Province,so as to explore the establishment of an efficient and appropriate science popularization model.Methods A total of 300 residents aged 15-60 years old were selected from Tonghai County,Yuxi City,Yunnan Province using stratified and simple random sampling methods.A self-designed questionnaire was used to conduct an anonymous questionnaire survey.Results Only 20.3%of Tonghai County residents master CPR skills,and 26.2%of Tonghai County residents have never heard of CPR.There is a statistically significant difference in the awareness rate of CPR between rural residents and non-rural residents(P<0.01).There are differences in residents'age and CPR awareness(P<0.01),the age and CPR are inversely proportional.The residents have a higher willingness to perform chest compressions and mouth-to-mouth resuscitation on strangers,66.2%and 68.6%respectively.63.79%of residents have never attended relevant training.But 92.76%of the people said they were willing to participate in the relevant training when they learned the training news.Conclusion Residents in Tonghai County generally lack knowledge of CPR first aid,but the demand for first aid knowledge of residential CPR is high and the attitude towards rescue is positive.It is recommended that relevant departments increase CPR science popularization and training efforts,and popularize CPR into villages.