BACKGROUND: Rheumatoid arthritis (RA), a chronic systemic autoimmune disease, is characterized by synovitis and progressive damage to the bone and cartilage of the joints, leading to disability and reduced quality of life. This study was a randomized clinical trial comparing the outcomes between withdrawal and dose reduction of tofacitinib in patients with RA who achieved sustained disease control. METHODS: The study was designed as a multicenter, open-label, randomized controlled trial. Eligible patients who were taking tofacitinib (5 mg twice daily) and had achieved sustained RA remission or low disease activity (disease activity score in 28 joints [DAS28] ≤3.2) for at least 3 months were enrolled at six centers in Shanghai, China. Patients were randomly assigned (1:1:1) to one of three treatment groups: continuation of tofacitinib (5 mg twice daily); reduction in tofacitinib dose (5 mg daily); and withdrawal of tofacitinib. Efficacy and safety were assessed up to 6 months. RESULTS: Overall, 122 eligible patients were enrolled, with 41 in the continuation group, 42 in the dose-reduction group, and 39 in the withdrawal group. After 6 months, the percentage of patients with a DAS28-erythrocyte sedimentation rate (ESR) of <3.2 was significantly lower in the withdrawal group than that in the reduction and continuation groups (20.5%, 64.3%, and 95.1%, respectively; P  < 0.0001 for both comparisons). The average flare-free time was 5.8 months for the continuation group, 4.7 months for the dose reduction group, and 2.4 months for the withdrawal group. CONCLUSION: Withdrawal of tofacitinib in patients with RA with stable disease control resulted in a rapid and significant loss of efficacy, while standard or reduced doses of tofacitinib maintained a favorable state. TRIAL REGISTRATION Chictr.org, ChiCTR2000039799.
Humans ; Quality of Life ; China ; Arthritis, Rheumatoid/drug therapy* ; Piperidines/therapeutic use* ; Treatment Outcome ; Antirheumatic Agents/therapeutic use* ; Pyrroles/therapeutic use*

This study investigated the perceptions and medical history of third molars (M3s) and assessed the prevalence of visible M3s (V-M3s) among 904 Chinese adults. The enrolled participants were interviewed to complete a structural questionnaire focused on sociodemographic information and their understanding of, attitudes toward, behaviors regarding, and medical history with respect to M3s. In addition, the number of V-M3s in the cohort was determined by oral examination. Logistic regression analysis was performed to explore the association between individuals' sociodemographic characteristics and their perception of M3s or the presence of V-M3s. The Chi-square test was used to compare the actions taken against symptomatic M3s and the corresponding outcomes among different groups divided according to respondents' sociodemographic factors. In total, 904 completed questionnaires were gathered and analyzed. Nearly half (43.9%) of the respondents knew nothing about M3s, and only 12.7% provided correct answers to all the questions asked. Male sex, older age, occupation involving physical labor, and no previous dental experience were active factors in unawareness of M3s. Male sex was also significantly associated with the presence of at least one V-M3 and negative behavior about symptomatic M3s. In terms of medical history, 192 participants reported having had at least one M3 extracted (438 in total), and 72.6% of the M3s were removed due to the presence of related symptoms or pathologies. In conclusion, the population investigated had a shortage of knowledge about M3s and adopted negative attitudes and actions about M3-related problems.

OBJECTIVE: To investigate the value of hand-held retinal optometer and optical coherence tomography (OCT) in predicting postoperative visual acuity in patients with age-related cataract and idiopathic macular epiretinal membrane. METHODS: We retrospectively analyzed the data of patients undergoing phacoemulsification combined with intraocular lens implantation for age-related cataract in our hospital from January, 2019 to April, 2020.Preoperative examination detected idiopathic macular epiretinal membrane in 45 of the patients (52 eyes) with lens opacity grade C2N2P1 according to LOCSⅡ lens opacity classification criteria.Based on the thickness of the macular fovea, the eyes were divided into group A (9 eyes) with macular thickness < 300 μm by OCT examination, group B (25 eyes) with macular thickness of 300 to 400 μm, and group C (18 eyes) with macular thickness >400 μm.The best corrected visual acuity and retinal visual acuity before operation and the best corrected visual acuity on the first day and at 3 months after the surgery were compared among the 3 groups.The consistency between the preoperative retinal vision and the best corrected vision at 3 months after the surgery was analyzed. RESULTS: The best corrected visual acuity at one day and 3 months after the surgery differed significantly from that before the surgery in all the 3 groups ( CONCLUSIONS For patients with cataract and idiopathic macular epiretinal membrane, phacoemulsification combined with intraocular lens implantation can improve postoperative vision.Hand-held retinal optometer can accurately assess postoperative vision in patients with stage C2N2P1 cataract.Patients with a macular thickness >400 μm caused by idiopathic macular epiretinal membrane are likely to have poor postoperative visual outcomes.
Cataract/diagnostic imaging* ; Epiretinal Membrane/surgery* ; Humans ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy

Considering the adverse effects of nonimpacted third molars (N-M3s) on the periodontal health of adjacent second molars (M2s), the removal of N-M3s may be beneficial to the periodontal health of their neighbors. This study aimed to investigate the clinical, immunological, and microbiological changes of the periodontal condition around M2s following removal of neighboring N-M3s across a 6-month period. Subjects with at least one quadrant containing an intact first molar (M1), M2, and N-M3 were screened and those who met the inclusion criteria and decided to receive N-M3 extraction were recruited in the following investigation. M2 periodontal condition was interrogated before M3 extraction (baseline) and at 3 and 6 months postoperatively. Improvements in clinical periodontal indexes of M2s in response to their adjacent N-M3 removal, along with changes in inflammatory biomarkers among gingival crevicular fluid (GCF) and the composition of subgingival plaque collected from the distal sites of the M2s of the targeted quadrant were parallelly analyzed. Complete data of 26 tooth extraction patients across the follow-up period were successfully obtained and subsequently applied for statistical analysis. Compared to the baseline, the periodontal condition of M2s was significantly changed 6 months after N-M3 removal; specifically, the probing depth of M2s significantly reduced (P < 0.001), the matrix metalloproteinase (MMP)-8 concentration involved in GCF significantly decreased (P = 0.025), and the abundance of the pathogenic genera unidentified Prevotellaceae and Streptococcus significantly decreased (P < 0.001 and P = 0.009, respectively). We concluded that N-M3 removal was associated with superior clinical indexes, decreased GCF inflammatory biomarkers, and reduced pathogenic microbiome distribution within the subgingival plaque. Although the retention or removal of N-M3s continues to be controversial, our findings provide additional evidence that medical decisions should be made as early as possible or at least before the neighboring teeth are irretrievably damaged.
Humans ; Molar/surgery* ; Molar, Third/surgery* ; Periodontal Diseases ; Periodontal Index ; Tooth Extraction

Objective:To report our experience in diagnosis and treatment of posterior atlantoaxial dislocation with odontoid retrolisthesis.Methods:A retrospective study was conducted of the 5 patients who had been treated from July 2012 to August 2018 at Department of Orthopaedics, General Hospital of Southern Theater Command for posterior atlantoaxial dislocation. They were 4 men and one woman, aged from 34 to 67 years (average, 47 years). All of them had a history of trauma. Of them, 4 were complicated with odontoid fracture and one with congenital free os odontoideum. Their posterior atlantoaxial dislocation ranged from 3 to 9 mm (average, 6 mm). By the American Spinal Injury Association (ASIA) grading system, their preoperative spinal injury was rated as grade B in one, as grade C in 3 cases and as grade D in one. All the 5 patients underwent skull traction at 10° flexion. Surgical trans-oralpharyngeal atlantoaxial reduction and internal fixation was performed for the one patient whose reduction had not been achieved by traction while posterior atlantoaxial screw-rod fixation or anterior odontoid screwing was conducted for the 4 patients whose reduction had been achieved by traction. The distance of posterior atlantoaxial dislocation was measured to evaluate their reduction and ASIA grade system was used to assess their spinal function after operation.Results:The postoperative distance of posterior atlantoaxial dislocation was 0 mm, showing a reduction rate of 100%. The 5 patients were followed up for 6 to 36 months (average, 15 months). By the ASIA grade system, the postoperative functional recovery of the spine was grade D in 4 cases and grade C in one. No implant loosening or breakage occurred.Conclusion:As a kind of high-energy hyperextension injury, posterior atlantoaxial dislocation is rare in clinic, but an appropriate treatment can be adopted to deal with its different clinical types to achieve good outcomes.

BACKGROUND: In patients undergoing transoral atlantoaxial reduction and internal fixation, anterior atlantoaxial plate placement, soft tissue swelling and other factors may affect oropharyngeal space. Up to now no anatomical factors regarding dysphagia or dyspnea after anterior approach for atlantoaxial dislocation have been reported. OBJECTIVE: To observe the spatial changes of oropharyngeal airway after atlantoaxial dislocation and internal fixation with transoral atlantoaxial reduction screw-rod system and analyze the related influencing factors. METHODS: Sixty-six patients with atlantoaxial dislocation undergoing transoral atlantoaxial reduction screw-rod system surgery were retrospectively included from January 2012 to December 2016 in the General Hospital of Southern Theater Command. There were 38 males and 28 females aged from 11 to 71 years. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The narrowest oropharyngeal airway space, thickness of soft tissue before C2 vertebra, anterior atlantodental interval, O-C2 angle, and C2-C6 angle were measured in the neutral position before and after surgery. Changes of postoperative data and their effects on the narrowest airway distance in oropharynx were analyzed. RESULTS AND CONCLUSION: (1) The narrowest airway distance in oropharynx, anterior atlantodental interval and C2-C6 angle were significantly decreased after surgery compared with that before surgery (P <0.001). Thickness of soft tissue before C2 vertebra and O-C2 angle increased significantly after surgery compared with that before surgery (P < 0.001). (2) In the multiple regression analysis, the change in the anterior atlantodental interval (0=7.070) and thickness of soft tissue before C2 vertebra 03=0.387) were significant variables related to the change in the narrowest airway distance in oropharynx. On the contrary, there was no significant correlation with the O-C2 angle. (3) It is indicated that reduction of atlantoaxial dislocation and the thickness of soft tissue before C2 vertebrae have negative effect on the oropharyngeal airway space. Therefore, reduction of atlantoaxial dislocation during transoral reduction screw-rod surgery may cause postoperative dysphagia despite maintenance of the O-C2 angle.

Objective:To evaluate the feasibility of placement of S 2 alar iliac screw (S 2AI) using free-hand technique for sacrapelvic fusion in lumbar degenerative scoliosis. Methods:Eighteen patients with Lumbar Degenerative Scoliosis treated by S 2AI screw fixation at Department of Orthopedics, General Hospital of Southern Theater Command of People′s Liberation Army and Department of Orthopedics, 89th hospital of People′s Liberation Army from August 2014 to October 2018 were analyzed retrospectively. There were 5 males and 13 females, aged 63.2 years old (range:55 to 71 years old).Parameters of spine including: Cobb Angle, C 7 plumb line -center sacral vertical line (C 7PL-CSVL), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope (SS) and pI-LL were measured on the whole spine X-ray before operation and at final follow-up. Pelvic CT scan was performed postoperatively to assess the accuracy of S 2AI placement. Oswestry disability Index (ODI) was also recorded. The data were compared by paired t test or Wilcoxon tests. Results:All patients were followed up for 23.7 months (range: 12~62 months).At the last follow up, Cobb Angle decreased from (32.28±4.97) °preoperative to (6.56±3.20) ° ( t=41.142, P<0.01) and C 7PL-CSVL deceased from (1.11±2.07) cm preoperative to (0.18±1.08) cm ( t=41.142, P=0.06) .LL improved from (-22.39±13.07) °preoperative to (-36.39±4.29) ° ( t=4.470, P<0.01) , PI-LL decreased from (26.83±14.83)°preoperative to (13.72±8.3)° ( t=4.396, P<0.01) , PT decreased from (27.94±4.26) °to (23.39±6.08) ° ( t=2.680, P=0.02) , and SS increased from (22.22±6.36) °to (26.28±7.24) ° ( t=-2.178, P=0.04) .SVA decreased from (6.54±4.51) cm preoperative to (2.62±1.29) cm ( t=3.052, P=0.01) .ODI decreased from 0.58(0.40) ( M( QR)) to 0.18 (0.15) ( Z=-4.567, P<0.01) .No complications such as nerve and blood vessel injury occurred during the operation. A total of 32 S 2AI screws were placed, 3 screws were placed with mild to moderate cortical breaches, 2 were perforated the pelvis ventrally, 1 was perforated posteriorly, with no clinically notable neurovascular or visceral complications. Eight patients finished the SRS-22 questionnaire, with mean score of 4.4 in terms of satisfaction with management. Conclusions:Free-hand technique of S 2AI screw placement for sacrapelvic fusion in degenerative lumbar scoliosis is safe and feasible.S 2AI fixation in DLS can provide great correction of deformity, maintain the stability of lumbo-pelvic area and improve the clinical symptoms.

Objective:To evaluate the feasibility of placement of S 2 alar iliac screw (S 2AI) using free-hand technique for sacrapelvic fusion in lumbar degenerative scoliosis. Methods:Eighteen patients with Lumbar Degenerative Scoliosis treated by S 2AI screw fixation at Department of Orthopedics, General Hospital of Southern Theater Command of People′s Liberation Army and Department of Orthopedics, 89th hospital of People′s Liberation Army from August 2014 to October 2018 were analyzed retrospectively. There were 5 males and 13 females, aged 63.2 years old (range:55 to 71 years old).Parameters of spine including: Cobb Angle, C 7 plumb line -center sacral vertical line (C 7PL-CSVL), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope (SS) and pI-LL were measured on the whole spine X-ray before operation and at final follow-up. Pelvic CT scan was performed postoperatively to assess the accuracy of S 2AI placement. Oswestry disability Index (ODI) was also recorded. The data were compared by paired t test or Wilcoxon tests. Results:All patients were followed up for 23.7 months (range: 12~62 months).At the last follow up, Cobb Angle decreased from (32.28±4.97) °preoperative to (6.56±3.20) ° ( t=41.142, P<0.01) and C 7PL-CSVL deceased from (1.11±2.07) cm preoperative to (0.18±1.08) cm ( t=41.142, P=0.06) .LL improved from (-22.39±13.07) °preoperative to (-36.39±4.29) ° ( t=4.470, P<0.01) , PI-LL decreased from (26.83±14.83)°preoperative to (13.72±8.3)° ( t=4.396, P<0.01) , PT decreased from (27.94±4.26) °to (23.39±6.08) ° ( t=2.680, P=0.02) , and SS increased from (22.22±6.36) °to (26.28±7.24) ° ( t=-2.178, P=0.04) .SVA decreased from (6.54±4.51) cm preoperative to (2.62±1.29) cm ( t=3.052, P=0.01) .ODI decreased from 0.58(0.40) ( M( QR)) to 0.18 (0.15) ( Z=-4.567, P<0.01) .No complications such as nerve and blood vessel injury occurred during the operation. A total of 32 S 2AI screws were placed, 3 screws were placed with mild to moderate cortical breaches, 2 were perforated the pelvis ventrally, 1 was perforated posteriorly, with no clinically notable neurovascular or visceral complications. Eight patients finished the SRS-22 questionnaire, with mean score of 4.4 in terms of satisfaction with management. Conclusions:Free-hand technique of S 2AI screw placement for sacrapelvic fusion in degenerative lumbar scoliosis is safe and feasible.S 2AI fixation in DLS can provide great correction of deformity, maintain the stability of lumbo-pelvic area and improve the clinical symptoms.

Objective Myofascial pain syndrome (MPS) is a common muscle function disturbance.This study was to investigate the clinical value of acoustic radiation force impulse (ARFI) imaging in assessing the therapeutic effect of acupuncture for patients with trapezius MPS.Methods A total of 116 patients diagnosed with trapezius MPS received acupuncture therapy once a day for 10 days in Pudong Hospital from August 2015 to June 2016.Using ARFI imaging, we recorded the shear wave velocity (SWV) of the trapezius and obtained the short-form McGill Pain Questionnaire (SF-MPQ) scores of the patients before, at the end of, and at 7, 15 and 30 days after treatment.Then, we analyzed the interaction and correlation between the SWV values and SF-MPQ scores of the patients at different time points.Results Both the SF-MPQ scores and SWV values were first decreased, falling to lowest values (5.19 points and 1.43 m/s) at 7 days after treatment, and then increased again.The interaction between the SF-MPQ scores and SWV values were significantly different at different time points (Finteraction=2.553, Pinteraction=0.038), and there was a strong linear correlation between the two indexes (r=0.755, P=0.000).Conclusion ARFI imaging combined with SF-MPQ has a certain clinical value in assessing the effect of acupuncture on trapezius MPS.

Objective: To explore correlation among clinic blood pressure (CBP), ambulatory blood pressure (ABP) and cardiovascular diseases in diabetic populations.Methods: A total of 336 patients complicated with type 2 diabetes mellitus, who received 24h ambulatory blood pressure monitoring, were selected.According to complicated with coronary heart disease or stroke or not, they were divided into cardiovascular disease group (CVD group, n=122) and no cardiovascular disease group (NCVD group, n=214).Blood lipids, blood pressure, CBP and ABP etc.were compared between two groups;according to median of 24h mean SBP (122mmHg), they were divided into <122mmHg group (n=168) and ≥122mmHg group (n=168), incidence of cardiovascular diseases was compared between these two groups.Results: (1) Compared with NCVD group, there were significant rise in age, percentages of smoking and hypertension, and plasma hsCRP level in CVD group (P<0.05 or <0.01);for ambulatory blood pressure,there were significant rise in levels of 24h mean SBP(mSBP) [(119.8±8.7)mmHg vs.(124.4±9.6) mmHg], daytime SBP (dSBP)[(121.4±9.3) mmHg vs.(128.0±10.3) mmHg] and nighttime SBP(nSBP) [(114.4±4.2) mmHg vs.(120.8±4.7) mmHg] in CVD group, P<0.01 all;there was no significant difference in CBP between two groups;(2) compared with <122mmHg group, there were significant rise in percentages of stroke (20.2% vs.25.0%) and total cardiovascular diseases (32.7% vs.39.9%) in ≥122mmHg group, P<0.01 both;(3) Logistic regression analysis indicated that diabetic patients no matter complicated with hypertension or not, 24h mean SBP was always an independent risk factors of diabetic patients complicated cardiovascular diseases (OR=1.83, 1.36, P<0.05 all).Conclusion: ABP is superior to CBP in predicting cardiovascular risk in patients with diabetes, and 24h mean SBP may be a good ABP index to predict cardiovascular risk.