OBJECTIVE:At present,there are many reports on the related factors associated with the incidence of cervical spine instability in patients with rheumatoid arthritis,but there are problems such as small sample size and many confounding factors,and the research results of various studies on the same related factors are also different.This article analyzed the factors related to cervical spine instability in patients with rheumatoid arthritis by means of a systematic review. METHODS:Articles related to cervical spine instability in patients with rheumatoid arthritis were collected by searching both Chinese and English databases until March 2023.The outcome of cervical spine instability in patients with rheumatoid arthritis was used as the grouping criterion to abstract basic information,baseline patient characteristics,laboratory-related tests,medication use,and other relevant risk factors.Meta-analysis was done using Stata 14.0 software. RESULTS:(1)Sixteen relevant studies,all of moderate or above quality,were included,including seven studies with case-control studies and nine with cross-sectional studies.The overall incidence of cervical spine instability in patients with rheumatoid arthritis was 43.08%.(2)Meta-analysis showed:Related risk factors included female(OR=0.60,95%CI:0.44-0.82,P=0.002);age at disease onset(SMD=-0.52,95%CI:-0.86 to-0.18,P=0.003);duration of disease(SMD=0.58,95%CI:0.14-1.02,P=0.01);body mass index(OR=0.74,95%CI:0.63-0.88,P=0.001);rheumatoid factors positive univariate analysis subgroup(OR=1.33,95%CI:1.02 to 1.72,P=0.04),C-reactive protein(SMD=0.26,95%CI:0.16-0.35,P=0.00),erythrocyte sedimentation rate(SMD=0.15,95%CI:0.002-0.29,P=0.047),anti-cyclic-citrullinated peptide antibodies(OR=1.73,95%CI:1.19-2.51,P=0.004),28-joint Disease Activity Score(SMD=0.20,95%CI:0.04-0.37,P=0.02),destruction of peripheral joints(OR=2.48,95%CI:1.60-3.85,P=0.00),and corticosteroids(OR=1.91,95%CI:1.54-2.37,P=0.00)were strongly associated with the development of rheumatoid arthritis-cervical spine instability.Female and corticosteroid use were independently associated with the occurrence of rheumatoid arthritis-cervical spine instability. CONCLUSION:Based on clinical evidence from 16 observational studies,the overall incidence of rheumatoid arthritis-cervical spine instability was 43.08%.However,the incidence of cervical spine instability in rheumatoid arthritis patients varied greatly among different studies.Gender(female)and the use of corticosteroids were confirmed as independent correlation factors for the onset of cervical spine instability in patients with rheumatoid arthritis.The results of this study still provide some guidance for early clinical recognition,diagnosis,and prevention of rheumatoid arthritis-cervical spine instability.

Objective:To analyze the short-term clinical outcomes of total laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG) combined with Billroth-Ⅱ+Braun anastomosis.Methods:Clinical characteristics of patients undergoing laparoscopic distal gastrectomy combined with Billroth-Ⅱ+Braun anastomosis at Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from Jan 2020 to Oct 2022 were analyzed. Patients were divided into TLDG group ( n=62) and LADG group ( n=62) according to the surgical approach. Results:There were significant differences in the preoperative clinical data section between the two groups, and 124 patients (62 in each group) were enrolled after using propensity score matching to balance significant variables. Compared with the LADG group, the TLDG group showed statistically differences in time to first venting [(2.9±1.3) vs. (2.3±0.8) d, Z=-3.072, P=0.002], time to first fluid diet [(5.9±1.3) vs. (5.4±1.4) d, Z=-2.031, P=0.042] and incision length [(7.1±1.4) vs. (4.8±0.8) cm, Z=-6.331, P=0.000]. Total postoperative complication rate in the TLDG group and the LADG group (29% vs. 37%, χ2=0.911, P=0.340) was not statistically significant. Incidence of postoperative pneumonia was lower in the TLDG group than in the LADG group (3% vs. 13%, χ2=3.916, P=0.048), and incidence of all remaining postoperative complications were not statistically significant. There was no statistically significant difference in the incidence of serious postoperative complications between the TLDG and LADG groups ( P=1.000). Multifactorial analysis revealed that male ( P=0.023) and age ≥65 years ( P=0.001) were independent risk factors for postoperative complications. Conclusion:TLDG is safe and feasible and has better short-term clinical efficacy than LADG.

Objective To explore the predictive value of serum fibrinogen(Fbg)and pentaxin-3(PTX3)levels for perioperative major adverse cardiovascular events(MACE)in elderly patients undergoing hip re-placement surgery.Methods A total of 201 patients who underwent hip replacement surgery in the Qilu Hos-pital of Shandong University,Dezhou Hospital(the hospital)from January 2022 to December 2022 were re-garded as the study group,and based on the presence or absence of MACE during the perioperative period,pa-tients were separated into the non MACE group(183 cases)and the MACE group(18 cases).Another 150 healthy examinees from the hospital were selected as the control group.Fully automated biochemical analyzer and enzyme linked immunosorbent assay(ELISA)were applied to detect serum Fbg and PTX3 levels in re-search objects.Multivariate Logistic regression was applied to analyze the influencing factors of perioperative MACE in elderly patients undergoing hip replacement surgery.Receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of serum indicators for perioperative MACE in elderly patients un-dergoing hip replacement surgery.Results Compared with the control group,the serum Fbg and PTX3 levels in the study group were obviously increased,and the differences were statistically significant(P＜0.05).There were 18 cases who had MACE in elderly patients undergoing hip replacement surgery,with an incidence rate of 8.95％.Compared with the non MACE group,the serum Fbg and PTX3 levels in the MACE group were obviously increased,and the differences were statistically significant(P＜0.05).Elevated serum Fbg,PTX3,cardiac troponin I(cTnI),brain natriuretic peptide(BNP)levels,and decreased left ventricular ejection fraction were independent risk factors for perioperative MACE in elderly patients undergoing hip arthroplasty(P＜0.05).The area under the curve(AUC)of single and combined detection of serum Fbg and PTX3 levels for predicting the occurrence of perioperative MACE in elderly patients undergoing hip arthroplasty was 0.824,0.809,and 0.917,respectively.The combined prediction value of the two was higher than that of indi-vidual prediction(Z combination-Fbg=2.333,P=0.019;Z combination-PTX3=3.110,P=0.001).Conclusion The periop-erative serum Fbg and PTX3 levels in elderly patients undergoing hip replacement surgery are elevated,and the combination of the two has good predictive value for the occurrence of perioperative MACE.

Objective:To investigate the feasibility and clinical efficacy of posterior vertebral column resection (PVCR) combined with polymethylmethacrylate-augmented pedicle screw instrumentation and shortening of spinal column for stage Ⅲ Kümmell's disease with very severe collapse of fractured vertebra.Methods:From January 2017 to September 2021, 9 patients with stage Ⅲ Kümmell's disease with very severe collapse of fractured vertebra underwent PVCR combined with polymethylmethacrylate-augmented pedicle screw instrumentation and shortening of spinal column. Their medical records were retrospectively analyzed. There were 1 male and 8 females, aged (66.9±5.8) years. The injured vertebra was located at T 11 in 2 patients, at T 12 in 4, at L 1 in 2 and at L 2 in 1. X-ray, CT and MRI were performed before operation. The posterior intervertebral heights of adjacent vertebral bodies of the fractured vertebra in the median sagittal position were measured on CT or MRI to evaluate the shortening of the spinal column before PVCR. Recorded were intraoperative bleeding volume, operation time, complications, bone graft fusion, and American Spinal Injury Association (ASIA) grading at preoperation and the last follow-up. The visual analogue scale (VAS) pain scores, Oswestry disability index (ODI) scores, and kyphotic cobb angles at preoperation, 1 week and 3 months postoperation, and the last follow-up were compared to evaluate the clinical efficacy of PVCR. Results:All patients underwent surgery successfully, with tight closure of adjacent vertebrae after resection of the injured vertebra and bone grafting. Operation time was (240.6±23.2) min and intraoperative bleeding (505.6±95.0) mL. The 9 patients were followed up for (17.3±5.6) months. No worsening symptoms of nerve injury, cerebrospinal fluid leakage, or other serious complications were found after operation, nor such complications as loosening or breakage of internal fixation or adjacent vertebral fractures. Bone fusion was achieved at the bone graft sites in all patients by the last follow-up. The VAS and ODI scores and cobb angles at 1 week and 3 months postoperation and at the last follow-up were significantly decreased compared with preoperation ( P<0.05). There were no significant differences in VAS scores or cobb angles among postoperative 1 week and 3 months and the last follow-up ( P>0.05), but pairwise comparisons between different time points after operation showed significant differences in ODI, with postoperative 1 week > postoperative 3 months > the last follow-up ( P<0.05). The ASIA grading at the last follow-up was improved from preoperative grade C to grade D in 2 cases, from preoperative grade C to grade E in 1 case and from preoperative grade D to grade E in 5 cases. Conclusion:PVCR combined with polymethylmethacrylate-augmented pedicle screw instrumentation and shortening of spinal column is a feasible and effective surgical treatment for stage Ⅲ Kümmell's disease with very severe collapse of fractured vertebra, leading to good clinical efficacy.

BACKGROUND: Intervertebral disk (IVD) degeneration, which can cause lower back pain, is a major predisposing factor for disability and can be managed through multiple approaches. However, there is no satisfactory strategy currently available to reconstruct and recover the natural properties of IVDs after degeneration. As tissue engineering develops, scaffolds with embedded cell cultures have proved critical for the successful regeneration of IVDs. METHODS: In this study, an integrated scaffold for IVD replacement was developed. Through scanning electron microscopy and other mechanical measurements, we characterized the physical properties of different hydrogels. In addition, we simulated the physiological structure of natural IVDs. Nucleus pulposus (NP) cells and annulus fibrosusderived stem cells (AFSCs) were seeded in gelatin methacrylate (GelMA) hydrogel at different concentrations to evaluate cell viability and matrix expression. RESULTS: It was found that different concentrations of GelMA hydrogel can provide a suitable environment for cell survival. However, hydrogels with different mechanical properties influence cell adhesion and extracellular matrix component type I collagen, type II collagen, and aggrecan expression. CONCLUSION This tissue-engineered IVD implant had a similar structure and function as the native IVD, with the inner area mimicking the NP tissue and the outer area mimicking the stratified annulus fibrosus tissue. The new integrated scaffold demonstrated a good simulation of disc structure. The preparation of efficient and regeneration-promoting tissueengineered scaffolds is an important issue that needs to be explored in the future. It is hoped that this work will provide new ideas and methods for the further construction of functional tissue replacement discs.

Objective:To analyze the role of patient support system in multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment adherence and outcome, and provide evidence for deepening the patient-centered support system.Methods:Based on the stakeholder analysis, definite stakeholders (administrators from the Department of Medical Insurance, and those from the provincial CDC), expectant stakeholders (administrators from regional CDC, health workers from primary CDCs, medical workers from designated MDR/RR-TB hospitals and MDR/RR-TB patients), and latent stakeholders (MDR/RR-TB patient families and their neighbors or colleagues) were selected using a purposive sampling. These stakeholders were subject to a semi-structured interview on patient support. The inclusion of participants ceased after reaching code or thematic saturation and meaning saturation, while thematic framework analysis was applied in interview data.Results:The 25 interviewees included could be categorized into three groups of stakeholders, i. e., 4 definite stakeholders, 19 expectant stakeholders and 2 latent stakeholders. Three themes summarized in this regard were definite stakeholders providing policy support to advance these patients′ access to standardized diagnosis and treatment services; diagnosis and treatment and management support of expectant stakeholders of these patients to encourage their compliance to treatment and enable their access to high quality medical care; and support from latent stakeholders as a critical guarantee for the patients to welcome a desirable treatment outcome. Psychological support provided under MDR/RR-TB basic care program in some provinces contributed positively to raising patients′ compliance. Economic support, treatment support from family menmbers ccould help the patients to welcome desirable outcomes.Conclusions:MDR/RR-TB patient-centered support system operating in the Yangtze River delta provide the patients with MDR/RR-TB diagnostic and treatment services of some accessibility. Given the progress, there are still shortcomings for the respective stakeholders to enhance their attention and collaboration to improve the access and equity to medical service.

Objective:To evaluate the detection of MDR-TB and XDR-TB patients and to provide evidence for further improvement of MDR-TB and XDR-TB screening strategy.Methods:Patients who were under drug resistance surveillance, registered and reported by the TB Management Information System of the Chinese Disease Prevention and Control Information System from 2012 to 2019 and resided in Guizhou province were retrospectively analyzed. The contribution of five high-risk subgroups to detection of MDR/XDR-TB were evaluated using population attributable risk proportion (PARP).Results:Of the 18 506 cases under drug resistance surveillance, patients who were male, aged between 25 and 54 years, with drug-resistant TB or with MDR/XDR-TB accounted for 68.65% (12 705/18 506), 47.69% (8 826/18 506), 15.90% (2 943/18 506) or 5.42% (1 003/18 506), respectively. Five high-risk subgroups made significant contributions to the detection of MDR/XDR-TB with a PARP of 57.00%. Specifically, the PARP were 21.70%, 19.49%, 11.90% and 2.30% for patients that were relapse and return, failed initial treatment, chronic/retreatment failure and smear-positive at the end of the second or third month, respectively. The detection rate of MDR/XDR-TB in high-risk groups was 15.89% (578/3 637) while in low-risk groups was 2.86% (425/14 869).Conclusions:Number of patients under drug resistance surveillance and the detection of MDR/XDR-TB trended to increase in Guizhou province from 2012 to 2019. The detection rate of MDR/XDR-TB in high-risk groups was higher than low-risk groups.

Flavaspidic acid AB is a bicyclic phloroglucinol derivative with various biological activities in Dryopteris fragrans (L.) Schott. The structure of flavaspidic acid AB was analyzed by inverse synthesis techniques, and its synthesis was designed under the principle of association. Using phloroglucinol as raw material, the 2-methyl-4-butyrylphloroglucinol was synthesized by Vilsmeier-Haack reaction, reduction and acylation, and the flavaspidic acid fragment was synthesized by acylation, alkylation and deacylation, after which N, N-dimethylmethyleneammonium iodide was activated and the flavaspidic acid AB was obtained. The structures of intermediates and flavaspidic acid AB were confirmed by MS, 1H NMR and 13C NMR, and the yield of the target product reached 14.7%. Results indicate that the designed synthetic route of flavaspidic acid AB is simple and easy.

Objective: To investigate the variants of middle colic artery (MCA) and ileocolic vein (ICV) and their influence on the deci-sion regarding approach of laparoscopic right hemicolectomy. Methods: We analyzed the diagnosis and treatment of one right colon cancer patient with variant MCA and ICV who was admitted to the Tianjin Medical University Cancer Hospital in March 2018. The pa-tient underwent laparoscopic right hemicolectomy via a limited medial approach after a multidisciplinary treatment (MDT) discussion. Following were the observation indicators: 1) surgical and postoperative recovery situations; 2) postoperative pathological examina-tion; and 3) follow-up situation. Results: 1) Surgical and postoperative recovery situations: the patient successfully underwent laparo-scopic right hemicolectomy via a limited medial approach. No intraoperative or postoperative complications occurred. Duration of postoperative hospital stay was 11 days. 2) Postoperative pathological examination: the number of dissected lymph nodes was 39. Postoperative pathological tumor stage was pT3N0. Postoperative pathological tumor type was moderately differentiated adenocarci-noma. 3) Follow-up situation: the patient was followed-up for 10 months with disease-free survival. Conclusions: Individual and stan-dard surgery will be the best choice for treating colon cancer patients. MDT can facilitate clinical decision-making and benefit patients.

To investigate the correlation between magnetic resonance imaging (MRI) features and tumor risk grade of gas-trointestinal stromal tumors (GISTs). Methods: Between September 2007 to December 2017, 54 patients who underwent MRI and were pathologically diagnosed in Tianjin Medical University Cancer Institute and Hospital were retrospectively reviewed. We analyzed MRI features including the size, location, shape, boundary, and growth pattern of the tumor; cystic necrosis; metastasis; T1WI and T2WI signal intensities; enhancement signal intensity-time (SIT) curve pattern; and average apparent diffusion coefficient (ADC) val-ues. The MRI features were compared with the tumor risk grade. Results: Of the 54 cases, 16 were of low-risk grade, 13 were of inter-mediate-risk grade, and 25 were of high-risk grade. Statistical analysis showed that tumor size, location, shape, boundary, cystic necro-sis, signal intensity, and average ADC values were correlated with tumor risk grade (P<0.05). However, tumor growth pattern, metasta-sis, and enhancement SIT curve pattern were not correlated with tumor risk grade (P>0.05). GISTs with higher aggressive features were more likely to have larger size, irregular shape, unclear boundary, cystic necrosis, heterogeneous signal intensity, and lower ADC values on MRI. Conclusions: MRI has the potential to predict the risk grade of GISTs before surgery, thereby guiding clinical manage-ment, and evaluating prognosis.