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 investigate the correlation between neuropeptide S receptor(NPSR)single nucleotide polymorphism(SNP)(rs323917,rs323920,rs323922,rs2530547,rs324957)and primary insomnia(PI).Methods A total of 157 patients diagnosed with PI in the outpatient department of Center of Sleep Medicine,Gansu Provincial People's Hospital from December 2016 to May 2019 were selected as PI group,and 133 healthy physical examination subjects during the same period were selected as control group.Venous blood samples were collected and DNA,polymerase chain reaction(PCR)amplification and agarose gel electrophoresis were extracted.rs323917,rs323920,rs323922,rs2530547,rs324957 single nucleotide loci were genotypized by target site sequencing.Meanwhile,standard polysomnosis monitoring was performed to analyze the correlation between gene polymorphism and PI.Results There were no significant differences in the genotype distribution of NPSR SNP sites(rs323917,rs323920,rs323922,rs2530547)and allele frequency and rs324957 allele frequency between two groups(P＞0.05).There was significant difference in genotype distribution of rs324957(P=0.034).There was no significant difference in the frequency of different haplotypes between two groups(P＞0.05).Conclusion The expression of rs324957 SNP genotypes in NPSR may be related to PI,and AG genotype is dominant.

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.

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 analyze the molecular characteristics of dengue virus (DENV) strains circulating in Shantou city in 2018 and 2019 for elucidating the reasons causing strikingly different dengue fever epidemics during the two years and understanding the transmission characteristics and routes of DENV, and to provide reference for the prevention and control of dengue fever.Methods:Detection of viral nucleic acid contents and amplification and sequencing of E gene were carried out on 872 samples positive for DENV acid in 2018 and 2019. Phylogenetic trees were constructed based on the E gene sequences to analyze the homology of DENV strains. The sources and transmission routes of the strains were also analyzed. Results:A total of 99 sequences of DENV E gene were acquired, including 68 DENV-1 sequences and 31 DENV-2 sequences. The cases of dengue fever were sporadic in 2018. Phylogenetic tree showed the strains isolated in 2018 were from multi-sources and closely related to those found in Guangzhou city and Southeast Asia area. Dengue fever outbreaks occurred in 2019 and most of the prevalent strains were from a single source, which was speculated to be Cambodia. Conclusions:Dengue fever in Shantou city was mainly caused by imported strains of the same year rather than by local strains in previous years. DENV strains in Shantou might be traced back to Southeast Asia area and transmitted to Shantou through many routes.

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 assess the efficacy of internal fixation assisted with Halo-vest in the treatment of Anderson-D'Alonzo type Ⅱ and superficial type Ⅲ odontoid fractures.Methods A retrospective case series study was made on 15 patients clinically diagnosed as Anderson-D'Alonzo type Ⅱ and type Ⅲ odontoid fractures with a fracture gap over 2 mm,displacement over 5 mm and broken end angel over 11° from January 2007 to January 2015.There were nine males and six females,aged 27-61 years [(44.5 ± 10.9)years].The patients were treated in "three phases" with the assistance of Halo-vest external fixation system and a novel guide pin aiming device.The three phases were as follows:phase Ⅰ:cervical traction reduction and halo-vest external fixation;phase Ⅱ:Halo-vest assisted internal fixation using the novel aiming device;phase Ⅲ:the Halo-vest fixation removal and cervical collar fixation.Operation duration,intraoperative bleeding,and postoperative visual analogue scale (VAS) pain score one month after the operation were recorded.The cervical lateral and open mouth X-ray or atlantoaxial CT scan with sagittal and coronal two-dimensional reconstruction were regularly reviewed,and the location of screws,reduction and fracture healing were evaluated.Results Operation duration ranged from 54 to 96 minutes [(71.3-± 11.9) min].The intraoperative blood loss was 5-60 ml [(32.6 ± 16.8) ml].There was no spinal cord or nerve root injury,cerebrospinal fluid leakage,wound infection or other complications.All patients were followed up for 12-36 months (mean,28 months).Fourteen patients were seen bony union 6 months after the surgery and one patient was seen a false joint.At the last follow-up,the patient with false joint was seen bone sclerosis,and other patients with sound bone healing.The preoperative VAS and that of one month after the operation was (7.3 ± 0.6) points and (1.6 ± 0.7) points,respectively (P ＜ 0.05).Conclusion For Anderson-D'Alonzo type Ⅱ and type Ⅲ odontoid fractures,which have a fracture gap greater than 2 mm,displacement more than 5 mm,broken end angle above 11 degrees,the three-phase Halo-vest assisted internal fixation can provide good stability before operation and promote bone healing and pain relief after operation.

Objective To investigate the clinical efficacy of recombinant human epidermal growth factor in the treatment of recurrent oral ulcers in elderly patients.Methods 82 cases of elderly patients in our hospital in the treatment of recurrent oral ulcer were selected,41 cases in the control group,the conventional western medicine treatment,41 cases of the study group,recombinant human epidermal growth factor in treatment before and after treatment,blood determination of immune status,clinical efficacy and adverse reactions of comparison were performed at one-year follow-up.Results the effective rate of treatment group is lower than 78.05％of the effective rate of treatment group 95.12％,study group 3,6 and 12 months recurrence rate(4.88％,7.32％,7.32％)than in the control group the recurrence rate(19.51％,24.39％,29.27％),the study group after the treatment of CD3+ and CD4+/CD8+ and NK were higher than the control group,the CD8+ level is lower than the control group(P<0.05),the two groups had no serious adverse reaction.Conclusion recombinant human epidermal growth factor is effective in the treatment of oral ulcer.

Objective To investigate the influence of“double low”technology(low concentration iodinated contrast agent and low-dose scan) combined with body mass index(BMI) on radiation dose and image quality of contrast-enhanced upper abdominal CT examination. Methods One hundred and twenty patients who received upper abdominal enhanced CT examination were randomly divided into 4 groups:group A1, the iodinated contrast agent iodixanol(270 mg/ml), BMI<18.5 kg/m2 and 80 kVp;group A2, the iodinated contrast agent iodixanol(270 mg/ml), 18.5 kg/m2≤BMI≤24.9 kg/m2 and 100 kVp; group B1, the iodinated contrast agent ioversol(320 mg/ml),<18.5 kg/m2 and 120 kVp; group B2, the iodinated contrast agent ioversol(320 mg/ml), 18.5 kg/m2≤BMI≤24.9 kg/m2 and 120 kVp. Image quality was subjectively scored, the objective parameters(noise, CT values of abdominal aorta and liver parenchyma, contrast noise ratio of abdominal aorta and liver parenchyma) were evaluated and radiation dose was recorded. The differences of the indexes between A1 and B1 groups, A2 and B2 groups were compared with Mann-Whitney U test and pared-samples t test. Results All CT images were good. No images with 4 scores were obtained. No significant difference was found between group A1 and B1, between group A2 and B2(P>0.05). There was no significant difference in contrast noise ratio of liver parenchyma(P>0.05), while significant differences existed in CT values of abdominal aorta and liver parenchyma, contrast noise ratio of abdominal aorta between group A1 and B1(P<0.05). Significant differences existed in the parameters above mentioned between group A2 and B2, respectively(P<0.05). Radiation dose was lower in group A1 than in group B1 and in group A2 than in group B2(P<0.05), respectively. Radiation dose was decreased by 40.1%(0.89/2.22) in group A1 than group B1 while radiation dose decreased by 56.9%(3.02/5.31) in group A2 than group B2. Conclusion According to BMI, the low concentration iodinated contrast agent and low-dose scan CT scanning technology could effectively reduce radiation dose and generate ideal images during the contrast-enhanced upper abdominal CT examination.