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 efficacy and safety of the rotational arch method of revealing the spinal canal and implanting back in resection of benign intravertebral tumours.Methods:A total of 17 patients with benign intravertebral tumors of the thoracolumbar spine who underwent a rotational arch method of revealing the spinal canal and implantation back in combination with tumor resection in Luoyang Orthopaedic-Traumatological Hospital of Henan Province from April 2017 to October 2022 were retrospectively analyzed. There were 9 males and 8 females, aged 58.59±13.57 years (range, 29-75 years). There were 7 cases of thoracic intravertebral tumors, 2 cases of thoracolumbar intravertebral tumors, and 8 cases of lumbar intravertebral tumors. The operated segments were 6 cases of single-segment, 8 cases of double-segment, and 3 cases of triple-segment. The disease duration was 20.35±16.58 months (range, 3-60 months). Histopathology showed 9 cases of schwannoma, 5 cases of meningioma, 2 cases of teratoma, and 1 case of dermoid cyst. The operation time, intraoperative blood loss, postoperative spinal canal volume, stability of internal fixation, and lamina healing were recorded. The Cobb angle, American Spinal Injury Association (ASIA) classification and Oswestry disability index (ODI) were compared before and after operation.Results:All patients were successfully operated and followed up for an average of 10.5±2.4 months (range, 6-20 months). The operation time was 156.76±26.81 min (range, 120-210 min) and intraoperative bleeding was 338.24±97.68 ml (range, 200-600 ml). There was no neurovascular injury during the operation. Incomplete spinous process fracture occurred in 1 case due to excessive exertion, which healed well without special treatment. Postoperative drainage volume was 147.06±31.58 ml (range, 100-210 ml). The patient's local Cobb angle was 14.15°±6.58° preoperatively and 14.73°±6.34° postoperatively, with no statistically significant difference ( t=1.810, P=0.089). The patient's ODI was 63.65%±6.57% preoperatively and decreased to 23.88%±4.21% at the final follow-up, with statistically significant difference ( t=53.359, P<0.001). In 17 patients, there were 2 cases of ASIA grade B, 9 cases of grade C, and 6 cases of grade D before operation, and 1 case of ASIA grade B, 4 cases of grade C, 8 cases of grade D, and 4 cases of grade E at the final follow-up, which was a significant improvement compared with the preoperative period, and the difference was statistically significant ( Z=2.587, P=0.010). All patients' incisions healed at stage I, and none of them had complications such as cerebrospinal fluid leakage and epidural haematoma. Three-dimensional CT of the spine at 6 months after operation showed that none of the patients had displacement of the vertebral plate, loosening of the internal fixation, infection or fracture. Conclusion:The rotational arch method of revealing the spinal canal and implantation back in combination with tumor resection for the treatment of benign intravertebral canal tumors has good postoperative neurological function recovery and a low complication rate, which is a safe and effective surgical procedure for the treatment of benign intravertebral canal tumours.

【Objective】 To investigate the prevalence of occult hepatitis B virus infection (OBI) among blood donors in Huzhou, and to analyze the viral load and molecular characteristics of OBI. 【Methods】 45 368 blood samples were screened by enzyme linked immunosorbent assay (ELISA) and nucleic acid testing (NAT) for HBV infection from October 2018 to February 2020 in our center. HBsAg-/NAT+ blood donors were studied as experimental group, contemporary HBsAg+ /NAT+ donors as the control. The serum viral nucleic acids of the two groups were extracted, and HBV DNA copies were detected by real-time PCR, the differences between the two groups were compared. The S region gene of the virus was amplified and sequenced by Nested PCR, then compared with the reference sequence of HBV wild type, in order to confirm the genotyping and molecular mutation characteristics of S region. 【Results】 36 samples were confirmed as OBI (0.08%, 36 / 45 368). The HBV DNA load of 8 samples was lower than the detection limit, and the average HBV DNA load of other 28 samples was (42.3±1.24) IU / mL, which was significantly lower than that of the controls (3.32±1.94) ×10⁴ IU / mL(P<0.05). Among the 28 OBI samples, 20 were type B (71.43%), and 8 were type C (28.57%). The frequency of amino acid variation in HBsAg epitopes was significantly higher in OBI than in MHR(P<0.05). 【Conclusion】 The viral load of OBI blood donors in Huzhou, mainly genotype B, is low, and the variation sites were mainly focused in HBsAg epitope and amino acid region (124~147).

Objective to investigate the clinical efficacy of decompression and pedicle screw fixation through posterior approach for complete thoracic spine fracture dislocation.Methods The clinical data of six patients with complete thoracic spine fracture and dislocation treated from September 2002 to June 2016 were analyzed retrospectively by case series study.There were five males and one female,aged 21-67 years old (mean,47.2 years).The injury segments were T3～4 dislocation in one case,T5～6 dislocation in two cases,T6 ～7 dislocation in two cases and T8 ～9 dislocation in one case.There was one case of ASIA grade E and five cases of Grade A,and all of six cases were associated with multiple rib fractures and hemopneumothorax.The companied status was one case of sternal fracture,one case of atlantoaxial complex fractures and three cases of pulmonary contusion.The posterior median incision decompression and pedicle screw system fixation were performed,and the intervertebral bone grafting was conducted after restoration.The surgery time,bleeding volume during surgery,fracture restoration,bone grafting fusion,failure of internal fixation and other complications were recorded.The Visual Analogue Scale (VAS) and American Spinal Injury Association (ASIA) classification were used to assess the pain and neurological function improvement between the preoperative visit and final follow-up visit.Results The surgery time was 150-240 minutes (mean,205 minutes).The bleeding volume during the surgery was 700-2 100 ml (mean,1167 ml).One case was died of pulmonary infection at one week after surgery,the others were followed up for 3-14 months (mean,7.4 months).After operation,five patients were satisfied with the reduction,and the lateral displacement was partially restored in one cases.Five cases of intervertebral bone grafting all had bone fusion.There was no fixation failure.The VAS was (7.4 ± 0.6) points before surgery,(4.5 ± 1.6) points at one week after surgery and (1.8 ± 0.3) points at final visit of follow-up,which had significant difference from the preoperative status (P ＜ 0.05).One case of ASIA grade E had no postoperative aggravation and four cases of grade A had no improvement.Conclusion Posterior decompression and pedicle screw fixation system is optimal choice of treatment for complete thoracic fractures and dislocations for it can attain reduction of fracture and dislocation as well as bone fusion,provide stability for spine and relieve pain.

Objective:To study the possible immune escape mechanisms of HCoV-OC43 from human dendritic cells(DC).Methods:HCoV-OC43 was isolated from clinical specimen using BSC-1 cells and identified by Real-time PCR,and the cytopathic effect was observed by phase contrast microscope.DCs were induced in vivo using hu-GM-CSF and IL-4 cytokines,and after 7 days of differentiation,DCs were infected by HCoV-OC43.The morphology of HCoV-OC43 infected DC was observed by transmission electron microscope,and the cytokines related to DC functions were detected by Real-time PCR after infection.DC proportion and function related co-stimulatory molecules were analyzed by flow cytometry.Results:In vitro HCoV-OC43 infected human DC model was successfully built.HCoV-OC43 can infect DC and generate immune response of DC in vitro,but no virus nucleonic acid could be detected in culture supernatant.The DC expression of IFN-α,IFN-β,CCL3 and CCL5 were significant decreased when infected with HCoV-OC43,but the expression of costimulatory molecules including HLA-DR,CD1c and CD86 were not affected by HCoV-OC43 infection.Conclusion:Human DC could be infected by HCoV-OC43 and generate immune response,but could not produce progeny virus.HCoV-OC43 may escape from immune response by suppressing the expression of IFN-α and other inflammatory cytokines and chemokines in DC.

Objective To study the distribution of bacterium extended spectrum beta lactamases (ESBLs) in sputum samples from patients with lower respiratory tract infection in Panzhihua Hospital of Integrated Traditional Chinese and Western Medicine . Methods A total of 512 strains of gram negative bacterium were isolated from sputum samples of patients with lower respiratory tract infection from January 2014to January 2016 ,standard disk diffusion method was used to detected ESBLs ,drug sensitivity was performed by K-B disk diffusion method .Distribution and drug resistant status of ESBLs bacterium were analyzed .Results Detec-tion rate of ESBLs bacteriumin cadre ward and ICU were higher than that in department of respiration ,and the difference was sta-tistical significant(P< 0 .01) .Among ESBLs bacterium isolated from department of respiration ,Escherichia coli accounted for 37 .5% ,Enterobacter cloacae accounted for 25 .8% .Among ESBLs bacterium isolated from cadre ward ,Escherichia coli accounted for 58 .2% ,Enterobacter cloacae accounted for 45 .5% .The resistant rate of gram negative bacterium producing ESBLs to trime-thoprim was lowest .Conclusion It′s important to understand the distribution and drug resistant status of gram negative bacterium , so as to provide the basis for rational use of antibiotics .

Objective To understand the difference of serological characteristic between alloantibodies,'simple'Rhspecific autoantibodies and autoantibodies mimicking alloantibodies by studies of a patient who produces alloantibodies and autoantibodies that to distinguish Serologically them in order to more appropriate RBC component transfusion administration would be performed for patients.Methods Several serological methods were performed to the patient's serum samples for identification of antibodies by using two antibody screening cell reagents from different manufacturers.Using adsorption of the patient's Rh antibodies in the presence of LISS with the antibody was similar to that of the antigen negative cell from a donor who had a ccDEE Rh type and O type,and to detect antibodies in the absorbed serum and the eluting solution.Results The patient had a ccDEE Rh type with a positive direct antiglobulin test (DAT).Serum antibodies were identified as IgM anti-C,anti-e and IgG anti-e;the possibility of anti-Ce antibody is not excluded.After absorption,serum antibodies were identified as IgM anti-C,anti-e and IgG anti-e;anti-Ce antibody is not excluded.The antibody in patient's RBC elution was identified as IgG anti-e antibody.Conclusion Alloantibody and mimicking alloantibody can be distinguished by comprehensive analysis of patient's Rh phenotype,DAT result and antibody specificity in the serum and absorbed serum and elution of RBC.The low affinity antibody can be better absorbed by adding low ionic liquid (LISS).

Objective: To investigate the molecular evolution characteristics of human coronavirus (HCoV) subtypes in patients with fever and respiratory tract infection in Guangzhou from 2010 to 2012. Methods: Partial fragments of NP, RdRp and S genes of HCoV-OC43, HCoV-229E and HCoV-NL63 positive samples were amplified by RT-PCR and sequencing. Bioinformatics software, including Bio-edit, Mega4.0 and Clustal1.83 were used for comparison and analysis of NP, RDRp and S gene sequences. Molecular evolutionary tree of different gene regions of HCoV-OC43, HCoV-229E and HCoV-NL63 were built. Results: No remarkable variation or recombinant strain of HCoV-OC43, HCoV-229E and HCoV-NL63 was found in Guangzhou during 2010—2012. The HCoV-OC43 substrains were genetically closest to the strains found in Belgium and Hong Kong (GenBank accession number JN129834 and AY903460). HCoV-229E substrains were genetically closest to those found in Amsterdam (GenBank accession number JX503060) and HCoV-NL63 most genetically close to those in Amsterdam and Beijing (GenBank accession number JX104161 and DQ445911). The NP and RDRp genes of all subtypes were highly conserved, while S gene was more variable. Conclusions There were at least 3 substrains of HCoV-OC43, HCoV-229E and HCoV-NL63 epidemic in Guangzhou during 2010—2012, and no remarkable variation or recombinant viral strain was found. The NP and RDRp genes of all subtypes were highly conserved and can be used in virus detection, while S gene was more variable and suitable for phylogenetic and variation study.

[Objective]To evaluate the clinical efficacy and side effects of DHAOx±R regimen in the patients with relapsed and refractory non-Hodgkin's lymphoma(NHL).[Methods]Twenty patients with relapsed or refractory NHL were enrolled into this study in Cancer Center of Sun Yat-sen University.These patients were treated with DHAOx±R regimen(Dexamethasone 20 mg/day intravenous(Ⅳ)on day 1 to day 4,cytarabine 2 000 mg/m~2 3 h Ⅳ,every 12 hours on day 2;oxaliplatin 130 mg/m~2 2 h Ⅳ on day 1;with or without rituximab 375 ms/m~2 on day 0).Six patients were followed by high dose chemotherapy with autologous peripheral blood stem cell transplantation.Response to treatment wag assessed according to The International Working Group Criteria,including CR,PR,SD and PD.Side effects were graded according to WHO criteria,including 0-Ⅳ grades.[Results]Twenty patients received 47 cycles chemotherapy,13 patients(65%)received DHAOx chemotherapy and 7(35%)received DHAOx+R.The response rate(RR)for the whole group was 55%(11/20)with comeplete response(CR)rate 35%(7/20).The response can also be obtained in the patients who were already treated by platinum-based regimen before.The major toxicity Wag myelosuppression.The incidence of grade Ⅲ～Ⅳ neutropenia Wag 35%(16/47),and febrile neutropenia was 17%(8/47).The incidence of grade Ⅲ～Ⅳ thrombocytopenia was 20%(9/47).Eight cycles(17%)occurred mild neumtoxicity.With median follow-up of 12 months,1 and 2-year overall survival rate were 70.6%.[Conclusion]DHAOx was an effective regimen for recurrent and relapsed NHL patients with mild side effects and further investigation is needed.

Objective To evaluate the efficacy and toxicity of SMILE regimen for NK/T-cell lymphoma. Methods From November 2006 to February 2008, 5 patients with relapsed and 5 with first treatment NK/T-cell lymphoma were involved in this study. These patients were treated with SMILE regimen including methotrexate, isofosfamide, L-asparaginase and etoposide.1 patient were treated with autolognus hematopoietic stem cell transplantation (AHSCT), and 2 patients received local regional radiation following SMILE. Results Among 10 patients, 8 were eligible to response evaluation. The overall response rate for whole group was 50 %(4/8) without complete remission. The overall response rate for both previously untreated and relapsed patients were 50 %(2/4). Major toxicity were bone marrow supression and transient transaminase elevation, the incidence of grade Ⅲ -Ⅳ neutroponia was 65 %, and febrile neutropenia was 25 %, Grade Ⅲ transaminase elevation was 10 %. Other toxicities were mild, no treatment-related mortality occurred. 26.1% cycles discontinued due to severe side effect. Conclusion SMILE may be an effective regimen for relapsed or refractory NK/T-cell lymphoma while significant toxicities were observed. Further investigation is requried before SMILE become a standard combination for relapsed or refractory NK/T-cell lymphoma.