BACKGROUND: Vaccination has been shown effective in controlling the global coronavirus disease 2019 (COVID-19) pandemic and reducing severe cases. This study was to assess the flare and change in disease activity after COVID-19 vaccination in patients with stable rheumatoid arthritis (RA). METHODS: A prospective cohort of RA patients in remission or with low disease activity was divided into a vaccination group and a non-vaccination group based on their COVID-19 vaccination status. Each of them was examined every 3 to 6 months. In the vaccination group, disease activity was compared before and after vaccination. The rates of flare defined as disease activity scores based on 28-joint count (DAS28) >3.2 with ΔDAS28 ≥0.6 were compared between vaccination and non-vaccination groups. RESULTS: A total of 202 eligible RA patients were enrolled. Of these, 98 patients received no vaccine shot (non-vaccination group), and 104 patients received two doses of vaccine (vaccination group). The median time interval from pre-vaccination visit to the first immunization and from the second dose of vaccine to post-vaccination visit was 67 days and 83 days, respectively. The disease activity scores at pre-vaccination and post-vaccination visits in the vaccination group patients were similar. At enrollment, gender, RA disease course, seropositivity, and disease activity were comparable across the two groups. Flare was observed in five (4.8%) of the vaccination group patients and nine (9.2%) of the non-vaccination group patients at post-vaccination assessment ( P  = 0.221). In terms of safety, 29 (27.9%) patients experienced adverse events (AEs) after vaccination. No serious AEs occurred. CONCLUSIONS COVID-19 vaccinations had no significant effect on disease activity or risk of flare in RA patients in remission or with low disease activity. Patients with stable RA should be encouraged to receive the COVID-19 vaccination.
Humans ; Arthritis, Rheumatoid ; Cohort Studies ; COVID-19/prevention & control* ; COVID-19 Vaccines/adverse effects* ; East Asian People ; Prospective Studies ; Vaccination/adverse effects*

Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation of the joints with high risk of disability. In recent years, remarkable progress has been made towards the diagnosis and treatment of RA, and the international RA guidelines have been also kept updated. Nevertheless, there are many challenges in China, especially inadequate number of rheumatologists and insufficient experience in the diagnosis and treatment of RA. Therefore, Chinese Rheumatology Association drafted the standardized diagnosis and treatment of RA based on the available evidence, so as to improve the management of RA patients in China.

By removing a part of the structure, the tooth preparation provides restorative space, bonding surface, and finish line for various restorations on abutment. Preparation technique plays critical role in achieving the optimal result of tooth preparation. With successful application of microscope in endodontics for >30 years, there is a full expectation of microscopic dentistry. However, as relatively little progress has been made in the application of microscopic dentistry in prosthodontics, the following assumptions have been proposed: Is it suitable to choose the tooth preparation technique under the naked eye in the microscopic vision? Is there a more accurate preparation technology intended for the microscope? To obtain long-term stable therapeutic effects, is it much easier to achieve maximum tooth preservation and retinal protection and maintain periodontal tissue and oral function health under microscopic vision? Whether the microscopic prosthodontics is a gimmick or a breakthrough in obtaining an ideal tooth preparation should be resolved in microscopic tooth preparation. This article attempts to illustrate the concept, core elements, and indications of microscopic minimally invasive tooth preparation, physiological basis of dental pulp, periodontium and functions involved in tool preparation, position ergonomics and visual basis for dentists, comparison of tooth preparation by naked eyes and a microscope, and comparison of different designs of microscopic minimally invasive tooth preparation techniques. Furthermore, a clinical protocol for microscopic minimally invasive tooth preparation based on target restorative space guide plate has been put forward and new insights on the quantity and shape of microscopic minimally invasive tooth preparation has been provided.

Objective To explore the risk factors of urate deposition on ultrasound in patients with gout.Methods All the gout patients who visited our center between February 2015 and February 2017 and underwent ultrasound examination of bilateral knees,ankles and first metatarsophalangeal joints (MTP1) were enrolled.Subgroup analysis was done depending on whether double contour sign (DCS) or tophus was found on ultrasound.Main statistical analysis methods were t test,chi-square test and logistic regression model.Results One hundred and twenty-six patients were included.DCS was found in 50(39.7％) patients and tophus was found in 48 (38.1％) patients.The serum uric acid (SU) level of the DCS positive group was signi-ficantly higher than the DCS negative group [(602±79) μmol/L vs (538±101) μmol/L,t=3.998,P=0.044].The hyperuicemia duration of the two groups were (186±87) months and (130±77) months,which was significantly different (t=3.330,P=0.002).The hyperuicemia duration of the tophus positive group was significantly higher than tophus negative group [(175±102) months vs (138±96) months,t=2.003,P=0.045].The SU level and hyperuicemia duration were independent risk factors of positive DCS in gout patients [OR =1.006,95％ CI (1.002,1.01 1);OR=1.028,95％CI (1.013,1.042)].The hyperuicemia duration was independent risk factor of positive tophus in gout patients [OR=1.004,95％CI (1.000,1.007)].Receiver operating characteristic curve (ROC) curve showed gout patient whose hyperuricemia duration was longer than 94months and SU level was higher than 505.5 μmol/L were more likely to have positive DCS in joints;meanwhile,patient whose hyperuricemia duration was longer than 137 months were more likely to have positive tophus in joints.Conclusion Gout patients who have positive DCS and tophus on ultrasound have longer hyperuicemia duration.Positive DCS is also related with patients' higher serum levels.The hyperuicemia duration is an independent risk factor of urate deposition on ultrasound in patients with gout.

Objective To explore the risk factors of urinary stone formation in primary gout patients by urinary chemical,serum and urinary biochemical features analysis.Methods All the patients diagnosed as primary gout at Peking University First Hospital from 2009 to 2015 were included in the study.All patients were diagnosed with or without urolithiasis by ultrasound or computed tomography.Their clinical features,baseline urinary metabolic panels and stone composition were analyzed and compared between the two group of patients.Moreover,the risk factors of uric acid stone formation were determined by comparing different composition of stone formation group.Analysis of variance,t-test,chi-square test,spearman's test and logistic regression were used for statistical analysis.Results One hundred and forty-four male gout patients were enrolled in the study among these patients,48 were with urolithiasis and 96 patients were without urolithiasis.Most (136,94.4％) patients were under excretion of uric acid.Among 48 gout patients with uric acid urolithiasis,30 (62.5％) patients who had pure uric acid stones,and 18 (37.5％) had stones composed of mixed uric acid and oxalic acid.Compared with mixed stone group,the mean age was significantly lower in pure uric acid stone group [(46±13) years vs (60±15) years,t=4.1,P＜0.05];and disease duration was shorter [(42±11)months vs (71±22) months,t=-0.2,P＜0.01].The 24-hour urinary uric acid were significantly higher in the uric acid stone group [(5 205±3 524) μmol/d vs (2 132±1 326) μmol/d,t=3.6,P＜0.05].Also,the mean of both Ccr and Cua were higher [(119±61) ml/min vs (75±39) ml/min,t=3.6,P＜0.05;(6.3±3.6) ml/min vs (3.2±2.0)ml/min,t=l.4,P＜0.05].Urinary pH was negatively correlated with uric acid stone in primary gouty patients (r=-0.212,P＜0.01);The total excretion of urinary uric acid was positively correlated with uric acid stones formation (r=0.633,P＜0.05).High urinary uric acid excretion and Ccr were independent risk factors for uric acid stone formation in primary gout patients.Conclusion Urine pH is negatively correlated with uric acid stone formation.Urinary analysis of 24-hour uric acid and Ccr are risk factors for pure uric acid urolithiasis in primary gout patients.

Objective To explore the impact of dyslipidemia on uric acid stones by analyzing the relationship between blood lipids and urolithiasis in primary gouty patients.Methods We retrospectively identified patients with nephrolithiasis in primary gout patients who underwent stone chemical analysis,compared with gout patients without nephrolithiasis.The clinical parameters,urine analysis and lipid levels were analyzed.Patients were divided into groups based on serum lipid levels.The groups were compared based on demographic data and stone composition.Correlations were analyzed between serum lipid,urinary pH and uric acid stones.Moreover,the risk factors of uric acid stones were determined by logistic regression analysis.Analysis of variance,t-test,chi-square test,Spearman's test and Logistic regression were used for statistical analysis.Results ① A total of 144 gout patients were included in study,48 patients with urolithiasis and 96 patients without urolithiasis.② Serum lipid levels were significantly lower in urolithiasis group than those patients without urolithiasis including triglyceride (TG) [1.6(0.9,2.1) mmol/L vs 2.2(1.4,3.2) mmol/L,Z=2.38,P=0.01],total cholesterol (TC) [(4.4±1.2) mmol/L vs (5.1±1.0) mmol/L,t=5.3,P=0.006];low density lipoprotein cholesterol (LDL-C) [(2.5±0.9) mmol/L vs (3.2±0.9) mmol/L,t=4.2,P=0.005].③ Compared to oxalate stone formers,uric acid stone formers had significantly higher TG [(1.8±0.6) mmol/L vs (0.9±0.5) mmol/L,t=4.9,P=0.001),TC [(4.4±1.1) mmol/L vs (3.8±1.0) mmol/L,t=1.8,P=0.001] and LDL-C [(2.8±0.9) mmol/L vs (2.0±0.7) mmol/L,t=3.5,P=0.045],while the high density lipoprotein (HDL) level was lower [(0.94±0.23) mmol/L vs (1.32±0.41) mmol/L,t=-4.0,P=0.002].④ Percentage of uric acid stones in high TG group was higher than normal TG group [85％(17/20 vs 46.4％(13/28),x2=7.4,P=0.007],in addition,the percentage of uric acid stones in low HDL group was higher than normal HDL group [(82.1％(23/28) vs 35.0％(7/20),x2=11.1,P=0.001].⑤ Uric acid stones were significantly correlated with high TG,low LDL and urinary pH(r=0.522,0.47,-0.212,respectively).Logistic analysis showed risk factors for uric acid stone in primary gouty patients were high TG [OR=2.38,95％CI(1.41,13.7);P=0.01] and lower HDL level [OR=0.01,95％CI(0.01,0.43);P=0.01].Conclusion There is a link between dyslipidemia and kidney uric acid stone risk in primary gout patients.Specific alterations in patient's lipid profile may portend unique aberrations in urine physico-chemistry and uric acid stone risk.

BACKGROUND: Pedicle screws are widely used in spinal internal fixation, while complications related to screw mistaken placement can be found occasionally. Conventional imaging examination cannot provide the accurate situation of the nail, and the nail path can be directly revealed on CT.OBJECTIVE: To discuss the application of CT scanning in the preoperative planning of lumbar spine surgery using digital technology.METHODS: 136 patients were enrolled, and digital technology was used to determine the best nailing track on planar CT images. Then the length of the pedicle screws, width of the pedicle, angle between pedicle screws and standard sagittal plane, and angle between pedicle screw and spinous process as well as sagittal plane were measured. The difference in measured values on each side was compared. Also, the difference in angle between pedicle screw and sagittal plane and spinous process was compared.RESULTS AND CONCLUSION: (1) There was no significant difference in the length of pedicle screw in both sides (P > 0.05). (2) There was significant difference in the width of pedicle screw at L1 and L4 of two sides (P < 0.05). (3) The angle between pedicle screw and standard sagittal plane at each level bilaterally did not differ significantly (P > 0.05). (4) The angle between pedicle screw and spinous process at each level bilaterally did not differ significantly (P > 0.05). (5) To conclude, pedicle CT scanning can accurately reflect patients' pedicle anatomic situation, which can help surgeons to design an appropriate scheme. Moreover, the anatomical variations of lumbar spine are remarkable, so pedicle screw insertion should be planned individuality.

SUMMARY Here we reported two patients who presented with panuveitis and were transferred from oph-thalmologists to rheumatologists,for both the patients had oral and genital ulcers.They were misdiag-nosed with Behcet’s disease at first glance.Two young males presented with acute uveitis with history of recurrent oral and genital ulcers.They initially presented with symptoms and signs resembling Behcet’s disease and were treated with systemic steroids with suboptimal responses.Routine laboratory test re-vealed syphilis and human immunodeficiency virus (HIV)infection.After treatment of penicillin and anti HIV virus therapy,the panuveitis was relived.The other patient was lost in the follow up.Recently epi-demiological data indicate that syphilis and HIV infection increase,which can mimic the manifestation of Behcet’s disease.Diagnosis of sexual transmitted diseases,such as HIV or syphilis needs to be ruled out in all cases that mimic the clinical feature of Behcet’s disease,especially for those who had a history of high risk behaviors.Every patient should have history analysis in detail.Screening of sexual transmitted diseases,such as HIV or syphilis is important especially in those rapid progressive panuveitis.Also, other virus infections,such as cytomegalovirus,epstein-barr virus or Herpes simplex virus can cause mucosa ulcers and uveitis.CD4 T cell count is a very important marker to indicate that the patient has immunodeficiency.Erythema nodosa and pseudofolliculitis are the third common clinical manifestation in Chinese Behcet’s disease patients.Rheumatologist should watch out for patients without skin involvement when making the diagnosis of Behcet’s disease.Syphilis-associated uveitis usually has a good prognosis. Treatment of antibiotics can get good response,92% uveitis can be relieved,with 67% improved vision. Acute syphilitic posterior placoid chorioretinitis (ASPPC)is a clinically and angiographically distinct manifestation of ocular syphilis.Systemic glucocorticoid can be used in syphilis induced posterior uveitis, sleritis and optic neuritis,and it can also prevent the Hector’s reaction.However,for patients diagnosed with both HIV and syphilis,regular antibiotic can not prevent relapse.So doctors need to follow up them regularly.Patients who present with uveitis,oral and genital ulcers can be easily diagnosed with Behcet’s disease.Rheumatologists need to be aware of the reemergence of sexual transmitted disease.High degree of clinical suspicion can allow ophthalmologists and rheumatologists to diagnose and treat the disease ear-ly.Correct diagnoses timely can get the good treatment response,and rescue the vision.Treatment with regular antivirus and Penicillin can receive the good response,and moreover glucocorticoid can relieve the inflammation.

SUMMARY A 36-year-old woman had an 8-year history of systemic lupus erythematosus (SLE) and was being treated with 10 mg/d of prednisone.She presented with a 6-month history of intermittent fever and multiple painful multi skin erythematous macules in her button, hips and extremities that had slowly en-larged to 8 cm ×4 cm in diameter.The lesions started as painful erythematous macules, which eventually ulcerated and scared.Laboratory tests showed leukopenia, protenuria, positive anti-double strand DNA and hypocomplementemia.Cultures of the bottom ulcer were E.Coli, fugus and Tuberculous mycobacteria were both negative.Biopsy was performed and revealed necrosis of epidermis, thrombus and cellulose de-generation in epidermis with neutrophils karyorrhexis and vasculitis.Her SLE was active, so she was pre-scribed antibiotics for 2 weeks and prednisone was added to 60 mg/d for a month.However her skin ul-cers did not relieve.When prednisone was added to 120 mg/d with combination therapy of cyclophospha-mide and hydroxychloroquine, her skin ulcer cicatrized gradually.

Objective:To verify the fracture risk assessment tool ( FRAX) to estimate the probability of osteoporotic fracture in patients with rheumatoid arthritis ( RA ) with or without bone mineral density (BMD), and identify associated risk factors of osteoporosis .Methods: In the study, 200 patients with rheumatoid arthritis aged more than 40 years in Peking University First Hospital from Dec .2009 to Dec. 2012 were recruited.Clinical information was obtained from a questionnaire of their case history and medical records.FRAX tool was administered.Their lumber spine and left femoral BMD were determined by dual energy X ray absorptiometry.The gender, age, disease duration, menopause status, body mass index ( BMI) and accumulative dose of glucocorticoid were obtained in retrospect .Correlation analysis was conducted between the BMD and clinical information .Results:The study population ( female, 77.5%) had a mean age of 59.4 years, in which 10 (13%) patients showed a normal BMD, 67 (87%) were osteopenia or osteoporosis , while 32 patients (16%) had fragile fracture.Compared with the patients with normal BMD, the subjects with low BMD had significantly older age , longer period for corticoids usage , higher day dose and accumulated dose of corticoids .The 10-year fracture risk of sustai-ning major osteoporotic fractures and hip fracture was higher .No significant difference was observed be-tween the 10-year fracture risks calculated with BMD and without BMD .The values of the different area under the receiver operating characteristic ( ROC) curve ( AUC) for major and hip fractures calculated in three ways:without BMD, with the femoral neck BMD, and with T-score.The best result was for FRAX tool for hip fracture with the T-score ( AUC 0 .899 ) .A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low BMD . Three statistically significant variables for lumber BMD were pain on visual assessment scale ( VAS ) (P=0.02), fracture history (P=0.003) and a higher steroid accumulated dose (P=0.008).Three statistically significant variables for left hip BMD were age (P<0.001), fracture history (P=0.05) and lower BMI ( P=0.03) .Conclusion:Low BMD is a common complication in RA patients .Risk factors for major fracture and hip fracture are increased .There is a positive correlation between FRAX calculated with and without BMD or T score .FRAX with the femoral neck T score or BMD presents a discriminatory capacity better than FRAX without BMD , according to the AUC ROC .