RESUMO
Objective:To investigate the effect of tofacitinib combined with methotrexate on disease activity, rheumatoid factor (RF) level and morning stiffness time in patients with refractory rheumatoid arthritis (RA).Methods:A total of 120 patients with refractory RA diagnosed and treated in the First Affiliated Hospital of Hebei North University from June 2019 to June 2020 were selected as the study subjects, and they were randomly divided into three groups by random number table method: etanercept group, etanercept+ methotrexate group, and tofacitinib+ methotrexate group, with 40 patients in each group. The etanercept group was given etanercept treatment, the etanercept+ methotrexate group was given etanercept combined with methotrexate treatment, and the tofacitinib+ methotrexate group was given tofacitinib combined with methotrexate treatment. The clinical efficacy (12 W, 24 W and 48 W of treatment), disease activity, RF level, morning stiffness time and incidence of adverse reactions were compared among the three groups.Results:Comparison of the total clinical effective rate of the three groups: the total clinical effective rate of the etanercept+ methotrexate group and the tofacitinib+ methotrexate group was higher than that of the etanercept group (both P<0.05), and the tofacitinib+ methotrexate group was higher than that of the etanercept+ methotrexate group ( P<0.05). After treatment, the clinical symptoms and disease activity scores (DAS28) in the etanercept+ methotrexate and tofacitinib+ methotrexate groups were significantly improved compared with the etanercept group (all P<0.05), and the improvements in the tofacitinib+ methotrexate group were more significant than those in the etanercept+ methotrexate group ( P<0.05). After treatment, the erythrocyte sedimentation rate (ESR), RF and C-reactive protein (CRP) levels were lower in the etanercept+ methotrexate and tofacitinib+ methotrexate groups than those in the etanercept groups (all P<0.05), and the ESR, RF and CRP levels in the tofacitinib+ methotrexate groups were lower than those in the etanercept+ methotrexate group (all P<0.05). There was no significant difference in the incidence of total adverse reactions among 3 groups (7.50% vs 12.50% vs 12.50%) ( P>0.05). Conclusions:Tofacitinib combined with methotrexate can effectively improve the disease activity, RF level and morning stiffness time in patients with refractory RA, with high safety, which is worthy of clinical application and promotion.
RESUMO
Objective:To analyze the application value of three-dimensional finite element (FE) analysis technology and 3D printing biological model technology in the precise surgery of degenerative lumbar scoliosis (DLS).Methods:A total of 96 patients with DLS undergoing precision surgery at the Second Hospital of Zhangjiakou from December 2020 to December 2022 were selected and randomly divided into two groups using a random number table method. The control group (48 cases) was determined based on the surgical plan determined by pre-operative 3D computed tomography (CT) reconstruction, while the observation group (48 cases) was determined using 3D FE combined with 3D printing biological model technology. The perioperative indicators (time of implanting pedicle screws, radiation exposure time, operation time, intraoperative blood loss), pre-and post-operative Japanese Orthopaedic Association scale (JOA), visual analog self-assessment scale (VAS), Scoliosis Research Society-22 (SRS-22) scale scores, lumbar lordosis angle, scoliosis Cobb angle, and complication rate were compared between the two groups.Resultsl:The time of pedicle screw insertion, radiation exposure time, and operation time in the observation group were shorter than those in the control group (all P<0.05), and the intraoperative blood loss was less than that in the control group ( P<0.05). The JOA and SRS-22 scale scores in the observation group were higher than those in the control group (all P<0.05), and the VAS score was lower than that in the control group ( P<0.05). The lumbar lordotic angle in the observation group was greater than that in the control group ( P<0.05), and the Cobb angle of lateral curvature was smaller than that in the control group ( P<0.05). The incidence of complications in the observation group [4.17%(2/48)] was lower than that in the control group [20.83%(10/48)], and the difference was statistically significant ( P<0.05). Conclusions:Preoperative simulation of the surgical process using 3D FE combined with 3D printing of a biological model can effectively reduce blood loss, shorten operation time, promote the functional recovery of the damaged lumbar spine, alleviate postoperative pain, restore the anterior curvature angle, improve quality of life, and reduce complications.