Abstract: Objective　In order to understand and master the prevalence of different genotypes and the rate of different drug-resistant Mycobacterium tuberculosis genotypes in Hainan Province, 136 drug-resistant Mycobacterium tuberculosis strains collected in Hainan province in 2022 were genotyped, and to provide scientific basis for tuberculosis prevention and control strategy in Hainan Province. Methods　A total of 136 drug-resistant Mycobacterium tuberculosis strains were collected in Hainan Province. The clinical isolates were genotyped using the Spoligotyping technique, and the drug resistance rates of different genotypes of Mycobacterium tuberculosis were statistically analyzed. Results　Among the 136 strains of drug-resistant Mycobacterium tuberculosis, 54.41% (74/136) belonged to the Beijing types, 27.94% (38/136) to non-Beijing types and newly identified genotypes accounted for 17.65% (24/136). The Beijing type included two genotypes, SIT1 and SIT269 genotypes, accounting for 52.94% (72/136) and 1.47% (2/136) respectively. Among the non-Beijing genotypes, the T type (T1, T2, T3) accounted for 21.32% (29/136), the U type accounted for 6.62% (9/136). Clustering analysis of genotyping results revealed two major clusters, Beijing type and non-Beijing type, as well as several scattered novel genotypes. Clustering analysis of Spoligotyping results classified the 136 drug-resistant strains into 3 clusters, with a clustering rate of 75.74% (103/136). The rates of mono-resistance (MR), poly-resistance (PR), multi-drug resistance (MDR), and other types of drug resistance in Beijing type and non-Beijing type were 41.89% (31/74), 13.51% (10/74), 24.33% (18/74), 20.27% (15/74) and 36.84% (14/38), 15.79% (6/38), 26.32% (10/38), 21.05% (8/38) respectively. Chi-square test results showed no statistically significant differences in drug resistance rates between the Beijing and non-Beijing types (P>0.05). Conclusion　The genotype of Mycobacterium tuberculosis in Hainan Province showed genetic polymorphism, with the main epidemic genotype being SIT1 in the Beijing type. Monitoring of Mycobacterium tuberculosis in this genotype should be strengthened.

Objective To understand the drug resistance surveillance situation of Mycobacterium tuberculosis in Hainan Province from 2018 to 2022, analyze the drug resistance status and trends of Mycobacterium tuberculosis in Hainan Province, and provide scientific basis for the formulation of tuberculosis prevention and treatment strategies. Methods A total of 2 481 sputum culture-positive isolates from pulmonary tuberculosis patients collected from 2018 to 2022 were subjected to strain identification and drug sensitivity testing. Strain identification was performed using the p-nitrobenzoic acid (PNB) inhibition test, and the sensitivity test for six anti-tuberculosis drugs, including Rifampicin (RFP), Isoniazid (INH), Streptomycin (SM), Ethambutol (EMB), Ofloxacin (OFX), and Kanamycin (KM), was conducted using the solid culture proportion method. The drug sensitivity results were statistically analyzed. Results Of the 2 481 isolates, 2 211 were identified as Mycobacterium tuberculosis complex (MTBC). The overall drug-resistance rate was 19.9% (441/2 211). The drug resistance rates for initial-treatment and retreatment patients were 15.7% (271/1 729) and 35.3% (170/482) respectively, with a statistically significant difference (χ2=90.65, P<0.01). The mono-resistance rate (MR) was 6.0% (132/2 211), with monoresistance rates of 5.6% (97/1 729) for initial-treatment patients and 7.3% (35/482) for retreatment patients, with no statistically significant difference (χ2=1.83, P>0.05). The overall poly-resistance rate (PR) was 4.1% (91/2 211), with polyresistance rates of 3.5% (61/1 729) for initial-treatment patients and 6.2% (30/482) for retreatment patients. The overall multidrug-resistance rate (MDR) was 8.0% (176/2 211), with multidrug resistance rates of 4.2% (72/1 729) for initial-treatment patients and 21.6% (104/482) for retreatment patients. According to the χ2 test, the retreatment group had significantly higher rates of polyresistance and multidrug resistance than the initial-treatment patient group, with statistically significant differences (χ2=6.94, P<0.01; χ2=155.98, P<0.01). The resistance rates to individual drugs in descending order were 11.6% (251/2 211) to INH, 11.4% (255/2 211) to RFP, 8.6% (191/2 211) to SM, 8.2% (181/2 211) to OFX, 4.0% (88/2 211) to EMB, and 1.6% (35/2 211) to KM. Conclusions The overall drug-resistance rate, poly-resistance rate, and multidrug resistance rate of Mycobacterium tuberculosis in retreatment patients in Hainan Province are higher than those in initial-treatment patients. Standardized treatment and management of TB patients are particularly important.

Objective To observe the clinical effects of medicine-separated moxibustion in treating renal edema.Methods Totally 134 patients with renal edema in the first affiliated hospital of Hunan University of Chinese Medicine from July 2014 to June 2015 were selected and divided into the observation group and the control group by random number table.Patients in the observation group received conventional nursing and medicine-separated moxibustion treatment,while patients in the control group received conventional treatment and nursing.The clinical effect and patient satisfaction were compared in two groups.Results The total efficiency of hematuria was 96.97％ and negative conversion rate was 54.55％ in the observation group.The total efficiency of hematuria was 80.56％ and negative conversion rate was 36.11％ in the control group.The data in the observation group were significantly better than those of the control group (x2 =4.526,P＜0.05).The total efficiency of proteinuria was 92.68％ and negative conversion rate was 58.54％ in the observation group.The total efficiency of hematuria was 79.07％ and negative conversion rate was 46.51％ in the control group.Data in the observation group were significantly better than those of the control group (x2=5.591,P＜0.05).The weights of patients were lost,urine volume in 24 hours increased and muscle circumference decreased.Besides that,the effect in the observation group was better than that of the control group (P＜0.05).The patient satisfaction of the observation group (100.00％) was significantly better than that in the control group (78.79％) (P＜0.01).Conclusions The medicine-separated moxibustion combined with western medicine can help to improve the clinical efficacy and negative conversion rates of hematuria and proteinuria;reduce the patient's weight,increase urine volume in 24 hours;and significantly reduce leg circumference in treating the patients with renal edema.in addition,it can greatly reduce the relapse of edema,and it is beneficial to improve patient satisfaction,which should be applied to the clinical treatment.

BACKGROUNDControversy still exists regarding whether medial parapatellar approach (MP) or midvastus approach (MV) is preferable in total knee arthroplasty (TKA) up to now. The aim of this meta-analysis was to compare the clinical and radiological outcomes following the MV or MP for TKA.

METHODSA comprehensive search of unrestricted-language literature of all studies comparing MP with MV was conducted through the electronic literature databases of PubMed, EMBASE, Cochrane Library, CNKI, VIP, and WANFANG. Retrieval time was from the time when databases were built to October 2013. Manual search of relevant trials, reviews, and related articles was also performed. Outcomes of interest included postoperative knee extensor and flexor function, postoperative pain, patella tilt, and complications. Relative risk (RR) and weighted mean differences (WMD) from each trial were pooled using random-effects or fixed-effects model depending on the heterogeneity of the included studies. A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.

RESULTSTwenty-one randomized controlled trials (RCTs) comprising 1 188 patients (1 450 knees) were eligible. Our results showed that MV was associated with better early postoperative extension (WMD = -1.26, 95% CI -2.36 to -0.16, P = 0.02) and flexion (WMD = 10.13, 95% CI 5.36 to 14.90, P < 0.01), less postoperative pain (WMD = -0.21, 95% CI -0.34 to -0.07, P = 0.002) , and no greater risk for complications than MP. The patella tilt did not differ significantly between the two groups (WMD = -0.70, 95% CI -1.94 to 0.54, P = 0.27).

CONCLUSIONSMV may be a better approach than MP, as it improves postoperative early joint function and decreases pain. Future multi-center randomized controlled studies with large sample sizes are required to verify the current findings.

Arthroplasty, Replacement, Knee ; methods ; Humans ; Knee Joint ; surgery

Antibodies, Antiphospholipid ; Antiphospholipid Syndrome ; Female ; Humans ; Killer Cells, Natural ; Pregnancy ; Pregnancy Complications