Objective The purpose of the study was to understand the resistance status of to anti-tuberculosis drug in Yunnan province, and to provide evidence for tuberculosis (TB) control. Methods The proportional method was used in drug sensitivity test according to the guidelines recommending by WHO. Results Of 301 mycobacterial isolates, 279 (92.7%) strains were complex (MTBC) . The total drug resistance rate was 31.5% (88/279),the initial drug resistance rate of was 27.3%, and the acquired drug resistance rate was 44.3%. The drug resistance rates to INH,RFP,EMB and SM were 19.7%, 10.8%, 12.9%and 19.0%, respectively. The multi-drug resistance (MDR) rate was 9.3%. Conclusion The drug resistant rate of is still high in Yunnan province,and TB control is still a long way to go. Early detection and regular treatment should be done for MDR patients. Drug resistance monitoring as an important part of TB control programs should be regular observation and research.

Objective To study the effects of natural walking on human plantar pressure and surface electromyogrphy (sEMG) of lower limbs.Methods 28 healthy male volunteers were enrolled,and their plantar pressure and surface electromyogrphy related parameters were measured before and after 30 min natural walking.These parameters not only include plantar peak pressure and peak impulse,but also include time domain parameter (integral electromyogrphy,iEMG) and frequency domain parameter (mean power frequency,MPF) of tibial anterior muscle,gastrocnemius,femoral rectus,and biceps femoris muscle.The correlations between peak pressure and height as well as weight were analyzed.Results The feature parameters showed significant difference between left and right foot before and after 30 min natural walking (all P＜0.05).The differences of peak pressure and peak impulse values between left and right limb were found in different plantar areas.In the metatarsal areas M3,M4 and M5,the pressure parameters of left side were larger than those of right side (all P＜0.05).The values of iEMG and sEMG of left limb were larger than those of right side in tibialis anterior,gastrocnemius,rectus femoris and biceps femoris (all P＜ 0.05).The MPF values of sEMG of left limb were larger than those of right side in tibialis anterior and gastrocnemius (all P＜0.05).After 30 min natural walking,the peak pressures in right toe2-5 areas were decreased (all P＜0.05),the differences of iEMG of sEMG in all muscles were not significantly,and the MPF value of sEMG in left rectus femoris was decreased.Weak correlations were observed between peak pressure and height as well as weight.Conclusions The differences of left and right lower limbs were found in plantar pressure and sEMG values during natural walking.The results showed that 30 min natural walking did not cause significant stress-related fatigue in plantar areas.Therefore,the stability of gait can be maintained for a 30 min natural walking.However,that may lead to fatigue of the femoris rectus in the left limb.

Objective To establish a stable and reliable mouse model as an alternative to the traditional model of impaired glucose tolerance induced by calorie restriction and its effect on glucose homeostasis.Methods Forty 16-week-old SPF C57BL/6J mice (half male and half female) were randomly divided into four groups by sex and the way of feeding.The mice in the ad libitum (AL) group had free access to basic diet, while the mice in the intermittent fasting (IF) group had normal diet and fasting on alternate days, with free access to water on the fasting days.The changes of body weight and blood glucose concentration in each group were monitored, and intraperitoneal glucose tolerance test and insulin tolerance test in mice were performed before and after the 12-week IF treatment.Results At 12 weeks after IF treatment, the body weight and blood glucose concentration of mice did not show significant difference.After i.p.injection of glucose, the blood glucose concentration of IF mice was less increased than the AL group, and after the insulin injection, the blood glucose concentration was more decreased.Compared to the AL group, the areas under the curve of tolerance test in the IF group were significantly decreased (P < 0.05).Conclusions After IF treatment, the mice show an enhanced sensitivity to insulin and improved glucose tolerance.This establishment method of mouse model of intermittent fasting is easy and simple, therefore, can be used as an effective alternative to traditional calorie restriction model of impaired glucose tolerance.

A 3D printed patient-specific surgical guide plate is an auxiliary device made with the help of computer-aided design and 3D printing technology according to a surgical plan. It is used in reduction and internal fixation of fracture and specific corrective osteotomy as well. It is very adaptive as it has been widely used in trauma surgery, joint surgery and spine surgery, as well as in surgical treatment of bone tumors. Digital orthopedic technology is an important means to realize orthopedic precision medicine. This paper reviews the technical advantages, applications, main problems and future prospects of 3D printed patient-specific surgical guide plates in the field of orthopedics based on the recent literature.

Posttraumatic ankle arthritis caused by trauma, a common articular disease, mainly destroys the biomechanical balance of the ankle joint and results in degeneration of the joint.It often occurs in young people, leading to articular pain and stiffness and other symptoms which may deteriorate to end-stage posttrau-matic ankle arthritis with no intervention.At present, a variety of therapies are available for the disease. However, no domestic literature has addressed the choice and application of its treatment methods.To be useful in clinic, this review deals with the etiology, diagnosis and treatment (including choice, efficacy, indications and contraindications) of the disease.

The sources of common knee valgus deformities were classified in order to better plan the orthopedic methods, matching prostheses and soft tissue repair of knee valgus deformities.Based on the analysis of typical clinical cases and the operability of classification standards in practical clinical practice, it is of great significance to establish a reasonable morphological classification of knee valgus deformity, in order to grasp the characteristics and patterns of the onset of valgus deformity. According to the origin of the deformity and the tension of the medial and lateral collateral ligaments, the classification of the genu valgus deformity can be divided into the classification of the traditional Genu valgum deformity origin and the classification of the new Genu valgum deformity origin. Although both of them highlight the skeletal characteristics and soft tissue conditions of the valgus deformity, they are quite different. Traditional classification is based on femoral tibial angle, valgus angle, etc; The new classification is divided into mechanical angle, anatomical angle, distal condylar angle, etc. The origin of Genu valgum deformity is generally complex. The traditional classification cannot fully reflect the origin of valgus deformity and the tension state of soft tissue. The new classification, especially based on the classification of anatomical angle valgus deformity, can not only reflect the morphological and anatomical details of knee valgus deformity, but also reflect the tension state of the medial and lateral collateral ligaments and local soft tissue stress state that determine the stability of the knee joint. At present, the commonly used surgical methods for valgus deformity of the knee include periarticular osteotomy of the knee and total knee Joint replacement. The former focuses on correcting extraarticular deformity without over repairing ligaments, and the latter focuses on force line correction, which is the final treatment for terminal valgus deformity. The application of digital technology in clinical orthopedics can improve the accuracy of implant placement. Implant placement needs to be based on the patient's bone characteristics and degree of deformity. For patients with severe deformity, the application of digital technology can improve the accuracy of implant placement and assist in the treatment of knee valgus deformity.

Objective:To propose a method to measure the femoral anteversion angle based on the three-dimensional model of femur.Methods:From January 2019 to December 2023, a total of 50 patients (100 femurs) with patellar instability who underwent full-length CT examination of both lower limbs in Tianjin Hospital were retrospectively analyzed, including 16 males and 34 females, aged 28.5±11.9 years (range, 16-57 years). All patients underwent CT examination of both lower limbs, and the imaging data were imported into Mimics 21.0 software as DICOM format files. The femur was extracted by the threshold segmentation function, and the 3D model of the femur was reconstructed by appropriate trimming and smoothing. Three-dimensional models of the femur from 30 patients (60 femurs) were selected and imported into 3-matic 13.0 software for labeling of anatomical points and drawing of axes. The angle between the axis of the distal femur and the axis of the proximal femur was the femoral anteversion angle. Two observers positioned the spatial coordinates of the intercondylar fossa apex, the greater trochanter apex, the center of the femoral head, the femoral through-condylar axis and the posterior condylar tangent marker points on a 3D model of the femur to compare the differences between the groups. The femoral anteversion angles measured by different three-dimensional measurement methods were compared with the clinically reported femoral anteversion angles.Results:The difference between the femoral head center and intercondylar fossa apex coordinate data of 30 patients (60 femurs) measured by the two observers was not statistically significant ( P>0.05), whereas the data for the Y-axis coordinate of the greater trochanter apex were 25.77±23.21 and 22.08±25.73, respectively, and the difference was statistically significant ( t=2.906, P=0.017). The difference between the data of femoral through condylar and posterior condylar tangential coordinates of 30 patients (60 femurs) measured by the two observers was not statistically significant ( P>0.05). Using the femoral mechanical axis as the projection direction, the angle between the transcondylar axis and the posterior condylar tangent line was 5.97°±2.02° (range, 1.48°-12.08°). The anterior tilt of the femur measured by the two observers in the femoral neck cylinder fitting method was 23.35°±7.45° and 24.94°±9.01°, respectively, and the difference was statistically significant ( t=-2.147, P=0.040). The anterior inclination of the femur measured by the two observers in the femoral head ball enlargement method was 24.63°±7.66° and 25.12°±8.84°, the difference was not statistically significant ( t=-0.820, P=0.419). Using the femoral head ball expansion method to locate the proximal femoral axis, two observers measured the anterior tilt angle of the femur in 50 patients (100 femurs) according to the method described above, which was 23.30°±9.41° and 23.57°±9.97°, respectively, without a statistically significant difference ( t=-0.664, P=0.508), both smaller than the 29.56°±8.74° measured based on two-dimensional images in the imaging report, and the difference was statistically significant ( P<0.05). Conclusion:The femoral anteversion angle measured by the angle between the axis of the femoral condyle and the axis of the femoral neck based on the three-dimensional model is accurate and effective, and the measured value is smaller than that based on the two-dimensional images in clinical practice.

Objective: To understand the characteristics of genotypes of Mycobacterium tuberculosis isolates in Yunnan province, and provide the molecular epidemiological evidence for prevention and control of tuberculosis in Yunnan Province. Methods: Mycobacterium Tuberculosis isolates were collected from 6 prefectures of Yunnan province in 2014 and their Genetypes of Mycobacterium tuberculosis isolates were obtained using spoligotyping and multiple locus variable numbers of tandem repeats analysis (MLVA). The results of spoligotyping were entered into the SITVITWEB database to obtain the Spoligotyping International Type (SIT) patterns and the sublineages of MTB isolates. The genoyping patterns were clustered with BioNumerics (version 5.0). Results: A total of 271 MTB isolates represented patients were collected from six prefectures in Yunnan province. Out of these patients, 196 (72.3%) were male. The mean age of the patients was (41.9±15.1) years. The most MTB isolates were from Puer, totally 94 iusolates(34.69%). Spoligotyping analysis revealed that 151 (55.72%) MTB isolates belonged to the Beijing genotype, while the other 120 (44.28%) were from non-Beijing genotype; 40 genotypes were consisted of 24 unique genotypes and 16 clusters. The 271 isolates were differentiated into 30 clusters (2 to 17 isolates per cluster) and 177 unique genotypes, showing a clustering rate of 23.62%. Beijing genotype strains showed higher clustering rate than non-Beijing genotype strains (29.14% vs 16.67%). The HGI of 12-locus VNTR in total MTB strains, Beijing genotype strains and non-Beijing genotype was 0.993, 0.982 and 0.995 respectively. Conclusion The Beijing genotype was the predominant genotype in Yunnan Province, the characteristics of Mycobacterium tuberculosis showed high genetic diversity. The genotyping data reflect the potential recent ongoing transmission in some area, which highlights the urgent need for early diagnosis and treatment of the infectious TB cases, to cut off the transmission and avoid a large TB outbreak.

Objective:To analyze the postoperative paravertebral muscle degeneration and its correlations with health related quality of life (HRQL) in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).Methods:The clinical data of the 50 patients were retrospectively analyzed who had undergone single-segmental MIS-TLIF at Department of Spinal Cord Surgery, The People's Hospital of Henan Province from January 2019 to December 2021. The relative volumes of lumbar posterior muscle (LM), the relative volumes of the psoas major (PM), and the rates of fatty degeneration (FD) of the fused segment and its adjacent segments were compared respectively between preoperation, 6 and 12 months postoperation. The correlations were analyzed between the HRQL scores [visual analog scale (VAS) for pain and Oswestry disability index (ODI)] and the relative LM volumes, the relative PM volumes, and the FD rates of the fused segment and its adjacent segments at 12 months postoperation.Results:Compared with the preoperative values, the relative LM volumes and the relative PM volumes of the fused segment and its adjacent segments at 6 and 12 months postoperation were significantly reduced while the FD rates significantly increased. However, the FD rate of the fused segment at 12 months postoperation (20.6% ± 6.1%) was significantly lower than that at 6 months postoperation (29.7% ± 8.2%) ( P < 0.05). The VAS score was strongly negatively or positively correlated with the relative LM volume ( r = -0.819, P < 0.001) and the FD rate ( r = 0.86, P < 0.001) of the fused segment, and moderately negatively correlated with the relative PM volume ( r = -0.435, P = 0.016). The ODI index was moderately negatively correlated with the relative LM volume ( r = -0.512, P = 0.004) and the relative PM volume ( r = -0.402, P = 0.020) of the fused segment, but moderately positively correlated with the FD rate of the fused segment ( r = 0.565, P = 0.001). There was a moderate negative correlation between the ODI index and the relative LM volume of the adjacent segments ( r = -0.478, P = 0.012). Conclusions:After MIS-TLIF, the volume of the paravertebral muscles decreases and the dorsal muscles develop fatty degeneration. The improvement of LM fatty degeneration may be observed by 12-month follow-up in the fused segment, but not in the adjacent segments. The LM volume and the FD rate of the fused segment are the most closely related to the postoperative HRQL.

Objective:To analyze the morphology and distribution characteristics of subchondral bone cysts of the talus by CT three-dimensional reconstruction.Methods:A total of 176 patients diagnosed with subchondral bone cyst of the talus after CT scan of the ankle or foot from 2015 to 2020 were retrieved from the imaging report database of Tianjin Hospital, including 77 males and 99 females, aged 14-84 years［(56.1±14.0)years］. After three-dimensional reconstruction of the talus and cyst area by Mimics 20.0 software, an equal 2×2 grid configuration was constructed to divide the domed articular surface into four regions: anteromedial, anterolateral, posteromedial and posterolateral. For subchondral cyst of the talus, area involved under grid localization, gender, age and side of the onset were recorded. The anteroposterior diameter, transverse diameter, depth, surface area and volume of the subchondral bone cyst of the talus were measured.Results:Subchondral cyst of the talus was anteromedial in 131 patients (74.4%), anterolateral in 5(2.8%), posteromedial in 34(19.3%), and posterolateral in 6(3.4%). Subchondral cyst of the talus occurred in the older aged (≥60 years) for 78 patients (44.3%), in the middle aged (45-59 years) for 62(35.2%), in young adults for 32(18.2%), and in preadolescents for 4(2.3%). The age composition of the subchondral cyst of the talus involving the anteromedial, anterolateral, posteromedial and posterolateral regions was 59(49, 64)years, 44(39, 45)years, 61(54, 68)years and 40(22, 58) years, respectively (all P<0.01). There were no statistically significant differences in gender and side of the onset (all P>0.05). The anteroposterior diameter of the subchondral bone cysts located anteromedially, anterolaterally, posteromedially and posterolaterally was (9.7±4.4)mm, (3.5±1.1)mm, (10.3±4.4)mm and (2.1±0.8)mm, respectively; the transverse diameter was (5.4±1.7)mm, (3.9±1.8)mm, (5.9±2.2)mm and (3.4±1.1)mm, respectively; the depth was (7.1±2.4)mm, (3.2±2.2)mm, (8.2±3.0)mm and (3.9±1.9)mm, respectively; the surface area was 156.1(82.6, 198.2)mm 2, 23.0(21.4, 28.9)mm 2, 180.0(75.1, 230.4)mm 2 and 28.0(20.3, 36.7)mm 2, respectively; the volume was 77.1(37.1, 129.1)mm 3, 23.9(14.2, 37.8)mm 3, 104.6(37.7, 157.4)mm 3 and 13.0(10.4, 16.0)mm 3, respectively. When comparing the anteroposterior diameter, transverse diameter, depth, surface area and volume of the subchondral bone cysts in the anteromedial and posteromedial regions with the anterolateral and posterolateral regions, the differences were statistically significant (all P<0.01) except for the transverse diameter of the subchondral bone cysts in the anteromedial region and the anterolateral region ( P>0.05). In addition, the depth of subchondral bone cysts in the anteromedial region was significantly greater than that in the posteromedial region ( P<0.05). Conclusions:Subchondral bone cysts of the talar are commonly found in the middle- and old-aged population. Anteromedial lesions of the talar dome are the most commonly seen, with large and deeply involved cysts, followed by posteromedial lesions of the dome, while anterolateral and posterolateral lesions of the dome are less common and have smaller cyst sizes. An equal 2×2 grid configuration for talar cysts is useful in positioning and characterizing bone cysts, and can assist clinicians in accurately diagnosing and treating bone cysts.