BACKGROUND:With changing lifestyles and aging,sagittal spinal imbalance has become a common orthopedic issue significantly affecting knee and pelvic function.Understanding the impact of sagittal spinal imbalance and its compensatory mechanisms is crucial for improving the clinical management of chronic pain.OBJECTIVE:To evaluate the alignment of the spine-pelvis-lower extremities using whole-body EOS imaging,analyze the correlation between spinal sagittal imbalance and knee joint parameters,and explore their compensatory mechanisms.METHODS:A total of 71 patients with chronic low back pain or patellofemoral pain who visited Department of Orthopedics,First Affiliated Hospital of Soochow University between January 1,2021 and December 31,2023 were included.Radiographic measurements were performed using whole-body EOS to determine pelvic tilt,pelvic incidence,lumbar lordosis,sagittal vertical axis,global tilt,hip-knee-angle,knee flexion angle,lateral distal femoral angle,and medial proximal tibial angle.Patients were classified into normal group(pelvic incidence-lumbar lordosis＜10°),compensated group(10°＜pelvic incidence-lumbar lordosis＜20°),and decompensated group(pelvic incidence-lumbar lordosis＞20°)based on the SRS-Schwab spinal deformity classification according to pelvic incidence-lumbar lordosis difference.The differences in radiographic parameters among the groups were analyzed.The differences in American Knee Society Knee Score and Oswestry Disability Index scores were compared among each group.Patients were divided into chronic low back pain group and non-chronic low back pain group,patellofemoral pain group and non-patellofemoral pain group based on clinical symptoms,and the relationship between radiographic parameter differences and clinical symptoms was analyzed.RESULTS AND CONCLUSION:(1)When pelvic incidence-lumbar lordosis was less than 20°,lateral distal femoral angle and medial proximal tibial angle tended to stabilize.When pelvic incidence-lumbar lordosis was greater than 20°,it showed a linear correlation with lateral distal femoral angle and medial proximal tibial angle,with lateral distal femoral angle increasing and medial proximal tibial angle decreasing with increasing pelvic incidence-lumbar lordosis values.(2)Compared with the normal group,the compensated group had significantly increased pelvic tilt(P＜0.01),while knee joint parameters hip-knee-angle and knee flexion angle showed no significant differences;the decompensated group showed significant increases in pelvic tilt(P＜0.01),and decreases in hip-knee-angle,and knee flexion angle(P＜0.01).Compared with the compensated group,the decompensated group showed a significant decrease in hip-knee-angle(P＜0.05),but had no significant differences in pelvic tilt and knee flexion angle.(3)Compared with the non-patellofemoral pain group,patients with patellofemoral pain had significant decreases in spinal lumbar lordosis,lateral distal femoral angle,and medial proximal tibial angle(P＜0.05)and a significant increase in pelvic incidence-lumbar lordosis(P＜0.05).(4)Patients with low back pain had significant differences in radiographic parameters compared with the non-chronic low back pain group(P＜0.05).(5)Compared with the normal group,both the compensated and decompensated groups showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).Compared with the compensated group,the decompensated group showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).(6)Pelvic incidence-lumbar lordosis values increased with age and were higher in females compared with males.(7)This study systematically reveals the spine and lower limbs play an important role in disease progression and clinical symptoms.Associated symptoms low back pain and patellofemoral pain are related to the stability of the spine-pelvis-lower extremity alignment.Furthermore,spinal sagittal imbalance is more severe in elderly and female patients.

BACKGROUND:With changing lifestyles and aging,sagittal spinal imbalance has become a common orthopedic issue significantly affecting knee and pelvic function.Understanding the impact of sagittal spinal imbalance and its compensatory mechanisms is crucial for improving the clinical management of chronic pain.OBJECTIVE:To evaluate the alignment of the spine-pelvis-lower extremities using whole-body EOS imaging,analyze the correlation between spinal sagittal imbalance and knee joint parameters,and explore their compensatory mechanisms.METHODS:A total of 71 patients with chronic low back pain or patellofemoral pain who visited Department of Orthopedics,First Affiliated Hospital of Soochow University between January 1,2021 and December 31,2023 were included.Radiographic measurements were performed using whole-body EOS to determine pelvic tilt,pelvic incidence,lumbar lordosis,sagittal vertical axis,global tilt,hip-knee-angle,knee flexion angle,lateral distal femoral angle,and medial proximal tibial angle.Patients were classified into normal group(pelvic incidence-lumbar lordosis＜10°),compensated group(10°＜pelvic incidence-lumbar lordosis＜20°),and decompensated group(pelvic incidence-lumbar lordosis＞20°)based on the SRS-Schwab spinal deformity classification according to pelvic incidence-lumbar lordosis difference.The differences in radiographic parameters among the groups were analyzed.The differences in American Knee Society Knee Score and Oswestry Disability Index scores were compared among each group.Patients were divided into chronic low back pain group and non-chronic low back pain group,patellofemoral pain group and non-patellofemoral pain group based on clinical symptoms,and the relationship between radiographic parameter differences and clinical symptoms was analyzed.RESULTS AND CONCLUSION:(1)When pelvic incidence-lumbar lordosis was less than 20°,lateral distal femoral angle and medial proximal tibial angle tended to stabilize.When pelvic incidence-lumbar lordosis was greater than 20°,it showed a linear correlation with lateral distal femoral angle and medial proximal tibial angle,with lateral distal femoral angle increasing and medial proximal tibial angle decreasing with increasing pelvic incidence-lumbar lordosis values.(2)Compared with the normal group,the compensated group had significantly increased pelvic tilt(P＜0.01),while knee joint parameters hip-knee-angle and knee flexion angle showed no significant differences;the decompensated group showed significant increases in pelvic tilt(P＜0.01),and decreases in hip-knee-angle,and knee flexion angle(P＜0.01).Compared with the compensated group,the decompensated group showed a significant decrease in hip-knee-angle(P＜0.05),but had no significant differences in pelvic tilt and knee flexion angle.(3)Compared with the non-patellofemoral pain group,patients with patellofemoral pain had significant decreases in spinal lumbar lordosis,lateral distal femoral angle,and medial proximal tibial angle(P＜0.05)and a significant increase in pelvic incidence-lumbar lordosis(P＜0.05).(4)Patients with low back pain had significant differences in radiographic parameters compared with the non-chronic low back pain group(P＜0.05).(5)Compared with the normal group,both the compensated and decompensated groups showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).Compared with the compensated group,the decompensated group showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P＜0.05).(6)Pelvic incidence-lumbar lordosis values increased with age and were higher in females compared with males.(7)This study systematically reveals the spine and lower limbs play an important role in disease progression and clinical symptoms.Associated symptoms low back pain and patellofemoral pain are related to the stability of the spine-pelvis-lower extremity alignment.Furthermore,spinal sagittal imbalance is more severe in elderly and female patients.

ObjectiveTo analyze the epidemiological characteristics of hepatitis B virus （HBV） infection among blood donors in Hainan Province. MethodsHBV screening was conducted on 6 851 samples from voluntary blood donors in Hainan Province from January 2020 to January 2023. The samples were grouped according to donation frequency， method， age， gender， occupation， and education level， and risk factors related to HBV infection and genotypes were analyzed. ResultsThe HBV infection rate among first-time blood donors （3.59%） was higher than that among repeat donors （0.16%）. Among first-time blood donors， the HBV infection rate in males （2.22%） was higher than in females （1.66%）， and the infection rate increased with age （all P<0.05）. Blood donors who were teachers （1.18%）， militaries （1.01%）， civil servants （1.27%）， and medical staffs （0.85%） had lower HBV infection rate， while workers （6.05%）， farmers （6.15%）， and freelancers （7.61%）， and service industry workers （8.77%） had higher HBV infection rate. The infection rate decreased with higher education levels （P<0.05）. Multivariate logistic regression analysis showed that multiple blood donations （OR=0.623， 95%CI： 0.337‒0.945）， history of intravenous transfusions （OR=1.694，95%CI： 1.517‒1.946）， and family history of HBV infection （OR=1.768， 95%CI： 1.265‒1.934） were independent risk factors for HBV infection （all P<0.05）. Significant differences were observed among different HBV genotypes in terms of HBeAg positivity rate， HBeAb positivity rate， incidence of post hepatitis B cirrhosis， as well as levels of ALT， AST， and HBV-DNA （all P<0.05）. The results of multivariate logistic regression analysis showed that age， HBeAg， HBV-DNA， and clinical type were risk factors for HBV genotype distribution （P<0.05）. ConclusionHainan Province is a low-prevalence area for HBV infection， but the latent risk for HBV infection still exists. Therefore， it is important to thoroughly understand the basic information and HBV infection genotypes of blood donors， so as to select healthy blood donors and reduce the discovery and transmission of HBV-positive cases among blood donors.

[Objective] To investigate the prevalence of human T-lymphotropic virus (HTLV) infection among voluntary blood donors and provide reference for the development of blood safety screening strategy in Hainan Province. [Methods] Enzyme linked immunosorbent assay (ELISA) was used to screen for HTLV, and the reactive samples were confirmed by Western blot (WB). [Results] A total of 326 269 blood samples from 2016 to 2023 in Hainan were screened, among which 117 samples showed reactive results for initial screening, with a reactive rate of 0.036% (117/326 269), and 9 were confirmed positive by WB, with a positive rate of 0.002 7%(9/326 269). The prevalence of HTLV antibody varied among different demographic groups, with a significantly higher rate among males compared to females (P<0.05). [Conclusion] There are HTLV antibody positive blood donors in the voluntary blood donors in Hainan. Although it is a low prevalence area for HTLV, it is necessary to continue to expand the blood screening and conduct epidemiological investigations on positive blood donors for blood safety.

Objective To analyze and compare the differences between 3D-printed patient-specific instrumentation(PSI)-assisted medial open-wedge high tibial osteotomy(OWHTO)and conventional medial OWHTO in terms of the postoperative mechanical stability,accuracy of weight-bearing alignment adjustment,and clinical outcomes.Methods Data from patients diagnosed with knee osteoarthritis(KOA)and undergoing OWHTO from Jan.2019 to Jan.2022 were collected.The patients were divided into the conventional method group(23 individuals)and 3D-printed PSI-assisted group(18 individuals)based on the surgical methods.The accuracy of correction between the two methods was evaluated by comparing the preoperatively planned target correction of the hip-knee-ankle(HKA)angle with the postoperative HKA angle difference.The preoperative posterior tibial slope(PTS)and postoperative PTS angle differences were also assessed.The clinical efficacy of the two methods was assessed by collecting and analyzing the Lysholm score,visual analog scale(VAS),and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)of the patients in both the groups prior to surgery and at the 1st,6th,12th,and 24th month postoperatively.The occurrence of postoperative complications in both the groups was analyzed to evaluate the safety of PSI-assisted OWHTO.Results There were no differences in demographic characteristics,preoperative imaging observations,and clinical symptoms between the two groups(P>0.05).With regard to the results of correction accuracy,the postoperative HKA angle difference was 2.7°±1.8° in the conventional OWHTO group and 0.8°±1.1° in the 3D-printed PSI-assisted OWHTO group(P<0.001).The postoperative PTS angle difference was 2.8°±2.2° for conventional OWHTO and 1.7°±1.9° for PSI-assisted OWHTO(P=0.003).In terms of clinical efficacy,the surgical time of the PSI-assisted group was 59.2±14.8 min.This was significantly shorter than that of the conventional method group(87.6±21.4 min)(P=0.019).The Lysholm,VAS,and WOMAC scores of the PSI-assisted group were superior to those of the conventional method group at each postoperative follow-up visit.With regard to postoperative complications,there were four cases(17.3%)in the conventional method group and three(16.7%)in the PSI-assisted group.The statistical difference between the two groups is not significant.Conclusions Compared with the conventional method,3D-printed PSI-assisted OWHTO demonstrated superior accuracy in correcting lower limb alignment,in conjunction with favorable clinical efficacy and safety.This study has provided an effective reference for clinicians in selecting surgical treatment plans.

Objective To analyze and compare the differences between 3D-printed patient-specific instrumentation(PSI)-assisted medial open-wedge high tibial osteotomy(OWHTO)and conventional medial OWHTO in terms of the postoperative mechanical stability,accuracy of weight-bearing alignment adjustment,and clinical outcomes.Methods Data from patients diagnosed with knee osteoarthritis(KOA)and undergoing OWHTO from Jan.2019 to Jan.2022 were collected.The patients were divided into the conventional method group(23 individuals)and 3D-printed PSI-assisted group(18 individuals)based on the surgical methods.The accuracy of correction between the two methods was evaluated by comparing the preoperatively planned target correction of the hip-knee-ankle(HKA)angle with the postoperative HKA angle difference.The preoperative posterior tibial slope(PTS)and postoperative PTS angle differences were also assessed.The clinical efficacy of the two methods was assessed by collecting and analyzing the Lysholm score,visual analog scale(VAS),and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)of the patients in both the groups prior to surgery and at the 1st,6th,12th,and 24th month postoperatively.The occurrence of postoperative complications in both the groups was analyzed to evaluate the safety of PSI-assisted OWHTO.Results There were no differences in demographic characteristics,preoperative imaging observations,and clinical symptoms between the two groups(P>0.05).With regard to the results of correction accuracy,the postoperative HKA angle difference was 2.7°±1.8° in the conventional OWHTO group and 0.8°±1.1° in the 3D-printed PSI-assisted OWHTO group(P<0.001).The postoperative PTS angle difference was 2.8°±2.2° for conventional OWHTO and 1.7°±1.9° for PSI-assisted OWHTO(P=0.003).In terms of clinical efficacy,the surgical time of the PSI-assisted group was 59.2±14.8 min.This was significantly shorter than that of the conventional method group(87.6±21.4 min)(P=0.019).The Lysholm,VAS,and WOMAC scores of the PSI-assisted group were superior to those of the conventional method group at each postoperative follow-up visit.With regard to postoperative complications,there were four cases(17.3%)in the conventional method group and three(16.7%)in the PSI-assisted group.The statistical difference between the two groups is not significant.Conclusions Compared with the conventional method,3D-printed PSI-assisted OWHTO demonstrated superior accuracy in correcting lower limb alignment,in conjunction with favorable clinical efficacy and safety.This study has provided an effective reference for clinicians in selecting surgical treatment plans.

Objective To evaluate the clinical application of early total care (ETC) for polytrauma patients combined with thoracolumbar fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 137 polytrauma patients combined with thoracolumbar fractures admitted to the First Affiliated Hospital of Soochow University and the Third People's Hospital of Zhang,jiagang from January 2012 to October 2015.There were 90 males and 47 females,aged 26-69 years,with an average age of 48.2 years.The patients were divided into ETC group (n =59) and TMC group (n =78).In the ETC group,physicians from different departments evaluated the patients and developed individualized therapeutic regimens to allow the patients to undergo surgery at early stage after injury.The TMC group preferentially stabilized the patient's condition or transferred the patients to specialist treatment,and then the surgery was performed electively after the condition of the patient was stable.The ISS of the ETC group was (22.15 ± 9.28)points,and that of the TMC group was (23.37 ± 10.74) points.All patients underwent conventional posterior pedicle screw internal fixation.For patients with burst fracture and nerve injury,posterior spinal canal decompression was performed.The thoracolumbar injury classification and severity score (TLICS),spinal load sharing classification (LSC),preoperative and postoperative Glasgow coma score (GCS),Frankel classification,hospitalization time and postoperative complications were compared between the two groups.Results The TLICS scores of ETC group were significantly lower than those of TMC group (P ＜ 0.05) while the LSC scores showed no significant differences between the two groups (P ＞ 0.05).ETC group had shorter hospitalization time [(11.8 ± 3.7)days ∶ (17.5 ±4.5)days] and lower pressure ulcer incidence [(5％ ∶ 21％)] than the TMC group (P ＜ 0.05 or 0.01),but the former had significantly higher wound infection rate [(17％ ∶ 15％)] (P ＜ 0.05).There was no significant difference in pulmonary infection and deep venous thrombosis incidence between the two groups (P ＞ 0.05).No significant differences were found in the preoperative GCS scores between the two group (P ＞ 0.05) while the postoperative GCS scores of TMC group were higher than those of ETC group (P ＜ 0.01).Postoperative GCS scores in both groups were significantly higher than their preoperative GCS (P ＜ 0.05).The results of postoperative Frankel classification in the ETC group were as follows:Grade A in one patient,Grade B in one,Grade C in three,Grade D in four and Grade E in two patients,with an improvement rate of 82％.The results of postoperative Frankel classification in the TMC group were as follows:Grade A in three patients,Grade B in three,Grade C in three,Grade D in four and Grade E in four,with an improvement rate of 65％.Conclusions For polytrauma patients combined with thoracolumbar fractures,ETC can shorten hospitalization time,reduce the pressure ulcer incidence,and better facilitate the recovery of nerve function,yet with higher wound infection risk compared with TMC.TMC was preferred subjectively for patients with unstable thoracolumbar fractures and high TLICS.

Establishment of the “Happy Reading Club” was to create a personal reading space for undergraduates. The reading situation of undergraduates was analyzed with the creation processes of “Happy Reading Club” summa-rized.The reading popularizing activities were described, including questionnaire investigation of reading, sign of DIY “tree”, and recommendation of classic booklist, with the existing problems pointed out.

Objective This study investigates the protective effect of bicyclol on liver function in patients after liver resection.Methods One hundred and twenty patients undergoing liver resection with Pringle's maneuver were randomly divided into groups A,B,and C,and given bicyclol (50 mg),diammonium glycyrrhizinate (150 mg),and silybum marianum (77 mg),respectively.The medication was orally given preoperatively for 5 days and postoperatively for days 3 to 7.The fasting serum ALT,AST,TB,ALP,and PAB levels were determined before operation and on days 1,3,5,and 7 after operation.Results ALT levels in the A group were significantly lower than those in the B and C group on post operative days 1,3,5,and 7 (P＜0.01).On postoperative day 7,the ratio of serum ALT returned to normal was significantly higher than the B and C group ratios (P＜0.05).Conclusion Therefore,oral bicyclol given before and after liver resection can significantly inhibit the rapid increase and promote the normalization of serum ALT levels.

OBJECTIVE: To investigate the efficacy of revision endoscopic sinus surgery and combined therapy on recurrent sinusitis and polyps. METHOD: Revision endoscopic sinus surgery was performed in 72 patients, of which endoscopic nasal lateral wall dissection was used in 3 cases, the endoscopic frontal sinus surgery (Draf I-II) was used in 16 cases, and all patients received combined therapy including peri-operation conservative management and nasal endoscopy examination during the follow-up period. RESULT: All patients were followed up for more than one year. Of 72 patients, 52 patients were successfully cured, 10 patients showed improvement, but there was no change in other 13 patients. The total efficacy rate was 91.67% (66/72). No serious complication occurred. CONCLUSION The treatment efficacy can be greatly improved by enough preoperative preparation, fine operation, combined pre-operation conservative therapy and postoperative follow-up.
Adult ; Aged ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nasal Polyps ; prevention & control ; surgery ; Recurrence ; Sinusitis ; prevention & control ; surgery ; Young Adult