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.

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 assess the prevalence of HIV primary drug resistance and drug resistance gene mutations among men who have sex with men (MSM).Methods:We searched eight electronic databases (CNKI,VIP,CBM,Wanfang Database,PubMed,Web of Knowledge,Springer,Medline) for the studies of HIV drug resistance relevant to MSM.Drug resistance and drug resistance mutations data were pooled and analyzed according to statistical test of homogeneity.Subgroups were further divided according to sample size,location,race,quality rating score,sampling time.Results:Forty-three studies were included in this Meta-analysis.The pooled rate of total to protease inhibitor (PI),nucleoside reverse transcriptase inhibitor(NRTI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) were 10.21％ (95％ CI 8.65％ to12.03％),2.98％ (95％ CI 2.25％ to 3.93％),4.05％ (95％ CI 3.14％ to 5.21％),4.42％ (95％ CI 3.31％ to 5.88％),respectively.The pooled rates of PI major mutation,PI secondary mutations,NRTI mutations and NNRTI mutations were 0.55％ (95％ CI 0.38％ to 0.80％),1.31％ (95％ CI 0.98％ to 1.75％),0.85％ (95％ CI 0.51％ to 1.40％),1.19％ (95％ CI 0.70％ to 2.01％),0.79％ (95％ CI 0.55％ to 1.13％),1.73％ (95％ CI 1.21％ to 2.46％),0.86％ (95％ CI 0.61％ to 1.21％),2.24％ (95％ CI 1.77％ to 2.83％),respectively.Sample size,region,and race were heterogeneous sources;the rate of resistance mutations and gene mutation rate were different in different subgroups.Conclusion:The prevalence of primary drug resistance among MSM was high in Americas and Europe,and it was gradually increased in Asia.We should pay attention to the high incidence of PI secondary mutations.

OBJECTIVE: To translate the English version of the assessment of chronic illness care (ACIC) to Chinese, to conduct a trial in Hunan province and to develop a Chinese version ACIC. METHODS: According to the WHO rules, we translated the English version of the ACIC to Chinese and took the culture factor into account. Three hundred and ninety persons, who engaged in the work of chronic disease management in primary medical and health services in Hunan province, were enrolled for this study. One hundred and eighty three valid questionnaires were randomly selected. Six methods including discrete tendency method, good-poor analysis, correlation analysis, stepwise regression analysis, Cronbach's alpha coefficient and factor analysis were used for evaluation the questionnaire items. RESULTS: The items in Chinese version ACIC showed as follows: 1) good sensitivity. The standard deviation of each item was more than 2 and the P value from the t test between the good and poor group was less than 0.001; 2) good representation. The correlation coefficients range of each item with the total score and each dimension score was 0.588-0.916; 3) high internal consistency. Cronbach's alpha coefficient for the total scale was 0.975, and for each dimension range was 0.854-0.936; 4) independent. Factor loadings were greater than 0.40 entries, and factor loadings ranged from 0.487-0.798; 5) importance. Stepwise regression analysis α(in)=0.01, α(out)=0.05) showed 34 items were kept in the equation. CONCLUSION Items of Chinese version ACIC retains ACIC 7 dimensions of 34 items in the original English version, which are sensitivity and typical with the internal consistency, independence and importance.
China ; Chronic Disease ; Factor Analysis, Statistical ; Humans ; Language ; Regression Analysis ; Surveys and Questionnaires