BACKGROUND:The aim of spinal mobilization and spinal manipulation is to correct vertebral subluxation. However, facet joint pressures are not clear during these two therapies.
OBJECTIVE:To compare human lumbar facet joint pressures during simulated high-velocity, low-amplitude spinal manipulationversuslow-velocity, low-amplitude spinal mobilization.
METHODS:Totaly 12 adult fresh lumbar spinal specimens (T12-S2) were divided into two groups randomly. Parameters of simulated spinal mobilization (n=6): preload angle 15° (speed 3°/s), maximum angle 20° (speed 1°/s), with 9 N horizontal force to L5 spinous process. Parameters of simulated spinal manipulation (n=6): preload angle 15° (speed 3°/s), impulse angle 20° (impulse speed 33°/s), with 22 N horizontal force to L5 spinous process. Pressures of bilateral L4-5/L5-S1 facet joints were measured with Tekscan system.
RESULTS AND CONCLUSION:(1) During two spinal manipulative therapies (rotation to the right and then back to the neutral position), pressures of right facet joints decreased first and then increased gradualy, while pressures of left facet joints changed oppositely. (2) Pressures of right facet joints were similar regardless of manipulation type (P > 0.05). The maximum pressure of left facet joints was larger during manipulation than that during mobilization (P < 0.05). (3) Descending speed of pressures of right joint was larger during manipulation than that during mobilization (P < 0.01), and no significant difference in ascending speed of pressure of right facet joints was detected (P > 0.05). Both ascending and descending speeds of the left facet joints were larger during manipulation than that during mobilization (P < 0.01). (4) During two spinal manipulative therapies, pressures of ipsilateral facet joints decreased first and then increased, while pressures of contralateral facet joints increased first and then decreased. Joint pressure after treatment restored to that before treatment. (5) Impulse speed and magnitude of pressures of facet joints during manipulation were larger than that during mobilization. Facet joints are more possible to be injured during manipulation than that during mobilization. During manipulation, we should pay attention to the speed and intensity of the impact.

OBJECTIVE To evaluate the efficacy and safety of rituximab （RTX） in the treatment of children with refractory nephrotic syndrome （RNS） based on the real world by meta-analysis. METHODS A systematic search was conducted on CNKI， Wanfang， VIP， PubMed， Embase， Web of Science， the Cochrane Library， and CINAHL databases to strictly screen the literature and evaluate their quality. A meta-analysis was performed on the extracted literature data using R 4.2.2 and RStudio software. RESULTS A total of 26 real-world studies were included in this study， involving 996 children with steroid-dependent nephrotic syndrome/frequente-relapse nephrotic syndrome （SDNS/FRNS） and 205 children with steroid-resistant nephrotic syndrome （SRNS）. The results of the meta-analysis showed that the complete remission （CR） rate of RTX treatment for RNS was 46% （95%CI： 37%-56%）， the partial remission （PR） rate was 22% （95%CI： 14%-31%）， and the discontinuation rate was 35% （95%CI： 25%-44%）. The results of subgroup analysis showed that the CR rate of RTX treatment in SDNS/FRNS children was 49% （95%CI： 37%-62%）， PR rate was 25% （95%CI： 0-50%）， discontinuation rate was 41% （95%CI： 29%-52%）； the CR rate in SRNS children was 42% （95%CI： 27%-56%）， PR rate was 22%（95%CI： 12%-32%）， discontinuation rate was 21% （95%CI： 4%-38%）. The recurrence rate in children with SDNS/FRNS was 39% （95%CI： 21%-57%） within 1 year or less， 18% （95%CI： 18%-98%） in 2 years and more. As for safety， the majority of adverse reactions were mild infusion reactions， with an incidence of 13% （95%CI： 8%-22%）. Sensitivity analysis suggested that the results were robust. There was publication bias in mild infusion 20210908-BZ-CACM） reaction rate. CONCLUSIONS RTX is effective and safe in the treatment of RNS in children.