BACKGROUND:Lumbar degenerative disease is a disease of the musculoskeletal system that primarily affects the intervertebral structures,and the disease is treated with lumbar fusion and disc replacement.OBJECTIVE:To conduct comparative analysis of the differences between lumbar fusion,mechanical lumbar disc prosthesis replacement,and viscoelastic lumbar disc prosthesis replacement.METHODS:The computerized tomography images of a healthy adult were used to construct a finite element model of the L2-L5 normal lumbar spine with Mimic,Geomagic,and Ansys software.The equipment required for lumbar fusion and lumbar spine replacement was constructed using modeling software,and the L3-L4 segment of the lumbar spine was processed according to the surgical requirements for lumbar fusion and intervertebral disc replacement,creating the corresponding finite element model.Specific boundary conditions were applied to extract the mobility of each lumbar spine segment,the stresses on the neighboring intervertebral discs,and the stresses on the prosthesis lining.RESULTS AND CONCLUSION:(1)Compared with the preoperative period,the maximum stress in the upper neighboring discs increased by 64.09％and 39.79％in the forward flexion and lateral bending states if the original mobility was maintained after lumbar fusion surgery.The maximum stress in the lower neighboring discs increased by 24.39％and 20.98％in forward flexion and lateral bending.This suggested that the upper adjacent discs would suffer greater stress changes than the lower adjacent discs during heavy physical labor.(2)Disc replacement did not show significant changes in adjacent disc stress,with mechanical prosthesis replacement slightly reducing adjacent disc stress,while viscoelastic prosthesis replacement was more in line with the biological properties of the disc,with maximum adjacent disc stress similar to that of the preoperative period.(3)In terms of stability,the mechanical prosthesis replacement segment showed a 51.67％increase in range of motion in the lateral bending state and a 53.27％increase in range of motion in the posterior extension state,whereas the viscoelastic prosthesis was better able to maintain mobility in the replacement segment.(4)In addition,the stresses in the liner of the mechanical prosthesis were mainly concentrated in the edge region,and this stress distribution may lead to edge wear and thus affect the service life of the prosthesis.

BACKGROUND:Lumbar degenerative disease is a disease of the musculoskeletal system that primarily affects the intervertebral structures,and the disease is treated with lumbar fusion and disc replacement.OBJECTIVE:To conduct comparative analysis of the differences between lumbar fusion,mechanical lumbar disc prosthesis replacement,and viscoelastic lumbar disc prosthesis replacement.METHODS:The computerized tomography images of a healthy adult were used to construct a finite element model of the L2-L5 normal lumbar spine with Mimic,Geomagic,and Ansys software.The equipment required for lumbar fusion and lumbar spine replacement was constructed using modeling software,and the L3-L4 segment of the lumbar spine was processed according to the surgical requirements for lumbar fusion and intervertebral disc replacement,creating the corresponding finite element model.Specific boundary conditions were applied to extract the mobility of each lumbar spine segment,the stresses on the neighboring intervertebral discs,and the stresses on the prosthesis lining.RESULTS AND CONCLUSION:(1)Compared with the preoperative period,the maximum stress in the upper neighboring discs increased by 64.09％and 39.79％in the forward flexion and lateral bending states if the original mobility was maintained after lumbar fusion surgery.The maximum stress in the lower neighboring discs increased by 24.39％and 20.98％in forward flexion and lateral bending.This suggested that the upper adjacent discs would suffer greater stress changes than the lower adjacent discs during heavy physical labor.(2)Disc replacement did not show significant changes in adjacent disc stress,with mechanical prosthesis replacement slightly reducing adjacent disc stress,while viscoelastic prosthesis replacement was more in line with the biological properties of the disc,with maximum adjacent disc stress similar to that of the preoperative period.(3)In terms of stability,the mechanical prosthesis replacement segment showed a 51.67％increase in range of motion in the lateral bending state and a 53.27％increase in range of motion in the posterior extension state,whereas the viscoelastic prosthesis was better able to maintain mobility in the replacement segment.(4)In addition,the stresses in the liner of the mechanical prosthesis were mainly concentrated in the edge region,and this stress distribution may lead to edge wear and thus affect the service life of the prosthesis.

ObjectiveTo observe the clinical efficacy and radiographic outcomes of manipulative reduction combined with small splint fixation in the treatment of distal radius fractures. MethodsThe clinical data of 1051 patients with distal radius fractures were retrospectively collected from five hospitals included in the Jiangsu Diagnosis and Treatment Data Platform for Traditional Chinese Medicine（TCM） Dominant Diseases. Propensity score matching at a 1∶4 ratio was applied， resulting in 580 cases selected for final analysis， which comprised 448 patients in the TCM group（manipulative reduction plus small splint fixation） and 132 in the surgical treatment group（open reduction and internal fixation）. Each group was further stratified into type A， B， and C subgroups based on AO fracture classification. Radiographic indicators including palmar tilt， radial inclination， and radial height were compared between groups before treatment and 1 day， 1 week， and 4-6 weeks after treatment， and pain visual analog scale（VAS） scores before treatment and 1 week and 4-6 weeks after treatment were also compared. Wrist joint function was assessed 12 weeks after treatment， using the Dienst wrist function score and the Gartland and Werley（G-W） wrist function score. Additionally， the radiographic indicators at different timepoints and the 12-week wrist function levels were compared between groups across different fracture types. ResultsNo statistically significant difference was observed in radiographic indicators and VAS scores at all timepoints before and after treatment， as well as wrist joint function grades assessed by the Dienst score and the G-W score at 12 weeks after treatment （P＞0.05）. Compared to those before treatment， both groups showed increased palmar tilt， radial inclination， and radial height 1 week and 4-6 weeks after treatment， and decreased VAS scores （P＜0.05）. Compared to those 1 week after treatment， both groups showed a decrease in palmar tilt， an increase in radial inclination and radial height， and a reduction in VAS score 4-6 weeks after treatment（P＜0.05）. In type A and B subgroups， the surgical treatment group had a higher radial inclination than the TCM group 4-6 weeks after treatment， while in the type C subgroup， a higher radial height was shown in the surgical treatment group than in the TCM group 4-6 weeks after treatment（P＜0.05）. In type C subgroup， there was significant difference between groups in the wrist joint function by G-W scores 12 weeks after treatment（P＜0.05）. ConclusionManipulative reduction combined with small splint fixation can maintain fracture alignment and alleviate pain in treating distal radius fractures， which achieves therapeutic outcomes comparable to surgical treatment. It is particularly suitable for type A and B fractures and can be considered an effective treatment option for distal radius fractures.

ObjectiveTo construct an automatic measurement model for palmar tilt and radial inclination suitable for traditional Chinese medicine （TCM） clinical scenarios， and to validate its accuracy and efficiency in TCM manipulative reduction settings. MethodsData on anteroposterior （AP） and lateral X-rays of distal radius fractures were collected from patients admitted to 18 TCM/ integrated TCM and western medicine hospitals in Jiangsu province between September 1st， 2023， and September 1st， 2024， via the Jiangsu Diagnosis and Treatment Big Data Platform for TCM Dominant Diseases. A medical image segmentation framework based on multi-scale feature fusion and edge-awareness was employed， combined with anatomical knowledge specific to TCM orthopedics， to optimize the feature extraction strategy of an artificial intelligence （AI） model. This framework enabled automatic segmentation of fracture regions and measurement of distal radius palmar tilt and radial inclination. The accuracy of the AI model in measuring radial inclination and volar tilt was validated， and the measurement time and average time gain rate of the AI model were compared to those of manual measurement. ResultsA total of 15,444 AP and lateral X-ray images of distal radius fractures were collected， and were divided into a training set （11,144 images， 5066 AP and 6078 lateral）， a validation set （3700 images， 1840 AP and 1860 lateral）， and an independent test set （600 images， 300 AP and 300 lateral） after preprocessing. In the measurement of 300 AP X-rays in the independent test set for radial inclination， when the degree error between AI measurement and manual measurement was ＜3° and ＜5°， AI measurement accuracy was 83% and 93%， respectively. In 300 lateral X-rays in the test set for palmar tilt， when AI measurements had an error of ＜3° and ＜5° compared to manual measurements， corresponding accuracy rate was 78% and 90%， respectively. For 50 X-ray images， AI measurement time was （1.37±0.05） min for radial inclination while manual measurement time was （22.57±2.52） min （P＜0.001）； in terms of palmar tilt， the AI measurement time was （1.33±0.14） min， shorter than （23.70±2.80） min for manual measurement time （P＜0.001）. Average time gain rates for manual and AI measurements were 93.93% and 94.39% respectively. ConclusionAn automatic measurement model for palmar tilt and radial inclination in distal radius fractures has been established， enabling more accurate and efficient assessment as well as providing a tool to support the quantitative evaluation of the efficacy of TCM manipulative reduction and large-sample clinical research.

Objective To evaluate the efficacy and safety of super-mini percutaneous nephrolithotomy(SMP)and standard percutaneous nephrolithotomy(sPCNL)in the treatment of 2-4 cm renal calculi, so as to provide reference for the management of medium-sized renal calculi. Methods A retrospective analysis was conducted on 168 patients with 2-4 cm renal calculi who underwent either SMP or sPCNL at our hospital during Sep. 2020 and Mar. 2025. The patients were divided into the SMP group(n=85)and sPCNL group(n=83). The baseline characteristics, stone features, operation time, perioperative complications, transfusion rate, postoperative hemoglobin drop, pain score, hospital stay, and stone-free rate(SFR)were compared between the two groups. Results There were no significant differences in baseline characteristics, stone features, and SFR between the two groups(P＞0.05). Compared to the sPCNL group, the SMP group had a longer operation time [(71.76±22.49)vs.(64.22±15.01)min, P=0.034]. However, it had lower postoperative pain score [(2.51 ±0.85)vs.(4.11±0.47), P＜0.001], shorter hospital stay [(3.16±1.45)vs.(4.30±1.06)days, P＜0.001], lower hospitalization costs [(19982.67±4267.80)vs.(21688.53±4575.74)RMB, P=0.004], a slighter decrease in hemoglobin [(6.64±10.56)vs.(12.22±11.50)g/L, P=0.032], and a significantly higher tubeless rate(83.53% vs. 0%, P＜0.001). There was no statistically significant difference in the overall complication rate between the two groups(P＞0.05). Conclusion For 2—4 cm renal calculi, SMP achieves a comparable SFR as sPCNL. Although the operation time with SMP is slightly longer, it offers significant advantages, including reduced postoperative pain, shorter hospitalization, lower costs, less bleeding, and a higher tubeless rate. SMP is a valuable technique worthy of broader clinical application.

Objective To investigate the capacity of municipal and county-level Centers for Disease Control (CDC) in Shandong Province for γ radionuclides in food as well as gross α and gross β in drinking water, and to provide evidence for strengthening radiological laboratories. Method Data regarding radioactive detection capacity were collected from 16 prefecture-level cities and 136 county-level CDCs. Chi-square test and Fisher's exact tests were used to compare capacity differences across regions and between cities with and without nuclear power plants. Correlation analysis was used to evaluate the spatial equity of gross α and gross β detection capacity for drinking water. Result The detection capacity of gross α and gross β in drinking water varied significantly among counties (χ²=81.026, P<0.001），no significant difference was found between coastal and inland cities (χ²=2.021，P>0.155); Cities with nuclear power plants showed better detection capacity (χ²=20.253，P<0.01). The detection capacity for γ radionuclides in food was primarily concentrated in the prefecture-level cities that host nuclear power plants. Conclusion The overall detection capacity for radioactivity in drinking water was acceptable but spatially uneven. The capacity for monitoring radioactive contamination in food was generally weak. It is necessary to strengthen capacity building at the grassroots level.

Objective To discuss the mechanism of the streaking artifact of Star-volumetric interpolated body examination(Star-VIBE)sequence and the influence of phase coding on it.Methods Twenty-six volunteers underwent many times Star-VIBE sequences scanning with different phase coding(320,640,960,1 280,1 600).The severity of streaking artifact of images in different phase cod-ing groups was evaluated qualitatively.The signal-to-noise ratio(SNR)of muscle,thyroid and contrast-enhanced artery,contrast-to-noise ratio(CNR)between soft tissues,and CNR between muscle and contrast-enhanced artery of the images in different phase coding groups were evaluated quantitatively.Results In qualitative evaluation,with the number of phase coding increased,the streaking artifact decreased(H=83.022,P＜0.005).In quantitative evaluation,SNRmuscle,SNRthyroid,SNRcontrast-enhanced artery and CNRcontrast-enhanced gradually increased with the increase of phase coding number(SNRmuscle:F=6.913,P＜0.005;SNRthyroid:F=3.930,P=0.005;SNRcontrast-enhanced artery:F=6.980,P＜0.005;CNRcontrast-enhanced:F=6.482,P＜0.005),while CNRsoft tissue showed no statistical difference(F=1.114,P=0.339).Conclusion There is streaking artifact on the image of the Star-VIBE sequence,which can be reduced by increas-ing the number of phase coding appropriately.The most suitable phase coding is 960.

Objective To discuss the mechanism of the streaking artifact of Star-volumetric interpolated body examination(Star-VIBE)sequence and the influence of phase coding on it.Methods Twenty-six volunteers underwent many times Star-VIBE sequences scanning with different phase coding(320,640,960,1 280,1 600).The severity of streaking artifact of images in different phase cod-ing groups was evaluated qualitatively.The signal-to-noise ratio(SNR)of muscle,thyroid and contrast-enhanced artery,contrast-to-noise ratio(CNR)between soft tissues,and CNR between muscle and contrast-enhanced artery of the images in different phase coding groups were evaluated quantitatively.Results In qualitative evaluation,with the number of phase coding increased,the streaking artifact decreased(H=83.022,P＜0.005).In quantitative evaluation,SNRmuscle,SNRthyroid,SNRcontrast-enhanced artery and CNRcontrast-enhanced gradually increased with the increase of phase coding number(SNRmuscle:F=6.913,P＜0.005;SNRthyroid:F=3.930,P=0.005;SNRcontrast-enhanced artery:F=6.980,P＜0.005;CNRcontrast-enhanced:F=6.482,P＜0.005),while CNRsoft tissue showed no statistical difference(F=1.114,P=0.339).Conclusion There is streaking artifact on the image of the Star-VIBE sequence,which can be reduced by increas-ing the number of phase coding appropriately.The most suitable phase coding is 960.

BACKGROUND:Plasma coagulation factors have been shown to be strongly associated with chronic kidney disease in many observational studies.Nevertheless,the causal relationship between plasma coagulation factors and chronic kidney disease has not been fully revealed.OBJECTIVE:To assess and explore the association between plasma coagulation factors and chronic kidney disease risk using a two-sample Mendelian randomization approach.METHODS:Genome-wide association study data of 39 plasma coagulation factors with different ID numbers were obtained from the GWAS Catalog database and chronic kidney disease genome-wide association analysis data(ebi-a-GCST003374)were obtained from the Open Genome-Wide Association Study database(IEU Open GWAS),where the sample size of the chronic kidney disease dataset was 117 165 cases and the number of single nucleotide polymorphisms was 2 179 497.Inverse variance weighting,MR-Egger regression,weighted median,weighted mode,and simple mode were used to explore causality.Meanwhile,Cochran Q test was used to assess the variability of single nucleotide polymorphism loci.Horizontal pleiotropy of single nucleotide polymorphisms was verified by MR-Egger intercept test.Sensitivity analyses were performed using the"leave-one-out"method to determine whether the Mendelian randomization results would be confounded by a single single nucleotide polymorphism site.RESULTS AND CONCLUSION:(1)A total of four plasma coagulation factors were associated with chronic kidney disease by Mendelian randomization analysis of 39 plasma coagulation factors and chronic kidney disease.Plasma coagulation factor V(FV)level(odds ratio[OR]=0.922,95％confidence interval[CI]:0.875-0.971,P=0.002),plasma FVII level(OR=0.719,95％CI:0.521-0.991,P=0.044),plasma FXa level(OR=1.113,95％CI:1.009-1.227,P=0.032),plasma antithrombin-level(OR=0.849,95％CI:0.739-0.975,P=0.020)were significantly associated with chronic kidney disease(all P＜0.05).Horizontal pleiotropy and heterogeneity were not detected.(2)Based on the two-sample Mendelian randomization in the genetic epidemiologic method,plasma FVII level,plasma antithrombin-level,and plasma FV level of coagulation factors were protective factors for the risk of chronic kidney disease,and plasma FXa level was a risk factor of chronic kidney disease.(3)The above results confirm that there is a significant potential causal relationship between plasma coagulation factors and chronic kidney disease.Although we analyzed the data of European populations from international databases,these data analyses have a reference value for the study of chronic kidney disease and coagulation factors in China,and they also provide innovative insights into the study of the genetic epidemiology of chronic kidney disease,and they also provide a certain reference value for the in-depth study of the related databases in China,including the China Health and Retirement Longitudinal Study database.Future studies can focus on the assessment of hypocoagulability or hypercoagulability of related coagulation factors in patients with chronic kidney disease.

Objective To evaluates the effects of cross-balance training on knee function,dynamic balance,and rectus femoris(RF)activation in patients after anterior cruciate ligament reconstruction(ACLR).Methods Forty ACLR patients at 5th-6th week after operation were randomly divided into experimental group and control group.The experimental group received the cross-balance training on the basis of standard rehabilitation,while the control group received only standard rehabilitation.Knee function was assessed with the Lysholm score,dynamic balance,and root mean square(RMS)of RF surface electromyography.The correlation between RMS and dynamic balance was also examined.Results After intervention,the Lysholm score of the experimental group was significantly higher than that of the control group(P<0.01).Regarding balance function,both the gait line length and single support line length of the experimental group were significantly greater than those of the control group(P<0.01).Conversely,the mediolateral displacement of the experimental group was significantly lower than that of the control group(P<0.01).Furthermore,the RF RMS of the experimental group was significantly larger than that of the control group(P<0.01).The RF RMS was positively correlated with the gait line length and single support line length,whereas it was negatively correlated with the mediolateral displacement(P<0.05).Conclusions Cross-balance training significantly enhances knee function,dynamic balance,and RF activation in post-ACLR patients,supports the theory of cross-education.Cross-balance training has certain application values in ACL postoperative rehabilitation.