BACKGROUND:Based on different algorithms of machine learning,how to carry out clinical research on lumbar disc herniation with the help of various algorithmic models has become a trend and hot spot in the development of intelligent medicine at present. OBJECTIVE:To review the characteristics of different algorithmic models of machine learning in the diagnosis and treatment of lumbar disc herniation,and summarize the respective advantages and application strategies of algorithmic models for the same purpose. METHODS:The computer searched PubMed,Web of Science,EMBASE,CNKI,WanFang,VIP and China Biomedical(CBM)databases to extract the relevant articles on machine learning in the diagnosis and treatment of lumbar disc herniation.Finally,96 articles were included for analysis. RESULTS AND CONCLUSION:(1)Different algorithm models of machine learning provide intelligent and accurate application strategies for clinical diagnosis and treatment of lumbar disc herniation.(2)Traditional statistical methods and decision trees in supervised learning are simple and efficient in exploring risk factors and establishing diagnostic and prognostic models.Support vector machine is suitable for small data sets with high-dimensional features.As a nonlinear classifier,it can be applied to the recognition,segmentation and classification of normal or degenerative intervertebral discs,and to establish diagnostic and prognostic models.Ensemble learning can make up for the shortcomings of a single model.It has the ability to deal with high-dimensional data and improve the precision and accuracy of clinical prediction models.Artificial neural network improves the learning ability of the model,and can be applied to intervertebral disc recognition,classification and making clinical prediction models.On the basis of the above uses,deep learning can also optimize images and assist surgical operations.It is the most widely used model with the best performance in the diagnosis and treatment of lumbar disc herniation.The clustering algorithm in unsupervised learning is mainly used for disc segmentation and classification of different herniated segments.However,the clinical application of semi-supervised learning is relatively less.(3)At present,machine learning has certain clinical advantages in the identification and segmentation of lumbar intervertebral discs,classification and grading of the degenerative intervertebral discs,automatic clinical diagnosis and classification,construction of the clinical predictive model and auxiliary operation.(4)In recent years,the research strategy of machine learning has changed to the neural network and deep learning,and the deep learning algorithm with stronger learning ability will be the key to realizing intelligent medical treatment in the future.

Objective:To provide references for the application of finite element model in the study of cervical vertebra by statistically analysing the frequency, numerical value, properties, and boundary setting of the finite element model and the corresponding material features as well as boundary settings in the literature.Methods:The literature on cervical vertebra-related finite element models was collected from CNKI, Wanfang, VIP, PubMed, Web of Science, and Embase databases from January 2013 to December 2023. The quality assessment was followed by manual screening. The data sources, application classification, material properties (Young’s modulus and Poisson’s ratio), and boundary conditions of cervical vertebra, cervical intervertebral, and cervical ligaments were statistically analyzed.Results:A total of 102 papers were included. The finite element models of the cervical vertebra were derived from medical image reconstruction modeling techniques, predominantly CT plain scan and magnetic resonance imaging. Among the 102 cervical vertebra models, the C3-C7 (lower cervical segment) model appeared with the highest frequency (19). The Young’s modulus of the cortical bone, cancellous bone, and posterior structure of cervical vertebrae were set at about 12 000 or 10 000, 440, and 3 600 MPa, respectively, and the Poisson’s ratios were mainly set at about 0.29 or 0.30, 0.29, and 0.29. The Young’s modulus of the cervical intervertebral disc endplate, nucleus pulposus, and annulus fibrosus were concentrated around 500 or 2 000, 1, and 100 MPa, respectively, and the Poisson’s ratios were set at about 0.40, 0.50, and 0.40, respectively. The Young’s modulus of the anterior longitudinal ligament, posterior longitudinal ligament, transverse ligament, ligamentum flavum, interspinous ligament, capsular ligament, and articular cartilage of the cervical spine were set around 30, 20, 20, 6-10, 4-8, 10 or 20, 10 MPa, and the Poisson’s ratios were set at aoubt 0.30, 0.30, 0.30, 0.30, 0.30, 0.40, and 0.30, respectively. The Young’s modulus of the upper cervical interdental ligament, lamina, cruciate ligament, nuchal ligament, and pterygoid ligament were set at about 10, 10, 10 or 20, 20, and 5 MPa, respectively, and the Poisson’s ratios were set at about 0.30. Head weight settings were more common at 50, 74, and 100 N.Conclusions:The finite element model of the cervical vertebra has great value in the study of cervical spondylosis, but further optimization is still needed in the assignment of material properties, mesh division, and model verification to improve the accuracy and clinical applicability of the model.

Objective:To explore the application effect of an intelligent teaching robot system of lifting manipulation in cervical spine manipulation teaching.Methods:60 doctors were randomly divided into an experimental group ( n = 30) and a control group ( n = 30). The control group was taught by a certified chief physician using a combination of "PowerPoint presentations, video demonstrations, and operation demonstrations" . Each part is 5 min. The experimental group was taught by the intelligent teaching robot system with a spinning technique. The teaching time is 15 min for both groups. At the end of the two teaching sessions, the two groups were trained five times under different BMIs and passed the system assessment. The qualified rates of pre-traction force, lifting and pulling force, maximum force, pre-traction time, lifting and pulling time, rotation amplitude, and pitch amplitude were compared between the two groups. Results:In normal, there was significant differences between the qualified rates of pre-traction force, lifting and pulling force, maximum force, pre-traction time, lifting and pulling time, rotation amplitude, and pitch amplitude in two groups (all P<0.05). For overweight people, there were significant differences in pre-traction force, pulling force, maximum force, and rotation amplitude (all P <0.05), while there were no significant differences in pre-traction time, pulling time, or pitching amplitude (all P >0.05). In obesity, there were significant differences in pre-traction force, lifting and pulling force, maximum force, and pitch amplitude (all P <0.05), but no significant differences in pre-traction time, lifting and pulling time, or rotation amplitude (all P >0.05). Conclusions:The proposed system can improve the pass rate of spinning manipulation, especially by effectively controlling the pre-traction force, pulling force, and maximum force.

Objective:To explore the application of compound Huangbai solution sitz bath in patients after surgery for perianal abscess.Methods:A convenient sampling method was used to select 100 patients with perianal abscess who received surgical treatment in Huai'an First Hospital Affiliated to Nanjing Medical University Nanjing Medical University from January 2020 to December 2021. Patients admitted from January to December 2020 and January to December 2021 were included in the control group (50 cases) and the observation group (50 cases), respectively. The control group was given warm water sitz bath, while the observation group was given compound Huangbai solution sitz bath. The clinical curative effects, wound edema, granulation growth, wound pain, exudation, recovery of anal function and inflammatory reaction were compared between the two groups.Results:After 7 days of intervention, the total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant ( P<0.05). The CRP levels of wound edema and granulation growth, wound pain, exudate and Wexner scores, and CRP levels were lower than those before and 3 days after intervention, and the observation group was lower than that of the control group after 7 days of intervention, and the differences were statistically significant ( P<0.05) . Conclusions:Compound Huangbai solution sitz bath can effectively promote wound healing and anal function improvement of patients after perianal abscess operation, reduce the inflammatory response of patients, and then improve the therapeutic effect.

Objective? To develop an effective and practical palliative care quality indicators for cancer hospital, to provide basis for standardizing palliative care and to realize the systematization and standardization of palliative care quality evaluation in cancer hospitals. Methods? Based on "constructure-process-outcome"quality paradigm, a palliative care quality evaluation system for cancer hospital was constructed preliminarily. The system was finally confirmed by two-round Delphi expert consultation. The reliability and representativeness of expert advice were tested by using the indicators of concentration, coordination, positive coefficient and authority coefficient of expert advice. Results? Totally 19 experts in palliative care were involved in the study. The consultation response rate was 95% for round one, and 100% for round two. The authority coefficient was 0.82, and the Kendal's coefficient of concordance was 0.395 for round one and 0.425 for round two. The final evaluation system contains 3 domains, 14 subdimensions, and 45 items. Conclusions? The consensus of experts is reliable, which can be confirmed from involvement and authority of experts. The final evaluation system states distinguish features of palliative care.

Objective To study the effect of the preset temperature,heating time and the spacing of radio frequency electrodes.Methods Fresh egg white was used to study the effects of heater spacing,temperature and heating time.Two electrodes were fixed to keep the needles perpendicular to the center of egg white confined on a square plate.Temperatures from 50 to 90℃ were tested with heating times of 60 and 120 seconds and electrode spac ings of 2.0,1.0,0.5 and 0.25 centimetres.The real-time temperature and the time to the appearance of a spindleshaped bridge between the electrodes was observed.The egg white's impedance and resistance,the lowest temperature of denaturation,and the mass (or volume) denatured at different time points were also observed.Results With an electrode spacing of 2 cm and the thermostat set at 63℃,the true electrode temperatures were 63.7 and 52.6℃,with the secondary electrode the cooler.Significant differences between the secondary electrode temperature and the preset temperature as well as the temperature between the primary and the secondary electrodes were observed.It was also found that different electrode spacing caused significant differences between the preset temperature and the primary as well as the secondary electrode temperature.Denaturation began at 56℃ with a spacing of 0.25 cm.At spacings of 0.25 and 0.50 cm,a spindle-shaped connection between the two electrodes was observed at temperatures above 70℃,but higher temperature was required at 1.00 and 2.00 cm.When the spacing was 0.25 cm and the preset temperature was 75℃,the denatured volume after 60 s of heating was 90.21+0.64 mm3.Heating for 120 s denatured 95.08+ 0.53 mm3 and two 60.s heatings 92.88+0.74 mm3,all significant differences.There were no significant differences in the resistance of the egg white before and after a single heating for 60 s,but after a single heating lasting 120 s it had increased significantly from 128.41+8.04 to 121.29±8.04 Ω.Conclusion Bipolar radio frequency heating can denature egg white.Higher temperature,longer heating and smaller electrode spacing heat more effectively.

Objective To explore the effects of multidisciplinary teamwork continuity of care for community-dwelling patients with advanced renal cell carcinoma treated with targeted drugs.Methods A total of 80 patients with stage IV renal cell carcinoma treated in our hospital from February 2014 to February 2017 were enrolled using convenience sampling method,and were randomly divided into the experimental group and the control group using random number table,with 40 cases in each group.Both groups were given routine nursing care,and multidisciplinary teamwork continuity of care was adopted in the experimental group additionally.Results One month after intervention,the patients' score of medication compliance questionnaire in the experimental group was significantly higher than that in the control group(P＜0.05);three months after intervention,the quality of life(QLQ-C30) score of the experimental group was significantly improved than that of the control group(P＜0.05),and the number of rehospitalization was significantly less than that in the control group(P＜0.05).The number and severity of adverse effects in the experimental group were lower than those in the control group,and no case of stopping medication or decreasing doses occurred.Conclusion The multidisciplinary teamwork continuity of care model can enhance health status of community-dwelling patients,improve medication compliance and quality of life,and reduce readmission.

Objective To explore the clinical effect and safety of S-1 combined with paclitaxel in treatment of advanced gastric cancer.Methods 80 patients with advanced gastric cancer accepted in our hospital from Sep.2013 to Dec.2015 were selected and randomly divided into 2 groups.Patients in observation group were given S-l,cisplatin and paclitaxel,and patients in control group were given S-1 and paclitaxel.Then the short term and long term clinical effect and adverse reactions of 2 groups were compared.Results The total effective rate of observation group was 52.50％ (21/40),which was obviously higher than 40.00％ (16/40) of control group (P ＜ 0.05).The median progression-free survival,median overall survival and 1 year survival rate of 2 groups had no great differences.The main adverse reaction of 2 groups were bone marrow suppression and gastrointestinal reactions of grade 0～Ⅱ.The grade of nausea and vomiting of observation group was much lighter than control group (P ＜ 0.05).But the other adverse reaction of 2 groups had no differences.Conclusion Using S-l,cisplatin and paclitaxel has good effect in treatment of advanced gastric cancer,which is safety and worthy of clinical applications.

Objective To observe the effects of neurotrophin 3 (NT3)-chitosan on motor function, and proliferation and differentiation of the neural stem cells (NSCs) in the injury area and subventricular zone (SVZ) in rats with motor cortex injury. Methods Sixty-five Wistar rats were divided into control group (n=7), injury group (n=29) and NT3-chitosan group (n=29). The motor cortex was aspirated and re-moved as cerebral injury model. NT3-chitosan was immediately implanted into the injured area after operation, and the control group re-ceived no intervention. Pellet reaching test was performed to detect the recovery of the forelimb function, HE staining was used to observe the lesion cavity size, and immunofluorescence staining was used to observe the proliferation and differentiation of NSCs 3 days, 7 days, 14 days, 1 month, 2 months and 3 months after operation. Results The grasp success rate was higher (F>6.00, P≤0.05), and the lesion cavity size was significantly smaller (F>629.5, P<0.001) in the NT3-chitosan group than in the injury group. In the NSCs differentiation experi-ment, the number of BrdU cells at all the time points was significantly higher in the NT3-chitosan group than in the injury group (F>171.43, P<0.001). In the NSCs proliferation experiment, the number of BrdU positive cells was still significantly higher in the NT3-chitosan group than in the control group and in the injury group (F>155.06, P<0.001), the number of Dcx positive cells was significantly higher in the NT3-chitosan group than in the injury group (F=62.367, P<0.001), and the number of BrdU/Dcx positive cells was significantly higher in the NT3-chitosan group than in the control group (F=33.527, P<0.001). Conclusion NT3-chitosan could activate NSCs in the SVZ, and pro-mote endogenous neurogenesis and forelimb function recovery in rats after motor cortex injury.

Objective To compare and analyze the accuracy and safety of robot-assisted and conventional freehand open approach in pedicle screw fixation using meta-analysis.Methods PubMed,Embase,Cochrane,China Biology Medicine,Wanfang and CNKI databases were searched by computer retrieval to identify the relevant literatures published before December1,2016.The qualified literatures were selected according to the preestablished the inclusion criteria and exclusion criteria,and processed for data extraction and quality evaluation.The RevMan 5.3 software was used for the meta-analysis.The relative risk (RR) and 95％ confidence interval (CI) were adopted to represent the effect differences in the dichotomous variable data.The effect difference of continuous variable data was represented by mean difference (MD) or standardized mean difference (SMD).When P＜0.05 and 95％ CI does not contain the value of 1,the difference was considered statistically significant.Results A total of 266 patients were enrolled,including 138 cases of robot-assisted group and 128 cases of conventional freehand open group,in which 1 200 screws were implanted,including 608 screws by robot-assisted system and 592 screws by conventional freehand open approach.The Gertzbein-Robbins grading criteria (grade A to C) were used.The results showed that there was no significant difference in the accuracy of pedicle screw fixation between the robotic-assisted and conventional freehand open approach according to the grading criteria,i.e.grades A (RR =1.07,95％CI:0.82,1.39,I2=46％,P=0.62),grades B (RR=l.56,95％CI:0.86,2.82,I2=0％,P=0.14) and grades C (RR=0.91,95％CI:0.32,2.55,I2=0％,P=0.85).For the two groups,the difference was no statistically significance in the complication rate (RR=0.33,95％CI:0.05,2.17,I2=0％,P=0.25),and in the revision rate (RR=0.53,95％CI:0.10,2.90,I2=0％,P=0.47).The difference was statistically significance in the overall surgical time (MD=20.90,95％CI:5.54,36.26,I2=15％,P=0.008),and in the exposure time (MD=-1.19,95％CI:-1.63,-0.75,I2=15％,P＜0.000 01).The difference was no statistically significance in the distance between screws and facet joint surfaces (SMD=-1.15,95％CI:0.79,1.51,I2=16％,P＜0.000 01).Conclusions Compared with the conventional freehand open approach,the current evidence cannot confirm that the robot-assisted system has significant advantages in the surgical accuracy of pedicle screw fixation and complication rate.The spinal surgical robot-assisted system,as a new technology,has considerable potential for further development and application in spinal surgery.