[Objective]To analyze the effect of lever positioning manipulation(LPM)on the stress and strain of lumbar spine and intervertebral disc in different regions by using three-dimensional finite element technique,so as to reveal the biomechanical mechanism of manipulation.[Methods]A three-dimensional finite element model of the whole lumbar spine was constructed based on lumbar CT images,and the validity of the model was verified.The finite element model was used to analyze and compare the differences in the stress and strain of lumbar vertebrae and intervertebral discs by LPM at different manipulation points.[Results]The finite element model constructed indicates the point of manipulation is about 15 mm beside the L4 spinous process,the stress around the L4-5 intervertebral disc is large and the intermediate stress is small.The minimum strain point of the L4-5 intervertebral disc is about the lateral area of the intervertebral disc.The stress and strain of other intervertebral discs are similar to those of L4-5 intervertebral discs.The nucleus pulposus of L4-5 intervertebral disc move forward relatively to the lumbar spine;the stress under the lumbar pedicle is large,L4 has a certain degree of activity in the direction of extension,left bending and right rotation.Manipulation point is in the L4 spinous process,the stress around the L4-5 intervertebral disc is large and the intermediate stress is small.The minimum strain point of the L4-5 intervertebral disc is about the central area of the intervertebral disc.The stress and strain of other intervertebral discs are similar to those of L4-5 intervertebral discs.The nucleus pulposus of L4-5 intervertebral disc move forward relatively to the lumbar spine;the stress under the lumbar pedicle is large,and L4 has activity in the extension direction,and the activity in other directions is almost zero.[Conclusion]The LPM has the tendency to restore lumbar curvature and correct lumbar scoliosis and rotation.It can make the lumbar intervertebral disc move closer to the middle and make the nucleus pulposus move forward relatively to the posterior edge of the lumbar spine to reduce disc herniation and release compression.In the treatment of lumbar disc herniation,the manipulation points of the corresponding position can be selected according to the prominent position.

BACKGROUND:In recent years,artificial intelligence has been increasingly integrated into the diagnosis and treatment of lumbar disc herniation,enhancing the accuracy and efficiency of diagnostic procedures and diversifying therapeutic approaches.This integration has positioned artificial intelligence as a burgeoning focal point within the field.OBJECTIVE:To provide a comprehensive overview of the current applications of artificial intelligence in the diagnosis and treatment of lumbar disc herniation,to analyze the limitations of the relevant technologies.METHODS:A systematic computer-assisted literature search was performed in PubMed,CNKI,WanFang Database,and VIP Database for relevant publications regarding the application of artificial intelligence in the diagnosis and treatment of lumbar disc herniation from database inception up to August 2024.The search keywords included"lumbar disc herniation,artificial intelligence,machine learning,deep learning,big data,robot,neural network,model,algorithm."A total of 101 articles were selected based on predefined inclusion criteria and were reviewed.RESULTS AND CONCLUSION:Different artificial intelligence technologies have propelled the intelligent treatment of lumbar disc herniation,showing great potential for future development.Deep learning technology,based on advanced algorithms,constructs corresponding learning models to optimize the processing of X-ray,CT,and MRI images,achieving precise localization,identification,and analysis of degenerated intervertebral discs,and improving the accuracy of automated diagnosis.Big data technology utilizes data platforms to analyze vast medical data,simulate disease development trends,and provide a new perspective for disease assessment and prediction.Surgical robots,combined with robotic arms,3D high-definition vision systems,and 5G communication technology,support remote precise surgical operations,demonstrating significant technological advantages.In the future,the diagnosis and treatment of lumbar disc herniation by artificial intelligence will evolve towards standardization,efficiency,and precision through continuous optimization of algorithms and the professional development of data platforms.

BACKGROUND:Fixed-point rotation manipulation of cervical spine is a mechanical operation with high technical requirements,but the biomechanics of fixed-point manipulation of cervical spine still lacks relevant quantitative data.Moreover,the research on the influencing factors of cervical fixed-point rotation manipulation includes many parameters and there are differences,so it is necessary to further analyze its influencing factors to improve its related data. OBJECTIVE:To quantify the biomechanical parameters of cervical spine fixed-point rotation manipulation,explore the correlation between different biomechanical parameters,and the influence of individual characteristics of the subjects on the biomechanical parameters of cervical spine fixed-point rotation manipulation. METHODS:Totally 35 cases of cervical spondylosis were Outpatients from Orthopedic Department of Renai Branch of the First Affiliated Hospital of Guangxi University of Chinese Medicine and selected as the subjects investigated.Wearable mechanical measuring gloves were used to collect biomechanical parameters of cervical spine fixed-point rotation manipulation,including:thumb preload,thumb maximum thrust,palm preload,palm wrench force,and palm wrench maximum force.Personal characteristic parameters were collected,including age,height,weight,and neck circumference.The key biomechanical parameters in the process of cervical spine fixed-point rotation manipulation were analyzed and different individual characteristics were quantified.The results of biomechanical parameters were analyzed using Spearman correlation analysis.The possible effects of different individual characteristic parameters on biomechanics were analyzed. RESULTS AND CONCLUSION:(1)Compared with bilateral mechanical parameters,there was no significant difference between left manipulation and right manipulation(P>0.05).(2)The average of thumb preload force was(7.21±1.19)N;the average of thumb maximum thrust was(28.40±4.48)N;the average of palm preload was(5.67±2.49)N;the average of palm wrench force was(10.90±5.11)N,and the average of palm wrench maximum force was(16.00±7.27)N.(3)There was a significant positive correlation between palm preload and palm wrench force(Rs=0.812,P<0.01).There was a significant positive correlation between palm preload and palm wrench maximum force(Rs=0.773,P<0.01).There was a significant positive correlation between palm wrench force and palm wrench maximum force(Rs=0.939,P<0.01).(4)The weight was positively correlated with thumb preload,palm preload,palm wrench force and palm wrench maximum force(P<0.05).(5)These findings confirm that there is a certain biomechanical standard value in the operation of cervical spine fixed-point rotation manipulation to treat cervical spondylosis.There is no significant difference between the left and right manipulations,which indicates that the manipulation has good consistency and repeatability.There is consistency and coordination among palm preload force,palm wrench force,and palm wrench maximum force.Their contributions to the therapeutic effect are similar.Body weight is an important factor affecting cervical spine fixed-point rotation manipulation.

BACKGROUND:In recent years,artificial intelligence has been increasingly integrated into the diagnosis and treatment of lumbar disc herniation,enhancing the accuracy and efficiency of diagnostic procedures and diversifying therapeutic approaches.This integration has positioned artificial intelligence as a burgeoning focal point within the field.OBJECTIVE:To provide a comprehensive overview of the current applications of artificial intelligence in the diagnosis and treatment of lumbar disc herniation,to analyze the limitations of the relevant technologies.METHODS:A systematic computer-assisted literature search was performed in PubMed,CNKI,WanFang Database,and VIP Database for relevant publications regarding the application of artificial intelligence in the diagnosis and treatment of lumbar disc herniation from database inception up to August 2024.The search keywords included"lumbar disc herniation,artificial intelligence,machine learning,deep learning,big data,robot,neural network,model,algorithm."A total of 101 articles were selected based on predefined inclusion criteria and were reviewed.RESULTS AND CONCLUSION:Different artificial intelligence technologies have propelled the intelligent treatment of lumbar disc herniation,showing great potential for future development.Deep learning technology,based on advanced algorithms,constructs corresponding learning models to optimize the processing of X-ray,CT,and MRI images,achieving precise localization,identification,and analysis of degenerated intervertebral discs,and improving the accuracy of automated diagnosis.Big data technology utilizes data platforms to analyze vast medical data,simulate disease development trends,and provide a new perspective for disease assessment and prediction.Surgical robots,combined with robotic arms,3D high-definition vision systems,and 5G communication technology,support remote precise surgical operations,demonstrating significant technological advantages.In the future,the diagnosis and treatment of lumbar disc herniation by artificial intelligence will evolve towards standardization,efficiency,and precision through continuous optimization of algorithms and the professional development of data platforms.

Lumbar manipulation plays an important role in the non-surgical treatment of lumbar degenerative diseases.Lumbar manipulation is a compound technique that contains many mechanical elements and motion characteristics at the moment of operation.Quantifying and objectifying parameters of the manipulation,summarizing technical characteristics of the operation,and discussing biomechanical mechanism of the manipulation in-depth,can contribute to teaching assessment and clinical diagnosis and treatment standards of the manipulation,making the manipulation safer and efficient,and further promoting inheritance and development of the traditional Chinese medicine manipulation.This article reviews and synthesizes domestic and foreign biomechanical research papers on lumbar manipulation for the treatment of lumbar degenerative diseases in recent years.The biomechanical effects on the lumbar spine and its accessory structures under manual transient loading,the measurement of technical parameters,and the characteristics of manual operation are summarized.

[Objective]To analyze the effect of lever positioning manipulation(LPM)on the stress and strain of lumbar spine and intervertebral disc in different regions by using three-dimensional finite element technique,so as to reveal the biomechanical mechanism of manipulation.[Methods]A three-dimensional finite element model of the whole lumbar spine was constructed based on lumbar CT images,and the validity of the model was verified.The finite element model was used to analyze and compare the differences in the stress and strain of lumbar vertebrae and intervertebral discs by LPM at different manipulation points.[Results]The finite element model constructed indicates the point of manipulation is about 15 mm beside the L4 spinous process,the stress around the L4-5 intervertebral disc is large and the intermediate stress is small.The minimum strain point of the L4-5 intervertebral disc is about the lateral area of the intervertebral disc.The stress and strain of other intervertebral discs are similar to those of L4-5 intervertebral discs.The nucleus pulposus of L4-5 intervertebral disc move forward relatively to the lumbar spine;the stress under the lumbar pedicle is large,L4 has a certain degree of activity in the direction of extension,left bending and right rotation.Manipulation point is in the L4 spinous process,the stress around the L4-5 intervertebral disc is large and the intermediate stress is small.The minimum strain point of the L4-5 intervertebral disc is about the central area of the intervertebral disc.The stress and strain of other intervertebral discs are similar to those of L4-5 intervertebral discs.The nucleus pulposus of L4-5 intervertebral disc move forward relatively to the lumbar spine;the stress under the lumbar pedicle is large,and L4 has activity in the extension direction,and the activity in other directions is almost zero.[Conclusion]The LPM has the tendency to restore lumbar curvature and correct lumbar scoliosis and rotation.It can make the lumbar intervertebral disc move closer to the middle and make the nucleus pulposus move forward relatively to the posterior edge of the lumbar spine to reduce disc herniation and release compression.In the treatment of lumbar disc herniation,the manipulation points of the corresponding position can be selected according to the prominent position.

Lumbar manipulation plays an important role in the non-surgical treatment of lumbar degenerative diseases.Lumbar manipulation is a compound technique that contains many mechanical elements and motion characteristics at the moment of operation.Quantifying and objectifying parameters of the manipulation,summarizing technical characteristics of the operation,and discussing biomechanical mechanism of the manipulation in-depth,can contribute to teaching assessment and clinical diagnosis and treatment standards of the manipulation,making the manipulation safer and efficient,and further promoting inheritance and development of the traditional Chinese medicine manipulation.This article reviews and synthesizes domestic and foreign biomechanical research papers on lumbar manipulation for the treatment of lumbar degenerative diseases in recent years.The biomechanical effects on the lumbar spine and its accessory structures under manual transient loading,the measurement of technical parameters,and the characteristics of manual operation are summarized.

Objective:To investigate the risk factors associated with early hyperuricemia and gout attacks following laparoscopic sleeve gastrectomy (LSG) .Methods:This study was a retrospective observational study. Obese patients who underwent LSG surgery at Tianjin Medical University General Hospital from Jan. 2022 to Jul. 2023 were included according to inclusion and exclusion criteria. General information, body composition data, and laboratory tests were collected preoperatively and at one month postoperatively.Results:This study included a total of 300 patients. ①During the postoperative follow-up period, 216 out of 300 patients developed hyperuricemia, and 14 patients experienced gout attacks. ②Analysis of risk factors for early hyperuricemia revealed that male gender ( OR=5.32, 95% CI=1.953-14.489), postoperative creatinine ( OR=1.031, 95% CI=1.005-1.058), and preoperative uric acid levels ( OR=1.01, 95% CI=1.005-1.014) were independent risk factors for early hyperuricemia after laparoscopic sleeve gastrectomy (LSG). The area under the ROC curve (AUC) for the logistic regression model diagnosing hyperuricemia was 0.803 (95% CI=0.752-0.853), with sensitivity and specificity of 72.2% and 78.6%, respectively. ③Analysis of risk factors for early gout attacks showed that a history of gout ( OR=11.464, 95% CI=1.755-74.873), male gender ( OR=161.895, 95% CI=13.469-1946.022), postoperative fluid ratio ( OR=0.702, 95% CI=0.554-0.889), and changes in uric acid levels ( OR=1.017, 95% CI=1.006-1.028) were independent risk factors for early gout attacks after LSG. The AUC for the logistic regression model diagnosing gout was 0.921 (95% CI=0.808-1), with sensitivity and specificity of 93.4% and 92.9%, respectively. Conclusions:The incidence of early postoperative hyperuricemia is high, whereas the incidence of gout is low after LSG. Gender, preoperative uric acid, and postoperative creatinine are independent risk factors for hyperuricemia after LSG. History of gout, gender, postoperative water ratio, and change in uric acid levels are independent risk factors for gout after LSG.

Objective:To investigate the risk factors associated with early hyperuricemia and gout attacks following laparoscopic sleeve gastrectomy (LSG) .Methods:This study was a retrospective observational study. Obese patients who underwent LSG surgery at Tianjin Medical University General Hospital from Jan. 2022 to Jul. 2023 were included according to inclusion and exclusion criteria. General information, body composition data, and laboratory tests were collected preoperatively and at one month postoperatively.Results:This study included a total of 300 patients. ①During the postoperative follow-up period, 216 out of 300 patients developed hyperuricemia, and 14 patients experienced gout attacks. ②Analysis of risk factors for early hyperuricemia revealed that male gender ( OR=5.32, 95% CI=1.953-14.489), postoperative creatinine ( OR=1.031, 95% CI=1.005-1.058), and preoperative uric acid levels ( OR=1.01, 95% CI=1.005-1.014) were independent risk factors for early hyperuricemia after laparoscopic sleeve gastrectomy (LSG). The area under the ROC curve (AUC) for the logistic regression model diagnosing hyperuricemia was 0.803 (95% CI=0.752-0.853), with sensitivity and specificity of 72.2% and 78.6%, respectively. ③Analysis of risk factors for early gout attacks showed that a history of gout ( OR=11.464, 95% CI=1.755-74.873), male gender ( OR=161.895, 95% CI=13.469-1946.022), postoperative fluid ratio ( OR=0.702, 95% CI=0.554-0.889), and changes in uric acid levels ( OR=1.017, 95% CI=1.006-1.028) were independent risk factors for early gout attacks after LSG. The AUC for the logistic regression model diagnosing gout was 0.921 (95% CI=0.808-1), with sensitivity and specificity of 93.4% and 92.9%, respectively. Conclusions:The incidence of early postoperative hyperuricemia is high, whereas the incidence of gout is low after LSG. Gender, preoperative uric acid, and postoperative creatinine are independent risk factors for hyperuricemia after LSG. History of gout, gender, postoperative water ratio, and change in uric acid levels are independent risk factors for gout after LSG.

BACKGROUND:Previous studies have shown the correlation between lumbosacral sagittal plane parameters and natural absorption of lumbar disc herniation.However,the lumbosacral sagittal plane parameters included lumbar lordosis angle,lumbosacral joint angle,sacral inclination angle and many other parameters.The effects of each parameter on the natural absorption of the herniated disc were different.In addition,there are few studies on the reabsorption of a specific segment of intervertebral disc herniation at present,and most of the measured data are obtained from digital radiography or CT,while the correlation between lumbosacral sagittal plane parameters measured from MRI and reabsorption after L5/S1 intervertebral disc herniation is rarely reported. OBJECTIVE:To study the corresponding changes of lumbar sagittal plane parameters after L5/S1 intervertebral disc herniation reabsorption and to screen out the lumbosacral sagittal plane parameters with the most significant changes during intervertebral disc reabsorption. METHODS:Totally 57 patients with lumbar disc herniation who had complete MRI image data were selected and met the diagnostic criteria for lumbar disc herniation and only received non-surgical treatment for reabsorption of L5/S1 protrusion segments.MRI measured the protrusion area of the maximum protrusion plane in the coronal plane,lumbosacral sagittal plane parameters[lumbar curvature index,lumbar lordosis(α),L5/S1 disc angle(β),intervertebral height measurement,lumbosacral joint angle,sacral platform angle,sacral inclination angle,and lower lumbar lordosis angle].Besides,lumbosacral sagittal plane parameters were ranked in the importance of variables by random forest model in R software,and then significant variables were fitted with multiple linear regression.The changes between parameters before and after treatment were analyzed and compared by paired sample t-test. RESULTS AND CONCLUSION:(1)A total of 57 patients with L5/S1 lumbar disc herniation were included in this study,and the symptoms and imaging features of the patients were significantly relieved to a large extent.(2)Before treatment,there were 4 cases of grade 1,29 cases of grade 2 and 24 cases of grade 3 according to the Classification of Michigan State University.After treatment,there were 48 cases of grade 1 and 9 cases of grade 2.(3)The random forest model suggested that intervertebral height,lumbar curve index,sacral inclination angle,and lower lumbar lordosis angle changed significantly in L5/S1 disc herniation reabsorption,and the order of their change significance was lumbar curve index>intervertebral space height>sacral inclination angle>lower lumbar lordosis angle.(4)Lumbar curve index,lumbar lordosis and sacral platform angle increased,with statistical significance(P<0.05).There were no significant differences in disc angle,intervertebral height,lower lumbar lordosis angle,sacral inclination angle or lumbosacral joint angle(P>0.05).(5)Lumbar curvature index was the most significant parameter of the lumbosacral sagittal plane in herniated disc reabsorption.In addition,lumbar curve index,sacral inclination angle,and lower lumbar lordosis angle are commonly used clinically to describe the change of lumbar curvature,suggesting that L5/S1 disc herniation reabsorption is correlated with the change of lumbar curvature.It is indicated that in the treatment of lumbar disc herniation,a clinical cure can be achieved by improving or restoring the disordered lumbar curvature.