Protocol for lower back pain management: Insights from the French healthcare system

In this editorial we comment on the article published in a recent issue of the World Journal of Clinical Cases.This article described a novel ultrasound-guided lateral recess block approach in treating a patient with lateral recess stenosis.The impact of spinal pain-related disability extends significantly,causing substantial human suffering and medical costs.Each county has its preferred treatment strategies for spinal pain.Here,we explore the lower back pain(LBP)treatment algorithm recommended in France.The treatment algorithm for LBP recommended by the French National Authority for Health emphasizes early patient activity and minimal medication use.It encourages the continuation of daily activities,limits excessive medication and spinal injections,and incorporates psychological assessments and non-pharmacological therapies for chronic cases.However,the algorithm may not aggressively address acute pain in the early stages,potentially delaying relief and increasing the risk of chronicity.Additionally,the recommended infiltrations primarily involve caudal epidural steroid injections,with limited consideration for other injection procedures,such as transforaminal or interlaminar epidural steroid injections.The fixed follow-up timeline may not accommodate patients who do not respond to initial treatment or experience intense pain,potentially delaying the exploration of alternative therapies.Despite these limitations,understanding the strengths and weaknesses of the French approach could inform adaptations in LBP treatment strategies globally,potentially enhancing patient outcomes and satisfaction across diverse healthcare systems.

Chondroid syringoma of the lower back simulating lipoma:A case report

BACKGROUND Chondroid syringoma(CS)is a rare tumor of the apocrine or eccrine glands.CS of the lower back is rare,and its clinical manifestations are similar to those of lipoma,which is a common misdiagnosis for this disease.CASE SUMMARY A 39-year-old woman presented with a 2-year history of an asymptomatic subcutaneous mass on the lower back.The lesions increased progressively over time.The patient denied any history.Dermatological examination showed that there was a subcutaneous mass,ranging from 3-4 cm in diameter,with a clear boundary on the lower back.The surface of the skin was smooth without ulceration or scaling.Histopathologic examination was consistent with the diagnosis of CS.CONCLUSION CS is a rare tumor of the apocrine or eccrine glands.It usually presents as a wellcircumscribed and single subcutaneous masses.Histopathology showed the tumor was located in the dermis,with nests,sheets,and cords of basal-like cells,mucin deposition,and chondroid structures.We herein report a case of CS located in the lower back.CS of the lower back is rare,and its clinical manifestations are similar to those of lipoma,for which it is commonly misdiagnosed.

Lower Back Pain and Forearm Tendinitis Linked to Irritation of Oral Mucosa by Teeth

We present a case of a woman with refractory lower back pain and forearm tendinitis, which improved dramatically after morphological modification of natural teeth. The subject was a 35-year-old Japanese woman, who was suffering from lower back pain when bending forward and she had severe pain from her right thumb to her wrist. These symptoms were not improved by massage and orthopedic treatment. On the other hand, once modifying the morphology of natural teeth, those symptoms improved dramatically. No side effects were observed, and the prognosis was good. Our observation suggested a close relationship between the oral situation and remote musculoskeletal conditions, and further multidisciplinary studies are needed to clarify the mechanisms.

An Exercise Rehabilitative Solution to Work-Related Musculoskeletal Lower Back Pain among Nurses

The attrition of professional nurses is a sad reality. Work-related musculoskeletal lower back pain (WRMLBP) among nurses has been cited as a factor of increased sick leave and poor health. Occupational predisposing factors of lower back pain are strenuous physical stresses of nursing, obesity and poor physical conditioning. Regular stretching and strengthening exercises dissipate lower back pain. This commentary’s objectives are to explain the association between obesity and lower back pain and the exercise mechanism that dissipates this pain, thereby concluding that nurses should consider regular exercise as a therapeutic option.

Model Parameters Identification and Backstepping Control of Lower Limb Exoskeleton Based on Enhanced Whale Algorithm

Exoskeletons generally require accurate dynamic models to design the model-based controller conveniently under the human-robot interaction condition.However,due to unknown model parameters such as the mass,moment of inertia and mechanical size,the dynamic model of exoskeletons is difficult to construct.Hence,an enhanced whale optimization algorithm(EWOA)is proposed to identify the exoskeleton model parameters.Meanwhile,the periodic excitation trajectories are designed by finite Fourier series to input the desired position demand of exoskeletons with mechanical physical constraints.Then a backstepping controller based on the identified model is adopted to improve the human-robot wearable comfortable performance under cooperative motion.Finally,the proposed Model parameters identification and control are verified by a two-DOF exoskeletons platform.The knee joint motion achieves a steady-state response after 0.5 s.Meanwhile,the position error of hip joint response is less than 0.03 rad after 0.9 s.In addition,the steady-state human-robot interaction torque of the two joints is constrained within 15 N·m.This research proposes a whale optimization algorithm to optimize the excitation trajectory and identify model parameters.Furthermore,an enhanced mutation strategy is adopted to avoid whale evolution’s unsatisfactory local optimal value.

Kinematics ofmandibular advancement devices(MADs):Why do some MADs move the lower jaw backward duringmouth opening?

Mandibular advancement devices(MADs)are widely used treatments for obstructive sleep apnea.MADs function by advancing the lower jaw to open the upper airway.To increase patient comfort,most patients allow the mouth to be opened.However,not all systems maintain the lower jaw in a forward position during mouth opening,which results in the production of a retrusion that favors the collapse of the upper airway.Furthermore,the kinematic behavior of the mechanism formed by the mandible-device assembly depends on jaw morphology.This means that,during mouth opening,some devices cause lower jaw protrusion in some patients,but cause its retraction in others.In this study,we report the behavior of well-known devices currently on themarket.To do so,we developed a kinematic model of the lower jawdevice assembly.Thismodelwas validated for all devices analyzed using a high-resolution camera system.Our results show that some of the devices analyzed here did not produce the correct behavior during patient mouth opening.

Metastatic lymph node distribution and pathology correlations in upper and lower gastric cancer patients:A multicenter retrospective study

BACKGROUND Gastric cancer(GC)poses a significant threat to public health.However,the clinicopathological features and tumor biological behaviors vary among the GC patients,leading to individual variations in lymph node metastasis.Consequently,the stratification of lymph node dissection according to the specific type,particularly upper GC,has emerged as a prominent area of research.AIM To investigate the distribution of metastatic lymph nodes in patients with upper and lower GC and to analyze the differences in related pathological elements and prognosis.METHODS Differential analysis between upper and lower GC patients with various clinicopathological factors was performed using the chi-square test and rank-sum regression models were used to analyze risk factors affecting patient prognosis.The Kaplan-Meier method was used to construct survival curves associated with prognostic risk factors for GC.RESULTS Significant differences were observed between the two GC populations regarding tumor diameter,histological grade,pT stage,pN stage,tumor-node-metastasis(pTNM)stage,vascular invasion,and adjuvant chemotherapy usage(all P<0.05).Lymph node metastasis rates were highest for Siewert type II patients in groups Nos.1,3,2 and 7;for Siewert type III patients in groups Nos.3,1,2 and 7;and for other/unclassified patients in groups Nos.1,3,7,2.In the lower GC samples,the sequences were Nos.3,6,7,4.Pathological type,pT stage,pTNM stage,and positive vascular invasion were independent risk factors for development of lymph node metastasis.Age,pathological type,pT stage,pN stage,pTNM stage,vascular invasion,and absence of adjuvant chemotherapy were identified as independent prognostic factors.CONCLUSION Upper GC showed a significantly higher malignancy grade and different lymph node metastasis pattern than lower GC.

Association between serum retinol-binding protein and lower limb atherosclerosis risk in type 2 diabetes mellitus

BACKGROUND Serum retinol-binding protein(RBP)is the primary transport protein of circulating vitamin A.RBP has a crucial role in maintaining nutrient metabolism and physiologic homeostasis.Several studies have indicated that serum RBP participates in the progression of diabetes and diabetes-related complications.However,the impact of serum RBP on lower limb atherosclerosis has not been determined in individuals with type 2 diabetes mellitus(T2DM).AIM To determine the association between serum RBP and lower limb atherosclerosis in individuals with T2DM.METHODS This retrospective study enrolled 4428 eligible T2DM patients and divided the patients into non-lower limb atherosclerosis(n=1913)and lower limb atherosclerosis groups(n=2515)based on lower limb arterial ultrasonography results.At hospital admission,baseline serum RBP levels were assessed,and all subjects were categorized into three groups(Q1-Q3)based on RBP tertiles.Logistic regression,restricted cubic spline regression,subgroup analysis,and machine learning were used to assess the association between RBP levels and lower limb atherosclerosis risk.RESULTS Among 4428 individuals with T2DM,2515(56.80%)had lower limb atherosclerosis.Logistic analysis showed that lower limb atherosclerosis risk increased by 1%for every 1 unit rise in serum RBP level(odds ratio=1.01,95%confidence interval:1.00-1.02,P=0.004).Patients in the highest tertile group(Q3)had a higher lower limb atherosclerosis risk compared to the lowest tertile group(Q1)(odds ratio=1.36,95%confidence interval:1.12-1.67,P=0.002).The lower limb atherosclerosis risk gradually increased with an increase in RBP tertile(P for trend=0.005).Restricted cubic spline analysis indicated a linear correlation between serum RBP levels and lower limb atherosclerosis risk(non-linear P<0.05).Machine learning demonstrated the significance and diagnostic value of serum RBP in predicting lower limb atherosclerosis risk.CONCLUSION Elevated serum RBP levels correlate with an increased lower limb atherosclerosis risk in individuals with T2DM.

Effect of stimulating acupoint Guanyuan(CV 4) on lower back pain by burning moxa heat for different time lengths: a randomized controlled clinical trial

OBJECTIVE: To investigate the effect of different heat-stimulating time lengths on lower back pain.METHODS: Forty participants were randomly assigned to four groups of various heating time lengths. The short heating time length group(SL),moderate heating time length group(ML), and long heating time length group(LL) respectively received 15, 30, and 60 min of moxibustion therapy stimulating the acupoint Guanyuan(CV 4). The conventional acupuncture group(CA) received needle acupuncture treatment as a control group. The participants were treated continuously over a 2-week treatment period for a total of 10 sessions, with five sessions given per week. Participants were assessed weekly by blinded assessors, using the visual analogue scale(VAS) and Roland Morris Questionnaire(RMQ).RESULTS: The VAS and RMQ scores reduced in all four groups during treatment. There were significant differences in VAS scores(P < 0.01) and RMQ scores(P < 0.01) between before treatment and after 2 weeks of treatment in the LL group. After treatment, the LL group reported significantly lower VAS scores compared with the CA group, ML group,and SL group(P < 0.05).CONCLUSION: The long and moderate lengths of heat-stimulating time of 30 and 60 min may be more effective for relieving lower back pain than that of short stimulating time lengths.

The Background of Regional Lead Isotopic Compositions and Its Application in the Lower and Middle Reaches of the Yangtze River and Neighbouring Areas

The paper systematically deals with the background of regional isotopic compo-sitions in the lower and middle reaches of the Yangtze River and neighbouring areas. It isshown that the lead isotopic compositions of different geological formations and units are con-trolled by the primary mantle heterogeneity, dynamic process of crust-mantle interchange,abundances of uraninm, thorium and lead of various layers of the earth and timing. Studies onthe background of regional isotopic compositions may offer significant information forgeochemical regionalization, tracing of sources of ore-forming materials, and regionalprognosis of ore deposits.

Organic Matter Accumulation in the Upper Permian Dalong Formation from the Lower Yangtze Region,South China

The Late Permian was marked by a series of important geological events and widespread organic-rich black shale depositions,acting as important unconventional hydrocarbon source rocks.However,the mechanism of organic matter(OM)enrichment throughout this period is still controversial.Based on geochemical data,the marine redox conditions,paleogeographic and hydrographic environment,primary productivity,volcanism,and terrigenous input during the Late Permian in the Lower Yangtze region have been studied from the Putaoling section,Chaohu,to provide new insights into OM accumulation.Five Phases are distinguished based on the TOC and environmental variations.In Phase I,anoxic conditions driven by water restriction enhanced OM preservation.In Phase II,euxinic and cycling hydrological environments were the two most substantial controlling factors for the massive OM deposition.During Phase III,intensified terrestrial input potentially diluted the OM in sediment and the presence of oxygen in bottom water weakened the preservation condition.Phase IV was characterized by a relatively higher abundance of mercury(Hg)and TOC(peak at 16.98 wt%),indicating that enhanced volcanism potentially stimulated higher productivity and a euxinic environment.In Phase V,extremely lean OM was preserved as a result of terrestrial dilutions and decreasing primary productivity.Phases I,II and IV are characterized as the most prominent OM-rich zones due to the effective interactions of the controlling factors,namely paleogeographic,hydrographic environment,volcanism,and redox conditions.

Early-diverging Titanosauriform(Dinosauria,Sauropoda)Teeth from the Lower Cretaceous Yixian Formation of Southeastern Inner Mongolia,Northeast China

Three eusauropod teeth(SDUST-V1064,PMOL-AD00176,PMOL-ADt0005)are reported from the Lower Cretaceous Yixian Formation of Ningcheng,southeastern Inner Mongolia,China.Two of them(SDUST-V1064,PMOL-AD00176)are assigned to early-diverging titanosauriforms in having slightly mesiodistal expansion at the base of the tooth crown,a slenderness index value>2.0 and<4.0,and D-shaped cross section.Furthermore,SDUST-V1064 and PMOL-AD00176 are referred as an Euhelopus-like titanosauriform on the basis of having a sub-circular boss on the lingual surface and an asymmetrical crown-root margin which slants apically,respectively.CT scan data of SDUST-V1064 reveals new dental information of early-diverging titanosauriforms,for example,the enamel on the labial side thicker than that on the lingual side,an enamel/dentine ratio of 0.26 and a boss present on the lingual side of the dentine of the crown.

Monitoring and evaluation of the water quality of the Lower Neches River, Texas, USA

Increasing bacteria levels in the Lower Neches River caused by Hurricane Harvey has been of a serious concern.This study is to analyze the historical water sampling measurements and real-time water quality data collected with wireless sensors to monitor and evaluate water quality under different hydrological and hydraulic conditions.The statistical and Pearson correlation analysis on historical water samples determines that alkalinity,chloride,hardness,conductivity,and pH are highly correlated,and they decrease with increasing flow rate due to dilution.The flow rate has positive correlations with Escherichia coli,total suspended solids,and turbidity,which demonstrates that runoff is one of the causes of the elevated bacteria and sediment loadings in the river.The correlation between E.coli and turbidity indicates that turbidity greater than 45 nephelometric turbidity units in the Neches River can serve as a proxy for E.coli to indicate the bacterial outbreak.A series of statistical tools and an innovative two-layer data smoothing filter are developed to detect outliers,fill missing values,and filter spikes of the sensor measurements.The correlation analysis on the sensor data illustrates that the elevated sediment/bacteria/algae in the river is either caused by the first flush rain and heavy rain events in December to March or practices of land use and land cover.Therefore,utilizing sensor measurements along with rainfall and discharge data is recommended to monitor and evaluate water quality,then in turn to provide early alerts on water resources management decisions.

Intervention Effect of Lower Limb Rehabilitation Robot with Task-Oriented Training on Stroke Patients and Its Influence on KFAROM Score

Objective: To explore the effect of lower limb rehabilitation robot combined with task-oriented training on stroke patients and its influence on KFAROM score. Methods: 100 stroke patients with hemiplegia admitted to our hospital from January 2023 to December 2023 were randomly divided into two groups, the control group (50 cases) was given task-oriented training assisted by nurses, and the observation group (50 cases) was given lower limb rehabilitation robot with task-oriented training. Lower limb balance, lower limb muscle strength, motor function, ankle function, knee flexion range of motion and walking ability were observed. Results: After treatment, the scores of BBS, quadriceps femoris and hamstrings in the observation group were significantly higher than those in the control group (P Conclusion: In the clinical treatment of stroke patients, the combination of task-oriented training and lower limb rehabilitation robot can effectively improve the lower limb muscle strength, facilitate the recovery of balance function, and have a significant effect on the recovery of motor function, which can improve the walking ability of stroke patients and the range of motion of knee flexion, and achieve more ideal therapeutic effectiveness.

Natural Disasters of the Lower Reaches of Yellow River during the Longshan Period——The Natural Background of Dayu's Flood Control

It is very important to study the archaeological culture and origin of civilization in ancient China.The changes of the channels in the lower reaches of the Yellow River in the prehistoric period are part of the natural environmental background of the development of the ancient civilization in that area to be explored.This paper presents a series of legends,indications,scientific evidence,and macroscopic geographical background information of the evolution in the lower reaches of the Yellow River during the Longshan period.At first the river flowed from Northern Henan and Hebei to southwestern Shandong Province and Northern Anhui–Jiangsu provinces,and the mainstream of the Yellow River changed from the southeast to return to the north and flowed into the Bohai Sea in the late Longshan Period.During this period,floods were frequent.Various ethnic groups in the northern China plains suffered natural disasters and made great migrations which also contributed to the ethnic exchanges and integration.The people of the Central Plains made more dynamic adjustments in the relationship between mankind and the land by primitively escaping from the water and self–defensively controlling the rivers then to maintaining the local ecological environment by large–scale flood control measures,which promoted the settlement of Shandong,Henan,Jiangsu and Anhui provinces,the urban cultural development,and social evolution.Based on these events,the culture symbol of Dayu's Flood Control could be formed.

Surface and Deep Structure of the Hanshan-Wuwei Basins in the Lower Yangtze Region:Implications for Mesozoic Tectonic Evolution of the South China Block

Indicating the tectonic features of the Hanshan-Wuwei basin can reconstruct the framework of the basins formed in Mesozoic and further understand the Mesozoic tectonic evolution of the South China Block.Studies on surface structure,regional stress field and deep geophysical characteristics of the Mesozoic Hanshan-Wuwei basin in Lower Yangtze region were carried out.NE-NNE trending folds and faults developed in the northern margin of the basins.The reconstruction of tectonic stress fields indicates four stress stages dominating the basins'evolution including NW-SE compression,N-S compression,NW-SE extension and NWW-SEE compression.2D seismic profiles reveal coexistence of thrust,strike-slip and normal faults in the basin.Combined with regional geological studies,the geodynamic processes for the formation of the Hanshan-Wuwei basin can be divided into five stages:1)During the Late Triassic,EW trending foreland basin was formed by N-S compression;2)From Mid-Jurassic to Late Jurassic,continuous compression strengthened the foreland deformation and formed thrust nappes.In this stage,the integrated foreland basin was compartmentalized or fragmented,and transferred to the broken foreland basin;3)NE-trending sinistral strike-slip movement at the beginning of the Early Cretaceous;4)Regional extension resulted in normal faults and rift basins developing in the Late Cretaceous;5)The NWW-SEE compression at the end of the Late Cretaceous caused NW sinistral strike-slip faults to form,which partly transformed the rift basin.

Neural Network Robust Control Based on Computed Torque for Lower Limb Exoskeleton

The lower limb exoskeletons are used to assist wearers in various scenarios such as medical and industrial settings.Complex modeling errors of the exoskeleton in different application scenarios pose challenges to the robustness and stability of its control algorithm.The Radial Basis Function(RBF)neural network is used widely to compensate for modeling errors.In order to solve the problem that the current RBF neural network controllers cannot guarantee the asymptotic stability,a neural network robust control algorithm based on computed torque method is proposed in this paper,focusing on trajectory tracking.It innovatively incorporates the robust adaptive term while introducing the RBF neural network term,improving the compensation ability for modeling errors.The stability of the algorithm is proved by Lyapunov method,and the effectiveness of the robust adaptive term is verified by the simulation.Experiments wearing the exoskeleton under different walking speeds and scenarios were carried out,and the results show that the absolute value of tracking errors of the hip and knee joints of the exoskeleton are consistently less than 1.5°and 2.5°,respectively.The proposed control algorithm effectively compensates for modeling errors and exhibits high robustness.

Establishing the relationship between land use land cover,normalized difference vegetation index and land surface temperature:A case of Lower Son River Basin,India

The study explores the intricate interplay between land use land cover(LULC),normalized difference vegetation index(NDVI),and land surface temperature(LST)within the Lower Son River Basin in India from 1991 to 2020.The region’s ecological balance has been increasingly strained due to rapid urbanization and changing land use patterns.Through a combination of Landsat TM&OLI/TIRS satellite imageries and geospatial analysis techniques,this study unveils the intricate connection between land use and land cover changes,vegetation,and land surface temperature variations.The study area is classified into three altitudinal zones(Zone Ⅰ:39–300 m,Zone Ⅱ:301–600 m and Zone Ⅲ:601–1,247 m)to examine the changes in depth.The area has seen significant changes in LULC,vegetation and LST in all the three altitudinal zones.The findings hold significant implications for sustainable land management and environmental conservation strategies in the Lower Son River Basin.As per the result,103,438 ha of vegetation was converted into agriculture land and 82,572 ha of agricultural land was transformed into settlements from 1991 to 2020.This trend shows human pressure on the land resource in the study area.Minor increase in water body is seen which is attributed to commissioning of Bansagar dam.Zone Ⅰ has seen highest settlement growth while Zone Ⅲ experienced severe deforestation of around 15%.Zone Ⅱ and Ⅲ needs attention for holistic sustenance.Analysis of LST shows that it has increased by 0.82℃ from 1991 to 2020 which is a red flag.The study underscores the critical importance of balanced land use practices to preserve ecological integrity and mitigate the adverse effects of urbanization and climate change.