Background: Percutaneous pedicle screw fixation (PPSF) is the primary approach for single-segment thoracolumbar burst fractures (TLBF). The healing angle at the thoracolumbar junction is one of the most significant criteria for evaluating the efficacy of PPSF. Therefore, the purpose of this study was to analyze the predictors associated with the poor postoperative alignment of the thoracolumbar region from routine variables using a support vector machine (SVM) model. Methods: We retrospectively analyzed patients with TLBF operated at our academic institute between March 1, 2014 and December 31, 2019. Stepwise logistic regression analysis was performed to assess potential statistical differences between all clinical and radiological variables and the adverse events. Based on multivariate logistic results, a series of independent risk factors were fed into the SVM model. Meanwhile, the feature importance of radiologic outcome for each parameter was explored. The predictive performance of the SVM classifier was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy (ACC) and confusion matrices with 10-fold cross-validation, respectively. Results: In the recruited 150 TLBFs, unfavorable radiological outcomes were observed in 53 patients (35.33%). The relationship between osteoporosis (p = 0.036), preoperative Cobb angle (p = 0.001), immediate postoperative Cobb angle (p = 0.029), surgically corrected Cobb angle (p = 0.001), intervertebral disc injury (Score 2 p = 0.001, Score 3 p = 0.001), interpedicular distance (IPD) (p = 0.001), vertebral body compression rate (VBCR) (p = 0.010) and adverse events was confirmed by univariate regression. Thereafter, independent risk factors including preoperative Cobb angle, the disc status and IPD and independent protective factors surgical correction angle were identified by multivariable logistic regression. The established SVM classifier demonstrated favorable predictive performance with the best AUC = 0.93, average AUC = 0.88, and average ACC = 0.87. The variables associated with radiological outcomes, in order of correlation strength, were intervertebral disc injury (42%), surgically corrected Cobb angle (25%), preoperative Cobb angle (18%), and IPD (15%). The confusion matrix reveals the classification results of the discriminant analysis. Conclusions: Critical radiographic indicators and surgical purposes were confirmed to be associated with an unfavorable radiographic outcome of TLBF. This SVM model demonstrated good predictive ability for endpoints in terms of adverse events in patients after PPSF surgery.

Background. Symptomatic rotator cuff calcific tendinitis (RCCT) is a common shoulder disorder, and approaches combined with artificial intelligence greatly facilitate the development of clinical practice. Current scarce knowledge of the onset suggests that clinicians may need to explore this disease thoroughly. Methods. Clinical data were retrospectively collected from subjects diagnosed with RCCT at our institution within the period 2008 to 2020. A standardized questionnaire related to shoulder symptoms was completed in all cases, and standardized radiographs of both shoulders were extracted using a human-computer interactive electronic medical system (EMS) to clarify the clinical diagnosis of symptomatic RCCT. Based on the exclusion of asymptomatic subjects, risk factors in the baseline characteristics significantly associated with the onset of symptomatic RCCT were assessed via stepwise logistic regression analysis. Results. Of the 1,967 consecutive subjects referred to our academic institution for shoulder discomfort, 237 were diagnosed with symptomatic RCCT (12.05). The proportion of women and the prevalence of clinical comorbidities were significantly higher in the RCCT cohort than those in the non-RCCT cohort. Stepwise logistic regression analysis confirmed that female gender, hyperlipidemia, diabetes mellitus, and hypothyroidism were independent risk factors for the entire cohort. Stratified by gender, the study found a partial overlap of risk factors contributing to morbidity in men and women. Diagnosis of hyperlipidemia, diabetes mellitus, and hypothyroidism in male cases and diabetes mellitus in female cases were significantly associated with symptomatic RCCT. Conclusion. Independent predictors of symptomatic RCCT are female, hyperlipidemia, diabetes mellitus, and hypothyroidism. Men diagnosed with hyperlipidemia, diabetes mellitus, and hypothyroidism are at high risk for symptomatic RCCT, while more medical attention is required for women with diabetes mellitus. Artificial intelligence offers pioneering innovations in the diagnosis and treatment of musculoskeletal disorders, and careful assessment through individualized risk stratification can help predict onset and targeted early stage treatment.

Backgrounds: Obstructive sleep apnea (OSA) and hypertension both had significant impacts on human health. Whether OSA increases the risk of hypertension in relation to heredity remains unclear. We sought to clarify this issue using bidirectional Mendelian randomization (MR) analysis in large cohorts. Methods: A bidirectional two‐sample MR was conducted to evaluate the potential causality between OSA and hypertension by selecting single‐nucleotide polymorphisms (SNPs) as instrumental variables (IVs) from meta genome‐wide association studies (mGWAS). The inverse‐variance weighted (IVW) method was the main approach for data analysis to estimate the possible causal effects. Alternative methods such as MR‐Egger, the MR pleiotropy residual sum and outlier (MR‐PRESSO), and leave‐one‐out analysis methods were also performed as sensitivity analysis approaches. In order to adjust the confounding factors, a multivariable MR (MVMR) was also performed. Results: In the forward analysis, the IVW analysis demonstrated a significant association of OSA on increased hypertension risk (OR, 1.044; 95% CI, 1.012–1.076; and p = 0.006), DBP value (β, 0.041; 95% CI, 0.012–0.071; and p = 0.005), and hypertension of siblings risk (OR, 1.025; 95% CI, 1.003–1.049; and p = 0.028), but after adjusting the confounding factors (BMI, smoking, and alcohol consumption), the association disappeared. The reverse analysis demonstrated the causal effect of hypertension of father on elevated OSA risk (OR, 3.803; 95% CI, 1.135–12.726; and p = 0.030). Conclusions: Our forward analysis found the association between OSA and increased hypertension risk, DBP, and hypertension risk of siblings, but after adjusting the confounding factors, the association disappeared; on the reverse analysis, we found the causal effect of hypertension of father on elevated OSA risk.