Diagnostic Value of Neutrophil-Lymphocyte Ratio in Predicting Post-Operative Infection after Orthopedic Surgery: A Systematic Review and Meta-Analysis.

Objective: This study aims to evaluate the predictive value of neutrophil-lymphocyte ratio (NLR) in determining infection after orthopedic surgery. Methods: A comprehensive search was conducted in PubMed, EBASE, CNKI, and Wanfang databases to identify relevant studies. The quality of the included studies was assessed using QUADAS-2. Data extraction was performed to calculate sensitivity, specificity, and other indicators. Bivariate mixed-effects meta-analysis was conducted using Stata software. The sources of heterogeneity were evaluated, and a summary receiver operating characteristic curve was generated. Results: A total of 16 literatures comprising 18 studies involving 3737 patients were included in this analysis. NLR demonstrated moderate sensitivity (0.77) and specificity (0.69) in diagnosing orthopedic post-operative infection, with an area under the curve of 0.80 and diagnostic odds ratio of 7.76. Significant heterogeneity was observed among the studies, primarily due to variations in surgical type, infection type, blood test timing, and NLR cutoff value. Fagan nomogram indicated that NLR could increase the positive posterior probability to 72% and decrease the negative posterior probability to 25%. The pooled effect of the likelihood ratio dot plot for diagnosis fell in the lower right quadrant. Deek funnel plot suggested no publication bias in this study. Conclusion: NLR holds certain value in diagnosing infection after orthopedic surgery and can provide additional information to assess the risk of infection. However, its predictive performance is influenced by various factors, and it cannot be used as a sole criterion for confirming the diagnosis. Prospective studies should be conducted in the future to optimize the diagnostic threshold and explore its combination with other indicators.

Effect of miR-146a polymorphism on lipoic acid therapy in patients with T2DM peripheral polyneuropthy.

For investigating the impact of miR-146a rs2910164 polymorphism on the therapeutic efficacy of lipoic acid therapy in patients with type 2 diabetes mellitus (T2DM) peripheral neuropathy (DPN). 106 T2DM-DPN patients in our hospital from Jan. 2020- 2022 were selected. The probe detection method was utilized to determine the polymorphism of the miR-146a rs2910164 gene in peripheral blood. All patients were treated with zinc sulfate for 3 weeks period. According to the treatment effect, 37 patients who were ineffective in treatment will be divided into an ineffective group, and 79 patients who were effective in treatment will be divided into an effective group. The condition of miR-146a gene peptides was analyzed after treatment in both groups. The motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), and Toronto Clinical Scoring System (TCSS) scores of the median nerve and common peroneal nerve with different genotypes were compared between the 2 sets. The genotype frequencies of alleles G, GG, and GC in the valid group were lower than those in the invalid group; After treatment, MNCV and SNCV of CC genotype median nerve and common peroneal nerve in DPN patients were higher than those before treatment; The TCSS scores of the three genotypes less than post-treatment. The above results showed statistically significant differences (P<0.05). Lipoic acid is influenced by the miR-146a polymorphism gene in the treatment of T2DM-DPN patients, with the CC genotype having a lower susceptibility and the best clinical treatment effect.

Anterior cervical discectomy and fusion for the treatment of giant cervical disc herniation.

OBJECTIVE: Giant cervical disc herniation (GCDH) was defined as a herniated intervertebral disc that accounted for more than 50% of the spinal canal. The purpose of this study was to analyse the feasibility of anterior cervical discectomy and fusion (ACDF) for the treatment of GCDH. METHODS: Patient demographic and imaging data, clinical results, and perioperative complications were analysed retrospectively. RESULTS: A total of 23 patients were included in the study. Spinal cord recovery pulsation was observed under a microscope in all cases. Postoperative magnetic resonance imaging showed complete decompression of the spinal cord and no residual intervertebral disc. The patients were followed up for 12 to 18 months. The average visual analogue scale score and Neck Disability Index decreased from 8.6 ± 0.5 and 86.0 ± 2.7% to 2.2 ± 0.2 and 26.7 ± 2.0%, respectively, three days after surgery. The average Japanese Orthopedic Association score increased from 6.9 ± 2.1 to 13.9 ± 1.1. The cervical spinal cord function improvement rate was 69.3%. No neurological complications after surgery were observed. CONCLUSION: This study shows that ACDF is feasible for the treatment of GCDH disease. The results indicate that this approach can be used to safely remove herniated disc fragments, effectively relieve compression of the spinal cord, and improve neurological function.

Risk of Cardiovascular Death in Osteosarcoma.

OBJECTIVE: To assess the risk of cardiovascular mortality (CVM) in patients with osteosarcoma. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Orthopaedics, The People's Hospital of Baoan, Shenzhen, Guangdong, China, from 1st January 2019 to 1st January 2022. METHODOLOGY: Data on patients diagnosed with osteosarcoma, between 1975 and 2019, were obtained from the surveillance, epidemiology, and end results (SEER) database. Using the Nelson-Aalen cumulative risk curve to assess the risk of CVM in patients with osteosarcoma. Competing risk models were used for identifying and analysing independent risk factors for CVM in the patients. RESULTS: Data from a total of 1335 patients with osteosarcoma were obtained from the SEER database. The characteristics of patients with osteosarcoma independently related with a high risk of CVM were age over 65 years (HR: 2.528; 95% CI: 1.156 - 5.527), race of other categories (HR: 1.498; 95% CI: 1.044 - 2.151), and exposure radiotherapy (HR: 0.493; 95% CI: 0.244 - 0.998). Receiving chemotherapy was independently associated with a low risk of CVM (HR: 1.911; 95% CI: 1.016 - 3.593). CONCLUSION: Cardiovascular disease death from osteosarcoma was significantly associated with older age at diagnosis, race other class, receiving radiation therapy, and not undergoing chemotherapy. KEY WORDS: Osteosarcoma, Cancer risk factors, Epidemiology.

Differences in Efficacy between Short- and Long-Course Antibiotic Agents for Joint Prosthesis Infection: A Systematic Review and Meta-Analysis.

Background: To evaluate systematically the failure rate of short versus long courses of antibiotic agents for prosthetic joint infections (PJIs). Methods: PubMed, Embase, and Cochrane Library databases were searched for controlled studies of short- and long-course antibiotic agents for joint prosthesis infections, all from the time of database creation to April 2022. Literature search, quality evaluation, and data extraction were performed independently by two researchers, and the primary outcome was the rate of surgical failure after antibiotic treatment. Stata 11.0 software was then applied for meta-analysis. Publication bias was assessed using Begg test. Heterogeneity was assessed using the I2 test, and fixed or random effects models were used accordingly. Meta-regression was used to determine the causes of heterogeneity. Results: A total of 14 articles involving 1,971 participants met the inclusion criteria, including 12 observational studies and two randomized controlled trials. Meta-analysis showed no difference between short and long courses of antibiotic agents (relative risk, 1.08; 95% confidence interval [CI], 0.89-1.32). The results of the subgroup analysis showed no differences between the failure rates of patients with PJI treated with short and long courses of antibiotic agents in studies with different study areas, different treatment modalities, and different locations of the artificial joints. Conclusions: Patients with PJIs may not require long-term or lifelong antibiotic agents after surgical treatment, and short-term (four to six weeks) antibiotic therapy is usually safe.

Successful Management of Esophageal Perforation by Intraoperative Microscopy and Esophagoscopic Assistance: A Case Report.

Surgical repair of esophageal perforation is a challenging procedure with a high risk of secondary complications, such as early esophageal leakage and late esophageal stricture, which can significantly reduce the patient's quality of life. A 34-year-old man underwent anterior cervical corpectomy decompression and fusion. On the ninth day post-operation, the patient developed fever and neck swelling. A computed tomography scan of the neck showed multiple subcutaneous pneumatosis. An esophageal perforation of approximately 1.5 cm in diameter was identified by esophagoscopy. During the operation, the fistula was first located using an esophagoscope. The distal end of the esophagoscope was then placed into the stomach to support the damaged segment of the esophagus. The esophageal mucosa was sutured under the microscope, and the perforation was successfully repaired. Postoperatively, the patient's body temperature decreased, and the infection indexes gradually returned to normal. Three months after the operation, the esophagoscopic review showed complete healing of the perforation. Esophagoscopy plays an important role in diagnosing and repairing esophageal perforations. The esophagoscope provides direct visualization of the perforation during diagnosis and detects smaller and not yet fully penetrated esophageal injuries. During the repair process, the esophagoscope immobilizes the esophagus, prevents its movement and facilitates suturing, maintains proper dilatation of the esophagus, provides space for suturing, and prevents esophageal stricture.

The prognostic role of tumor size in stage T1 gastric cancer.

BACKGROUND: The purpose was to assess the contribution of tumor size to the prognosis of patients with gastric cancer. METHODS: Patient data were sourced from the Surveillance, Epidemiology, and End Results program (SEER) database. Cox proportional risk regression was performed to determine the prognostic role of tumor size. Kaplan-Meier curves were conducted to calculate survival curves. Consistency index (c-index) and subject exercise curve (ROC) were utilized to assess the predictive ability of each factor on the prognosis of gastric cancer. RESULTS: Tumor size is preferable to other widely accepted prognostic clinical features in forecasting the survival of patients with gastric cancer. CONCLUSIONS: The discriminatory ability of tumor size at T1 stage is superior to many other clinical prognostic factors.

Unilateral Percutaneous Kyphoplasty with O-Arm Navigation for the Treatment of Kümmell's Disease.

PURPOSE: To evaluate the efficacy and safety of unilateral O-arm navigation-assisted percutaneous kyphoplasty (PKP) for the treatment of Kümmell's disease. METHODS: The clinical data from patients with Kümmell's disease who attended our hospital between January 2015 and January 2019 were retrospectively analyzed. For each patient, the visual analog scale (VAS) score, anterior height of the vertebral body, sagittal kyphotic angle, Oswestry Disability Index (ODI), and postoperative cement leakage rate were recorded before and after surgery. Any surgical complications were documented. RESULTS: The patients were followed up for 12 to 18 months. The average preoperative VAS score, kyphotic angle, and ODI decreased from 8.6 ± 0.5, 18.0 ± 3.7°, and 86.027%, respectively, to 2.2 ± 0.2, 5.8 ± 0.8°, and 26.720% three days after surgery. The anterior height of the vertebral body increased significantly from 14.5 ± 1.2 mm preoperatively to 19.4 ± 1.2 mm three days after surgery, and this improvement was maintained until the last follow-up. After surgery, bone cement leakage occurred in one vertebral body; this patient exhibited leakage to the intervertebral disc space, a complete pedicle and spinal canal structure, no clinical symptoms, and required no treatment. CONCLUSION: This study shows that unilateral PKP assisted by O-arm navigation is safe and effective. Moreover, the observed improvements can be maintained over the longer term.

Clinical validity of the smallest oblique sagittal area of the neural foramen in patients with suspected cervical spondylotic radiculopathy.

OBJECTIVE: To evaluate the smallest oblique sagittal area of the neural foramen in detecting cervical spondylotic radiculopathy (CSR) and to determine its potential significance for treatment decisions. METHODS: The subjects of the study were patients with CSR who visited the spine surgery from 2016 to 2019. All patients were compared according to the minimum oblique sagittal area and the cut-off point value, and they were divided into positive and negative parameters. The changes in neck disability index (NDI), Japanese Orthopaedic Association score (JOA), and visual analog scale (VAS) during the two treatment groups from baseline to at least 24 months of follow-up were compared. RESULTS: In the surgery group, there was no significant difference in symptom improvement between patients with positive and negative parameters. In the non-surgical group, for patients with positive parameters, NDI decreased by 2.35, JOA increased by 0.88, and neck VAS score improved by 0.42. For patients with negative parameters, NDI decreased by 10.32, JOA increased by 2.86 on average, and neck VAS score improved by 2.46 points on average (both p<0.01 on t test). CONCLUSIONS: Patients with both positive and negative parameters showed significant improvement in their symptoms after surgery, and the smallest oblique sagittal area of the neural foramen seems to be unable to predict the outcome of the surgery. However, in non-surgical patients, symptomatic improvement was more limited in patients with positive parameters than in those with negative parameters. This suggests that patients with positive parameters may be more suitable for surgery and those with negative parameters are more suitable for conservative treatment.

Surgical versus Nonsurgical Treatment for Adult Spinal Deformity: A Systematic Review and Meta-Analysis.

OBJECTIVE: To systematically evaluate the efficacy and safety of surgical and nonsurgical methods for the treatment of adult spinal deformity (ASD). METHODS: The PubMed, Embase, and Cochrane Library databases were searched for relevant controlled studies of surgical and nonsurgical approaches for the treatment of ASD; all studies reported from database creation to October 2021 were eligible for inclusion. Stata 11.0 software was used for the meta-analysis. Publication bias was assessed using a Begg test. Heterogeneity was assessed using the I2 test, and fixed-effects or random-effects models were used, as appropriate. Meta-regression was used to determine the cause of heterogeneity. Subgroup analyses were performed to assess the effects of age on the outcomes. RESULTS: Eleven articles comprising 1880 participants met the inclusion criteria. Meta-analysis showed that surgical treatment was associated with a better improvement in function than was nonsurgical treatment (Scoliosis Research Society 22 questionnaire score change value: weighted mean difference = 0.696; 95% confidence interval [CI], 0.686-0.705; P < 0.0001; Oswestry Dysfunction Index change value: WMD = 11.222; 95% CI, 10.801-11.642; P < 0.0001). Surgical treatment was more effective in relieving pain and correcting the deformity (numeric rating scale pain score: WMD = 3.341; 95% CI, 2.832-3.85; P < 0.0001; Cobb angle change value: WMD = 15.036°; 95% CI, 13.325-16.747; P < 0.0001). The complication rate in the surgical group was 17.6%-80.3%. CONCLUSIONS: Surgical treatment is better than nonsurgical methods for improving the function of patients with ASD and achieving good pain improvement and deformity correction. Elderly patients with ASD can also obtain good symptomatic improvement through surgery.

A New Parameter, the Smallest Oblique Sagittal Area of the Neural Foramen, as an Index to Diagnose Cervical Neural Foramen Stenosis.

OBJECTIVE: The objective was to reconstruct the cervical neural foramen and accurately measure the minimum oblique sagittal area of the neural foramen. Then, a quantitative diagnostic standard for cervical neural foramen stenosis was proposed and its value as an indication for surgery was evaluated. METHODS: (1) CT data were used to reconstruct the neural foramen using Mimics software, and the minimum area was measured. (2) The optimal cut-off value was determined using a receiver operating characteristic (ROC) curve. (3) Patients who underwent single-segment surgery were divided into 2 groups according to the cut-off value. Then the postoperative neurological function improvement rate was analyzed to identify any significant difference between the 2 groups. RESULTS: A total of 1056 neural foramens were measured in 132 patients, of which 495 (46.88%) were diagnosed as radiculopathy by clinical neurological examination. The optimal cut-off value determined by the ROC curve was 25.95 mm2 (sensitivity 74.1%, specificity 80.9%) and the area under the curve (AUC) was 0.827 (95%CI: 0.803-0.849). There was a significant difference in the neurological function improvement rate between the 2 groups after surgery (P < 0.05). The intraclass correlation coefficient (ICC) was 0.969. CONCLUSION: Three-dimensional digital simulation reconstruction of CT data is a good measurement method. The optimal cut-off value determined here not only has a certain reference value for the diagnosis of cervical neural foramen bony stenosis, but also helps to select patients suitable for neural foramen decompression and can be used as a reference for surgical indication.

Diagnostic Performance of Single-Photon Emission Computed Tomography/Computed Tomography in Aseptic Loosening: A Systematic Review and Meta-Analysis.

BACKGROUND: The aim of this study is to evaluate the diagnostic value and clinical applicability of single-photon emission computed tomography/computed tomography (SPECT/CT) in aseptic loosening (AL) of prostheses by meta-analysis. METHOD: Literature on the diagnostic value of SPECT/CT in AL of prostheses was obtained by computer and manual review. The quality of the included studies was evaluated according to the Quality Assessment Diagnostic Accuracy Studies 2. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and other indicators were calculated, and a forest map and summary receiver operating characteristic were drawn to calculate the area under the curve. Meta-regression analysis was performed to identify the sources of heterogeneity and corresponding subgroup analysis was performed. A Fagan plot, likelihood ratio point plot, and Deek's funnel plot were drawn and analyzed. RESULTS: A total of 15 studies were included. The meta-analysis results showed that the pooled sensitivity and specificity of SPECT/CT for the diagnosis of aseptic prosthetic loosening were 0.94, 95% confidence interval [CI] (0.90-0.96) and 0.89, 95% CI (0.78-0.95), respectively while the pooled positive likelihood ratio and pooled negative likelihood ratio were 8.65, 95% CI (4.18-17.90) and 0.07, 95% CI (0.04-0.11), respectively. The pooled diagnostic odds ratio was 130.36, 95% CI (45.18-376.19), and the area under the curve was 0.97, 95% CI (0.95-0.98). CONCLUSION: As a diagnostic method for AL, SPECT/CT has high diagnostic sensitivity and specificity as well as high diagnostic efficiency. It has good clinical application value and should be a primary choice in the diagnosis of AL after joint replacement.

Eimeria acervulina Microneme Protein 3 Inhibits Apoptosis of the Chicken Duodenal Epithelial Cell by Targeting the Casitas B-Lineage Lymphoma Protein.

Eimeria acervulina (E. acervulina) causes coccidiosis in poultry which persists as economic pain worldwide. Most damage to the intestinal mucosa results from apoptosis of the infected intestinal epithelial cells. The Microneme protein 3 (MIC3) protein is a key virulence factor in some parasites involved in host cell apoptosis inhibition. Here, we studied whether and how MIC3 affects the apoptosis in E. acervulina infected chicken duodenal epithelial cells. Through flow cytometry (FCM), we found that the presence of merozoites and the overexpression of MIC3 significantly decreased apoptosis and the activity of caspase-3 in chicken duodenal epithelial cells at 4, 6, and 8 h post merozoite infection (P < 0.01). Silencing the Casitas B-lineage lymphoma (CBL) protein, a host receptor for MIC3 with shRNA was shown to promote apoptosis in the chicken duodenal epithelial cells. The early apoptotic rate of host cells in the lentiviral-MIC3 group was significantly lower than that in the lentiviral-MIC3 + shRNA CBL group at 4 h after MIC3 expression (P < 0.01), and it was moderately decreased in the lentiviral-MIC3 + shRNA CBL group compared with that in the shRNA CBL group. Our data indicated that MIC3 inhibited early apoptosis of E. acervulina infected chicken duodenal epithelial cells by targeting host receptor-CBL protein. These findings unveiled one of the mechanisms of how intracellular parasites affect the apoptosis of infected host cells, which provided a deeper understanding of their pathogenesis.