Effect of electrical stimulation on the fusion rate after spinal surgery: a systematic review and meta-analysis.

Electrical stimulation is an important adjuvant therapy for spinal surgery, but whether receiving electrical stimulation can improve the fusion rate after spinal surgery is still controversial. The purpose of this study was to analyse and evaluate the effect of electrical stimulation on the fusion rate after spinal surgery. We systematically searched for related articles published in the PubMed, Embase and Cochrane Library databases on or before September 30, 2023. The odds ratio (OR) with 95% confidence interval (CI) and the fusion rates of the experimental group and the control group were calculated by a random-effects meta-analysis model. The analysis showed that receiving electrical stimulation significantly increased the probability of successful spinal fusion (OR 2.66 [95% CI 1.79-3.97]), and the average fusion rate of the electrical stimulation group (86.8%) was significantly greater than that of the control group (73.7%). The fusion rate in the direct current (DC) stimulation group was 2.33 times greater than that in the control group (OR 2.33 [95% CI 1.37-3.96]), and that in the pulsed electromagnetic field (PEMF) group was 2.60 times greater than that in the control group (OR 2.60 [95% CI 1.29-5.27]). Similarly, the fusion rate in the capacitive coupling (CC) electrical stimulation group was 3.44 times greater than that in the control group (OR 3.44 [95% CI 1.75-6.75]), indicating that regardless of the type of electrical stimulation, the fusion rate after spinal surgery improved to a certain extent. Electrical stimulation as an adjuvant therapy seems to improve the fusion rate after spinal surgery to a certain extent, but the specific effectiveness of this therapy needs to be further studied.

Topological Magneto-optical Effect from Skyrmions in Two-Dimensional Ferromagnets.

Skyrmions in two-dimensional (2D) magnetic materials are considered as ideal candidates for information carriers in next-generation spintronic devices. However, conventional methods for elucidating the physical properties of skyrmions have limited the development of skyrmions in diverse 2D magnetic material systems due to their requirements for electrical conductivity. To overcome this limitation, we propose to utilize an optical method (magneto-optical Kerr technique) to detect the skyrmions in 2D magnetic materials. Herein, the graphene/Fe3GeTe2/graphene vertical van der Waals (vdW) heterostructure devices are fabricated to generate stabilized skyrmions by applying out-of-plane current. In combination with magnetic circular dichroism measurements, we observe topological-reflective magnetic circular dichroism (T-RMCD) effects in Fe3GeTe2 flakes and attribute the peak-shaped component in T-RMCD to the annihilation of skyrmion magnetic domains. Notably, the T-RMCD signal can maintain up to a temperature as high as the Curie temperature of Fe3GeTe2 flakes (∼200 K). Our work provides a universal, contactless, and nondestructive approach for studying the physical properties of skyrmions in 2D vdW magnetic materials while adding another degree of freedom to the modulation of skyrmions.

Ionic Photovoltaics-in-Memory in van der Waals Material.

The photovoltaic effect is gaining growing attention in the optoelectronics field due to its low power consumption, sustainable nature, and high efficiency. However, the photovoltaic effects hitherto reported are hindered by the stringent band-alignment requirement or inversion symmetry-breaking, and are challenging for achieving multifunctional photovoltaic properties (such as reconfiguration, nonvolatility, and so on). Here, a novel ionic photovoltaic effect in centrosymmetric CdSb2Se3Br2 that can overcome these limitations is demonstrated. The photovoltaic effect displays significant anisotropy, with the photocurrent being most apparent along the CdBr2 chains while absent perpendicular to them. Additionally, the device shows electrically-induced nonvolatile photocurrent switching characteristics. The photovoltaic effect is attributed to the modulation of the built-in electric field through the migration of Br ions. Using these unique photovoltaic properties, a highly secure circuit with electrical and optical keys is successfully implemented. The findings not only broaden the understanding of the photovoltaic mechanism, but also provide a new material platform for the development of in-memory sensing and computing devices.

In-Sublattice Carrier Transition Enabled Polarimetric Photodetectors with Reconfigurable Polarity Transition.

Miniaturized polarimetric photodetectors based on anisotropic two-dimensional materials attract potential applications in ultra-compact polarimeters. However, these photodetectors are hindered by the small polarization ratio values and complicated artificial structures. Here, a novel polarization photodetector based on in-sublattice carrier transition in the CdSb2Se3Br2/WSe2 heterostructure, with a giant and reconfigurable PR value, is demonstrated. The unique periodic sublattice structure of CdSb2Se3Br2 features an in-sublattice carrier transition preferred along Sb2Se3 chains. Leveraging on the in-sublattice carrier transition in the CdSb2Se3Br2/WSe2 heterostructure, gate voltage has an anisotropic modulation effect on the band alignment of heterostructure along sublattice. Consequently, the heterostructure exhibits a polarization-tunable photo-induced threshold voltage shift, which provides reconfigurable PR values from positive (unipolar regime) to negative (bipolar regime), covering all possible numbers (1→+∞/-∞→-1). Using this anisotropic photovoltaic effect, gate-tunable polarimetric imaging is successfully implemented. This work provides a new platform for developing next-generation highly polarimetric optoelectronics.

Nicotinamide riboside alleviates brain dysfunction induced by chronic cerebral hypoperfusion via protecting mitochondria.

Chronic cerebral hypoperfusion (CCH) is an enduring inadequate blood flow to the brain, resulting in vascular dementia (VaD). However, the effective treatment strategies are lacking. Supplementing with nicotinamide adenine dinucleotide (NAD+) has shown neuroprotective benefits in other neurodegenerative disorders. Nicotinamide riboside (NR), as a precursor of NAD+, is believed to hold promise in improving mitochondrial health, autophagy, and cognitive function. Meanwhile, NR has unique oral bioavailability, good tolerability, and minimal side effects, and it is the most promising for clinical translation. However, the effectiveness of NR in treating CCH-related VaD is still uncertain. The present study examined the neuroprotective effects of NR supplementation and its underlying mechanisms in a CCH rat model. The rats with CCH were given NR at a daily dosage of 400 mg/kg for 3 months. NR supplementation increased blood and brain NAD+ levels and improved brain function in CCH rats, including cognitive function and oxygenation capacity. It also reduced hippocampal neuronal loss and abnormalities and mitigated the decrease in dendritic spine density. The analysis of RNA sequencing in hippocampal tissue supports these findings. Electron microscopy and protein detection results suggest that NR may maintain mitochondrial structural integrity and exert a protective role by attenuating mitochondrial fission and impaired autophagy flux caused by CCH. In conclusion, these findings offer evidence for the neuroprotective potential of NR supplementation in ameliorating cognitive impairment induced by CCH.

General synthesis of ionic-electronic coupled two-dimensional materials.

Two-dimensional (2D) AMX2 compounds are a family of mixed ionic and electronic conductors (where A is a monovalent metal ion, M is a trivalent metal, and X is a chalcogen) that offer a fascinating platform to explore intrinsic coupled ionic-electronic properties. However, the synthesis of 2D AMX2 compounds remains challenging due to their multielement characteristics and various by-products. Here, we report a separated-precursor-supply chemical vapor deposition strategy to manipulate the chemical reactions and evaporation of precursors, facilitating the successful fabrication of 20 types of 2D AMX2 flakes. Notably, a 10.4 nm-thick AgCrS2 flake shows superionic behavior at room temperature, with an ionic conductivity of 192.8 mS/cm. Room temperature ferroelectricity and reconfigurable positive/negative photovoltaic currents have been observed in CuScS2 flakes. This study not only provides an effective approach for the synthesis of multielement 2D materials with unique properties, but also lays the foundation for the exploration of 2D AMX2 compounds in electronic, optoelectronic, and neuromorphic devices.

Role of angiomotin family members in human diseases (Review).

Angiomotin (Amot) family members, including Amot, Amot-like protein 1 (Amotl1) and Amot-like protein 2 (Amotl2), have been found to interact with angiostatins. In addition, Amot family members are involved in various physiological and pathological functions such as embryonic development, angiogenesis and tumorigenesis. Some studies have also demonstrated its regulation in signaling pathways such as the Hippo signaling pathway, AMPK signaling pathway and mTOR signaling pathways. Amot family members play an important role in neural stem cell differentiation, dendritic formation and synaptic maturation. In addition, an increasing number of studies have focused on their function in promoting and/or suppressing cancer, but the underlying mechanisms remain to be elucidated. The present review integrated relevant studies on upstream regulation and downstream signals of Amot family members, as well as the latest progress in physiological and pathological functions and clinical applications, hoping to offer important ideas for further research.

AabHLH48, a novel basic helix-loop-helix transcription factor from Adonis amurensis, promotes early flowering in Arabidopsis by activating FRUITFULL expression.

Basic helix-loop-helix (bHLH) transcription factors play various important roles in plant growth and development. In this study, a AabHLH48 was identified in the floral organ of Adonis amurensis, a perennial herb that can naturally complete flowering at extreme low temperatures. AabHLH48 was widely expressed in various tissues or organs of A. amurensis and was localized in the nucleus. Overexpression of AabHLH48 promotes early flowering in Arabidopsis under both photoperiod (12 h light/12 h dark and 16 h light/8 h dark) and temperature (22 and 18 °C) conditions. Transcriptome sequencing combined with quantitative real-time PCR analysis showed that overexpression of AabHLH48 caused a general upregulation of genes involved in floral development in Arabidopsis, especially for AtAGAMOUS-LIKE 8/FRUITFULL (AtAGL8/FUL). The yeast one-hybrid assay revealed that AabHLH48 has transcriptional activating activity and can directly bind to the promoter region of AtAGL8/FUL. These results suggest that the overexpression of AabHLH48 promoting early flowering in Arabidopsis is associated with the upregulated expression of AtAGL8/FUL activated by AabHLH48. This indicates that AabHLH48 can serve as an important genetic resource for improving flowering-time control in other ornamental plants or crops.

Characteristics and Influencing Factors of Post-Traumatic Growth: A Cross-Sectional Study of Psychiatric Nurses Suffering from Workplace Violence in Guangdong China.

Background: Workplace violence (WPV) had become an important issue that endangered the occupational safety of psychiatric nurses. A growing number of studies showed positive post-traumatic growth (PTG) resulting from coping with trauma. Objective: To investigate the characteristics of PTG in psychiatric nurses who experienced violence in the workplace and analyze its influencing factors. Methods: A total of 1202 psychiatric nurses participated in the study. From October 2022 to December 2022, this cross-sectional study collected data on psychiatric nurses from five tertiary hospitals in Guangdong Province, China. Twenty-item Chinese version post-traumatic growth inventory (PTGI), Jefferson Scale of Empathy Health Professional (JSE-HP), Confidence in Coping with Patient Aggression Instrument (CCPAI), Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Connor-Davidson Resilience Scale (CD-RISC) measured PTG level, empathy, the confidence in coping with WPV, post-traumatic stress disorder, and resilience, respectively. Bivariate analysis and multiple linear regression explored potential influencing factors of PTG. This study complies with the EQUATOR (STROBE) checklist. Results: The sample was composed of a total of 1202 psychiatric nurses suffering from WPV. The average score of PTGI in psychiatric nurses was above average (65.75 points; SD = 20.20). Linear regression analyses showed from single-child family (ß=0.052,95% CI=0.342,5.409, P<0.05), education background (ß=0.108,95% CI=1.833,5.097, P<0.001), the confidence in coping with patient aggression (ß=0.106,95% CI=1.385,4.317, P<0.001), empathy (ß=0.057,95% CI=0.312,4.374, P<0.05), and resilience (ß=0.484,95% CI=7.737,9.575, P<0.001) were associated with PTG level. Conclusion: Psychiatric nurses who were non-single child, had received higher education, had confidence in coping with patient aggression, had good resilience and strong empathy were prone to PTG after experiencing WPV. The study findings could help hospitals and nursing managers identify vulnerable individuals and take early intervention measures against such populations.

Comparative analysis of differential gene expression reveals novel insights into the heteroblastic foliage functional traits of Pinus massoniana seedlings.

Pinus massoniana needles, rich in medicinal polysaccharides and flavonoids, undergo heteroblastic foliage, transitioning from primary needles (PN) to secondary needles (SN) during growth, resulting in altered functional traits. Despite its significance, the molecular regulatory mechanisms governing these traits remain unclear. This study employs Iso-Seq and RNA-Seq analyses to explore differentially expressed genes (DEGs) associated with functional traits throughout the main growth season of heteroblastic foliage. Co-expression network analysis identified 34 hub genes and 17 key transcription factors (TFs) influencing light-harvesting antenna, photosystem I and II, crucial in photosynthesis regulation. Additionally, 14 genes involved in polysaccharide metabolism pathways, synthesizing sucrose, glucose, UDP sugars, and xylan, along with four genes in flavonoid biosynthesis pathways, regulating p-coumaroyl-CoA, quercetin, galangin, and myricetin production, exhibited differential expression between PN and SN. Further analysis unveils a highly interconnected network among these genes, forming a pivotal cascade of TFs and DEGs. Therefore, heteroblastic changes significantly impact needle functional traits, potentially affecting the pharmacological properties of PN and SN. Thus, these genomic insights into understanding the molecular-level differences of heteroblastic foliage, thereby establishing a foundation for advancements in the pharmaceutical industry related to needle-derived products.

Risk factors of postoperative delirium following spine surgery: A meta-analysis of 50 cohort studies with 1.1 million participants.

Objectives: Postoperative delirium (POD) is considered to be a common complication of spine surgery. Although many studies have reported the risk factors associated with POD, the results remain unclear. Therefore, we performed a meta-analysis to identify risk factors for POD among patients following spinal surgery. Methods: We systematically searched the PubMed, Embase and the Cochrane Library for relevant articles published from 2006 to February 1, 2023 that reported risk factors associated with the incidence of POD among patients undergoing spinal surgery. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed, and random effects models were used to estimate pooled odds ratio (OR) estimates with 95 % confidence intervals (CIs) for each factor. The evidence from observational studies was classified according to Egger's P value, total sample size, and heterogeneity between studies. Results: Of 11,329 citations screened, 50 cohort studies involving 1,182,719 participants met the inclusion criteria. High-quality evidence indicated that POD was associated with hypertension, diabetes mellitus, cardiovascular disease, pulmonary disease, older age (>65 years), patients experiencing substance use disorder (take drug ≥1 month), cerebrovascular disease, kidney disease, neurological disorder, parkinsonism, cervical surgery, surgical site infection, postoperative fever, postoperative urinary tract infection, and admission to the intensive care unit (ICU). Moderate-quality evidence indicated that POD was associated with depression, American Society of Anesthesiologists (ASA) fitness grade (>II), blood transfusion, abnormal potassium, electrolyte disorder, length of stay, inability to ambulate and intravenous fluid volume. Conclusions: Conspicuous risk factors for POD were mainly patient- and surgery-related. These findings help clinicians identify high-risk patients with POD following spinal surgery and recognize the importance of early intervention.

Room-Temperature Magnetic-Induced Circularly Polarized Photoluminescence in Two-Dimensional Er2O2S.

Two-dimensional (2D) materials with spin polarization have great potential for achieving next-generation spintronic applications. However, spin polarization of 2D materials is usually produced at a cryogenic temperature because of thermal fluctuations, which severely hinder their further applications. Here, we report room-temperature intrinsic magnetic-induced circularly polarized photoluminescence (PL) in 2D Er2O2S flakes. The geff factor of 2D Er2O2S stays at around -6.3 from the liquid He temperature limit to room temperature, which is independent of temperature. This anomalous phenomenon in Er2O2S is totally different from previous materials, which all have a decreasing Zeeman splitting with increasing temperature resulting from thermal fluctuations. The anomalous temperature-dependent magnetic-induced circularly polarized PL originates from the weak electron-phonon coupling in 2D Er2O2S, which has been proven by both the temperature-dependent Raman and theoretical calculations. This work sheds light on the understanding and manipulation of 2D materials for practical spintronic applications.

Effectiveness of nurse-delivered stepwise swallowing training on dysphagia in patients with Alzheimer's disease: A multi-center randomized controlled trial.

BACKGROUND: Although swallowing exercises are a fundamental treatment for dysphagia, few studies have evaluated the effectiveness of swallowing training in patients with Alzheimer's disease. METHODS: We recruited 93 patients with Alzheimer's disease from three hospitals in Guangdong, China. This was a parallel armed randomized controlled trial that randomly assigned patients to intervention (n = 48) and control (n = 45) groups. The intervention group adopted systematic stepwise swallowing training for four weeks based on routine dysphagia care. The control group implemented routine dysphagia care, including diet and posture management and health education about swallowing dysfunction. The swallowing function was the primary outcome, which was assessed using the Water Swallowing Test and Standard Swallowing Assessment. An abnormal eating behavior questionnaire was used to assess the incidence of aberrant eating behavior in patients with Alzheimer's disease. The Mini-Nutritional Assessment Short Form and Barthel index were adopted to evaluate the nutritional status and ability to carry out daily activities between groups. SPSS software was used to perform the chi-square test, t-test, and generalized estimation equation for data analysis. RESULTS: We analyzed the effects of the stepwise swallowing training program using the generalized estimating equation method. The intervention group exhibited greater improvements in their swallowing function (Water Swallowing Test: ß = -3.133, 95 % CI: -4.113, -2.154, P < 0.001; Standard Swallowing Assessment: ß = -5.813, 95 % CI: -7.782, -3.844, P < 0.001), abnormal eating behaviors (abnormal eating behavior questionnaire: ß = -13.324, 95 % CI: -21.643, -5.005, P = 0.002), daily function (Barthel index: ß = 11.280, 95 % CI: 4.021, 18.540, P = 0.002), and nutritional status (Mini-Nutritional Assessment Short Form: ß = 2.402, 95 % CI: 1.313, 3.490, P < 0.001) over time than the routine-care group in the fourth week. CONCLUSIONS: Stepwise swallowing training is a safe and effective intervention for managing dysphagia and other related symptoms in patients with Alzheimer's disease.

Programmable Physical Unclonable Functions Using Randomly Anisotropic Two-Dimensional Flakes.

Physical unclonable functions (PUFs) have been developed as promising strategies for secure authentication. Conventional strategies of PUFs have a limitation in the aspect of security for their static single channel. The introduction of polarization will endow a static PUF with many dynamic transformations based on polarized properties. Herein, high-security PUFs based on the polarized luminescence of chaotic luminescent patterns are fabricated by anisotropic rare earth (RE) material Er3O4Cl flakes. These derivatives under different polarizations show strong randomness (with similarity of the same PUF as high as 97%, while that for different PUFs is as low as 44%), which further widens the security and capacity of PUFs. Polarized luminescence control of Er3O4Cl patterns gives freedom to the PUFs and ensures a high encoding capacity of 2380000. Furthermore, we build a convolutional neural network (CNN) to realize fast intelligent authentication by extracting image features for convolution operation with a very high accuracy of 99.8% and fast classification speed in only 5 epochs.

Detection of the CD8+ T cell immune response in mice infected with OVA-Listeria monocytogenes.

T cells are able to recognize and kill pathogens that infect host cells, including bacteria, viruses, and tumor cells. Here, we present a protocol to detect T cell function and bacterial load in OVA-Listeria monocytogenes-infected mice. We provide a detailed description of the steps for detecting OVA-specific CD8+ T cells and their cytokine expression levels in splenocytes using flow cytometry on day 7 after infecting mice with OVA-Listeria monocytogenes. Additionally, we describe the steps for detecting the OVA-Listeria monocytogenes load in the mouse liver. For complete details on the use and execution of this protocol, please refer to Chen et al.1.

Transcriptomic and targeted metabolomic unravelling the molecular mechanism of sugar metabolism regulating heteroblastic changes in Pinus massoniana seedlings.

Pine seedling leaf characteristics show a distinct transition from primary to secondary needles, known as heteroblastic change. However, the underlying regulatory mechanism is poorly understood. The molecular mechanism of sugar metabolism involved in regulating heteroblastic changes in Pinus massoniana seedlings was investigated via transcriptomics and targeted metabolomics. The results identified 12 kinds of sugar metabolites in the foliage. Three types of sugar accumulated at the highest levels: sucrose, glucose and fructose. Compared to seedlings with only primary needles (PN), the contents of these soluble sugars were lower in seedlings with developing secondary needle buds (SNB). RNA-seq analysis highlighted 1086 DEGs between PN and SNB seedlings, revealing significant enrichment in KEGG pathways including starch and sucrose metabolism, plant hormone signal transduction and amino sugar and nucleic acid sugar metabolism. Combined transcriptomic and metabolomic analysis revealed that HK, MDH, and ATPase could potentially enhance sugar availability by stimulating the glycolytic/TCA cycle and oxidative phosphorylation. These processes may lead to a reduced sugar content in the foliage of SNB seedlings. We also identified 72 transcription factors, among which the expression levels of MYB, WRKY, NAC and C2H2 family genes were closely related to those of DEGs in the sugar metabolism pathway. In addition, we identified alternative splicing (AS) events in one NAC gene leading to two isoforms, PmNAC5L and PmNAC5S. PmNAC5L was significantly upregulated, while PmNAC5S was significantly downregulated in SNB seedlings. Overall, our results provide new insights into how sugar metabolism is involved in regulating heteroblastic changes in pine seedlings.

Hepatocellular carcinoma cell differentiation trajectory predicts immunotherapy, potential therapeutic drugs, and prognosis of patients.

The aim of this study is to explore a novel classification and investigate the clinical significance of hepatocellular carcinoma (HCC) cells. We analyzed integrated single-cell RNA sequencing and bulk RNA-seq data obtained from HCC samples. Cell trajectory analysis divided HCC cells into three subgroups with different differentiation states: state 1 was closely related to phosphoric ester hydrolase activity, state 2 was involved in eukaryotic initiation factor 4E binding, translation regulator activity and ribosome, and state 3 was associated with oxidoreductase activity and metabolism. Three molecular classes based on HCC differentiation-related genes (HDRGs) from HCC samples were identified, which revealed immune checkpoint gene expression and overall survival (OS) of HCC patients. Moreover, a prognostic risk scoring (RS) model was generated based on eight HDRGs, and the results showed that the OS of the high-risk group was worse than that of the low-risk group. Further, potential therapeutic drugs were screened out based on eight prognostic RS-HDRGs. This study highlights the importance of HCC cell differentiation in immunotherapy, clinical prognosis, and potential molecular-targeted drugs for HCC patients, and proposes a direction for the development of individualized treatments for HCC.

Perspectives on physical restraint in psychiatric hospital: A qualitative study of mentally ill patients.

The use of physical restraint had caused a series of unexpected impacts on patients, particularly psychological trauma. This qualitative study aimed to identify perspectives on physical restraint among patients with mental health conditions and to seek effective interventions targeting the psychological trauma which is caused by physical restraint. A semi-structured interview was conducted in a public psychiatric hospital in China to explore perspectives on physical restraint among 26 patients who had undergone or witnessed physical restraint. The interview was conducted by experienced and qualified interviewers with mental health service backgrounds. The interviews were recorded and transcribed into words, and then preliminary themes were extracted and coded, finally thematic analysis was used to identify focused themes. Five themes were extracted: these were as follows: (1) The negative effects of physical restraint on patients; (2) The impairment of the relationship between nurse and patient due to physical restraint; (3) The decrease in patients' treatment adherence caused by physical restraint; (4) The positive outcomes of physical restraint; (5) The expectations of patients for improving the quality of nursing care. Conclusively, the use of physical restraint had critical impacts on patients, including psychological trauma, destruction of the nurse-patient relationship, and decreased adherence of treatment. These negative effects could impede clinical work.

Manipulation and Optical Detection of Artificial Topological Phenomena in 2D Van der Waals Fe5 GeTe2 /MnPS3 Heterostructures.

2D ferromagnet is a good platform to investigate topological effects and spintronic devices owing to its rich spin structures and excellent external-field tunability. The appearance of the topological Hall Effect (THE) is often regarded as an important sign of the generation of chiral spin textures, like magnetic vortexes or skyrmions. Here, interface engineering and an in-plane current are used to modulate the magnetic properties of the nearly room-temperature 2D ferromagnet Fe5 GeTe2 . An artificial topology phenomenon is observed in the Fe5 GeTe2 /MnPS3 heterostructure by using both anomalous Hall Effect and reflective magnetic circular dichroism (RMCD) measurements. Through tuning the applied current and the RMCD laser wavelength, the amplitude of the humps and dips observed in the hysteresis loops can be modulated accordingly. Magnetic field-dependent hysteresis loops demonstrate that the observed artificial topological phenomena are induced by the generation and annihilation of the magnetic domains. This work provides an optical method for investigating the topological-like effects in magnetic structures and proposes an effective way to modulate the magnetic properties of magnetic materials, which is important for developing magnetic and spintronic devices in van der Waals magnetic materials.

Risk factors of epidural hematoma in patients undergoing spinal surgery: a meta-analysis of 29 cohort studies.

OBJECTIVE: The authors conducted this meta-analysis to identify risk factors for spinal epidural haematoma (SEH) among patients following spinal surgery. METHODS: The authors systematically searched Pub: Med, Embase, and the Cochrane Library for articles that reported risk factors associated with the development of SEH in patients undergoing spinal surgery from inception to 2 July 2022. The pooled odds ratio (OR) was estimated using a random-effects model for each investigated factor. The evidence of observational studies was classified as high quality (Class I), moderate quality (Class II or III) and low quality (Class IV) based on sample size, Egger's P value and between-study heterogeneity. In addition, subgroup analyses stratified by study baseline characteristics and leave-one-out sensitivity analyses were performed to explore the potential sources of heterogeneity and the stability of the results. RESULTS: Of 21 791 articles screened, 29 unique cohort studies comprising 150 252 patients were included in the data synthesis. Studies with high-quality evidence showed that older patients (≥60 years) (OR, 1.35; 95% CI, 1.03-1.77) were at higher risk for SEH. Studies with moderate-quality evidence suggested that patients with a BMI greater than or equal to 25 kg/m² (OR, 1.39; 95% CI, 1.10-1.76), hypertension (OR, 1.67; 95% CI, 1.28-2.17), and diabetes (OR, 1.25; 95% CI, 1.01-1.55) and those undergoing revision surgery (OR, 1.92; 95% CI, 1.15-3.25) and multilevel procedures (OR, 5.20; 95% CI, 2.89-9.37) were at higher risk for SEH. Meta-analysis revealed no association between tobacco use, operative time, anticoagulant use or American Society of Anesthesiologists (ASA) classification and SEH. CONCLUSIONS: Obvious risk factors for SEH include four patient-related risk factors, including older age, obesity, hypertension and diabetes, and two surgery-related risk factors, including revision surgery and multilevel procedures. These findings, however, must be interpreted with caution because most of these risk factors had small effect sizes. Nonetheless, they may help clinicians identify high-risk patients to improve prognosis.