The Association between High Preoperative MRI-based Vertebral Bone Quality (VBQ) Score and Titanium Mesh Cage Subsidence after Anterior Cervical Corpectomy and Fusion.

OBJECTIVE: Recently, the MRI-based vertebral bone quality (VBQ) score has been shown to correlate with Hounsfeld units (HU) value, dual-energy X-ray absorptiometry (DEXA) T-score and predict osteoporotic fractures. Preoperative cervical HU value is an independent correlative factor for early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF). However, to date the direct association between cervical VBQ score and TMC subsidence has not been studied. This study aims to investigate the predictive effect of cervical VBQ score derived from sagittal non-contrast-enhanced T1-weighted MRI on the early TMC subsidence after ACCF. METHODS: Patients who underwent one-level ACCF from January 2016 to January 2020 were included. We retrospectively collected baseline data on age, sex, body mass index (BMI), disease type, level of surgery and radiology parameters. The cervical VBQ score was measured using preoperative non-contrast-enhanced T1-weighted MRI. Univariate and multivariate logistic regression analysis were performed to screen the independent risk factors of TMC subsidence. The receiver operating characteristic (ROC) curve and area under curve (AUC) were performed to assess the predictive ability of TMC subsidence based on the cervical VBQ score. Spearman correlation analysis was used to determine the correlations between the cervical VBQ score and TMC subsidence. RESULTS: A total of 134 patients who underwent one-level ACCF were included in this study, and 46 (34.33%) patients had TMC subsidence. Univariable analyses demonstrated that the age, TMC placement depth and VBQ score were associated with subsidence. The cervical VBQ score in the subsidence group was significantly higher than that in the no subsidence group (3.75 ± 0.45 vs. 3.20 ± 0.42, p < 0.001). The multivariate logistic regression analysis proved that the higher VBQ score (odds ratio[OR] = 13.563, 95% confidence interval [CI] 4.968 - 37.031, p < 0.001) was the only variable that significantly predicted subsidence. Using a VBQ score cutoff value of 3.445, the cervical VBQ score yielded a sensitivity of 69.6% and a specificity of 85.2% with an AUC of 0.810 to differentiate patients with subsidence and with no subsidence. CONCLUSION: Preoperative higher cervical VBQ score is an independent risk factor for TMC subsidence after ACCF. The cervical VBQ score may be a valuable tool for assisting in distinguishing the presence of TMC subsidence.

Type 2 diabetes and fasting glycemic traits are causal factors of frozen shoulder: a 2-sample Mendelian randomization analysis.

BACKGROUND: The causal relationship between type 2 diabetes (T2D) and frozen shoulder is unclear. This study aims to explore the genetic causal association between T2D and glycemic traits (fasting glucose [FG], fasting insulin [FI], glycated hemoglobin [HbA1c], and 2-hour postprandial glucose [2hGlu]) on frozen shoulder. METHODS: Using 2-sample Mendelian randomization (MR), we analyzed nonconfounded estimates of the effects of T2D and glycemic traits on frozen shoulder. Single-nucleotide polymorphisms (SNPs) strongly associated (P < 5 × 10-8) with exposures from genome-wide association studies (GWAS) were identified. We employed fixed effect mode inverse variance weighting (IVW-FE), random effect mode IVW (IVW-MRE), MR-Egger, and weighted median to assess the association of exposures and outcome. Sensitivity analysis was conducted to test for heterogeneity and multidirectionality bias in MR. RESULTS: We found a significant genetic causal correlation between T2D (IVW-MRE P = .007, odds ratio [OR] 1.093, 95% confidence interval [CI] 1.03-1.16), FG (IVW-FE P < .001, OR 1.455, 95% CI 1.173-1.806), and frozen shoulder, but no evidence for causal correlation between FI, HbA1c, and 2hGlu and frozen shoulder. Although there was certain heterogeneity, sensitivity analysis reveals no deviation from the MR assumptions. CONCLUSION: This study supports a genetic causal relationship between T2D and FG and frozen shoulder.

Limb Symmetry Index of Single-Leg Vertical Jump vs. Single-Leg Hop for Distance After ACL Reconstruction: A Systematic Review and Meta-analysis.

CONTEXT: The limb symmetry index (LSI) is recommended as a milestone of return to play (RTP), and relying on the LSI value of a single-leg hop for distance (SLHD) test may overestimate rehabilitation status. Identifying a more reliable functional test can help to carefully make decisions for RTP. OBJECTIVE: The aim was to compare the LSI value of the SLHD test with that of a single-leg vertical jump (SLVJ) test after anterior cruciate ligament reconstruction (ACLR) and determine which test provides lower LSI values. DATA SOURCES: The PubMed, Web of Science, Embase, and Cochrane Library databases were searched from inception to July 2022. STUDY SELECTION: Observational studies with participants who had both SLHD and SLVJ tests after ACLR and LSI values of an SLHD and SLVJ were included. Disagreements were resolved after discussion between the 2 researchers. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data on the primary outcomes (LSI values of the SLVJ and SLHD tests) were collected. Means and standard deviations (SDs) for each variable of interest were used to calculate standardized mean differences (SMDs). RESULTS: A total of 12 studies met the inclusion criteria for the meta-analysis. A total of 587 patients underwent SLHD and SLVJ tests at different time points after ACLR. Compared with the SLHD test, the SLVJ test provided lower LSI values (SMD -0.42; 95% confidence interval (CI) -0.67 to -0.17). Subgroup analysis found that the SLVJ test provided a lower LSI value than the SLHD test in a specific period (approximately 7-18 months after ACLR, SMD -0.53; 95% CI -0.91 to -0.14) and a similar LSI value at other times. CONCLUSION: The SLVJ test provided lower LSI values in a specific period (7-18 months after ACLR).

En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report.

Malignant pleural mesothelioma (MPM) is associated with previous asbestos exposure, while more clinical insights into this disease have come from other case studies. Maximal cytoreduction is critical in disease control and might help to improve the prognosis. Here, a 41-year-old female presented with a 6-month history of a mass detected in the chest wall following resection of a right pleural mesothelioma 2 years previously. A fluorodeoxyglucose positron emission tomography/computed tomography scan showed a right chest wall mass with a blurred boundary 8.9 cm × 3.7 cm in size. The patient had received one cycle of bevacizumab, carboplatin, and pemetrexed, and two cycles of nivolumab, ipilimumab, and gemcitabine 5 months before admission. We subsequently resected the tumor, the involved diaphragm, and the fifth and sixth ribs, and titanium mesh and continuous suture were used to close the thoracic cage. The fixed paraffin-embedded tissues showed epithelioid pleural mesothelioma. The patient received nivolumab and ipilimumab postoperatively, and no recurrence was detected 16 months after surgery. En bloc resection with reconstructive surgery effectively removed the locally advanced malignancy and restored the biological function of the thorax with a favorable prognosis. Neoadjuvant immunotherapy might therefore be conducive to radical resection and perioperative immunotherapy might improve the prognosis.

Injectable mesoporous bioactive glass/sodium alginate hydrogel loaded with melatonin for intervertebral disc regeneration.

Intervertebral disc degeneration (IDD) is a major contributing factor to both lower back and neck pain. As IDD progresses, the intervertebral disc (IVD) loses its ability to maintain its disc height when subjected to axial loading. This failure in the weight-bearing capacity of the IVD is a characteristic feature of degeneration. Natural polymer-based hydrogel, derived from biological polymers, possesses biocompatibility and is able to mimic the structure of extracellular matrix, enabling them to support cellular behavior. However, their mechanical performance is relatively poor, thus limiting their application in IVD regeneration. In this study, we developed an injectable composite hydrogel, namely, Mel-MBG/SA, which is similar to natural weight-bearing IVD. Mesoporous bioactive glasses not only enhance hydrogels, but also act as carriers for melatonin (Mel) to suppress inflammation during IDD. The Mel-MBG/SA hydrogel further provides a mixed system with sustained Mel release to alleviate IL-1ß-induced oxidative stress and relieve inflammation associated with IDD pathology. Furthermore, our study shows that this delivery system can effectively suppress inflammation in the rat tail model, which is expected to further promote IVD regeneration. This approach presents a novel strategy for promoting tissue regeneration by effectively modulating the inflammatory environment while harnessing the mechanical properties of the material.

Prognostic values of geriatric nutrition risk index on elderly patients after spinal tuberculosis surgery.

Background: Spinal tuberculosis (STB) is a significant public health concern, especially in elderly patients, due to its chronic and debilitating nature. Nutritional status is a critical factor affecting the prognosis of STB patients. The geriatric nutritional risk index (GNRI) has been established as a reliable predictor of adverse outcomes in various diseases, but its correlation with surgical outcomes in elderly STB patients has not been studied. Objective: The study aimed to assess the prognostic value of the GNRI in elderly patients with STB who underwent surgery. Methods: We conducted a retrospective analysis of medical records of elderly patients (65 years or older) diagnosed with active STB who underwent surgical treatment. Data collection included patient demographics, comorbidities, clinical history, laboratory testing, and surgical factors. GNRI was calculated using serum albumin levels and body weight. Postoperative complications were observed and recorded. The patients were followed up for at least 1 year, and their clinical cure status was assessed based on predefined criteria. Results: A total of 91 patients were included in the study. We found that a GNRI value of <98.63 g/dL was a cutoff value for predicting unfavorable clinical prognosis in elderly STB patients undergoing surgery. Patients with a low GNRI had higher Charlson Comorbidity Index scores, were more likely to receive red blood cell transfusions, and had a higher prevalence of overall complications, particularly pneumonia. The unfavorable clinical prognosis group had lower GNRI scores compared to the favorable prognosis group. Multivariate analysis showed that lower GNRI independently predicted unfavorable clinical outcomes in elderly STB patients. Conclusion: The study concluded that the GNRI is a valuable biomarker for predicting prognosis in elderly STB patients undergoing surgical intervention. Patients with lower GNRI scores had worse outcomes and a higher incidence of complications.

Anatomical factors associated with the development of anterior tibial spine fractures based on MRI measurements.

BACKGROUND: Numerous studies have investigated anatomic factors for anterior cruciate ligament (ACL) injuries, such as posterior tibial slope (PTS) and notch width index (NWI). However, anterior tibial spine fracture (ATSF) as a specific pattern of ACL injury, a bony avulsion of the ACL from its insertion on the intercondylar spine of the tibia, has rarely been explored for its anatomical risk factors. Identifying anatomic parameters of the knee associated with ATSF is important for understanding injury mechanisms and prevention. METHODS: Patients who underwent surgery for ATSF between January 2010 and December 2021 were retrospectively reviewed, and 38 patients were included in the study group. Thirty-eight patients who suffered from isolated meniscal tear without other pathologic findings were matched in a 1:1 fashion by age, sex and BMI to the study group. The lateral posterior tibial slope (LPTS), medial posterior tibial slope (MPTS), medial tibial depth, lateral tibial height, lateral femoral condyle ratio (LFCR) and NWI were measured and compared between the ATSF and control groups. Binary logistic regressions identified independent predictors of ATSF. Receiver operator characteristic (ROC) curves were performed to compare the diagnostic performance and determine the cutoff values of associated parameters. RESULTS: The LPTS, LFCR and MPTS were significantly larger in the knees in the ATSF group than in the control group (P = 0.001, P = 0.012 and P = 0.005, respectively). The NWI was significantly smaller in the knees in the ATSF group than in the control group (P = 0.005). According to the results of logistic regression analysis, the LPTS, LFCR and NWI were independently associated with ATSF. The LPTS was the strongest predictor variable, and the ROC analysis revealed 63.2% sensitivity and 76.3% specificity (area under the curve, 0.731; 95% CI 0.619-0.844) for values above 6.9. CONCLUSION: The LPTS, LFCR and NWI were found to be associated with the ATSF; in particular, LPTS could provide the most accurate predictive performance. The findings of this study may aid clinicians in identifying people at risk for ATSF and taking individualized preventive measures. However, further investigation regarding the pattern and biomechanical mechanisms of this injury is required.

Treatment outcomes of injectable thermosensitive hydrogel containing bevacizumab in intervertebral disc degeneration.

Intervertebral disc (IVD) degeneration (IDD) is a common musculoskeletal disease and its treatment remains a clinical challenge. It is characterised by reduced cell numbers and degeneration of the extracellular matrix (ECM). Nucleus pulposus (NP) cells play a crucial role in this process. The purpose of this study is to explore the role of bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, in the treatment of IDD through local drug delivery. High expression of VEGF was observed in degenerating human and rat IVDs. We demonstrated that MMP3 expression was decreased and COL II synthesis was promoted, when VEGF expression was inhibited by bevacizumab, thereby improving the degree of disc degeneration. Thus, these findings provide strong evidence that inhibition of VEGF expression by local delivery of bevacizumab is safe and effective in ameliorating disc degeneration in rats. The injectable thermosensitive PLGA-PEG-PLGA hydrogels loaded with bevacizumab is a potential therapeutic option for disc degeneration.

A Scoping Review of Postoperative Rehabilitation Protocols After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears.

Background: Superior capsular reconstruction (SCR) is an option for patients with massive or irreparable rotator cuff tears. Purpose: To describe the literature on rehabilitation protocols after SCR of rotator cuff tears, with emphasis on the timing of the introduction of motion. Study Design: Scoping review; Level of evidence, 4. Methods: We conducted a scoping review of articles published on PubMed, Ovid, Embase, and the Cochrane Library from inception to October 2020. The methodological index for non-randomized studies (MINORS) was used to assess the individual studies. For each article, we summarized the study characteristics, patient demographics, and rehabilitation protocols after SCR: duration of immobilization, initiation of passive range of motion (ROM), active-assisted ROM, active ROM, strengthening, and return to activities. In a subgroup narrative analysis, rehabilitation protocols were stratified by graft type: autograft versus nonautograft (xenograft, allograft, and synthetic). Results: A total of 21 studies met the search criteria. Six studies had level 3 evidence and 15 had level 4 evidence; 16 studies were considered high quality according to the MINORS score. After SCR, an abduction immobilizer was recommended for a duration of 3 to 6 weeks. Of the 21 studies, 7 (33%) started passive ROM during the first week, and 5 reported strict immobilization without motion for up to 6 weeks. All 8 studies that reported return-to-sports timing recommended delaying return until at least 6 months postoperatively. Passive ROM was recommended earlier for patients with nonautograft versus autograft (χ2 = 225; P < .001). There was a high level of heterogeneity in the rehabilitation protocols after SCR. Conclusion: The majority of published protocols were descriptive. At present, there is little agreement on the published rehabilitation guidelines after SCR, precluding specific clinical best practice suggestions. Although there was a tendency of recommending early motion in nonautograft cases, the optimal protocols based on graft healing and functional outcomes require further verification based on the clinical outcomes from high-quality studies.

Regulations of Retinal Inflammation: Focusing on Müller Glia.

Retinal inflammation underlies multiple prevalent retinal diseases. While microglia are one of the most studied cell types regarding retinal inflammation, growing evidence shows that Müller glia play critical roles in the regulation of retinal inflammation. Müller glia express various receptors for cytokines and release cytokines to regulate inflammation. Müller glia are part of the blood-retinal barrier and interact with microglia in the inflammatory responses. The unique metabolic features of Müller glia in the retina makes them vital for retinal homeostasis maintenance, regulating retinal inflammation by lipid metabolism, purine metabolism, iron metabolism, trophic factors, and antioxidants. miRNAs in Müller glia regulate inflammatory responses via different mechanisms and potentially regulate retinal regeneration. Novel therapies are explored targeting Müller glia for inflammatory retinal diseases treatment. Here we review new findings regarding the roles of Müller glia in retinal inflammation and discuss the related novel therapies for retinal diseases.

Impact of Patient Age on Morbidity and Survival Following Laparoscopic Pancreaticoduodenectomy.

PURPOSES: To present preliminary perioperative and long-term outcomes in elderly patients compared with younger patients who underwent laparoscopic pancreaticoduodenectomy (LPD). MATERIALS AND METHODS: A total of 199 patients who underwent LPD were included in this study. The primary data relating to these patients were collected and analyzed in our center from October 2010 to 2017. RESULTS: The intraoperative and postoperative information, including the rate and severity of short-term complications, pathologic outcomes, and other surgical outcomes, showed no significant differences between the 2 groups. Furthermore, the median overall survival for 2 malignant diseases of the young patients was not significantly better than the elderly. CONCLUSIONS: Our data suggest that patient age showed little influence on postoperative morbidity, mortality, and long-term survival in pancreatic adenocarcinoma and periampullary adenocarcinoma following LPD, whereas studies with larger sample sizes and longer follow-up are necessary before definitive conclusions can be made.

The impact of metformin use on survival in kidney cancer patients with diabetes: a meta-analysis.

PURPOSE: The effects of metformin on the prognosis of kidney cancer patients with diabetes are in controversial. The present study is conducted to classify the association of metformin use with the survival of patients with kidney cancer. METHODS: Electronic databases, namely PubMed and Web of Science, were used to search the eligible studies up to December, 2016. Pooled hazard ratio (HR) and its corresponding 95% confidence interval (95% CI) were calculated. It was considered as statistically significant when P value was <0.05. RESULTS: Eight cohorts were eligible for the present meta-analysis, including 254,329 kidney cancer patients. The combined HR suggested that the use of metformin could improve the overall survival (OS) (HR 0.643, 95% CI 0.520-0.795, P < 0.001) and cancer-specific survival (CSS) (HR 0.618, 95% CI 0.446-0.858, P = 0.004) in kidney cancer patients. In subgroup analysis, positive associations were found between metformin use and OS/CSS of localized renal cell carcinoma patients (OS: HR 0.634, 95% CI 0.440-0.913, P = 0.014; CSS: HR 0.476, 95% CI 0.295-0.768, P = 0.002). Moreover, we also found that the use of metformin could reduce the risk of death in kidney cancer patients (HR 0.711, 95% CI 0.562-0.899, P = 0.004). CONCLUSION: Our findings suggest that the use of metformin is in favor of the prognosis of patients with kidney cancers. Further investigations are needed to evaluate the prognostic value of metformin on kidney cancer patients.