The Relationship between physical activity, nutritional status, and sarcopenia in community- dwelling older adults with type 2 diabetes: a cross-sectional study.

AIM: This study was conducted in Urumqi, Xinjiang, to assess the prevalence of sarcopenia and to determine the relationship between physical activity, nutritional status, and sarcopenia among community-dwelling patients with type 2 diabetes mellitus. METHODS: Four hundred eight cases of older people patients with type 2 diabetes mellitus in the community in Urumqi, Xinjiang, from May to August 2022 were selected for a cross-sectional on-site survey, and general information questionnaires, clinical information surveys, physical function measurements, and criteria developed by the Asian sarcopenia working group in 2019 were selected for diagnosis of sarcopenia, and unifactorial and multifactorial binary Logistic regression were applied to analyze the influencing factors of T2DM combined with sarcopenia in patients with sarcopenia. RESULTS: Among the 408 patients, 84 (20.6%) had sarcopenia, with a prevalence of 12.6%, 32.1%, and 51.9% in those aged 60-70, 71- 80, and 81 or older respectively. The prevalence increased significantly with age. Adjusting for variables, the study found that FFM of the Left Leg (OR: 0.710, 95% CI: 0.612-0.804, P = 0.024), FFM of the Right Arm (OR: 0.710, 95% CI: 0.612-0.804, P < 0.001), Age (OR: 1.246, 95% CI: 1.031-1.505, P = 0.023), Fasting Blood Glucose (OR: 1.649, 95% CI: 1.066-2.550, P = 0.025), and Post-Prandial Blood Glucose (OR: 1.455, 95% CI: 0.999-2.118, P = 0.025) were independent associated factors. An increase in MNA score (OR: 0.398, 95% CI: 0.244-0.6500, P < 0.001), ASMI (OR: 0.000, 95% CI: 0.00-0.01, P < 0.001) walking energy expenditure (MET-min) (OR: 0.998, 95% CI: 0.996-0.999, P = 0.001) reduced the prevalence of sarcopenia. CONCLUSION: This study shows that increased age, increased skeletal muscle mass index, decreased right arm FFM, increased postprandial glucose, increased MNA scores, and increased walking energy expenditure (MET-min) were associated with type 2 diabetes with sarcopenia.

Prophylactic use of vancomycin powder on postoperative infection after total joint arthroplasty.

OBJECTIVE: By reviewing the literature analyzing vancomycin powder for preventive surgery, the effect of this method on reducing the infection rate after TJA was systematically evaluated to provide a basis for future clinical work. METHODS: Using PubMed, Medline, Elsevier, and CNKI, with the following mesh words: "vancomycin", "local / intraoperative / topical / intrawound", "TJA", "TKA", "THA", "total joint arthroplasty", "total knee arthroplasty", "total hip arthroplasty", "infection", and "SSI", to search for case-control research papers on the impact of prophylactic application of vancomycin powder on the incidence of postoperative infection, we compared the overall infection rate in the literature by using RevMan 5.3 meta-analysis software and analyzed the impact of vancomycin on the infection rate of different parts and types of TJA according to different subgroups. RESULTS: A total of 22 qualified studies were selected; twenty-five studies compared the effect of prophylactic use of vancomycin powder on infection rates after TJA. There were 23,363 cases in total, including 9545 cases in the vancomycin group and 13,818 cases in the control group. The results of the meta-analysis showed that the possibility of postoperative infection after prophylactic use of vancomycin powder was significantly lower than that without vancomycin risk ratio: 0.38 [0.23,0.59], P < 0.01). However, a meta-analysis of randomized controlled trials (RCTs) showed no significant effect of vancomycin on postoperative infection (P = 0.52). CONCLUSION: Based on the retrospective studies, local prophylactic use of vancomycin powder in TJA can significantly reduce the incidence of postoperative infection. High-quality RCTs should be carried out to further evaluate these results.

Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis.

BACKGROUND: Spinal brucellosis is a less commonly reported infectious spinal pathology. There are few reports regarding the surgical treatment of spinal brucellosis in existing literature. This retrospective study was conducted to determine the effectiveness of single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral spinal brucellosis. METHODS: From February 2012 to April 2015, 32 consecutive patients (19 males and 13 females, mean age 53.7 ± 8.7) with lumbosacral brucellosis treated by transforaminal decompression, debridement, interbody fusion, and posterior instrumentation were enrolled. Medical records, imaging studies, laboratory data were collected and summarized. Surgical outcomes were evaluated based on visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scale. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms and complications were investigated. Graft fusion was evaluated using Bridwell grading criteria. RESULTS: The mean follow-up period was 24.9 ± 8.2 months. Back pain and radiating leg pain was relieved significantly in all patients after operation. No implant failures were observed in any patients. Wound infection was observed in two patients and sinus formation was observed in one patient. Solid bony fusion was achieved in 30 patients and the fusion rate was 93.8%. The levels of ESR and CRP were returned to normal by the end of three months' follow-up. VAS and ODI scores were significantly improved (P < 0.05). According to JOA score, surgical improvement was excellent in 22 cases (68.8%), good in 9 cases (28.1%), moderate in 1 case (3.1%) at the last follow-up. CONCLUSIONS: Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation is an effective and safe approach for lumbosacral brucellosis.

Application of electrophysiological methods and magnetic resonance tomographic angiography in the differentiation between hemifacial spasm and Meige syndrome.

Bilateral hemifacial spasm and Meige syndrome can be easily confused due to their similar clinical manifestation. Here, we aimed to investigate the application of electrophysiological methods and magnetic resonance tomographic angiography (MRTA) in the differentiation between hemifacial spasm and Meige syndrome. 10 patients with bilateral hemifacial spasm and 9 patients with Meige syndrome received electrophysiological monitoring of nerves. There were two males and eight females with bilateral hemifacial spasm, aged 16-58 years with a course of 5-54 months. For the patients with Meige syndrome, there were three males and six females, aged 51-68 years with a course of 12-36 months. All patients received conventional MRTA of the brain blood vessels before decompression. We found that all patients with Meige syndrome showed synchronous contraction of bilateral orbicularis oculi muscles and (or) burst discharge from orbicularis oris muscles in surface electromyography (sEMG). However, those with hemifacial spasm presented with bilaterally asynchronous burst discharge. Electromyography for patients with Meige syndrome did not record abnormal muscle response (AMR), but recorded AMR for those with bilateral hemifacial spasm. The offending vessels were compressed in patients with hemifacial spasm in MRTA, while MRTA results were generally negative for those with Meige syndrome. Combining sEMG and AMR detection in EMG and MRTA, bilateral hemifacial spasm can be differentiated from Meige syndrome with a reduction of misdiagnosis rate.

MicroRNA-338 and microRNA-21 co-transfection for the treatment of rat sciatic nerve injury.

The objective of this study is to find if co-transfecting microRNA-338 and microRNA-21 into the neurons in the spinal cord can promote functional recovery after peripheral nerve injury in rats. Animals were divided into three groups: 20 animals in the GFP control vector group (group A), 20 animals in the GFP experimental vector group (group B) and ten animals in the normal control group. Right sciatic nerves of animals in groups A and B were transected and were bridged with collagen nerve conduits with 10 mm distance between the stumps. 3 µl GFP control vector or 3 µl lentiviral vectors encoding the sequence of microRNA-338 and microRNA-21 were injected in the conduit. 8 weeks after the surgery, the treatment effect was evaluated by functional analysis, electrophysiological analysis, immunohistochemical analysis as well as transmitting electronic microscope observations in all the rats. Animals treated with microRNA-338 and microRNA-21 showed significantly better recovery than GFP control group animals by means of functional analysis (Sciatic nerve index -47.7 ± 2.5 vs -59.4 ± 3.7), electrophysiological analysis (Conduction velocity 20.5 ± 2.8 vs 10.5 ± 1.4 m/s), ratio of wet weight of the gastrocnemius muscles (0.83 ± 0.03 vs 0.55 ± 0.06), axon diameter (5.0 ± 1.8 µm vs 4.0 ± 2.2), myelin sheath thickness (1.4 ± 0.43 vs 0.80 ± 0.31 µm) and G-ratio (0.80 ± 0.06 vs 0.75 ± 0.04). Lentiviral vectors encoding microRNA 338 and 21 might be explored in the future as potential therapeutic intervention to promote nerve regeneration.

Effect of double-door laminoplasty on atypical symptoms associated with cervical spondylotic myelopathy/radiculopathy.

BACKGROUND: Double-door laminoplasty is an effective method in treating patients with cervical spondylosis. Many patients with cervical spondylosis experience a set of atypical symptoms such as vertigo and tinnitus, and wish to know if the surgical treatment for cervical spondylosis can also alleviate those symptoms. The current research was carried out to investigate if atypical symptoms can be alleviated in patients who received laminoplasty for the treatment of cervical spondylosis. METHODS: One hundred ninety patients who received laminoplasty to treat cervical spondylotic myelopathy/radiculopathy in our center and complained about one or more of the atypical symptoms before the surgery were followed for a mean of 61.9 months (from 39 to 87 months) after the surgery. Severity scores were retrospectively collected by follow up outpatient visits or phone interviews. The data was calculated based on patient feedback on the frequency and severity of those symptoms before the surgery and at last follow up, and were compared by paired sample t-tests. RESULTS: Most patients reported that the atypical symptoms such as vertigo (P <0.001), nausea (P <0.001), headache (P <0.001), tinnitus (P = 0.001), blur vision (P = 0.005), palpitation (P <0.001) and gastrointestinal discomfort (P = 0.001) were significantly alleviated at the last follow up; there was no significant change in the severity of hypomnesia (P = 0.675). CONCLUSION: Double-door laminoplasty can significantly alleviate most of the atypical symptoms in patients with cervical spondylosis. Further research is needed to explore mechanisms underlying this extra benefit of laminoplasty.

Effect of different surgical methods on headache associated with cervical spondylotic myelopathy and/or radiculopathy.

BACKGROUND: Anterior cervical discectomy and fusion, total disk replacement and open door laminoplasty have been widely used to treat patients with cervical spondylotic myelopathy and/or radiculopathy. In our clinical practice, many patients with cervical spondylosis also complain of headache, and wish to know if the surgical treatment for cervical spondylosis can also alleviate this symptom. Considering that there is no literature concerning this extra benefit of surgical manipulation on cervical spondylosis, we have carried out this retrospective study. METHODS: Among the patients treated with anterior cervical discectomy and fusion, total disk replacement and open door laminoplasty in our institute for cervical spondylotic myelopathy and/or radiculopathy between February 2002 to March 2011, 108 of whom that have complained about headache at the same time were included in this study. Those patients were followed by 25 to 145 months. Severity of headache before the surgery and at the last follow up was recorded by VAS pain scores and compared among the patients with different surgical methods using SPSS17.0 software. One way ANOVA was used to compare VAS scores between the groups, paired sample t-tests were used to compare the differences in a group at different time points. RESULTS: Headache was significantly alleviated in all groups (P < 0.01). Respectively, 75.0% of the patients in the ACDF group, 84.6% of the patients in the TDR group and 82.2% of the patients in the laminoplasty group were significantly relieved of the headache after the surgery. No significant differences were found with the VAS score at the last follow up among the groups (P > 0.05). No significant differences were found among the groups comparing the degree of alleviation of VAS scores before and after the surgery (P > 0.05). DISCUSSION: Considering that all the three procedures in the current study have achieved similar effect on alliviating headache in patients with cevical myelopathy, and that what they have in common was that was the decompression of spinal cord, it can be assumed that the headache associated with cervical spondylosis may be the result of compression on the spinal cord. CONCLUSIONS: Anterior cervical discectomy and fusion, total disk replacement and open door laminoplasty can all significantly alleviate headache in patients with cervical spondylotic myelopathy and/or radiculopathy. No surgical technique is better than any other technique on alleviating cervical headache associated with cervical spondylotic myelopathy and/or radiculopathy.

Neurorestorative strategies for Alzheimer's disease.

Alzheimer's disease (AD) is characterized by beta-amyloid plaques and neurofibrillary tangles that cause devastating cognitive and memory deficits. AD is known to be associated with neuronal death and synaptic loss. Thus, methods to retard the progression of the disease and to promote neuro-regeneration are vital for the prevention of advancement of AD. The recent trend is to decipher the molecular mechanisms of AD, and further aim at neuro-restorative mechanisms such as neuro-protection, neuro-modulation, and neuro-regeneration. In this review, we provide an overview of the recent studies describing various neuro-restorative strategies for AD and mainly focus on stem cell and neuro-modulation therapies. Furthermore, we briefly refer to the other neurorestorative treatments including medications, bioengineering, and gene therapies for AD. Although most of them remain in an experimental phase, neuro-restorative strategies may have the potential for clinical use in the management of this debilitative disease.

Study on anterior and posterior approaches for spinal tuberculosis: a meta-analysis.

BACKGROUND: Timely and appropriate surgical intervention can enhance the stability of spine, eliminate the compression on spinal cord and prevent the further development the complications that may follow. However, there is no optimum surgical approach that has been agreed by surgeons. OBJECTIVE: Incidence rate of spinal tuberculosis is still high in many developing countries. Except from chemotherapy, some patients require surgical treatment at certain phases of disease development. However, there is still not a standard operative procedure for spinal tuberculosis in the current research, and we studied the differences of anterior and posterior approach for spinal tuberculosis, to provide guidance for the further operative treatments. METHODS: We searched "Pubmed" (2000.1-2014.7), "Medline" (2000.1-2014.7), "Elseveir" (2000.1-2014.7), Cochrane library (2008.1-2014.7), Wanfang (2000.1-2014.7), and CNKI (2000.1-2014.7) databases with the key words of "thoracolumbar tuberculosis", "controlled randomized trial", "RCT", "anterior" "posterior", and searched for randomized controlled trials for spinal tuberculosis. We compared the operative time, total blood loss, correction of Cobb angle, loss of Cobb angle at final follow-up, fusion time of allograft, time of total hospital stay, and the effectiveness of operative treatment between the anterior and posterior surgical approaches by Revman5.3 software. RESULTS: From 1,523 papers found, we chose eight randomized controlled trials comparing different surgical approaches for the treatment of spinal tuberculosis. The total number of patients was 754, in which 377 were treated with anterior approach and 377 were treated with posterior approach correction of Cobb angle (P < 0.05), and no significant differences were found regarding operation time, loss of correction of Cobb angle in the last follow-up, time of total hospital stay, and fusion time of bone graft (P > 0.05). CONCLUSIONS: There are significant differences between the two operative approaches regarding the correction of Cobb angle, but no significant differences regarding operation time, blood loss, loss of Cobb angle at the last follow-up, total fusion time, and length of total stay in the hospital.

Comparison of the short- and long-term treatment effect of cervical disk replacement and anterior cervical disk fusion: a meta-analysis.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) has been used as a gold standard for the treatment of cervical spondylosis, but it may cause complications such as pseudarthrosis and junctional degeneration. Cervical disk arthroplasty (CDA) may help overcome such problems, but there are inconsistencies among the published literature on its effectiveness comparing with ACDF. METHODOLOGY: We searched "PubMed" (2000.1-2013.10), "Medline" (2000.1-2013.10), "Elsevier" (2000.1-2013.10), Cochrane library (2008.1-2013.10) databases with the key words of "cervical disk arthroplasy", "CDA", "anterior cervical disk fusion", "ACDF", "cervical", "randomized controlled study", "RCT" and searched for randomized controlled trials comparing the efficacy of ACDF and CDA for the treatment of cervical spondylosis. Neck disability index (NDI), VAS arm pain score, VAS neck pain score, ROM of the adjacent level, SF36-PCS score, SF36-MCS score and patient satisfaction were calculated by Revman5.2 software. RESULTS: From 1,400 papers found, we chose 18 randomized controlled trials and cohorts evaluating the efficacy of CDA and ACDF on symptomatic cerebral spondylosis. The total number of patients is 3,056, in which 1,576 were in the CDA group and 1,480 were in the ACDF group. The CDA group demonstrated better results than the ACDF group concerning VAS arm pain score 1, 2, 4 years after the surgery, VAS neck pain score 1, 2, 4 years after the surgery, ROM of the adjacent level 1 and 2 years after the surgery, patient satisfaction 1, 2, 4 years after the surgery, NDI scores 1, 2, 4 years after the surgery, SF36-PCS score 1 and 2 years after the surgery and SF36-MCS score at 1 and 4 years after the surgery. There are no significant differences between the groups concerning SF36-PCS score 4 years after the surgery and SF36-MCS score at 2 years after the surgery. CONCLUSIONS: CDA can be an effective alternative method to ACDF for the treatment of cervical spondylosis.

Pulmonary metastasis of giant cell tumor of bones.

Giant cell tumor of bone (GCTB) accounts for 5% of primary skeletal tumors. Although it is considered to be a benign lesion, there are still incidences of pulmonary metastasis. Pulmonary metastasis of GCTB may be affected by tumor grading and localization as well as the age, gender and overall health status of the patient. Patients with local recurrence are more likely to develop pulmonary metastasis of GCTB. High expression of some genes, cytokines and chemokines may also be closely related to the metastatic potential and prognosis of GCTB. The treatment of the primary GCTB is key to the final outcome of the disease, as intralesional curettage has a significantly higher local recurrence and pulmonary metastasis rate than wide resection. However, even patients with pulmonary metastasis seem to have a good prognosis after timely and appropriate surgical resection. It is hoped that with the development of novel surgical methods and drugs, pulmonary metastasis of GCTB can be prevented and treated more effectively.

Prediction of Lumbar Pedicle Screw Loosening Using Hounsfield Units in Computed Tomography

INTRODUCTION: One of the most common issues following pedicle screw fixation is pedicle screw loosening. There are, however, few trustworthy methods for predicting screw loosening. The goal of the current study was to identify an efficient technique for using preoperative CT scanning to predict screw loosening in older patients and to offer recommendations for preoperative surgical planning. METHODS: The current analysis included retrospectively all patients who underwent lumbar pedicle screw fixation for degenerative lumbar diseases in our department between January 2015 and January 2022. Hounsfield units were used to assess each vertebra's attenuation in a CT scan (HU). Postoperative X-ray testing identified screw loosening. Using IBMSPSS 24.00 software, one-way analysis of variance (ANOVA) and receiver operating characteristic (ROC) curve analysis were performed. RESULTS: Over a mean follow-up period of 28.4±11.5 (range 12-44 months) months, screw loosening was noted in 53 of 242 patients (136 male and 106 female, average age 58.7±7.3 years). Gender, BMI, smoking habits, and whether or not a patient had diabetes or spondylolisthesis were not shown to be significantly different among the patients (P>0.05). The difference between the average lumbar vertebral HU values in the screw-loosening group and the control group was significant (P<0.01) at 120.3±31.5HU and 138.6±37.6HU, respectively. The average HU value of L1-L4 exhibited an area under the curve (AUC) of 0.691 (95% CI: 0.614-0.784), according to ROC curve analysis. A HU cut-off value of 122 HU is a likely cut-off point to predict screw loosening with a sensitivity of 70% and a specificity of 58%. CONCLUSION: The use of screw augmentation techniques can be decided using a prospective CT scan HU value-based prediction. An independent risk factor for screw loosening in an instrumented lumbar vertebra is a cutoff L1-L5 average HU value of 122 HU.

The role of microRNAs in axon regeneration after peripheral nerve injury: a bibliometric analysis.

Objective: This study analyzed the current research hotspots and future development trends of the therapeutic effects of microRNA on PNI axonal regeneration through bibliometric methods. Moreover, the current advantages and disadvantages of this field as well as future development prospects are discussed in depth. Methods: CiteSpace V and VOSviewer were used as bibliometric tools to complete the analysis of the research focus and direction of the published articles. To supplement, sort out, and summarize, we analyzed the research status of the study on the application of microRNAs for axonal regeneration after peripheral nerve injury from 2013 to 2023. Results: A total of 207 publications were retrieved from the Web of Science database. After exclusion and screening, a final selection of 174 articles that met the research criteria. These 174 articles were authored by a total of 846 individuals, representing 24 countries and 199 institutions. Additionally, this study presents information on the annual publication output, country distribution, top 5 contributing authors, top 5 most cited articles, and top 10 contributing institutions. Conclusion: As one of the hottest topics today, microRNAs have become the current research hotspot in neural inflammation, neural cell repair and regeneration, neural protection, and functional recovery. With more investment in research in this field, more high-quality articles will be published in both domestic and international outstanding journals, which will bring a new era for the treatment of peripheral nerve injury.

Advances in experimental and clinical studies of chemotaxis.

The theory of chemotaxis has been widely accepted, but its mechanisms are disputed. Chemotactic growth of peripheral nerves may be tissue, topographic and end-organ specific. Recent studies indicated that peripheral nerve regeneration lacks topographic specificity, but whether it has end-organ specificity is disputed. Chemotaxis in nerve regeneration is affected by the distance between stumps, volume, and neurotrophic support, as well as the structure of distal nerve stumps. It can be applied to achieve precise repair of nerves and complete recovery of end organ function. Small gap sleeve bridging technique, which is based on this theory shows promising effects but it is still challenging to find the perfect combination of nerve conduits, cells and neurotrophic factors to put it intoits best use. In this paper, we made a comprehensive review of mechanisms, effect factors and applications of chemotaxis.

Prophylactic Application of Vancomycin Powder in Preventing Surgical Site Infections After Spinal Surgery.

OBJECTIVE: We sought to analyze the preventive effect of local vancomycin powder application on surgical site infection (SSI) in spinal surgeries and provide the basis for future clinical practice. METHODS: Through PubMed, Medline, Elsevier, and the Cochrane Library, with MeSH words "vancomycin powder," "local/intraoperative/topical/intra-wound," "spine/spinal/lumbar/cervical/thoracolumbar," "surgery," "infection," and "SSI," we searched for case-control research papers on the impact of prophylactic application of vancomycin powder on the incidence of SSI and compared the rate of infection using RevMan 5.3 meta-analysis software. RESULTS: A total of 1950 publications were found using the mesh words, and 50 of those studies were selected for final analysis. There were 34,301 cases in total, including 14,793 cases in vancomycin group and 19,508 cases in the control group. Results of meta-analysis showed that the incidence of SSI was significantly lower in the prophylactic vancomycin powder group than the control group (P < 0.001). Further subgroup analysis showed that the incidence of SSI was significantly lower in the prophylactic vancomycin powder group than the control group in spine surgeries with internal fixation, deformity correction, and deep tissue infections (P < 0.001). Meanwhile, there were no significant differences between the 2 groups concerning patients undergoing noninstrumented spine surgeries and the incidence of superficial tissue infection. CONCLUSIONS: Overall, prophylactic application of vancomycin powder in spinal surgery can significantly reduce the incidence of SSI in deep tissues, and this effect is more prominent in patients undergoing internal fixation and deformity correction surgeries.

Computed Tomography-Based Prediction of Lumbar Pedicle Screw Loosening.

Objective: Pedicle screw loosening is one of the main complications after pedicle screw fixation. However, there are few reliable measures for prediction of screw loosening. The current study was carried out to find an effective method to use preoperative CT scanning as a predictor of screw loosening in the elderly patients and provide guidance for preoperative surgical planning. Methods: Patients who were treated with lumbar pedicle screw fixation procedure in our department for degenerative lumbar disorders between January 2015 and January 2021 were retrospectively included in the current study. CT scan attenuation of each vertebra was measured with Hounsfield units (HU). Screw loosening was determined in postoperatively X-ray tests. One-way analysis of variance (ANOVA) and receiver operating characteristic (ROC) curve analysis were carried out with IBMSPSS 24.00 software. Results: Screw loosening was observed in 44 of 215 patients (124 male, 91 female, average age 58.4 ± 7.6 years) during a mean follow-up time of 19.0 ± 11.2 months (range 12-32 months). No significant differences were found among the patients concerning patient gender, BMI, habit of smoking, and whether or not the patient had diabetes or suffered from spondylolisthesis (P > 0.05). The average HU value of lumbar vertebra was 122.4 ± 32.8 HU in the screw loosening group and 142.4 ± 38.2 HU in the control group, and the difference was significant (P < 0.01). ROC curve analysis revealed that the average HU value of L1-L5 has a relatively larger area under the curve (AUC) of 0.689 (95% CI: 0.605-0.773). With the sensitivity of 68% and specificity of 57%, a HU cut-off value of ≤124 HU is a plausible cut-off point to predict screw loosening. Conclusions: A prospective CT scan HU value-based prediction can be used to decide whether or not to use screw augmentation methods. A cut-off L1-L5 average HU value of 124 HU can be used as an independent risk factor for screw loosening in instrumented lumbar vertebra. More predictive indexes should be involved to achieve higher sensitivity and specificity in future clinical practice.

Prediction of Sacral Screw Loosening after Lumbosacral Surgeries Involving Rigid Fixation of Sacral Bone Using Preoperative Computed Tomography Scans.

Objective: To find a preoperative computed tomography-based method to predict the incidence of sacral screw loosening and assist surgical planning. Methods: Surgically treated patients for degenerative lumbosacral disorders with rigid pedicle screw fixation of patients with L5-S1 vertebra in our center from January 2016 to January 2021 were retrospectively included in the current study. CT scan attenuation of the horizontal plane of the sacrum was measured with Hounsfield units (HU). Postoperative X-ray tests were used to diagnose screw loosening. The data was analyzed by independent sample t-tests, X 2 analysis, Pearson correlation analysis, and ROC curve analysis. Results: A total of 162 (114 male, 48 female, average age 63.7 ± 7.3 years) patients were included in the final analysis. Significant differences were found between the screw loosening group and nonloosening group concerning the HU value of the sacrum at the horizontal plane (P < 0.01). In ROC curve analysis, AUC was 0.674 (95% CI: 0.592-0.756). A cutoff of 200 HU provided 64.8% sensitivity and 62.4% specificity, and a cutoff of 150 HU provided 90.2% sensitivity. Conclusions: Analyzing 162 patients with at least 12 months of follow-up, we propose cutoff CT attenuation values of 200 HU and 150 HU to take moderate and radical measures of screw augmentation to prevent screw loosening in the sacral bone.

Relationship between tool-like receptor 4 gene polymorphism and the susceptibility to pulmonary tuberculosis.

OBJECTIVE: To evaluate the susceptibility of pulmonary tuberculosis based on the single nucleotide polymorphism (SNP) of Toll like receptor 4 (TLR4) gene. METHODS: We searched PubMed, Web of science, EMBASE, and Chinese National Knowledge Infrastructure (CNKI) databases using mesh words: "tuberculosis", "pulmonary", "TLR4", "SNP", "Toll like receptor 4", "nucleotide polymorphism" for studies on the relations between TLR4 SNP polymorphism and the risk of pulmonary tuberculosis that were published before September 1st, 2021. Papers were selected according to the inclusion and exclusion criteria established in advance. The allele and genotype data of the four most widely studied SNP loci (rs4986791, rs4986790, rs11536889, rs10759932) in TLR4 gene were extracted and analyzed by Review Manager 5.3 software. RESULTS: 20 studies including a total of 24727 patients were included in the final meta-analysis. Results of the meta-analysis showed that the C allele of rs10759932 increased the risk of pulmonary tuberculosis (odds ratio - OR: 1.144; 95% confidence interval (CI) 1.043-1.254, P = 0.004). Compared with TT genotype, CC+CT genotype of rs10759932 and CT alone genotype significantly increased the risk of pulmonary tuberculosis (OR = 1.218, 95% CI 1.084-1.369, P = 0.001; OR = 1.227, 95% CI 1.085-1.387, P = 0.001). However, rs4986790, rs4986791 and rs11536889 had no significant correlation with the susceptibility of pulmonary tuberculosis (P > 0.05). CONCLUSION: G allele GG+GA genotype, and the GA genotype of rs4986790; C allele, CC+CT genotype, and the CC genotype of rs10759932 increased the risk of pulmonary tuberculosis, and may potentially be used as a marker for pulmonary tuberculosis diagnosis and monitoring.

Hemodynamic analysis of intermittent pneumatic compression combined with hyperthermia after total hip arthroplasty: an experiment on male rabbits.

OBJECTIVE: To investigate the effect of intermittent pneumatic compression combined with hyperthermia (IPCH) on the hemodynamic changes in lower limbs of male rabbits and to clarify whether its efficacy is superior to that of intermittent pneumatic compression (IPC) or hyperthermia (HT) alone. METHODS: Thirty male adult New Zealand white rabbits with a body mass of 2.6±0.3 kg were obtained to establish a model of postoperative hypercoagulable state by simulating left hip surgery. Then they were randomly divided into HT group, IPC group, and IPCH group. Relevant hemodynamic parameters were examined by color Doppler ultrasound before and after treatment. A femoral vein finite element model was established according to fluid mechanics to analyze the blood flow velocity distribution vector, total deformation, equivalent stress of the femoral vein and venous valve. RESULTS: The heart rate, blood flow per minute, and mean and peak blood velocity of the femoral vein in IPCH group were significantly higher than those in HT and IPC groups (P<0.05). There was no significant difference in venous diameter (P>0.05). The blood flow velocity distribution vector, the total deformation of femoral vein, and the equivalent stress between femoral vein and venous valve in the IPCH group were higher than those in HT and IPC groups, but the total deformation of venous valve was smaller in IPCH group. CONCLUSIONS: IPCH superimposes the effects of IPC and HT, and can more effectively promote changes in local blood circulation to prevent deep vein thrombosis.

Biomechanical effects of fixed-bearing femoral prostheses with different coronal positions in medial unicompartmental knee arthroplasty.

BACKGROUND: To study the biomechanical effects of femoral prostheses at different coronal positions using finite element analysis and provide a clinical reference for unicompartmental knee arthroplasty (UKA). METHODS: A normal knee joint model was established and verified, establishing 13 working conditions for the femoral prosthesis: the standard position, varus and valgus angles of 3°, 6° and 9° and medial and lateral translations of 1 mm, 3 mm and 5 mm. The stress changes at different positions were analysed, including the polyethylene (PE) insert upper surface, the surface of lateral compartment cartilage and the surface of cancellous bone under tibial prosthesis. RESULTS: The stresses on the PE insert upper surface and the cancellous bone surface increased with increasing femoral prosthesis valgus/varus, and the stress increased gradually during medial to lateral translation. The stress change is more significant during valgus and lateral translation. However, the stress on the cartilage surface decreases in the process of varus to valgus and medial translation to lateral translation. CONCLUSION: The fixed-bearing femoral prosthesis of the medial UKA should avoid translation or varus/valgus tilt on the coronal plane as much as possible. The obvious misalignment of the femoral prosthesis will significantly affect the stress on the internal structure of the knee joint, especially the PE insert and cartilage surface. A femoral prosthesis coronal tilt of more than 6° may significantly increase the stress on the PE surface, and varus of more than 6° may significantly increase the stress on the cartilage surface. For the femoral prosthesis position at the distal end of the femoral condyle, it is recommended to be placed in the centre.