The impact of sarcopenia on the incidence of postoperative outcomes following spine surgery: Systematic review and meta-analysis.

PURPOSE: Sarcopenia is considered to be an important predictor of adverse outcomes following spinal surgery, but the specific relationship between the two is not clear. The purpose of this meta-analysis is to systematically review all relevant studies to evaluate the impact of sarcopenia on spinal surgery outcomes. METHODS: We systematically searched PubMed, Embase and the Cochrane Library for relevant articles published on or before January 9, 2023. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated in a random effects meta-analysis. The main outcome was the risk of adverse outcomes after spinal surgery, including adverse events and mortality. This systematic review and meta-analysis was conducted following the PRISMA guidelines to evaluate the impact of sarcopenia on spinal surgery outcomes. In addition, we also conducted a subgroup analysis and leave-one-out sensitivity analyses to explore the main sources of heterogeneity and the stability of the results. RESULTS: Twenty-four cohort studies, with a total of 243,453 participants, met the inclusion criteria. The meta-analysis showed that sarcopenia was significantly associated with adverse events (OR 1.63, 95% CI 1.17-2.27, P < 0.001) but was no significantly associated with mortality (OR 1.17, 95% CI 0.93-1.46, P = 0.180), infection (OR 2.24, 95% CI 0.95-5.26, P < 0.001), 30-day reoperation (OR 1.47, 95% CI 0.92-2.36, P = 0.413), deep vein thrombosis (OR 1.78, 95% CI 0.69-4.61, P = 0.234), postoperative home discharge (OR 0.60, 95% CI 0.26-1.37, P = 0.002) and blood transfusion (OR 3.28, 95% CI 0.74-14.64, P = 0.015). CONCLUSION: The current meta-analysis showed that patients with sarcopenia have an increased risk of adverse events and mortality after spinal surgery. However, these results must be carefully interpreted because the number of studies included is small and the studies are significantly different. These findings may help to increase the clinicians' awareness of the risks concerning patients with sarcopenia to improve their prognosis.

Can Multimodal Analgesia Reduce Postoperative Opioid Consumption in Patients Undergoing Shoulder Arthroscopy? A Retrospective Study.

AIM: The aim of this study was to investigate whether multimodal analgesia can decrease postoperative opioid usage in patients undergoing shoulder arthroscopy. METHODS: Patients diagnosed with subacromial impingement syndrome who underwent acromioplasty at our institution between October 2022 and November 2023 were retrospectively analyzed. Patients were divided into an observation group and a control group based on postoperative pain management methods. The control group received intravenous self-controlled electronic analgesia (sufentanil injection 1 µg/kg + butorphanol injection 4 mg + 0.9% NaCl injection to 100 mL), while the observation group received multimodal analgesia (ropivacaine subacromial pump 3 mL/h, combined with oral celecoxib and acetaminophen). Visual Analog Scale (VAS) scores were recorded preoperatively and at various postoperative time points, and opioid usage, length of hospital stay, and analgesia-related complications within 1 week postoperatively were compared between groups. The 36-item Short Form Health Survey (SF-36) scores and the Constant-Murley score (CMS), were also assessed 1 day and 1 week after treatment. RESULTS: One hundred thirty-two patients were included in the study, 66 in the observation group and 66 in the control group. In the control group, there were 46 males and 20 females, with a mean age of 55.47 ± 11.42 years and in the observation group 44 males and 22 females, with a mean age of 56.13 ± 12.19 years The observation group consistently reported significantly lower pain intensity compared to the control group at 8 h (T1), 24 (T2), and 48 h (T3) after surgery (p < 0.05). Additionally, the observation group exhibited significantly lower opioid usage and complication rates compared to the control group (p < 0.05). SF-36 scores and CMS scores were significantly higher in the observation group 1 week after treatment compared to the control group (p < 0.05). CONCLUSIONS: Following shoulder arthroscopy, multimodal analgesia effectively reduces opioid consumption, lowers complication rates, and provides effective short-term pain relief. This approach carries significant implications for improving patient outcomes.

The impact of perioperative nonsteroidal anti-inflammatory drugs on the postoperative outcomes of spinal surgery: a meta-analysis of 23 randomized controlled trials.

In recent years, nonsteroidal anti-inflammatory drug (NSAIDs), which are considered to affect the prognosis of spinal surgery, have been widely used in perioperative analgesia in spinal surgery, but the relationship between these two factors remains unclear. The purpose of this study was to explore the effect of perioperative use of NSAIDs on the prognosis of patients treated with spinal surgery. We systematically searched PubMed, Embase, and Cochrane Library for relevant articles published on or before July 14, 2023. We used a random-effect model for the meta-analysis to calculate the standardized mean difference (SMD) with a 95% confidence interval (CI). Sensitivity analyses were conducted to analyze stability. A total of 23 randomized clinical trials including 1457 participants met the inclusion criteria. Meta-analysis showed that NSAIDs were significantly associated with postoperative morphine use (mg) (SMD = -0.90, 95% CI -1.12 to -0.68) and postoperative pain (SMD = -0.71, 95% CI -0.85 to -0.58). These results were further confirmed by the trim-and-fill procedure and leave-one-out sensitivity analyses. The current study shows that perioperative use of NSAIDs appears to be an important factor in reducing postoperative pain and morphine use in patients undergoing spinal surgery. However, well-designed, high-quality randomized controlled trials (RCTs) are still required.

A Guided Wave Transducer with Sprayed Magnetostrictive Powder Coating for Monitoring of Aluminum Conductor Steel-Reinforced Cables.

Aluminum conductor steel-reinforced (ACSR) cables are typically used in overhead transmission lines, requiring stringent non-destructive testing owing to the severe conditions they face. Ultrasonic guided wave inspection provides promising online monitoring of the wire breakage of cables with the advantages of high sensitivity, long-range inspection, and full cross-sectional coverage. It is a very popular method to generate and receive guided waves using magnetostrictive and piezoelectric transducers. However, uniformly coupling the acoustic energy excited by transducers into multi-wire structures is always a challenge in the field application of guided waves. Long-term field application of piezoelectric transducers is limited due to the small coupling surface area, localized excitation, and couplant required. Conventional magnetostrictive transducers for steel strand inspection are based on the magnetostrictive effect of the material itself. Two factors affect the transducing performance of the transducers on ACSR cables. On one hand, there is a non-magnetostrictive effect in aluminum wires. On the other hand, the magnetostriction of the innermost steel wires is too weak to generate guided waves. The bias magnetic field is attenuated by the outer layers of aluminum wires. In this paper, an alternative sprayed magnetostrictive powder coating (SMPC) transducer was developed for guided wave generation and detection in ACSR cables. The Fe83Ga17 alloy powder with large magnetostriction was sprayed uniformly on the surfaces of certain sections of the outermost aluminum wires where the transducer would be installed. Experimental investigations were carried out to generate and receive the most commonly used L(0,1) guided waves for wire breakage detection at frequencies of 50 and 100 kHz. The results demonstrate that the discernable reflected waves of the cable end and an artificial defect of three-wire breakage (5.5% reduction in the cable's cross-sectional area) were received by the transducer with SMPC, which was impossible for the transducer without SMPC. This method makes long-term and online monitoring of ACSR cables feasible due to the high coupling efficiency and good structural surface adaptability.

Mismatch of AO anatomically shaped distal humeral plate with humeral shaft forward flexion angulation in adult Chinese population.

BACKGROUND: LCP extra-articular distal humerus plate (LCPEA) designed by AO has been introduced as an anatomically shaped plate that improves the results of surgical fixation in extra-articular distal humeral shaft fractures. However, no study analyzed whether LCPEA matches humeral shaft forward flexion angulation (FFA). OBJECTIVE: The aims of this study were to evaluate the morphological discrepancies between LCPEA and the humeral shaft FFA in Chinese cadaveric dried adult humeri and to propose a further design of pre-contoured plates to accommodate the FFA. MATERIALS AND METHODS: Forty-four Chinese cadaveric dried adult humeri were used for this study. An eight-hole LCPEA was applied to the posterior aspect of the distal humerus according to the contour. Mismatches between the bone and the plate were recorded. The distance between the inner surface of the plate and the underlying humeral dorsal cortex was measured at the sites of mismatch. The humeral shaft FFA was measured from the intersection angle between tangent lines placed on the dorsal aspect of the 1/3 distal humeral shaft and the dorsal ridge of the 2/3 proximal humeral shaft. The location of the apex of the FFA was determined by measuring the distance from the most distal point of trochlea of humerus to the point of intersection of the FFA tangent lines. The distance was defined as forward flexion distance (FFD). RESULTS: Mismatch was found at the level of proximal 3-6 holes of LCPEA with an average distance of 6.9 ± 3.1 mm (range 2.3-14.0 mm) at the tip of the plate. The FFA was present in all specimens. The average FFA was 8.2° ± 2.2° (range 4°-13°), the average FFD was 99.9 ± 9.6 mm (range 79.2-117.9 mm), and the average ratio of FFD to humerus length was 0.33 ± 0.03 (range 0.27-0.39). CONCLUSIONS: A rather consistent pattern of mismatch was found at the proximal part of LCPEA. An attempt to fit the plate to the bone at this level may cause a gap of the fracture at the opposite cortex. The main reason for the mismatch is the existence of the humeral shaft FFA. LCPEA is usually made a bend of about 8° between the fourth and the fifth dynamic-compression portion of the combination hole in the distal-to-proximal direction.

Possible regulatory role of Snail in NF-κB-mediated changes in E-cadherin in gastric cancer.

In the present study, we aimed to investigate the involvement of Snail in NF-κB-mediated changes of E-cadherin in gastric cancer. A total of 189 human gastric cancer tissues, and 32 normal gastric mucosal tissues were used to determine the expression levels of NF-κB, E-cadherin and Snail by immunohistochemistry. The correlation between the expression levels and patient clinicopathological data was analyzed. Human gastric cancer cell line SGC7901 was treated with the NF-κB inhibitor PDTC, and the expression levels of E-cadherin and Snail were investigated by qPCR and western blot. NF-κB, E-cadherin and Snail were all detected in normal gastric mucosa and cancer tissues of various differentiation statuses. However, the expression patterns of each protein were different. Strong expression of E-cadherin was detected in normal gastric mucosa, whereas its expression gradually declined in gastric cancer tissues, with weak expression observed in poorly differentiated gastric cancer tissues. In contrast, weak NF-κB and Snail expressions were present in normal gastric mucosa, while their expression levels gradually increased in gastric cancer tissues, with the strongest expression detected in poorly differentiated gastric cancers. The expression of E-cadherin was inversely correlated with that of Snail and NF-κB in the tissues tested. Blockade of NF-κB using its inhibitor PDTC led to a time-dependent reduction in Snail but a time-dependent increase in E-cadherin in SGC7901 cells. These results suggest that in human gastric cancer, loss of E-cadherin may be mediated through NF-κB-induced Snail upregulation. Further studies may reveal whether targeting the NF-κB-Snail-E-cadherin axis could be a useful approach for combating gastric cancer.

[Expression and significance of RhoA and NF-ΚB in human gastric carcinoma].

OBJECTIVE: To investigate the expression of RhoA and NF-κB in gastric carcinoma and their correlation with clinicopathological fearures. To determine the effective prognostic factors of long-term suivival of gastric carcinoma patients. METHODS: The role of RhoA and NF-κB in gastric carcinoma was assessed by tissue array technology and the levels of RhoA and NF-κB expression in paraffin-embedded tissues was quantified by immunohistochemistry from 189 cases of gastric carcinoma, 54 cases of their adjacent tissues, and 32 cases of normal gastric mucosa. The prognosis of gastric carcinoma was evaluated by Kaplan-Meier survival analysis and Cox multivariate regression analysis. RESULTS: The positive rates of RhoA expression were 84.7%, 68.5% and 65.6% in gastric carcinoma, adjacent tissues and normal mucosa, respectively. The expression of RhoA in gasric carcinoma was significantly higher than that in adjacent tissues and normal mucosa (P < 0.05). The positive rates of NF-κB expression were 75.1%, 42.6% and 15.6%% in gastric carcinoma, adjacent tissues and normal mucosa, respectively. The expression of NF-κB in gasric carcinoma was significantly higher than that in adjacent tissues and normal mucosa (P < 0.05). RhoA was positively linked with NF-κB (r = 0.203, P = 0.005). In gastric carcinoma, the expression of RhoA was related with depth of invasion (P < 0.05), and the expression of NF-κB was related with depth of invasion and lymph node metastasis (P < 0.05). The Kaplan-Meier survival analysis showed that the tumor size, lymph node metastasis, depth of invasion, expression of RhoA and NF-κB can shorten the cumulative survival rate. With these paramaters entering the Cox multivariate regression analysis mode, it was revealed that expression of NF-κB, lymph node metastasis and depth of invasion are independent prognostic factors. CONCLUSIONS: The overexpression of RhoA and NF-κB is involved in the occurrence and development of gastric carcinoma. RhoA is positively linked with NF-κB. They are correlated with the invasion and metastasis of gastric carcinoma. The expression of NF-κB, lymph node metastasis, depth of invasion are independent prognostic factors playing an important role in prediction of the clinical outcome after radical resection of gastric carcinoma.