Relationship between muscle and subcutaneous adipose tissue size and density and proximal femur bone in elderly women with hip fracture.

BACKGROUND: Both osteoporosis and sarcopenia are associated with aging, increasing the likelihood of falls in older adults and consequently raising the risk of hip fractures (HF). AIMS: To explore the relationship between the size and density of muscle and subcutaneous adipose tissue (SAT) and the bone mineral density (BMD) of the proximal femur in elderly women with HF. METHODS: Quantitative computed tomography (QCT) was conducted on the hips of 661 female participants who experienced low-energy acute HFs to measure both areal BMD (aBMD) and volume BMD (vBMD). Measurements were taken for the cross-sectional area (CSA) and density of the muscle around the hip and adjacent SAT. Multivariable linear regression models were applied to assess the relationship between these parameters. RESULTS: Most increases in the density of the gluteus medius and minimus muscle (G.Med/MinM) were correlated with higher BMD in the femoral neck fracture (FNF) group with osteoporosis. In the FNF group, gluteus maximus muscle (G.MaxM) density was negatively associated with the BMD parameters of the proximal femur in individuals with osteoporosis, while they were positively associated with nonosteoporosis. In the intertrochanteric fracture (ITF) group without osteoporosis, both FN aBMD and FN vBMD showed significant correlations with G.Med/MinM density. DISCUSSION: In women with HFs, bone and muscle are closely related. CONCLUSIONS: In older women with HFs, density but not CSA of the G.Med/MinM were associated with BMD parameters of the proximal femur. Osteoporosis may influence the relationship between G.MaxM density and proximal femur BMD in elderly women with FNF.

Analysis on the impact of dynamic innovation investment strategy of green supply chain enabled by blockchain.

Background: The emergence of the green supply chain represents a natural evolution from the traditional model. However, this transition has created trust concerns in operational processes. Fortunately, blockchain technology offers a promising solution to address this issue and help businesses overcome related obstacles. As artificial intelligence and blockchain continue to advance, enterprises are increasingly exploring opportunities for green innovation investments, although the optimal timing for successful product innovation can be difficult to predict. Methods: The effects of successful innovation on eco-friendly supply chains are analyzed through various factors such as optimal investment strategy, level of blockchain technology, and overall system profit. Differential game theory is used to determine the most effective approach across three alliance modes: horizontal cooperative, non-cooperative, and vertical cooperative. Additionally, the impact of innovation uncertainty on member strategies and alliance selection is thoroughly examined. Results: According to the results, predicting the likelihood of innovation realization can influence decision makers to prioritize current profits. Both horizontal and vertical cooperative alliance models can lead to Pareto improvements in total system profit, both before and after innovation success. However, the vertical cooperative alliance model proves to be more effective, especially at higher realization rates. Green suppliers stand to benefit from the vertical cooperative alliance model, as it can enhance their innovative investment strategy, while platform cooperation does not significantly affect their strategy. Platforms, on the other hand, can benefit from the vertical cooperative alliance model, as it can promote their innovative investment strategy and level of blockchain technology.

Burden of neck pain in general population of China, 1990-2019: An analysis for the Global Burden of Disease Study 2019.

Background: Neck pain has become very common in China and has greatly affected individuals, families, and society in general. In this study, we aimed to report on the rates and trends of the prevalence, incidence, and years lived with disability (YLDs) caused by neck pain in the general population of China from 1990 to 2019. Methods: We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) study to estimate the number and age standardised rates per 100 000 population of neck pain point prevalence, annual incidence, and YLDs in 33 provinces/municipalities/autonomous regions of China, stratified by age, sex, and sociodemographic index (SDI) from 1990 to 2019. We then compared these estimates with other G20 countries. Results: There were 6.80 × 107 patients with neck pain in 2019, presenting an increase from 3.79 × 107 in 1990. Likewise, the national age-standardised point prevalence increased slightly from 3.53% in 1990 to 3.57% in 2019. The YLDs increased by 78.08%, from 3814 × 103 in 1990 to 6792 × 103 in 2019. The age-standardised YLDs rate increased 1.50% from 352.84 in 1990 to 358.10 in 2019. The point prevalence of neck pain in 2019 was higher in females compared with males. These estimates were all above the global average level and increased more rapidly among G20 countries from 1990 to 2019. We generally observed a positive association between age-standardised YLD rates for neck pain and SDI, suggesting the burden is higher at higher sociodemographic indices. Conclusions: Neck pain is a serious public health problem in the general population in China, especially in its central and western regions, with an overall increasing trend in the last three decades. This is possibly related to changes of people's lifestyles and work patterns due to improvements in societal well-being and technology. Raising awareness of risk factors for neck pain in the general population and establishing effective preventive and treatment strategies could help reduce the future burden of neck disorders.

A multi-level classification based ensemble and feature extractor for credit risk assessment.

With the growth of people's demand for loans, banks and other financial institutions put forward higher requirements for customer credit risk level classification, the purpose is to make better loan decisions and loan amount allocation and reduce the pre-loan risk. This article proposes a Multi-Level Classification based Ensemble and Feature Extractor (MLCEFE) that incorporates the strengths of sampling, feature extraction, and ensemble classification. MLCEFE uses SMOTE + Tomek links to solve the problem of data imbalance and then uses a deep neural network (DNN), auto-encoder (AE), and principal component analysis (PCA) to transform the original variables into higher-level abstract features for feature extraction. Finally, it combined multiple ensemble learners to improve the effect of personal credit risk multi-classification. During performance evaluation, MLCEFE has shown remarkable results in the multi-classification of personal credit risk compared with other classification methods.

Incidence, prevalence, and causes of spinal injuries in China, 1990-2019: Findings from the Global Burden of Disease Study 2019.

BACKGROUND: Spinal injuries are an urgent public health priority; nevertheless, no China-wide studies of these injuries exist. This study measured the incidence, prevalence, causes, regional distribution, and annual trends of spinal injuries in China from 1990 to 2019. METHODS: We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 to estimate the incidence and prevalence of spinal injuries in China. The data of 33 provincial-level administrative regions (excluding Taiwan, China) provided by the National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (CDC) were use to systematically analyze the provincial etiology, geographical distribution, and annual trends of spinal injuries. The Bayesian meta-regression tool DisMod-MR 2.1 was used to ensure the consistency among incidence, prevalence, and mortality rates in each case. RESULTS: From 1990 to 2019, the number of living patients with spinal injuries in China increased by 138.32%, from 2.14 million to 5.10 million, while the corresponding age-standardized prevalence increased from 0.20% (95% uncertainty interval [UI]: 0.18-0.21%) to 0.27% (95% UI: 0.26-0.29%). The incidence of spinal injuries in China increased by 89.91% (95% UI: 72.39-107.66%), and the prevalence increased by 98.20% (95% UI: 89.56-106.82%), both the most significant increases among the G20 countries; 71.00% of the increase could be explained by age-specific prevalence. In 2019, the incidence was 16.47 (95% UI: 12.08-22.00, per 100,000 population), and the prevalence was 358.30 (95% UI: 333.96-386.62, per 100,000 population). Based on the data of 33 provincial-level administrative regions provided by CDC, age-standardized incidence and prevalence were both highest in developed provinces in Eastern China. The primary causes were falls and road injuries; however, the prevalence and specific causes differed across provinces. CONCLUSIONS: In China, the overall disease burden of spinal injuries increased significantly during the past three decades but varied considerably according to geographical location. The primary causes were falls and road injuries; however, the prevalence and specific causes differed across provinces.

Evaluation of three decades of the burden of low back pain in China before COVID-19: Estimates from the Global Burden of Disease Database 2019.

Background: Low back pain (LBP) is reported as an urgent public-health concern globally because it occurs in all age groups and is now the leading cause of disability, with health systems unable to cope with this burden. We present China's burden of LBP by estimating its prevalence and years lived with disability (YLDs) from 1990 to 2019. Methods: We obtained the data relating to LBP from the Global Burden of Disease Database (GBD) 2019. Then we calculated years lived with disability caused by LBP by multiplying the prevalence of LBP sequelae by their corresponding disability weights. We performed an analysis of the age-, sex-, and province-specific prevalence and YLDs of 33 provinces/regions in China, as well as their relationship with the sociodemographic index (SDI). Results: China has the largest numbers of people with LBP (91.3 million) and YLDs (8.6 million) globally, and LBP is the leading cause of YLDs. The age-standardised prevalence was 7.25% in 1990, and this decreased to 5.13% in 2019. The age-standardised YLD rate was 579/100 000 in 2019, having decreased by 28.97%. Both measurements increased with age, being higher in women and varying across the 33 provinces/regions. For the 5-to-14-year age group, the prevalence (4.50%) and YLD rate (4.51%) increased in 2019 from 1990 (3.21% and 3.21%, respectively) when compared to the elderly group. Age-standardised YLD rates experienced decreases with increasing SDI, while there was an increasing tendency as SDI increased further; the changes for women were more obvious. Conclusions: Over the three decades considered, China has continued to have the largest number of people with LBP in the world, even though the age-standardised prevalence has decreased. YLDs were found to decrease as SDI increased, but they subsequently increased again. LBP still presents a burden, particularly for children and postmenopausal women.

A bioenergetically-active ploy (glycerol sebacate)-based multiblock hydrogel improved diabetic wound healing through revitalizing mitochondrial metabolism.

Diabetic wounds impose significant burdens on patients' quality of life and healthcare resources due to impaired healing potential. Factors like hyperglycemia, oxidative stress, impaired angiogenesis and excessive inflammation contribute to the delayed healing trajectory. Mounting evidence indicates a close association between impaired mitochondrial function and diabetic complications, including chronic wounds. Mitochondria are critical for providing energy essential to wound healing processes. However, mitochondrial dysfunction exacerbates other pathological factors, creating detrimental cycles that hinder healing. This study conducted correlation analysis using clinical specimens, revealing a positive correlation between mitochondrial dysfunction and oxidative stress, inflammatory response and impaired angiogenesis in diabetic wounds. Restoring mitochondrial function becomes imperative for developing targeted therapies. Herein, we synthesized a biodegradable poly (glycerol sebacate)-based multiblock hydrogel, named poly (glycerol sebacate)-co-poly (ethylene glycol)-co-poly (propylene glycol) (PEPGS), which can be degraded in vivo to release glycerol, a crucial component in cellular metabolism, including mitochondrial respiration. We demonstrate the potential of PEPGS-based hydrogels to improve outcomes in diabetic wound healing by revitalizing mitochondrial metabolism. Furthermore, we investigate the underlying mechanism through proteomics analysis, unravelling the regulation of ATP and nicotinamide adenine dinucleotide metabolic processes, biosynthetic process and generation during mitochondrial metabolism. These findings highlight the therapeutic potential of PEPGS-based hydrogels as advanced wound dressings for diabetic wound healing.

Compressive buttress compared with off-axial screw fixation for vertical femoral neck fractures in young adults: a prospective, randomized controlled trial.

BACKGROUND: To compare the clinical outcomes of compressive buttress screw (CBS) fixation, a novel screw fixation strategy, to off-axial screw fixation (off-axial partial threaded cannulated screw, OPTCS) for vertical femoral neck fractures (FNFs) in young adults. METHODS: A total of 146 adults younger than 55 years old with high-energy Pauwels type III FNFs were randomized to receive CBS fixation or OPTCS fixation. Primary outcomes were complication rates, including fixation failure, fracture nonunion, and avascular necrosis of the femoral head (ANFH) at 24 months after treatment. Fixation loosening, femoral neck shortening and varus collapse, patient function and quality of life using the Harris hip score (HHS), and EuroQol-5 dimensional-5 levels (EQ-5D-5L) questionnaire (including EQ-5D-5L and EQ-VAS) were assessed as secondary outcomes at 24 months. RESULTS: CBS and OPTCS fixation groups were similar with regard to demographics at baseline. At 24 months, patients in the CBS fixation cohort had a significantly lower rate of fixation failure (10.5% vs. 25.0%, p = 0.041) and fracture nonunion (1.8% vs. 18.3%, p = 0.003) compared with patients who received OPTCS fixation. There was no difference in rate of ANFH (7.0% vs. 11.7%, p = 0.389) between groups. Additionally, patients managed with CBS fixation showed significantly less fixation loosening (19.3% vs. 58.3%, p < 0.001), less severe femoral neck shortening and varus collapse (10.5% vs. 25.0%, p = 0.007), higher HHS (93 vs. 83, p = 0.001) and more excellent grade (68.4% vs. 36.7%, p = 0.008), higher EQ-5D-5L (0.814 vs, 0.581, p < 0.001) and EQ-VAS (85 vs. 80, p = 0.002). CONCLUSION: CBS screw fixation confers significantly lower complication rate in addition to higher functional and quality of life outcomes for young adults with high-energy FNF compared with OPTCS fixation. TRIAL REGISTRATION: This prospective, randomized controlled trial was approved by the institutional review board of our center, Ethics Committee of Shanghai sixth people's Hospital, and registered at www.chictr.org.cn (Approval Number: ChiCTR1900026283; Registered 29 September 2019-Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=43164 ).

Morphological characteristics of femoral neck fractures in young and middle-aged population: a retrospective descriptive study.

BACKGROUND: A understanding of morphological characteristics are important to femoral neck fractures (FNFs) resulting in high rates of complications in the young and middle-aged adults and the detailed data is lack in the literature. We aimed to report on the detailed morphological characteristics and the relationship between them in young and middle-aged adults with femoral neck fractures (FNFs). METHODS: The postoperative CT images of one hundred and fifty-two adults with FNFs were retrospectively reviewed. After image standardization, morphological characteristics including fracture orientation, cortex comminution, and intraosseous bone defects were measured and analyzed. Additionally, the distribution and correlation of these morphological features were analyzed using Pauwels classification, the right angle of the neck axis (VNA) classification, and the anteromedial oblique angle (AMA). RESULTS: Pauwels III fractures accounted for approximately half (55.2%) of the FNFs analyzed. Pauwels II and III could be detected in all four VNA types, and the distribution of the Pauwels types in VNA classification showed significant differences (χ2 = 106.363, p < 0.001). The VNA (9.0° ± 12.1) showed positive correlation with the neck-shaft angle (139.5° ± 6.3) and modified Pauwels angle (49.8° ± 10.6) (r = 0.441, r = 0.855, all p < 0.001). Cortical comminutions were commonly observed in the posterior (86.7%) and the inferior (80.7%). AMAs within the cases without posterior and inferior cortex comminutions were significantly larger than those with comminution (t = 2.594, 2.1196; p = 0.01, 0.036), but no difference could be detected after the AMA being divided into three groups (< 85°, 85°-95°, > 95°). The MPA, VNA and AMA of the group with an intraosseous defect were significantly different compared with those without (t = 2.847, 2.314, 2.268; p = 0.005, 0.022,0.025). The incidence of intraosseous defects within the groups with coronal and axial cortex comminutions were significantly higher than those within the groups without comminutions (χ2 = 34.87, 25.303; p < 0.001). CONCLUSIONS: The present study highlights the morphological diversity and complexity within FNFs in young and middle-aged adults, which allows for more accurate simulation of FNF patterns in the future biomechanical studies.

In vitro inhalation bioaccessibility and health risk assessment of difenoconazole in the atmosphere.

BACKGROUND: Assessment of the risk of pesticide inhalation in populations around farmland is necessary because inhalation is one of the ways in which pesticides can risk human health. This study aimed to identify the inhalation risk of difenoconazole on humans by using dose-response and exposure assessments. RESULTS: In the field simulation application, respiratory exposure in populations around farmland ranged from 71 to 430 ng/m3 . Using response surface methodology, the maximum bioaccessibility of difenoconazole in three simulated lung fluids was 35.33% in Gamble's solution (GS), 34.12% in artificial lysosomal fluid (ALF), and 42.06% in simulated interstitial lung fluid (SLF). Taking the proliferation activity of the A549 cell model as the endpoint, the benchmark dose limit and benchmark dose of difenoconazole on A549 cells were 16.36 and 5.60 mg/kg, respectively. The margin of exposure to difenoconazole in GS, ALF and SLF were, respectively, 8.66 × 105 to 5.28 × 106 , 8.97 × 105 to 5.47 × 106 and 7.28 × 105 to 4.44 × 106 . CONCLUSION: The risk assessment results indicate that under all circumstances, applying difenoconazole is safe for populations around farmland. However, a fan-shaped nozzle, suspension concentrate and greater inhalation height increase the risk of inhalation. © 2023 Society of Chemical Industry.

Can new urbanization and ecological environment achieve synergistic development? Empirical evidence from 63 counties in Zhejiang, China.

As China's urbanization accelerates, ecological environmental issues have become increasingly prominent, and how to achieve the synergistic development of urbanization and ecological environment is worth exploring. The paper uses the Super-SBM model and the improved entropy method to calculate the ecological efficiency and the new urbanization in 63 counties in Zhejiang Province from 2000 to 2019. Furthermore, the coupling coordination degree between new urbanization and ecological efficiency is discussed with the coupling degree model, Markov chain, and spatial correlation methods, and its influencing factors are explored by the geographic detector. The results show that: (1) The development trends of new urbanization and ecological efficiency in Zhejiang Province counties both present a "U" shape. Their inflection points appeared in 2005 and 2006, respectively. The gap between counties is gradually narrowing. (2) The coupling coordination degree between new urbanization and ecological efficiency in Zhejiang Province counties also develops in a "U" shape with the minimum value appearing in 2006. Its temporal evolution is dominated by advancement towards a higher level and maintenance of the original type, with most countries advancing from General Disorder to Preliminary Coordination. There is a good positive correlation in the spatial distribution, showing significant High-High and Low-Low agglomeration. (3) In detecting the driving factors, the explanatory power of economic development, natural conditions and social conditions diminishes sequentially. The interaction groups mostly are nonlinear enhancements, and the rest are all two-factor enhancements. Social factors are the main interaction objects. (4) The empirical analysis verified the efficacy of the "Two Mountains" theory and the importance of government investment in the regional coordinated development.

Perioperative risk factors related to complications of lumbar spine fusion surgery in elderly patients.

PURPOSE: To analyze the perioperative risk factors related to lumbar spine fusion surgery in elderly patients. METHODS: 202 elderly patients (age range 77-92 years old) who have underwent lumbar spinal fusion surgeries between January 2019 and June 2021 were retrospectively investigated. Information of age, sex, comorbidity, fixation segments, operation time, surgical blood loss and perioperative complications during hospitalization were collected. Risk factors for complications were analyzed. Student's t-test, chi-square test, Mann-Whitney U­test and multivariate generalized linear models were used. RESULTS: In this study, 31 patients presented complications (15.3%) in these elderly patients with an average age of 79.1 years, including 1 patient with intraoperative complication and 30 patients with postoperative complications; and 2 out of 31 patients (1%) died. The elderly patients were divided into group A (24 patients) with major postoperative complications and group B (178 patients) without major postoperative complications. Major postoperative complications were significantly associated with age (univariate analysis, t = 3.92, P < 0.001; multivariate analysis, OR = 1.323, 95%CI 1.126-1.554, P = 0.001), but not significantly associated with other factors tested (sex, comorbidity, fixation segments, operation time, surgical blood loss). Then 173 patients (range 77-81 years) were selected and the rate of major postoperative complications of each age from 78 to 81 years was compared with that of 77 years patients, respectively. We found that the ratios of complications at 80 years (OR = 10.000, P = 0.019) and 81 years (OR = 10.000, P = 0.009) were higher than the ratio at 77 years. CONCLUSIONS: Although with great progress of medical technology, increasing age was still the independent risk factor for major postoperative complications in elderly patients undergoing lumbar spinal fusion surgery. As for the incidence of major postoperative complications, 80 and 81 years old patients was 10 folds higher than that of 77 years old patients, reminding us to pay more attention to 80 years old and even older patients.

Thoracolumbar/Lumbar Degenerative Kyphosis-The Importance of Thoracolumbar Junction in Sagittal Alignment and Balance.

PURPOSE: To conduct a more comprehensive study of sagittal alignment in patients with thoracolumbar/lumbar (TL/L) degenerative kyphosis. METHODS: A total of 133 consecutive patients from September 2016 to March 2019 with degenerative spinal kyphosis were enrolled. These patients were divided into different types according to sagittal alignment, including thoracolumbar junctional kyphosis (TLJK). Then, we divided the patients with TLJK into two groups: the Sagittal Balance group (C7-SVA < 50 mm) and the Sagittal Imbalance group (C7-SVA ≥ 50 mm). The sagittal parameters of each type or group were compared and correlation analysis was conducted. RESULTS: Thoracolumbar/lumbar degenerative kyphosis consists of four types: Type I, lumbar kyphosis; Type II, degenerative flat back; Type III, thoracolumbar junctional kyphosis; and Type IV, global kyphosis. According to different sagittal alignments, Type III can further be divided into three subtypes: IIIA, with smooth kyphosis of thoracic and upper lumbar; IIIB, like a clasp knife, with a flat thoracic and lumbar angle; and IIIC, with bigger thoracic kyphosis and lumbar lordosis. The thoracolumbar kyphosis angle (°) of the three subtypes were -23.61 ± 5.37, -25.40 ± 7.71, and -40.01 ± 8.40, respectively. Lumbar lordosis was correlated with thoracic kyphosis (IIIA, r = -0.600, p = 0.005; IIIB, r = -0.312, p = 0.046; IIIC, r = -0.657, p = 0.015), and correlated with sacral slope (IIIA, r = 0.537, p = 0.015; IIIB, r = 0.654, p = 0.000; IIIC, r = 0.578, p = 0.039). All spinopelvic parameters were compared between the Sagittal Balance group and the Sagittal Imbalance group, and only the thoracolumbar kyphosis angle showed statistical difference (t = -2.247, p = 0.028). CONCLUSIONS: The common characteristics of thoracolumbar junctional kyphosis were found to be a bigger thoracolumbar junctional angle and vertex of kyphosis located in the thoracolumbar junction (T10-L2). Despite TLJK, a change in the thoracic angle was still important to maintain sagittal balance. The thoracolumbar junction plays an important role in sagittal alignment and balance.

Biomechanical evaluation of compression buttress screw and medial plate fixation for the treatment of vertical femoral neck fractures.

OBJECTIVE: To compare the biomechanical properties of compression buttress screw (CBS) fixation with three plate fixation methods for the treatment of vertical femoral neck fractures (FNFs). METHODS: A total of forty synthetic femoral models with simulated Pauwels type III fractures (angle of 70°) were equally assigned to one of four fixation groups: CBS fixation, anteromedial plate fixation (AMP), medial buttress plate fixation (MBP) and medial buttress plate fixation without proximal screw (MBPw). Within each group, half of the specimens were randomly assigned to two loading settings, an axial compression loading test and a hip-flexion torsion test. RESULTS: There were no significant differences in axial load to failure, axial stiffness, torsional strength, or torsional stiffness when comparing CBS with MBP (p>0.05). In the axial compression loading test, both CBS and MBP showed higher load to failure and axial stiffness than MBPw (p<0.05). In torsional testing, AMP exhibited superior torsional strength and torsional stiffness than both MBPw and MBP (all p<0.05) and a higher torsional strength than CBS fixation (p<0.05). There were no significant differences in torsional stiffness between the CBS and AMP fixation groups (p>0.05). CONCLUSION: The biomechanical parameters of CBS fixation are comparable to that of AMP and MBP, and demonstrate superior axial stiffness than MBPw fixation. Although the CBS method for surgical fixation of vertical FNF holds promise as a less invasive surgical technique than plate fixation with similar biomechanical assessments, further clinical evaluation is warranted.

Efficacy and safety of unilateral biportal endoscopy versus other spine surgery: A systematic review and meta-analysis.

Background: This study aimed to evaluate the efficacy and safety of unilateral biportal endoscopy (UBE) versus other forms of spine surgery. Methods: Electronic databases were systematically searched up to February 2022. The authors used Review Manager 5.3 to manage the data and perform the review. Results: After the preliminary selection of 239 studies from electronic databases, the full inclusion criteria were applied; 16 studies were found to be eligible for inclusion. These 16 studies enrolled 1,488 patients: 653 patients in the UBE group, 570 in the microendoscopic discectomy group, 153 in the percutaneous endoscopic lumbar discectomy group, and 70 in the posterior lumbar interbody fusion group. UBE was superior to microendoscopic discectomy regarding 1-day Visual Analog Scale(VAS) back pain scores (P < 0.00001). No difference was found between UBE and microendoscopic discectomy regarding 1-day Visual Analog Scale leg pain scores (P = 0.25), long-term VAS back pain scores (P = 0.06), long-term VAS leg pain scores (P = 0.05), Oswestry Disability Index scores (P = 0.09) or complications (P = 0.19). Pooled analysis indicated that UBE was similar to percutaneous endoscopic lumbar discectomy regarding 1-day VAS back pain scores (P = 0.71), 1-day VAS leg pain scores (P = 0.37), long-term VAS back pain scores (P = 0.75), long-term VAS leg pain scores (P = 0.41), Oswestry Disability Index scores (P = 0.07) and complications (P = 0.88). One study reported no difference between UBE and posterior lumbar interbody fusion regarding long-term VAS back pain, long-term VAS leg pain, or Oswestry Disability Index scores. Conclusions: UBE is superior to microendoscopic discectomy to relieve back pain 1 day postoperatively. However, these two procedures are similar regarding 1-day leg pain relief, long-term effects, and safety. UBE and percutaneous endoscopic lumbar discectomy are similar regarding 1-day pain relief, long-term effects and safety. More evidence is needed to evaluate the efficacy and safety of UBE versus posterior lumbar interbody fusion.

Efficacy and safety of epidural anesthesia versus local anesthesia in percutaneous transforaminal endoscopic discectomy: a systematic review and meta-analysis.

BACKGROUND: For some patients, local anesthesia (LA) in percutaneous transforaminal endoscopic discectomy (PTED), especially during canal shaping and discectomy, is insufficient for analgesia. Epidural anesthesia (EA) is infrequently applied in PTED but reports satisfactory results. Previous studies present conflicting results in analgesia satisfactory and adverse events. Differences in surgery details and small sample size might explain conflicting results. Meta-analysis pools the results from individual studies to create a larger sample size and provides a more reliable conclusion. The aim of this study is to evaluate the efficacy and safety of EA in PTED. METHODS: The search terms "percutaneous transforaminal endoscopic discectomy" and "anesthesia" are used to search Cochrane, Web of Science, PubMed, Embase, OVID, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang from inception to 2021-08. Inclusion criteria is defined according to PICOS principals: P (patients): patients are diagnosed with lumbar disc herniation or spinal canal stenosis. I (intervention): patients undergo PTED under EA. C (comparisons): patients undergo PTED under LA. O (outcomes): primary outcomes: intraoperative visual analogue scale (VAS), anesthesia satisfactory, sufentanil usage. Secondary outcomes: adverse events, surgery exit, bleed volume, X-ray radiation. S (study design): randomized controlled trials (RCTs). The Cochrane RoB 2.0 is used to evaluate the quality of the included studies. Authors perform meta-analysis through Review Manager 5.4. RESULTS: A total of 6 studies representing 529 patients are included: EA group includes 261 patients, and LA group includes 268 patients. All studies lack design of allocation concealment and blinding of participants and personnel. Only Luo reports blinding of outcome assessment in 2019. Meta analysis concludes that EA is superior in intraoperative analgesic [mean difference (MD) =-4.31; 95% confidence interval (CI): -4.52 to -4.09; P<0.00001], anesthesia satisfactory [odds ratio (OR) =10.06; 95% CI: 2.41 to 41.98; P=0.002], sufentanil usage (MD =-9.12; 95% CI: -10.34 to -7.90; P<0.00001), adverse events (OR =0.19; 95% CI: 0.07 to 0.52; P=0.001). There is no difference in bleed volume (MD =-2.61; 95% CI: -5.45 to 0.23; P=0.07), exit rate (OR =0.23; 95% CI: 0.04 to 1.35; P=0.10) and future effects (MD =-0.23; 95% CI: -0.50 to 0.03; P=0.08). DISCUSSION: EA is an effective and safe anesthesia method for PTED and might achieve better clinical results than LA. More high-quality research is needed to provide high-quality evidence for efficacy and safety.

The compensatory mechanisms for global sagittal balance in degenerative spinal kyphosis patients: a radiological analysis of muscle-skeletal associations.

BACKGROUND: The position of the head relative to the spine can be used to evaluate the true global balance in patients with degenerative spinal kyphosis (DSK). However, it is still not clear how the position of the head is related to the spinal-pelvic parameters and lumbar muscles, which are most commonly considered. METHODS: Sixty-seven patients with DSK admitted in the hospital from January 2017 to January 2019 were retrospectively analyzed. All patients had whole spine X-ray and lumbar MRI. The head position parameters include: the angles of both lines joining the center of acoustic meati (CAM) to the center of the bi-coxofemoral axis (BA) (CAM-BA) and the most superior point of dentiform apophyse of C2 odontoid (OD) to BA (OD-BA) with the vertical line; the distance between the vertical line passing CAM and the posterior upper edge of the S1 (CAM-SVA). The spinal parameters include: C7 sagittal vertical axis (C7-SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), and lumbar lordosis (LL). The pelvic parameters include: pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The relative cross-sectional area (RCSA) of bilateral multifidus, erector spinae and psoas muscle at L3/4 and L4/5 segments were measured. The correlations between head position parameters and the spinal-pelvic parameters and RCSA of lumbar muscles were analyzed, respectively. RESULTS: Significant positive correlations were found between each two of CAM-SVA, C7-SVA, CAM-BA and OD-BA (p < 0.001). SS was found to be significantly positively correlated with CAM-BA (r = 0.377, p = 0.034) and OD-BA (r = 0.402, p = 0.023). CAM-BA was found to be significantly negatively correlated with TK (r = - 0.367, p = 0.039). Significant positive correlations were found between RCSA of multifidus at L3/4 level and CAM-SVA (r = 0.413, p = 0.021), CAM-BA (r = 0.412, p = 0.019) and OD-BA (r = 0.366, p = 0.04). CONCLUSIONS: Our study showed that the head position relative to the spine were significantly correlated to some spinal-pelvic parameters, and the lower lumbar multifidus muscle. The compensatory mechanisms of the global sagittal balance status should also involve the head position area.

Association between back muscle degeneration and spinal-pelvic parameters in patients with degenerative spinal kyphosis.

BACKGROUND: The paraspinal and psoas muscles have been considered to be essentially important for stabilizing the spinal column, and the muscle degeneration was found to exist in degenerative spinal kyphosis (DSK) patients. However, it is still not clear the relationship between muscle degeneration and spinal-pelvic alignment. The purpose of this study was to determine the correlations between the individual muscle degeneration at each lumbar spinal level and spinal-pelvic parameters in DSK patients. METHODS: The imaging data of 32 patients with DSK were retrospectively analyzed. The fat infiltration (FI) and relative cross-sectional area of muscle (RCSA) were quantitatively measured for multifidus (MF), erector spinae (ES) and psoas (PS) at each spinal level from L1/2 to L5/S1. The correlations were analyzed between RCSA and the sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). RESULTS: The FI of MF and ES at L3/4, L4/5 and L5/S1 were higher than that at L1/2 and L2/3. The FI of PS at L4/5 and L5/S1 were lower than that of L1/2, L2/3 and L3/4. The RCSA of ES and PS from L1/2 to L5/S1 gradually increased, whereas the RCSA of ES from L1/2 to S5/S1 gradually decreased. The RCSA of MF at the L1/2 level was negatively correlated SVA (r = - 0.397,p = 0.024); the RCSA at L3/4, L4/5 and L5/S1 levels were negatively correlated with TK (r = - 0.364, p = 0.04; r = - 0.38, p = 0.032; r = - 0.432, p = 0.014); the RCSA at L4/5 level was positively correlated with LL (r = 0.528, p = 0.002). The RCSA of ES at L3/4 and L4/5 levels were positively correlated with PI (r = 0.377, p = 0.037) and SS (r = 0.420, p = 0.019). CONCLUSIONS: FI of MF and ES at lower lumbar level is higher than that at upper level, but FI of PS at upper lumbar level is higher than that at lower level. MF and ES have different roles for maintaining the sagittal spinal-pelvic balance.