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.

The impact of perioperative opioid use on postoperative outcomes following spinal surgery: a meta-analysis of 60 cohort studies with 13 million participants.

BACKGROUND CONTEXT: An important factor for the prognosis of spinal surgery is the perioperative use of opioids. However, the relationship is not clear. PURPOSE: The purpose of this study was to evaluate the effect of perioperative opioid use on the prognosis of patients following spinal surgery. STUDY DESIGN/SETTING: Systematic review and meta-analysis. OUTCOME MEASURES: A meta-analysis was conducted using the random-effects method to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). METHODS: The PubMed, Embase, and Cochrane Library databases were systematically searched to find relevant articles that were published until September 2, 2022. The primary outcome was prolonged postoperative opioid use, and secondary outcomes included the length of stay (LOS), reoperation, the time to return to work (RTW), postoperative complications, gastrointestinal complications, new permanent disability, central nervous system events and infection. In addition, subgroup analysis of the primary outcome was conducted to explore the main sources of heterogeneity, and sensitivity analysis of all outcomes was performed to evaluate the stability of the results. RESULTS: A total of 60 cohort studies involving 13,219,228 individuals met the inclusion criteria. Meta-analysis showed that perioperative opioid use was specifically related to prolonged postoperative opioid use (OR 6.91, 95% CI 6.09 to 7.84, p<.01). Furthermore, the results also showed that perioperative opioid use was significantly associated with prolonged LOS (OR 1.74, 95% CI 1.39 to 2.18, p<.01), postoperative complications (OR 1.72, 95% CI 1.26 to 2.36, p<.01), reoperation (OR 2.38, 95% CI 1.85 to 3.07, p<.01), the time to RTW (OR 0.45, 95% CI 0.39 to 0.52, p<.01), gastrointestinal complications (OR 1.39, 95% CI 1.30 to 1.48, p<.01), central nervous system events (OR 1.99, 95% CI 1.21 to 3.27, p=.07) and infection (OR 1.22, 95% CI 1.09 to 1.36, p=.01). These results were corroborated by the trim-and-fill procedure and leave-one-out sensitivity analyses. CONCLUSIONS: Based on the current evidence, patients with perioperative opioid use, in comparison to controls, appear to have prolonged postoperative opioid use, which may increase the risk of poor outcomes including prolonged LOS, complications, reoperation, RTW and so on. However, these results must be carefully interpreted as the number of studies included was small and the studies were statistically heterogeneous. These findings may help clinicians to realize the harmfulness of perioperative use of opioids, reduce the use of prescription opioids, necessarily withdraw before operation or significantly wean to the lowest tolerable preoperative amount, and provide some inspiration for standardizing the use of opioids in the future.

Effects of Adding Ultrasound Biofeedback to Individualized Pelvic Floor Muscle Training on Extensibility of the Pelvic Floor Muscle and Anterior Pelvic Organ Prolapse in Postmenopausal Women.

The aim of the study was to determine effects of adding transperineal ultrasound (TPUS) biofeedback to individualized pelvic floor muscle training (PFMT) on extensibility of the pelvic floor muscle and anterior pelvic organ prolapse (POP) in postmenopausal women. A total of 77 patients with POP at stage I or stage II were admitted to Beijing Shijitan Hospital, China, from January 2017 to October 2018. They were randomly divided into a control group (CG) (n = 37) or a study group (SG) (n = 40). Both SG and CG received a 12-week PFMT including health education, verbal instruction, and home training. However, the SG, but not the CG, received additional TPUS biofeedback. Data of these patients were retrospectively reviewed. The distance from the lowest point of the bladder to the inferior-posterior margin of the symphysis pubis (BSP) and the levator hiatus area (LHA) were measured on maximal Valsalva via TPUS before and after the 12-week PFMT. Correct pelvic floor muscle contraction (PFMC) rates before and after PFMT were compared between the two groups. The correct PFMC rate was higher in the SG than that in the CG (92.5% vs. 73%; x 2 = 5.223, p=0.022). The BSP was increased but the LHA was reduced after the 12-week PFMT in both groups compared to those before PFMT (all p < 0.05). However, after the PFMT, the SG showed greater improvement than the CG for both BSP (0.77 ± 0.71 cm vs. 0.11 ± 0.66 cm, p < 0.05) and LHA (20.69 ± 2.77 cm2 vs. 22.85 ± 3.98 cm2, p < 0.05). TPUS might be an effective biofeedback tool for PFMT in clinical practice. Individualized PFMT with TPUS biofeedback could significantly attenuate POP severity and strengthen the extensibility of pelvic floor muscle in postmenopausal women when they are under increased intraabdominal pressure.

A bioinspired porous-designed hydrogel@polyurethane sponge piezoresistive sensor for human-machine interfacing.

Conductive coating sponge piezoresistive pressure sensors are attracting much attention because of their simple production and convenient signal acquisition. However, manufacturing sponge-structure pressure-sensing materials with high compressibility and wide pressure detection ranges is difficult because of the instability of rigid and brittle conductive coatings at large strains. Herein, a tough conductive hydrogel@polyurethane (PU) sponge with a porous design is prepared via immersion of a polyurethane sponge in a low-cost and biocompatible polyvinyl alcohol (PVA)/glycerin (Gl)/sodium chloride (NaCl) solution. The sensor based on the hydrogel/elastomer sponge composite material exhibits a compressible range of 0-93%, a pressure detection range of 100 Pa-470.2 kPa, and 10 000-cycle stability (80% strain) because of the compressibility, flexibility, and toughness of the porous hydrogel coating. Benefiting from the resistance change mechanism of microporous compression, the sensor also exhibits a wide range of linear resistance changes, and the corresponding sensitivity and gauge factor (GF) are -0.083 kPa-- (100 Pa-10.0 kPa) and -1.33 (1-60% strain), respectively. Based on its flexibility, compressibility, and wide-ranging linear resistance changes, the proposed sensor has huge potential application in human activity monitoring, electronic skin, and wearable electronic devices.

Poly(vinyl alcohol)/phosphoric acid gel electrolyte@polydimethylsiloxane sponge for piezoresistive pressure sensors.

Piezoresistive pressure sensors based on flexible, ultrasensitive, and squeezable conductive sponges have recently attracted significant attention. However, the preparation of cost-effective conductive sponges with good stability and wide strain range for pressure sensing remains a challenge. Herein, a conductive poly(vinyl alcohol)/phosphoric acid gel electrolyte@polydimethylsiloxane (PVA/H3PO4@PDMS) composite was fabricated by impregnating a PDMS sponge into a PVA/H3PO4 gel electrolyte. The conductivity of the as-prepared sponges was determined using a gel electrolyte polymer film. The sponge exhibited good sensitivity of 0.1145 kPa-1 in the low-pressure range (0-6.5 kPa), short response time (70 ms), and durability for over 2700 s (6000 cycles). The gauge factor of the PVA/H3PO4@PDMS sponge was 5.51, 1.49, and 0.33 at the strain range of 0-10%, 10-30%, and 30-80%, respectively. Based on these outstanding sensing performances, the sponges were applied for the detection of various human motions, such as vocal cord vibration, joint bending, respiratory rate, and pulse signal detection. Further, the sponge demonstrated their great potential in the fabrication of electronic skin and high-performance flexible wearable electronics. Therefore, the obtained PVA/H3PO4 gel electrolyte used as a sponge conductive coating material is a readily available and inexpensive material that can reduce the cost of composite materials for pressure sensing.

Contrast-enhanced ultrasound in uterine artery embolization treatment of cesarean scar pregnancy.

OBJECTIVE: The current study aimed to investigate the application of contrast-enhanced ultrasound (CEUS) in diagnosis and treatment of cesarean scar pregnancy (CSP). METHODS: A retrospective study was performed in 35 patients with clinically suspected CSP who requested termination of pregnancy and underwent contrast-enhanced ultrasound (CEUS). The patients were classified into two groups on the basis of whether they received uterine artery embolization (UAE). The CEUS characteristics of the two groups were reviewed. RESULTS: CEUS features of CSP were early enhancement of the cesarean scar and continuous infusion of contrast agent between the gestational sac and cesarean scar. Myometrial thickness in the cesarean scar was thinner in the UAE group than in the non-UAE group by CEUS and transvaginal ultrasound. Myometrial thickness measured by CEUS was thinner than that measured by transvaginal ultrasound in both groups. The parameters of the time-intensity curve in the UAE group were characterized by a faster arrival time, shorter time to peak, higher peak intensity, and greater enhancement rate compared with the non-UAE group. CONCLUSIONS: CEUS may be a novel supplementary method to diagnose and assess CSP, and to help evaluate whether UAE is required.

Application of contrast-enhanced ultrasound for scar pregnancy cases misdiagnosed as other diseases.

OBJECTIVE: To demonstrate the feasibility of utilizing contrast-enhanced ultrasound (CEUS) in scar pregnancies misdiagnosed by transvaginal ultrasound (TVS). METHODS: CEUS was performed in three patients with clinically suspected abnormal pregnancy, and the diagnosis were inconclusive by TVS. Clinical manifestations and features of TVS and CEUS in these cases were analyzed. RESULTS: Three cases included an intramural pregnancy (IMP) after hysteromyomectomy, and two mass-based cesarean scar pregnancy (CSP), the mass was caused by curettage and spontaneous abortion, respectively. In all these cases, early enhancement with high intensity was observed by CEUS at the site of implantation. Moreover, prominently enhanced signal was detected inside the mass, with or without peritrophoblastic ring. No enhancement was detected in clots or masses after effective treatment. CONCLUSION: CEUS can be used as a supplementary method to diagnose scar pregnancy and evaluate the treatment efficacy, especially in cases with ambiguous results by TVS.

The ultrasonic whirlpool sign combined with plasma d-dimer level in adnexal torsion.

OBJECTIVES: The whirlpool sign (WS) and plasma d-dimer are used as a sonographic marker and laboratory index for adnexal torsion (AT), respectively. The aim of this study was to evaluate whether their combination improved diagnostic efficiency of AT in patients presenting with a benign ovarian mass and abdominal pain and clinically suspected AT. MATERIALS AND METHODS: Fifty-four patients with clinically suspected AT with benign ovarian mass and abdominal pain were analyzed and divided into an AT group (n = 28) and control group (n = 26). Ultrasonography and venous blood collection were performed before surgery to observe the WS and plasma d-dimer level. All cases were confirmed by surgery. Diagnostic efficiency of the WS, plasma d-dimer level, and their combination was compared. RESULTS: There was a significant increase in the WS and plasma d-dimer level in AT patients (all p < 0.01). The sensitivity, specificity, Youden Index and area under the curve (AUC) of the WS (cut-off value of >1 circle), d-dimer level (cut-off value of 248 ng/ml) and their combinations were 71.43, 67.86 and 96.43%; 92.31, 100 and 100%; 0.637, 0.679 and 0.964; and 0.909, 0.899 and 0.995, respectively. There was a significant difference in AUC between the WS and d-dimer and their combination (all p < 0.01). CONCLUSIONS: The WS and d-dimer were useful for diagnosis of AT in patients with ovarian mass and abdominal pain. Combination of the WS and d-dimer may improve diagnostic efficiency for AT compared with each method alone.

[A study of the effectiveness and cost of de-escalation therapy for severe lower airway infection in a respiratory intensive care unit].

OBJECTIVE: To evaluate the effectiveness of de-escalation therapy (DET) in patients with severe lower airway infection in the respiratory care unit. METHODS: Sixty-seven cases of severe lower airway infection (SLAI) were divided into two groups: a DET group (n = 29), and a non-DET group (NDET, n = 38). Samples of lower airway secretions were collected by blinded protected specimen brush for culture and Gram stain. The clinical data were compared between the DET group and the NDET group, including the time of mechanical ventilation, time of stay in hospital, APACHE-II score, treatment responses and outcome, cost of antibiotics and total cost in the hospital. RESULTS: There were significant differences in time in hospital (14 +/- 8; 19 +/- 12), the time of mechanical ventilation (22 +/- 16; 32 +/- 16) and the total cost in-hospital (52 871 +/- 54 457; 82 913 +/- 49 564. t = 2.195, 2.449, 2.354, all P < 0.05), while there was no significant difference in the cost on antibiotics between the DET group (7896 +/- 4718) and the NDET group (8490 +/- 5786. t = 0.449, P > 0.05). The mortality and inappropriate antibiotic therapy rate of the DET group (13.8%, 27.6%) were lower than those of the NDET group (36.8%, 60.5%; chi(2) = 4.45, 7.18, all P < 0.05). CONCLUSION: The mortality of SLAI was significantly decreased by DET. DET also led to shorter time of mechanical ventilation, shorter course of therapy and less total cost of therapy.