Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis

Lumbar degenerative disc disease(DDD)in the elderly population remains a global health problem,especially in patients with osteoporosis.Osteoporosis in the elderly can cause failure of internal fixation.Cortical bone trajectory(CBT)is an effective,safe and minimally invasive technique for the treatment of lumbar DDD in patients with osteoporosis.In this review,we analyzed the anatomy,biomechanics,and advantages of the CBT technique in lumbar DDD and revision surgery.Additionally,the clinical trials and case reports,indications,advancements and limitations of this technique were further discussed and reviewed.Finally,we concluded that the CBT technique can be a practical,effective and safe alternative to traditional pedicle screw fixation,especially in DDD patients with osteoporosis.

The serum anion gap is associated with disease severity and all-cause mortality in coronary artery disease

Objective To evaluate the associations between the serum anion gap （AG） with the severity and prognosis of coronary artery disease （CAD）. Methods We measured serum electrolytes in 18,115 CAD patients indicated by coronary angiography. The serum AG was calculated according to the equation： AG = Na^＋ [（mmol/L） ＋ K^＋ （mmol/L）] - [Cl^- （mmol/L） ＋ HCO3^- （mmol/L）]. Results A total of 4510 （24.9%） participants had their AG levels greater than 16 mmol/L. The serum AG was independently associated with measures of CAD severity, including more severe clinical types of CAD （P 〈 0.001） and worse cardiac function （P = 0.004）. Patients in the 4th quartile of serum AG （≥ 15.92 mmol/L） had a 5.171-fold increased risk of 30 days all-cause death （P 〈 0.001）. This association was robust, even after adjustment for age, sex, evaluated glomerular filtration rate [hazard ratio （HR）： 4.861, 95% confidence interval （CI）： 2.150–10.993, P 〈 0.001], clinical diagnosis, severity of coronary artery stenosis, cardiac function grades, and other confounders （HR： 3.318, 95% CI： 1.76–2.27, P = 0.009）. Conclusion In this large population-based study, our findings reveal a high percentage of increased serum AG in CAD. Higher AG is associated with more severe clinical types of CAD and worse cardiac function. Furthermore, the increased serum AG is an independent, significant, and strong predictor of all-cause mortality. These findings support a role for the serum AG in the risk-stratification of CAD.

Surgical timing and long-term outcomes in patients with severe haemorrhagic spinal cord cavernous malformations

Background Surgical resection of the lesions remains the main treatment method for most symptomatic spinal cord cavernous malformations(SCCMs)to eliminate the occupation and associated subsequent lifelong haemorrhagic risk.However,the timing of surgical intervention remains controversial,especially for patients in the acute stage after severe haemorrhage.Methods Patients diagnosed with SCCMs who were surgically treated between January 2002 and December 2021 were selected and retrospectively reviewed.The Modified McCormick Scale(MMS)was used to evaluate neurological and disability status.All medical information was reviewed,and all patients were followed up for at least 6 months.Results A total of 279 patients were ultimately included.With regard to long-term outcomes,110(39.4%)patients improved,159(57.0%)remained unchanged and 10(3.6%)worsened.For patients with an MMS score of 2–5 on admission,in univariate and multivariate analyses,a≤6 weeks period between onset and surgery(adjusted OR 3.211,95%CI 1.504 to 6.856,p=0.003)was a significant predictor of improved MMS.Among 69 patients who first presented with severe haemorrhage,undergoing surgery within 6 weeks of the onset of severe haemorrhage(adjusted OR 4.901,95%CI 1.126 to 21.325,p=0.034)was significantly associated with improvement of MMS score.Conclusion Surgical timing can influence the long-term outcome of SCCMs.For patients with symptomatic SCCMs,especially those with severe haemorrhage,early surgical intervention within 6 weeks can provide more benefit.

Postoperative chemoradiotherapy with capecitabine and oxaliplatin vs.capecitabine for pathological stage N2 rectal cancer

Objective:Several studies have been conducted on the effects and toxicity of adding oxaliplatin to fluorouracilbased or capecitabine-based chemoradiotherapy(CRT)regimens as significantly increasing the toxic response without benefit to survival.In this study,we further explored the role of these two postoperative CRT regimens in patients with pathological stage N2 rectal cancer.Methods:This study was a subgroup analysis of a randomized clinical trial.A total of 180 patients with pathological stage N2 rectal cancer were eligible,85 received capecitabine with radiotherapy(RT),and 95 received capecitabine and oxaliplatin with RT.Patients in both groups received adjuvant chemotherapy[capecitabine and oxaliplatin(XELOX);or fluorouracil,leucovorin,and oxaliplatin(FOLFOX)]after CRT.Results:At a median follow-up of 59.2[interquartile range(IQR),34.0−96.8]months,the three-year diseasefree survival(DFS)was 53.3%and 64.9%in the control group and the experimental group,respectively[hazard ratio(HR),0.63;95%confidence interval(95%CI),0.41−0.98;P=0.04].There was no significant difference between the groups in overall survival(OS)(HR,0.62;95%CI,0.37−1.05;P=0.07),the incidence of locoregional recurrence(HR,0.62;95%CI,0.24−1.64;P=0.33),the incidence of distant metastasis(HR,0.67;95%CI,0.42−1.06;P=0.09)and grade 3−4 acute toxicities(P=0.78).For patients with survival longer than 3 years,the conditional overall survival(COS)was significantly better in the experimental group(HR,0.39;95%CI,0.16−0.96;P=0.03).Conclusions:Our results indicated that adding oxaliplatin to capecitabine-based postoperative CRT is safe and effective in patients with pathological stage N2 rectal cancer.

Evaluation of the vaginal microbiome in clinical diagnosis and management of vaginal infectious diseases

When patients attend with medical complaints such as abnormal leucorrhea,the clinician should consider the possibility of an infection in the lower genital tract,such as vulvovaginal candidiasis (WC).At that point,it is appropriate to then further assess the typical clinical manifestation,diagnosis,and routine management of the infection.However,sometimes,it is not possible to detect any pathogen at all through standard diagnostic techniques.In such a scenario,what happens to these patients?

Association between duration of return of spontaneous circulation and outcomes after out-of-hospital cardiac arrest

Background:Return of spontaneous circulation(ROSC)is a core outcome element of cardiopulmonary resuscitation(CPR);however,the definition or criterion of ROSC is disputed and varies in resuscitation for out-of-hospital cardiac arrest(OHCA).Methods:This was a retrospective study of 126 patients with OHCA who achieved ROSC between January and December 2020.The probability of survival after OHCA related to CPR and ROSC duration was analyzed using the probability density function and empirical cumulative density functions.Results:There were no significant differences between ROSC sustained until emergency department arrival and that sustained for at least 20 minutes in terms of the 24-hour survival rate(31.3%[31/99]vs.35.7%[10/30];P=0.84),30-day survival rate(23.2%[23/99]vs.25.0%[7/30];P=0.99),or survival at 30 days with cerebral performance category(CPC)1 and 2(18.2%[18/99]vs.10.7%[3/30];P=0.44).The Kolmogorov-Smirnov test values from the empirical cumulative density functions with ROSC sustained until hospital arrival and that sustained for at least 20 minutes were 0.44,0.20,and 0.24 for CPC 1 or 2,CPC 3 or 4,and CPC 5,respectively.Conclusion:Return of spontaneous circulation is a core outcome element of CPR.It should be defined as sustained for at least 20 minutes or until arrival at the emergency department and as a basic standard for evaluating resuscitation success after OHCA.