The Global Leadership Initiative on Malnutrition criteria for diagnosis of malnutrition and outcomes prediction in emergency abdominal surgery.

OBJECTIVES: Malnutrition has adverse postoperative outcomes, especially in emergency surgery. Among the numerous tools for nutritional assessment, this study aims to investigate malnutrition diagnosed by Global Leadership Initiative on Malnutrition criteria and the Global Leadership Initiative on Malnutrition predictive value for outcomes after emergency abdominal surgery. METHODS: This was a prospective observational study. Among the 468 patients undergoing emergency abdominal surgery admitted to a department of emergency surgery from June 2020 to December 2021, 53 patients were not eligible for enrollment, and 19 patients had missing data. Thus, the final number of participants was 396. Muscle mass was evaluated by skeletal muscle index at the third lumbar vertebra on computed tomography scans, and the lower quartile was defined as the threshold of muscle mass reduction. The associations of Global Leadership Initiative on Malnutrition, Global Leadership Initiative on Malnutrition (muscle mass reduction excluded), and skeletal muscle index with in-hospital mortality, postoperative complications, and postoperative stay were evaluated using χ2. In addition, confounding factors were screened, regression models were established, and the Global Leadership Initiative on Malnutrition predictive value was analyzed for clinical outcome. Ethical approval was obtained from the appropriate department. RESULTS: Malnutrition was observed in 19.9% of the total 396 patients based on the Global Leadership Initiative on Malnutrition and in 12.4% on the Global Leadership Initiative on Malnutrition (muscle mass reduction excluded). Sarcopenia by skeletal muscle index was found in 24.7% of patients. Univariate analysis indicated that in-hospital mortality, postoperative complications, infective complication rate, and postoperative hospital stay were significantly higher in malnourished and sarcopenic patients. Multivariate analysis found that malnutrition diagnosed by the Global Leadership Initiative on Malnutrition was predictive for complications, infective complications, and postoperative stay (total postoperative complications: odds ratio = 3.620; 95% CI, 1.635-8.015; P = 0.002; infective complications: odds ratio = 3.127; 95% CI, 1.194-8.192; P = 0.020; and postoperative stay: regression coefficient = 2.622; P = 0.022). The Global Leadership Initiative on Malnutrition (muscle mass reduction excluded) identified postoperative complications and postoperative stay (total postoperative complications: odds ratio = 3.364; 95% CI, 1.247-9.075; P = 0.017 and postoperative stay: regression coefficient = 3.547; P = 0.009). Sarcopenia by skeletal muscle index was a risk factor for postoperative complications (odds ratio = 3.366; 95% CI, 1.587-7.140; P = 0.002). CONCLUSION: The Global Leadership Initiative on Malnutrition and Global Leadership Initiative on Malnutritison (muscle mass reduction excluded) had predictive value for adverse clinical outcomes due to malnutrition in patients undergoing emergency abdominal surgery.

Laponite intercalated biomimetic multilayer coating prevents glucocorticoids induced orthopedic implant failure.

Implant failure, which is commonly associated with failure of osseointegration and peri-implant infection, is a severe complication of orthopedic surgery. In particular, the survival rate of implants is significantly decreased in patients using long-term glucocorticoids (GCs). However, the exact molecular mechanism underlying GCs-induced implant loosening, as well as preventive strategies for these patients, is unclear. To address this problem, we performed RNA-sequencing and found that WNT16 was correlated with GCs-induced osteopenia (LogFC = -5.17, p ＜ 0.01). Inspired by the concept of "organic-inorganic" hybrid, we theorized to introduce a bioactive two-dimensional nanosheet into a layer-by-layer (LbL) self-assembly coating to construct a customized implant that targets WNT16. After screening commercially available nanosheets, laponite (LAP) was identified as a cost-effective rescuer for GCs-induced WNT16 inhibition, which was then intercalated into LbL deposition system consisting of quaternized chitosan (QCS) and hyaluronic acid (HA). The hybrid coating (QCS/HA/LAP) showed micrometer thickness and improved hydrophilicity and interface roughness. Furthermore, QCS/HA/LAP coated polyetheretherketone (PEEK) implant enhanced cell viability, adhesion, and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs), and promoted osteointegration of PEEK in GCs-treated rats by targeting the WNT16/ß-catenin axis. The assembled QCS has proven antibacterial properties, and the hybrid coating exerted potent detrimental effects against methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli (E. coli), both in vitro and in vivo. Taken together, these results suggest that QCS/HA/LAP coating has great potential for use in implants customization, and has synergistic pro-osteogenic and antibacterial effects that help prevent implant failure in GCs-treated patients.

Decellularized tilapia fish skin: A novel candidate for tendon tissue engineering.

The poor regenerative ability of injured tendon tissues remains a clinical challenge. However, decellularized extracellular matrix (ECM) combined with stem cells shows promise. In contrast to bovine and porcine ECM, marine-derived decellularized ECM has several advantages; it is easily obtained, poses less biological risk, and is not contraindicated on religious grounds. This study successfully fabricated decellularized tilapia fish skin (DTFS) with copious preserved collagen fibers and natural pore structures. The outer layer is smooth and dense, while the inner layer has a soft structure with a rough surface. After crosslinking with 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC) and N-hydroxysuccinimide (NHS), crosslinked DTFS (C-DTFS) showed improved mechanics in dry and wet conditions. In vitro, the leach liquor of crosslinked DTFS showed no cytotoxicity and promoted migration and tenonic differentiation of tendon-derived stem cells (TDSCs). Meanwhile, TDSCs seeded in the inner surface of DTFS maintained viability, differentiated, and exhibited spreading. Furthermore, cell-seeded scaffolds guided the regeneration of tendon tissue in a rat Achilles tendon defect model. Our results suggest that DTFS combined with TDSCs is a novel and promising therapeutic option for tendon tissue engineering.