Modified Frailty Index and Body Mass Index as Predictors of Adverse Surgical Outcomes in Degenerative Spinal Disease.

AIM: To reveal the potential relationships and interactive effects between frailty and body weight and adverse surgical outcomes for degenerative spinal disease. MATERIAL AND METHODS: Patients who underwent open surgery for degenerative spinal disease in our hospital were included. Data on the patients and disease variables was obtained. The primary independent variables included body mass index (BMI) and modified Frailty Index (mFI). The primary outcome was the Clavien-Dindo complications classification. After univariate analyses, multinomial and ordinal regression analyses were applied with the Clavien-Dindo complications grade as the dependent variable and the potential risk factors for complications as independent variables, respectively, to determine the potential interactive relationship between the two primary risk factors and their impact on postoperative complications grading. RESULTS: A total of 1970 patients were included in the study. The results showed that "underweight" could significantly increase the odds ratios of "prefrail" and "frail" at the same time; however, "obese" could only increase the odds ratio of "frail". The "underweight", "obese", "prefrail" and "frail" subgroups could significantly increase the grading of postoperative complications, respectively. If mFI and BMI were combined as an interactive variable, the results showed that in the "underweight" and "normal weight" subgroups, both "prefrail" and "frail" could significantly increase the grading of postoperative complications; however, in the "overweight" and "obese" subgroups, only the "overweight/frail", "obese/non-frail" and "obese/frail" subgroups displayed significantly increased grading of postoperative complications. CONCLUSION: The present results serve to stratify susceptible patients with easily identified risk factors preoperatively.

3D printing-assisted preoperative plan of pedicle screw placement for middle-upper thoracic trauma: a cohort study.

BACKGROUND: This study aimed to evaluate the application of 3D printing in assisting preoperative plan of pedicle screw placement for treating middle-upper thoracic trauma. METHODS: A preoperative plan was implemented in seven patients suffering from middle-upper thoracic (T3-T7) trauma between March 2013 and February 2016. In the 3D printing models, entry points of 56 pedicle screws (Magerl method) and 4 important parameters of the pedicle screws were measured, including optimal diameter (ϕ, mm), length (L, mm), inclined angle (α), head-tilting angle (+ß), and tail-tilting angle (-ß). In the surgery, bare-hands fixation of pedicle screws was performed using 3D printing models and the measured parameters as guidance. RESULTS: A total of seven patients were enrolled, including five men and two women, with the age of 21-62 years (mean age of 37.7 years). The position of the pedicle screw was evaluated postoperatively using a computerized tomography scan. Totally, 56 pedicle screws were placed, including 33 pieces of level 0, 18 pieces of level 1, 4 pieces of level 2 (pierced lateral wall), and 1 piece of level 3 (pierced lateral wall, no adverse consequences), with a fine rate of 91.0%. CONCLUSIONS: 3D printing technique is an intuitive and effective assistive technology to pedicle screw fixation for treating middle-upper thoracic vertebrae, which improve the accuracy of bare-hands screw placement and reduce empirical errors. TRIAL REGISTRATION: The trial was approved by the Ethics Committee of the Fujian Provincial Hospital. It was registered on March 1st, 2013, and the registration number was K2013-03-001.

The impact of hemocoagulase for improvement of coagulation and reduction of bleeding in fracture-related hip hemiarthroplasty geriatric patients: A prospective, single-blinded, randomized, controlled study.

BACKGROUND: Uncontrolled bleeding is associated with poor outcomes and mortality in geriatric patients undergoing hemiarthroplasty. Hemocoagulase agkistrodon is a hemocoagulative, anti-hemorrhagic enzyme complex from Deinagkistrodon acutus snake venom. This study aimed to investigate the efficacy of hemocoagulase agkistrodon on coagulation and bleeding outcomes in fracture-related hemiarthroplasty. PATIENTS AND METHODS: This was a prospective, single-blinded, randomized controlled trial carried out between October 2013 and September 2014 in 96 geriatric patients undergoing hemiarthroplasty for unilateral femoral neck fracture. Patients were administrated hemocoagulase agkistrodon (n=48) or normal saline (n=48). Intraoperative blood loss, transfusion volume and rate, and drainage were assessed. Hemoglobin (Hb) and coagulation parameters (prothrombin time [PT], thrombin time [TT], plasma fibrinogen [FIB], and activated partial thromboplastin time [aPTT]) were recorded preoperatively and 30min and 1, 3, and 5days after surgery. Complications were followed up for 4 weeks. RESULTS: Compared to controls, hemocoagulase patients exhibited lower intraoperative blood loss (P<0.01) and postoperative blood loss, total drainage, mean transfusion volume, and transfusion rates (all P<0.05), with lower aPTT at 30min (P<0.05). No significant differences in postoperative FIB were observed. Controls exhibited significantly higher PP and TT on day 1, and Hb on days 1, 3, and 5 (P<0.05). No serious complications were reported. CONCLUSIONS: Hemocoagulase reduced blood loss and transfusion in fracture-related hip hemiarthroplasty without increasing short-term adverse event rates. In geriatric populations, hemocoagulase could be used for limiting bleeding and related complications. TRIAL REGISTRATION: This trial is registered in the Chinese Clinical Trial Register (no. ChiCTR-TRC-14004379).

The injection efficiency measurement and analysis for central region model cyclotron.

At the China Institute of Atomic Energy, a central region model cyclotron has been constructed, which is dedicated for various experimental verifications to study beam properties. The design features of the ion source and injection line have already been described in other papers. We shall report here the results of the initial beam tests. A wire scanner is employed in the injection line to measure beam transverse sizes and these data can be used to fit the phase plane parameters after the ion source. Based on the beam tests results, the ion source built in 2003 has been improved recently. The improvement is mainly due to the repair of the multicusp field. From the ion source to the exit of the inflector, a transmission efficiency of 93% has been obtained for a continuous and low current input beam. It is also described here the experimental arrangement and the results.

Ion source and low energy injection line for a central region model cyclotron.

At CIAE, a 100 MeV H(-) cyclotron (CYCIAE-100) is under design and construction. A central region model (CRM) cyclotron was built for various experimental verifications for the CYCIAE-100 project and for research and development of high current injection to accelerate milliampere H(-) beam. The H(-) multicusp source built in 2003 has been improved recently to make the source operation more stable. A new injection line for axial low energy high current injection has been designed and constructed for the CRM cyclotron.