A Novel MRI-Based Paravertebral Muscle Quality (PVMQ) Score for Evaluating Muscle Quality and Bone Quality: A Comparative Study with the VBQ Score.

Purpose: This study aims to develop a novel MRI-based paravertebral muscle quality (PVMQ) score for assessing muscle quality and to investigate its correlation with the degree of fat infiltration (DFF) and the vertebral bone quality (VBQ) score of paravertebral muscles. Additionally, the study compares the effectiveness of the PVMQ score and the VBQ score in assessing muscle quality and bone quality. Methods: PVMQ scores were derived from the ratio of paravertebral muscle signal intensity (SI) to L3 cerebrospinal fluid SI on T2-weighted MRI. Image J software assessed paravertebral muscle cross-sectional area (CSA) and DFF. Spearman rank correlation analyses explored associations between PVMQ, VBQ scores, DFF, and T-scores in both genders. Receiver operating characteristic (ROC) curves compared PVMQ and VBQ scores' effectiveness in distinguishing osteopenia/osteoporosis and high paraspinal muscle DFF. Results: In this study of 144 patients (94 females), PVMQ scores were significantly higher in osteoporosis and osteopenia groups compared to normals, with variations observed between genders (P < 0.05). PVMQ showed stronger positive correlation with VBQ scores and DFF in females than males (0.584 vs 0.445, 0.579 vs 0.528; P < 0.01). ROC analysis favored PVMQ over VBQ for low muscle mass in both genders (AUC = 0.767 vs 0.718, 0.793 vs 0.718). VBQ was better for bone mass in males (0.737/0.865 vs 0.691/0.858), whereas PVMQ excelled for females (0.808/0.764 vs 0.721/0.718). Conclusion: The novel PVMQ score provides a reliable assessment of paravertebral muscle quality and shows a strong correlation with VBQ scores and DFF, particularly in females. It outperforms VBQ scores in evaluating muscle mass and offers valuable insights for assessing bone mass in females. These findings underscore the potential of the PVMQ score as a dual-purpose tool for evaluating both muscle and bone health, informing future research and clinical practice.

Location-dependent occurrence and distribution of metal-based nanoparticles in bay environments.

Metal-based nanoparticles (MNPs) are increasingly being released into the marine environment, posing potential environmental risks. However, factors governing the environmental occurrence and distribution of MNPs in bays still lack a comprehensive understanding. Herein, we collected seawater and sediment samples from two adjacent bays (Daya Bay and Honghai Bay, which have similar water qualities), and determined the particle concentrations and sizes of multi-element MNPs (Ti-, Cu-, Zn-, Ag-, Mn-, Pb- and Cr-based NPs) via single particle inductively coupled plasma-mass spectrometry (spICP-MS). The internal circulation in Daya Bay has resulted in an even distribution of MNPs' particle concentrations and sizes in both seawater and sediments, while the terrestrial discharge in Honghai Bay has led to a gradient-decreasing trend in MNPs' concentrations from nearshore to offshore. Moreover, the relatively high abundance of MNPs in Honghai Bay has contributed to 2.35-fold higher environmental risks than Daya Bay. Overall, this study has provided solid evidence on the critical but overlooked factors that have shaped the occurrence and distribution of MNPs, providing new insights for risk management and emission regulation.

Simplified S1 Vertebral Bone Quality Score in the Assessment of Patients with Vertebral Fragility Fractures.

OBJECTIVE: To evaluate the effectiveness of the S1 vertebral bone quality (VBQ) score in assessing bone quality among patients with vertebral fragility fractures (VFF). Additionally, whether the combination of S1 VBQ and Hounsfield unit (HU) values improves the predictive accuracy of VFF. METHODS: Using lumbar noncontrast computed tomography and T1-weighted magnetic resonance imaging, we measured L1 HU values, S1 VBQ, and L1-L4 VBQ. To assess their predictive performance for VFF, we constructed receiver operating characteristic curves. We also compared the diagnostic efficacy of HU values with that of S1 VBQ and L1--L4 VBQ values for the joint diagnosis of VFF. The Delong test was used to compare the value of individual or combined predictions of VFF. RESULTS: In comparison to the nonfracture group, all patients exhibited markedly elevated S1 VBQ and L1--L4 VBQ and notably reduced HU values (P < 0.001). Multivariate analysis revealed that elevated S1 VBQ, increased L1--L4 VBQ, and decreased HU values independently correlated with VFF development. The areas under the curve for VFF prediction were 0.806 for S1 VBQ, 0.799 for L1--L4 VBQ, and 0.820 for HU values. According to the Delong test, the combination of HU values with S1 VBQ/L1--L4 VBQ significantly improved the diagnostic accuracy. CONCLUSIONS: The simplified S1 VBQ is a valuable tool for predicting the occurrence of VFF and can be used as an alternative to the L1--L4 VBQ. In addition, the combination of S1 VBQ and HU values can significantly improve the predictive value of VFF.

The Significance of Combined OSTA, HU Value and VBQ Score in Osteoporosis Screening Before Spinal Surgery.

OBJECTIVE: This study aimed to assess the utility of a combined assessment using the Osteoporosis Self-Assessment Tool for Asians (OSTA), Hounsfield unit (HU) value, and vertebral bone quality (VBQ) score for preoperative osteoporosis (OP) screening in patients scheduled for spinal surgery. METHODS: This study encompassed 288 participants, including 128 males and 160 females. Patients were stratified into 2 groups: the OP group (T-score ≤ -2.5) and the non-OP group (T-score > -2.5), determined by dual-energy X-ray absorptiometry (DEXA). Binary logistic regression was used to construct a combined diagnostic model, and the receiver operating characteristic (ROC) curve evaluated the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of these metrics individually or in combination to screen for OP. RESULTS: Osteoporosis patients exhibited significantly lower OSTA and HU values in comparison to non-OP patients, while their VBQ scores were significantly higher (P < 0.001). The ROC curve analysis results indicated that within the male group, the combined diagnosis had a sensitivity of 93.8%, specificity of 82.3%, accuracy of 85.2%, PPV of 63.8%, and NPV of 97.5%. In the female group, the combined diagnosis had a sensitivity of 93.9%, specificity of 87.4%, accuracy of 90.0%, PPV of 83.6%, and NPV of 95.4%. CONCLUSIONS: The combined use of OSTA, HU values, and VBQ scores in preoperative OP screening for spinal surgery demonstrates significantly higher accuracy and superior screening value compared to individual assessments. These results establish a robust scientific foundation for conducting preoperative OP screening in patients undergoing spinal surgery.

3D-printed custom implant for the management of "locked" posterior dislocation of the shoulder joint with reverse Hill-Sachs lesion: a case report.

Introduction: Irregular bone defects of the humerus are common in clinical practice, but there are fewer reported cases of irregular humeral defects accompanied by shoulder joint "locking" dislocation and reverse Hill-Sachs injury caused by an electric shock. The choice of treatment for such cases is closely related to the extent of shoulder joint function recovery. This is a case report of a 60-year-old male patient who suffered from a shoulder joint "locking" dislocation with accompanying reverse Hill-Sachs injury due to muscle contraction after being electrically shocked at work. The patient was treated with a 3D-printed custom humeral head prosthesis for the treatment of the shoulder joint "locking" dislocation and reverse Hill-Sachs injury. Case presentation: A 60-year-old male patient, working as a construction worker, presented to our emergency department with right shoulder pain and restricted movement for more than 30 min after an electric shock. Right humeral CT revealed a comminuted fracture of the right humeral head. D-dimer levels were significantly elevated at 3239.00 ng/mL, and oxygen partial pressure was slightly decreased at 68 mmHg. Treatment included emergency wound debridement and dressing for the electrical injury, cardioprotective measures, anticoagulation, and symptomatic management. After stabilizing the patient's condition, the patient underwent 3D-printed custom prosthesis-assisted partial replacement of the right humeral head and rotator cuff repair in the orthopedic department. Postoperatively, the patient's right shoulder joint wound healed well, and mobility was restored. Conclusion: This case report demonstrates that the use of a 3D-printed custom prosthesis for the treatment of irregular humeral bone defects caused by specific injury mechanisms, especially cases involving shoulder joint "locking" dislocation and reverse Hill-Sachs injury, can achieve precise bone defect repair, minimize surgical trauma, and provide superior outcomes in terms of postoperative functional rehabilitation.

Association of preoperative hypoprotein malnutrition with spinal postoperative complications and other conditions: A systematic review and meta-analysis.

BACKGROUND: Postoperative complications of spinal surgery are a common clinical problem, which impose significant economic and clinical burdens on patients and medical staff. Previous studies have suggested a close relationship between low-protein malnutrition and postoperative complications of surgery. However, the relationship between preoperative malnutrition and various orthopedic postoperative complications remains unclear. PURPOSE: To investigate the association between protein malnutrition and postoperative complications and outcomes. METHODS: We conducted a systematic search of the PubMed, Embase, Cochrane Library, and Web of Science databases for published research articles between the database inception and February 28th, 2023, that evaluated the association between malnutrition and the risk of postoperative complications and death in spinal surgery patients. Malnutrition was defined as low pre-albumin and albumin levels before surgery. Two evaluators independently extracted study data and assessed the risk of bias in each study. Fixed- or random-effect models were used to calculate the pooled effect estimates. Funnel plots and Egger's tests were used to detect publication bias, and the Trim-and -Fill method was conducted to evaluate the impact of publication bias on the results. RESULTS: A total of 26 studies were included in this meta-analysis, comprising 17 retrospective cohort studies and 9 case-control studies. The study included more than 86,000 participants. Analysis of postoperative complications revealed that the overall incidence of malnutrition-related complications after surgery was 3.17 times higher (OR = 3.17, 95% CI 2.69-3.75, z = 13.57, P < 0.05). The incidence of surgical site infections was 2.08 times higher (OR = 2.08, 95% CI 1.66-2.62, z = 6.307, P < 0.05), and the incidence of postoperative urinary tract infections was 2.55 times higher (OR = 2.55, 95% CI 1.80-3.60, z = 5.30, P < 0.05). The incidence of postoperative sepsis was 3.31 times higher (OR = 3.31, 95% CI 2.31-4.75, z = 6.51, P < 0.05), and the incidence of postoperative pneumonia was 3.02 times higher (OR = 3.02, 95% CI 1.331-6.857, z = 2.64, P = 0.008 < 0.05). The incidence of postoperative cardiac complications was 4.24 times higher (OR = 4.24, 95% CI 2.45-7.35, z = 5.15, P < 0.05), and the incidence of postoperative renal complications was 4.04 times higher (OR = 4.04, 95% CI 2.06-7.93, z = 4.05, P < 0.05). The incidence of postoperative pulmonary complications was 2.38 times higher (OR = 2.38, 95% CI 1.46-3.87, z = 6.98, P < 0.05), while the incidence of postoperative thrombotic complications was 2.76 times higher (OR = 2.76, 95% CI 1.756-4.345, z = 4.40, P < 0.05). Furthermore, the incidence of transfusion during and after surgery was 1.33 times higher (OR = 1.33, 95% CI 1.13-1.56, z = 3.40, P = 0.001 < 0.05), the incidence of postoperative readmission was 1.67 times higher (OR = 1.67, 95% CI 1.24-2.27, z = 3.33, P = 0.001 < 0.05), and the risk of postoperative death was 6.01 times higher (OR = 6.01, 95% CI 4.51-8.01, z = 12.27, P < 0.05). After conducting a publication bias test and Trim-and -Fill method analysis, we found no evidence of publication bias, and the results remained stable. CONCLUSION: Preoperative low protein malnutrition is closely related to the incidence of postoperative complications and postoperative status. More prospective multicenter studies should be conducted to validate this conclusion. Furthermore, more effective assessment and intervention of preoperative nutritional status should be carried out to prevent the occurrence of postoperative complications and mortality risk.