Background Frailty is associated with poorer outcomes in cardiac surgery, but the heterogeneity in frailty assessment tools makes it difficult to ascertain its true impact in cardiac surgery. Slow gait speed is a simple, validated, and reliable marker of frailty. We performed a systematic review and meta‐analysis to examine the effect of slow gait speed on postoperative cardiac surgical patients. Methods PubMED, MEDLINE, and EMBASE databases were searched from January 2000 to August 2021 for studies comparing slow gait speed and “normal” gait speed. Primary outcome was in‐hospital mortality. Secondary outcomes were composite mortality and major morbidity, AKI, stroke, deep sternal wound infection, prolonged ventilation, discharge to a healthcare facility, and ICU length of stay. Results There were seven eligible studies with 36,697 patients. Slow gait speed was associated with increased likelihood of in‐hospital mortality (risk ratio [RR]: 2.32; 95% confidence interval [CI]: 1.87–2.87). Additionally, they were more likely to suffer from composite mortality and major morbidity (RR: 1.52; 95% CI: 1.38–1.66), AKI (RR: 2.81; 95% CI: 1.44–5.49), deep sternal wound infection (RR: 1.77; 95% CI: 1.59–1.98), prolonged ventilation >24 h (RR: 1.97; 95% CI: 1.48–2.63), reoperation (RR: 1.38; 95% CI: 1.05–1.82), institutional discharge (RR: 2.08; 95% CI: 1.61–2.69), and longer ICU length of stay (MD: 21.69; 95% CI: 17.32–26.05). Conclusion Slow gait speed is associated with poorer outcomes in cardiac surgery. Frail patients are twofold more likely to die during hospital admission than nonfrail counterparts and are at an increased risk of developing various perioperative complications.

Giant cell tumour of bone (GCTB) is a locally aggressive bone neoplasm with a rare tendency to metastasise, most commonly to the lungs. The management of metastatic GCTB (metGCTB) is controversial due to its unpredictable behaviour. Asymptomatic patients should be monitored radiologically and undergo treatment only when disease progression occurs. Surgery is recommended for resectable metGCTB. Denosumab, a monoclonal antibody which inhibits receptor activator of nuclear factor‐κB ligand, is recommended for unresectable metGCTB with evidence from phase II trials demonstrating its safety and efficacy. Relapse after denosumab withdrawal may occur and prolonged treatment may be associated with serious adverse events, thus further research is warranted to inform a maintenance regimen with reduced dosing and frequency. Combined denosumab and bisphosphonate therapy has the potential to achieve sustained disease control or remission in unresectable metGCTB without requiring long‐term treatment and should be evaluated in prospective trials. Various novel agents have demonstrated in vitro and anecdotal efficacy and warrant further evaluation.

The corrosion tendency and fatigue behavior of a SM480C welded joint in a sea-crossing suspension bridge after twenty-year exposure to a marine environment was investigated in this work. It was found that the corrosion product on the whole surface of the welded joint is loose, with many holes and cracks, which allowing corrosive media enter and reach the surface of the substrate. Localized corrosion occurred in the weld zone (WZ) and the heat-affected zone (HAZ), the maximum depth of localized corrosion in the HAZ reached 1.8 mm, and the maximum local corrosion rate is 0.082 mm/y. By using Bimetallic Conjugation Theory calculations, the galvanic effect of the welded joint was qualified, indicates that HAZ was the most corrosion susceptible area in the welded joint. The galvanic corrosion current on HAZ reached approximately 2 μA, which is much higher than the corrosion of isolated HAZ by about 6.5 times. The corrosion has an obvious influence on the fatigue performance, the elongation of the bridge deck decreases by 40%~70%, and the tensile strength decreases by 4.5%~31.33%. In order to ensure the service safety and avoid premature failure, the average thickness of the corroded bridge deck should not be less than 10 mm under the stress amplitude of 115 MPa.

Objective: Frailty is an increasingly recognized marker of poor surgical outcomes in cardiac surgery. Frailty first was described in the seminal “Fried” paper, which constitutes the longest-standing and most well-recognized definition. This study aimed to assess the impact of the Fried and modified Fried frailty classifications on patient outcomes following cardiac surgery. Methods: The PUBMED, MEDLINE, and EMBASE databases were searched from January 2000 until August 2021 for studies evaluating postoperative outcomes using the Fried or modified Fried frailty indexes in open cardiac surgical procedures. Primary outcomes were one-year survival and postoperative quality of life. Secondary outcomes included postoperative complications, intensive care unit (ICU) length of stay (LOS), total hospital LOS, and institutional discharge. Results: Eight eligible studies were identified. Meta-analysis identified that frailty was associated with an increased risk of one-year mortality (Risk Ratio [RR]:2.23;95% confidence interval [CI]1.17 -4.23), postoperative complications (RR 1.78;95% CI 1.27 – 2.50), ICU LOS (Mean difference [MD] 21.2 hours;95% CI 8.42 – 33.94), hospital LOS (MD 3.29 days; 95% CI 2.19 – 4.94), and institutional discharge (RR 3.29;95% CI 2.19 – 4.94). A narrative review of quality of life suggested an improvement following surgery, with frail patients demonstrating a greater improvement from baseline over non-frail patients. Conclusions: Frailty is associated with a higher degree of surgical morbidity, and frail patients are twice as likely to experience mortality within one-year post-operatively. Despite this, quality of life also improves dramatically in frail patients. Frailty, in itself, does not constitute a contraindication to cardiac surgery.