12th Thoracic Vertebra Research Articles

Impact of osteopenia on surgical and oncological outcomes in patients with pancreatic cancer.

Osteopenia, which is defined as a decrease in bone mineral density, has been recently recognized as a metabolic and an oncological biomarker for surgery in patients with malignancy. We aimed to study the prognostic impact of osteopenia in patients with pancreatic cancer (PC) after resection. A total of 56 patients who underwent curative resection of PC were retrospectively investigated. The skeletal muscle index at the third lumbar spine and bone mineral density at the 11th thoracic vertebra were measured using computed tomography. Sarcopenia and osteopenia were identified in 24 (43%) and 27 (48%) patients, respectively. The overall and disease-free survival rates were significantly lower in the sarcopenia group than in the non-sarcopenia group (p < 0.01 and p < 0.01, respectively) and in the osteopenia group than in the non-osteopenia group (p < 0.01 and p < 0.01, respectively). In multivariate analysis, sarcopenia (odds ratio [OR] 4.05; 95% confidence interval [CI] 1.23-13.38; p = 0.02) was a significant independent predictor of 1-year disease-free survival. Further, sarcopenia (OR 6.00; 95% CI 1.46-24.6; p = 0.01) and osteopenia (OR 4.66; 95% CI 1.15-18.82; p = 0.03) were significant independent predictors of 2-year overall survival. Osteopenia is a significant negative factor for 2-year overall survival after curative resection of PC.

Prognostic Significance of Preoperative Osteopenia in Patients Undergoing Esophagectomy for Esophageal Cancer.

Osteopenia, which exhibits low bone mineral density (BMD), has been linked to sarcopenia and recently reported as a prognostic factor in various cancers. However, the prognostic significance of osteopenia in esophageal cancer remains unclear. Hence, this study aimed to clarify the impact of osteopenia on the prognosis of patients undergoing esophagectomy for esophageal cancer. We included 229 patients who underwent esophagectomy. BMD was calculated as the average pixel density (Hounsfield unit) within a circle in midvertebral core at the 11th thoracic vertebra on preoperative computed tomography. We then divided the patients into the Osteopenia group (n = 159) and the Non-Osteopenia group (n = 70) according to the optimal cutoff value obtained from the receiver operating characteristic curve. Their clinicopathological data, prognosis, and recurrence were analyzed. The mean age was significantly older in the Osteopenia group (p = 0.047). The Osteopenia group had significantly worse overall survival (OS) and relapse-free survival (RFS) than the Non-Osteopenia group (p = 0.001 and p = 0.012, respectively). Multivariate analysis revealed osteopenia was an independent prognostic factor for OS (p < 0.001; hazard ratio [HR], 2.243; 95% confidence interval [CI], 1.422-3.538) and RFS (p = 0.008; HR, 1.739; 95% CI, 1.154-2.620). In logistic regression model, advanced age and cStage III-IV were independent risk factors for preoperative osteopenia. Preoperative osteopenia is associated with poor survival and recurrence in patients undergoing esophagectomy for esophageal cancer.

Reduced muscle mass as predictor of intensive care unit hospitalization in COVID-19 patients.

PurposeTo evaluate if reduced muscle mass, assessed with Computed Tomography (CT), is a predictor of intensive care unit (ICU) hospitalization in COVID-19 patients.MethodsIn this Institution Review Board approved study, we retrospectively evaluated COVID-19 patients treated in our tertiary center from March to November 2020 who underwent an unenhanced chest CT scan within three weeks from hospitalization.We recorded the mean Hounsfield Unit (Hu) value of the right paravertebral muscle at the level of the 12th thoracic vertebra, the hospitalization unit (ICU and COVID-19 wards), clinical symptoms, Barthel Index, and laboratory findings.Logistic regression analysis was applied to assess if muscle loss (Hu<30) is a predictor of ICU admission and outcome.Fisher’s exact and Student’s tests were applied to evaluate if differences between patients with and without muscle loss occurred (p<0.05).ResultsOne-hundred-fifty patients matched the inclusion criteria (46 females; mean age±SD 61.3±15 years-old), 36 treated in ICU. Patients in ICU showed significantly lower Hu values (29±24 vs 39.4±12, p = 0.001). Muscle loss was a predictor of ICU admission (p = 0.004).Patients with muscle loss were significantly older (73.4±10 vs 56.4±14 years), had lower Barthel Index scores (54.4±33 vs 85.1±26), red blood-cell count (3.9±1 vs 4.6±1×1012L−1), and Hb levels (11.5±2 vs 13.2±2g/l) as well as higher white blood-cell count (9.4±7 vs 7.2±4×109L−1), C-reactive protein (71.5±71 vs 44±48U/L), and lactate dehydrogenase levels (335±163 vs 265.8±116U/L) (p<0.05, each).ConclusionsMuscle loss seems to be a predictor of ICU hospitalization in COVID-19 patients and radiologists reporting chest CT at admission should note this finding in their reports.

A Smart Technique to Remove Ruptured Inflatable Bone Tamp From the Vertebral Body in Balloon Kyphoplasty.

Accidental rupture of the inflatable bone tamp is a rare but possible complication during balloon kyphoplasty. We describe an easy and minimal invasive technique to remove this foreign body from fractured vertebra. A 62-year-old female patient with severe osteoporosis had a low energy trauma and sustained burst fracture of the 12th thoracic (Th12) vertebra. The inflated bone tamp was not possible to be fully deflated and during the maneuvers to withdraw the balloon, it was disassembled and trapped under the distal end of working cannula, remaining within the bone cavity formed by balloon. Since no standard recommendation for this complication exists in current literature, we faced the dilemma of either leaving ruptured bone tamp in situ or removing it with a more extensive approach. We decided to use an alternative minimal invasive technique and managed to remove it through the right pedicle using a small size straight pituitary rongeur forceps under biplane continuous image intensifier and neuromonitoring. Subsequently, balloon kyphoplasty (BK) was performed through the left cannula accompanied with pedicle screw fixation of the adjacent vertebrae. The patient was followed up to our outpatient department for one year without complications. This extremely rare complication during BK consists of a challenge for spine surgeons and interventional radiologists. The described technique is relatively easy, safe, minimal invasive, time-saving and avoids further complications related with trapping of foreign bodies within the vertebral body.

Computed Tomographic Morphometry of Lumbar Spine in Indian Population

Abstract Purpose Several studies have been conducted to determine morphometry of lumbar vertebrae, mostly in western population and data on other populations is relatively sparse. Most of these studies have been carried out using fresh cadavers or osteological collections and several of them having limitations such as a small sample size and lack of demographic information. We conducted morphometric analysis of the lumbar vertebrae in a relatively large number of Indian patients using computed tomography scan. Vertebral body and pedicle dimensions of lumbar spinal elements were documented in Indian population and compared with other studies from the subcontinent as well as from other parts of the world. The morphometric data thus compiled may help in the development of new spinal implants for transpedicular screw fixations. Methods An observational study was conducted and a total of 302 patients were evaluated. Thin section computed tomographic images of the 12th thoracic vertebra (D12) to 1st sacral vertebra (S1) were acquired and various dimensions of vertebral body and pedicle were recorded and analyzed. Results Generally, the lumbar vertebral and pedicle dimensions were found to be greater in male patients. Comparison of dimensions in different populations revealed statistically significant differences in pedicle dimensions between Indian population and others. Conclusion Morphometric analysis of lumbar vertebrae using computed tomography scan provides measurements of different vertebral dimensions. This will help in development of spinal implants in future to meet the specific needs of the studied population.

A Comparative Study of Dexmedetomidine as Adjuvant to 0.5% Bupivacaine in Erector Spinae Plane Block for Perioperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy

Context: Patients undergoing percutaneous nephrolithotomy (PCNL) experience considerable post-operative pain. Perioperative pain control for PCNL using regional anaesthesia techniques like erector spinae plane block (ESPB) helpsin better outcome in terms of pain, fentanyl requirement. It also indirectly helps in faster recovery and early discharge from hospital. Aims: To assess and compare perioperative pain control provided by ESPB with 0.5% bupivacaine and dexmedetomidine as adjuvant to it. Settings and Design: This randomized case control study was undertaken in a tertiary care centre. 60 patientsplanned for elective unilateral PCNL over a period of 15 months. Patients were randomized into two groups (Group B and group D) using envelope method. Patients were compared for fentanyl consumption, duration and effectiveness of analgesia obtained. Methods and Materials: ESPB was administered pre operatively under ultrasound guidance at the level of 10th thoracic vertebrae. Needle tip was visualised above transverse process of 10th thoracic vertebra. Position was confirmed by hydro dissection on injecting normal saline under ultrasound and drug was injected.Patients were assessed for painat specific time intervals. Total opioid consumption was noted. Data obtained was recorded and analysed. Statistical analysis used: Statistical analysis was performed by SPSS software v.23.0. Oneway analysis of variance, Bonferroni correction, Chi square test was used. P value of &lt;0.05 was considered statistically significant. Results: Dexmedetomidine as adjuvant to local anaesthetic agent improves the quality and prolongs the duration of analgesia. It also decreases total fentanyl consumption. Conclusion: ESPB provides adequate analgesia for PCNL. Addition of dexmedetomidine decreases fentanyl and sevoflurane consumption meanwhile increasing duration of analgesia.

Prognostic Implication of Baseline Sarcopenia for Length of Hospital Stay and Survival in Patients With Coronavirus Disease 2019.

BackgroundThe impact of sarcopenia on clinical outcomes of coronavirus disease 2019 (COVID-19) is not clearly determined yet. We aimed to investigate the association between baseline sarcopenia and clinical outcomes in patients with COVID-19.MethodsAll hospitalized adult patients with COVID-19 who had baseline chest computed tomography (CT) scans at a Korean university hospital from February 2020 to May 2020 were included. The main outcome was time from hospital admission to discharge. Death was considered as a competing risk for discharge. Baseline skeletal muscle cross-sectional area at the level of the 12th thoracic vertebra was measured from chest CT scans. The lowest quartile of skeletal muscle index (skeletal muscle cross-sectional area divided by height-squared) was defined as sarcopenia.ResultsOf 121 patients (median age, 62 years; 44 men; 29 sarcopenic), 7 patients died and 86 patients were discharged during the 60-day follow-up. Patients with sarcopenia showed a longer time to discharge (median, 55 vs. 28 days; p<0.001) and a higher incidence of death (17.2% vs. 2.2%; p=0.004) than those without sarcopenia. Baseline sarcopenia was an independent predictor of delayed hospital discharge (adjusted hazard ratio [aHR], 0.47; 95% CI, 0.23-0.96), but was not independently associated with mortality in patients with COVID-19 (aHR, 3.80; 95% CI, 0.48-30.26). The association between baseline sarcopenia and delayed hospital discharge was consistent in subgroups stratified by age, sex, comorbidities, and severity of COVID-19.ConclusionBaseline sarcopenia was independently associated with prolonged hospital stay in patients with COVID-19. Sarcopenia could be a prognostic marker in COVID-19.

Safety analysis of early oral feeding after esophagectomy in patients complicated with diabetes

ObjectiveTo evaluate the safety of early oral feeding in patients with type II diabetes after radical resection of esophageal carcinoma.MethodsThe clinical data of 121 patients with type II diabetes who underwent radical resection of esophageal carcinoma in the department of cardiothoracic surgery of Jinling Hospital from January 2016 to December 2018 were retrospectively analyzed. According to the median time (7 days) of the first oral feeding after surgery, the patients were divided into early oral feeding group (EOF, feeding within 7 days after surgery, 67 cases) and late oral feeding group (LOF, feeding after 7 days, 54 cases). Postoperative blood glucose level, incidence of complications, nutritional and immune indexes, inflammatory indexes, normalized T12-SMA (the postoperative/preoperative ratio of vertical spinal muscle cross-sectional area at the 12th thoracic vertebra level) and QLQ-C30 (Quality Of Life Questionnaire) scores were recorded and compared in the two groups.ResultsThere was no statistical difference in preoperative nutritional index and postoperative complication rates between the EOF and LOF group (p > 0.05). The postoperative nutritional index (ALB, PA, TRF, Hb) and immune index (IgA, IgG, IgM) of the EOF group were higher than those of the LOF group (p < 0.05), and the inflammatory indicators (CRP, IL-6) of the EOF group were significantly lower than those of the LOF group (p < 0.05). Moreover, postoperative T12-SMA variation and QLQ-C30 scores of the EOF group were higher than those in LOF group (p < 0.05).ConclusionsEarly oral feeding is safe and feasible for patients with type II diabetes after radical resection of esophageal cancer, and it can improve short-term nutritional status and postoperative life quality of the patients.

Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non-small-cell lung cancer.

BackgroundDespite the associations of both preoperative sarcopenia and physical performance with post‐operative mortality in non‐small‐cell lung cancer (NSCLC), there have been no comprehensive studies of the impact of physical status on prognosis. This study was performed to investigate the prognostic significance of preoperative sarcopenia and physical performance in NSCLC.MethodsThis retrospective cohort study was performed in NSCLS patients undergoing curative lung resection at a university hospital between January 2014 and December 2017. The patients were divided into four groups according to the skeletal muscle index [sarcopenia (lowest sex‐specific tertile) and non‐sarcopenia] and 6 min walking distance (6MWD) [short distance (<400 m) and long distance (≥400 m)]. Sarcopenia was assessed by preoperative cross‐sectional areas of right and left paraspinous muscles at the level of the 12th thoracic vertebra from computed tomography images, and physical performance was determined by preoperative 6MWD. The primary and secondary endpoints were post‐operative overall survival (OS) and disease‐free survival (DFS).ResultsThe 587 patients [mean age: 68.5 ± 8.8 years, 399 men (68%)] included in the study were divided into the non‐sarcopenia/long‐distance group (58%), sarcopenia/long‐distance group (26%), non‐sarcopenia/short‐distance group (9%), and sarcopenia/short‐distance group (7%). A total of 109 (18.6%) deaths and 209 (35.6%) combined endpoints were observed over a mean follow‐up of 3.1 ± 1.3 years. After adjusting for other covariates, the sarcopenia/short‐distance group showed significant associations with shorter OS (hazard ratio, 3.38; 95% confidence interval, 1.79–6.37; P < 0.001) and DFS (hazard ratio, 2.11; 95% confidence, 1.27–3.51; P = 0.004) compared with the non‐sarcopenia/long‐distance group on multivariate analyses. Although not significant, adding skeletal muscle index and 6MWD to the pre‐existing risk model increased the area under the curve on time‐dependent receiver operating characteristic curve analysis for OS and DFS, except within 2 years of surgery.ConclusionsThe presence of both preoperative paraspinous muscle sarcopenia and short distance in 6MWD had an adverse effect on post‐operative prognosis in patients with NSCLC, suggesting that preoperative assessment of thoracic sarcopenia and physical performance may be useful for risk stratification of surgical candidates with potential for targeted interventions.

Quantitative assessment of erector spinae muscles and prognosis in elderly patients with pneumonia

Erector spinae muscle (ESM) size has been reported as a predictor of prognosis in patients with some respiratory diseases. This study aimed to assess the association of ESM size on all-cause in-hospital mortality among elderly patients with pneumonia. We retrospectively included patients (age: ≥ 65 years) admitted to hospital from January 2015 to December 2017 for community-acquired pneumonia who underwent chest computed tomography (CT) on admission. The cross-sectional area of the ESM (ESMcsa) was measured on a single-slice CT image at the end of the 12th thoracic vertebra and adjusted by body surface area (BSA). Cox proportional hazards regression models were used to assess the influence of ESMcsa/BSA on in-hospital mortality. Among 736 patients who were admitted for pneumonia, 702 patients (95%) underwent chest CT. Of those, 689 patients (98%) for whom height and weight were measured to calculate BSA were included in this study. Patients in the non-survivor group were significantly older, had a greater frequency of respiratory failure, loss of consciousness, lower body mass index, hemoglobin, albumin, and ESMcsa/BSA. Multivariate analysis showed that a lower ESMcsa/BSA independently predicted in-hospital mortality after adjusting for these variables. In elderly patients with pneumonia, quantification of ESMcsa/BSA may be associated with in-hospital mortality.

Osteosarcopenia is a potential predictor for the prognosis of patients who underwent hepatic resection for colorectal liver metastases.

AimWe investigated the prognostic impact of osteosarcopenia, which is the combination of osteopenia and sarcopenia, in patients with colorectal liver metastases (CRLM) after hepatic resection.MethodsOne hundred and eighteen patients were analyzed retrospectively. Osteopenia was evaluated with computed tomographic measurement of pixel density in the midvertebral core of the 11th thoracic vertebra. Sarcopenia was evaluated with psoas muscle areas at the third lumbar vertebra. Osteosarcopenia was defined as the concomitant occurrence of osteopenia and sarcopenia.ResultsOsteosarcopenia was identified in 38 (32%) of the patients. In univariate analysis, the overall survival was significantly worse in patients with lymph node metastases (P = .01), extrahepatic lesion (P = .01), sarcopenia (P = .02), osteosarcopenia (P < .01), Glasgow Prognostic Score (GPS) 1 or 2 (P = .05), and curability R 1 or 2 (P = .04). In multivariate analysis, lymph node metastases (P < .01), osteosarcopenia (P < .01), and GPS 1 or 2 (P = .03) were independent and significant predictors of the overall survival. In patients with osteosarcopenia, there were more women than men and body mass index was lower compared to patients without osteosarcopenia.ConclusionOsteosarcopenia was the strong predictor for outcomes in patients who underwent liver resection for CRLM.

Relationship between Preoperative Neuroradiological Findings and Intraoperative Bulbocavernosus Reflex Amplitude in Patients with Intradural Extramedullary Tumors.

The current study aimed to evaluate the relationship between preoperative neuroradiological findings and intraoperative bulbocavernosus reflex (BCR) amplitude in patients with intradural extramedullary tumors. A total of 24 patients with lesions below the 12th thoracic vertebra were included in the analysis. Objective and subjective urinary symptoms were investigated using data obtained from medical records and the core lower urethral symptom score (CLSS) questionnaire. The lesion compression rate was evaluated with MRI. In the epiconus-to-conus medullaris (Epi-CM) group, BCR amplitude changes were found to be correlated with the compression rate (p <0.05). The preoperative CLSS of the group with a BCR amplitude of <50% was worse than that of the group with ≥50% (p <0.01). The group did not experience symptom improvement 6 months postoperatively based on the CLSS. The preoperative CLSS of the group with compression rate of ≥80% on imaging was worse than that of the group with <80% (p <0.05). In the group with preoperative compression rate of ≥80%, CLSS at 1 month and 6 months postoperatively was improved as compared to preoperative CLSS (p <0.01, p <0.05). Hence, BCR amplitude changes are associated with the degree of lesion compression on preoperative images and pre- and postoperative urinary symptoms. Patients with intradural extramedullary Epi-CM lesions with strong compression are likely to present with low BCR amplitude and worsened postoperative symptoms. It is considered that the risk of postoperative urinary symptoms increases even with careful surgical manipulation under these conditions.

Spinalna stabilizacija patoloških preloma kod metastatske bolesti na udaljenim segmentima - prikaz slučaja

About 2/3 of malignant tumors develop metastases. The skeletal system is the third most common site of metastases, of which the spine takes the first place in terms of prevalence. Skeletal metastases can occur in all types of malignant tumors, and the breast is one of the most common localizations. Treatment of vertebral fractures can be non-operative and operative. Although numerous studies have shown the benefits of both non-operative and operative treatments, depending on the situation, several of them have recommended a surgical approach as a better way to preserve the patient's mobility. The patient contacted a spinal surgeon due to back pain when she was diagnosed with a pathological fracture of the 7th cervical and 12th thoracic vertebrae. Both fractures were operatively treated, in two time intervals. Given the advances in the treatment of malignant diseases, more people with spinal metastases live today than ever before in history. Patients with unstable pathological fractures are treated surgically, while patients who have stable fractures without dislocations can be treated only with chemotherapy and radiotherapy. The presentation of this patient showed how pathologically unstable vertebral fractures were treated on several levels. Operational approaches were as different as operational techniques. After the surgical treatment and an early rehabilitation, there was a significant improvement in the clinical picture and quality of life of the patient.

Assessing skeletal muscle mass based on the cross-sectional area of muscles at the 12th thoracic vertebra level on computed tomography in patients with oral squamous cell carcinoma.

This study aimed to create a formula to estimate the third lumbar vertebra (L3)1 level skeletal muscle cross-sectional area (CSA), known as a standard value to evaluate skeletal muscle mass on computed tomography (CT), using the twelfth thoracic vertebra (Th12) level skeletal muscle CSA on chest CT. This retrospective observational study included patients aged 40+years with a diagnosis of oral squamous cell carcinoma (n=164). Skeletal muscle CSA on CT images was measured using the Th12 and the L3 levels of pretreatment CT scans. The predictive formula was created based on the five-fold cross-validation method with a linear regression model. Correlations between the predicted L3-level CSA and the actual L3-level CSA were evaluated using r and Intraclass Correlation Coefficients (ICC). The predictive formula for L3-level CSA from Th12-level CSA was: CSA at L3 (cm2)=14.143+0.779 * CSA at Th12 (cm2) - 0.212 * Age (y)+0.502 * Weight (kg)+13.763 * Sex. Correlations between the predicted and measured L3-level CSA were r=0.915 [0.886-0.937] and ICC=0.911 [0.881-0.934]. We developed a formula for predicting skeletal muscle mass from the Th12-level CT slice. The predicted L3-level CSA correlated with the measured L3-level CSA.

Clinical outcomes of a fenestrated frozen elephant trunk technique for acute type A aortic dissection.

We investigated the outcomes of a fenestrated frozen elephant trunk (FET) technique performed without reconstruction of one or more supra-aortic vessels for aortic repair in patients with acute type A aortic dissection. We investigated 22 patients who underwent the fenestrated FET technique for acute type A aortic dissection at our hospital between December 2017 and April 2020. The most common symptom was chest pain and/or back pain. Nine patients presented with malperfusion and 1 with cardiac arrest, preoperatively. A FET was deployed under hypothermic circulatory arrest and manually fenestrated under direct vision. Single fenestration was made in the FET in 15 patients, 2 fenestrations in 5 patients and a total fenestrated technique in 2 patients. Concomitant procedures were performed in 5 patients. The cardiopulmonary bypass, aortic cross-clamp and hypothermic circulatory arrest times were 181 ± 49, 106 ± 43 and 37 ± 7 min, respectively. In-hospital mortality, stroke, or recurrent nerve injury did not occur in any patient. One patient developed paraparesis, which completely recovered at discharge. During the follow-up period (mean 18 ± 7 months), 1 patient died of heart failure. Fenestration site occlusion did not occur. Follow-up computed tomography (mean 12 ± 6 months postoperatively) revealed that the maximal aortic diameter remained unchanged at the levels of the distal end of the FET, the 10th thoracic vertebra and the coeliac artery; however, the aortic diameter was significantly reduced at the level of the pulmonary artery bifurcation. The fenestrated FET technique is a simple, safe and effective procedure for selected patients with acute type A aortic dissection.

Dimorphic Mechanisms of Fragility in Diabetes Mellitus: the Role of Reduced Collagen Fibril Deformation.

Diabetes mellitus (DM) is an emerging metabolic disease, and the management of diabetic bone disease poses a serious challenge worldwide. Understanding the underlying mechanisms leading to high fracture risk in DM is hence of particular interest and urgently needed to allow for diagnosis and treatment optimization. In a case-control postmortem study, the whole 12th thoracic vertebra and cortical bone from the mid-diaphysis of the femur from male individuals with type 1 diabetes mellitus (T1DM) (n= 6; 61.3 ± 14.6 years), type 2 diabetes mellitus (T2DM) (n= 11; 74.3 ± 7.9 years), and nondiabetic controls (n= 18; 69.3 ± 11.5) were analyzed with clinical and ex situ imaging techniques to explore various bone quality indices. Cortical collagen fibril deformation was measured in a synchrotron setup to assess changes at the nanoscale during tensile testing until failure. In addition, matrix composition was analyzed including determination of cross-linking and non-crosslinking advanced glycation end-products like pentosidine and carboxymethyl-lysine. In T1DM, lower fibril deformation was accompanied by lower mineralization and more mature crystalline apatite. In T2DM, lower fibril deformation concurred with a lower elastic modulus and tendency to higher accumulation of non-crosslinking advanced glycation end-products. The observed lower collagen fibril deformation in diabetic bone may be linked to altered patterns mineral characteristics in T1DM and higher advanced glycation end-product accumulation in T2DM. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Abstract 15517: Sarcopenia in Heart Failure Patients Without Dementia is Associated With Local Brain Atrophy and Predicts Poor Prognosis

Background: Sarcopenia is age-related loss of skeletal muscle volume and strength. Aged Heart failure (HF) patients without dementia may have potential risk of cognitive impairment (CI) that attenuates the effect of treatment. Patients with CI have severe brain atrophy in parahippocampal gyrus (PHG). However, it is not clear whether sarcopenia is associated with local brain atrophy and predicts prognosis. Hypothesis: Sarcopenia in HF patients without dementia is associated with local brain atrophy of PHG, a potential risk of CI, and predicts prognosis. Methods: Fifty-four HF patients (age 78+/-8 years, NYHA class II, EF47+/-18 %) were enrolled. We excluded patients with dementia using mini-mental state examination. We took 3D-T1 weighted sagittal images of whole brain using 1.5T magnetic resonance imaging. Image analysis was performed to evaluate the severity of local brain atrophy of gray matter using 2mm voxel-based morphometry by the statistical parametric mapping software. The Z-score value was calculated to evaluate the severity of atrophy in PHG. The cross-sectional area of the erector spinae muscles (CSA), an index of sarcopenia, were measured at the 12th thoracic vertebra using computed tomography. Results: Patients were divided into sarcopenia HF group (n=27) and Non-sarcopenia HF group (n=27) according to median of CSA. The severity of total brain atrophy was similar between sarcopenia HF group (8.1 +/-3.8%) and Non-sarcopenia HF group (8.9+/-3.5%). However, as shown in the representative cases (Figure A), the Z-score value in PHG (pink circle), reflecting the severity of atrophy, was prominent in sarcopenia HF group (1.57+/-0.80) (white arrows) in comparison with Non-sarcopenia HF group (0.94+/-0.63, P=0.002). Although age, gender, BNP and hemodynamic factors were similar between groups, sarcopenia HF group had a lower survival rate (Figure B). Conclusions: HF patients with sarcopenia without dementia have potential risk of CI and poor prognosis.

Bone and Subcutaneous Fat Influence on Yield, Physicochemical Traits, and Color Stability of Dry-Aged Loin From Grass-Fed Nellore Bulls

The objective of the current study was to evaluate the influence of bone and subcutaneous fat on yield, physicochemical traits, and color stability of dry-aged beef from grass-fed Nellore bulls. Paired bone-in loins (from the 10th thoracic vertebra to 6th lumbar vertebra) from 8 carcasses were collected and cut in half, and the sections from each carcass were assigned to 4 treatments (n = 8): bone-in with subcutaneous fat, bone-in without subcutaneous fat, boneless with subcutaneous fat, and boneless without subcutaneous fat. Loin sections were dry-aged for 21 d, at 2°C and 70% relative humidity. After dry aging, the half-loins were weighed, trimmed, and weighed again to determine the evaporation loss, trimming loss, and yield. Additionally, water activity, pH, thiobarbituric acid-reactive substances, moisture content, cooking loss, pressed juice percentage, Warner-Bratzler shear force, and color stability (during 9 d of display) were analyzed. No interactions (P &amp;gt; 0.05) between bone and subcutaneous fat were found for evaporation and trimming loss, yield, and physicochemical traits. The treatments did not affect Warner-Bratzler shear force, pressed juice percentage, thiobarbituric acid-reactive sub-stances, and pH values (P &amp;gt; 0.05). Regarding color stability, there was a bone-by-time interaction (P &amp;lt; 0.05) for a* and b* parameters. Boneless treatments showed higher a* and b* values (P &amp;lt; 0.05) than bone-in treatments, after 6 and 7 d of display, respectively. Bone-in treatments and treatments with subcutaneous fat had lower evaporation and trimming loss and higher yield compared to boneless treatments and treatments without subcutaneous fat, respectively (P &amp;lt; 0.05). Therefore, although bone-in treatments showed lower color stability, bone and subcutaneous fat were considered important factors to the dry-aging process, as both resulted in a greater yield over dry-aged product that had bone and/or fat removed, without compromising other physicochemical traits of dry-aged beef from grass-fed Nellore bulls.

How the characteristics of sports bras affect their performance

Breast movement reduction (%) measures breast support and sports bra performance, however limited evidence exists on the sports bra characteristics which affect it. This study investigated breast movement reduction achieved by 98 sports bras, the categorisation of support levels, and the characteristics that contribute. Each bra was tested on ∼12 females (total n = 77). Relative breast position was recorded during sports bra and bare-breasted running, and breast movement reduction calculated; low, medium, high breast support tertiles were identified and compared to brand-classified support levels. Ten bra characteristics were identified, and regressions determined which characteristics contributed to performance. Breast movement reduction ranged from 36% to 74%; 69% of bras marketed as high support were in the high support tertile (>63%). Encapsulation style, padded cups, nylon, adjustable underband and high neck drop accounted for 37.1% of breast movement reduction variance. Findings facilitate high performance sports bra development and inform consumer choice. Practitioner summary: Little is known about the biomechanical breast support which sports bras actually provide. This original research facilitates high performance sports bra development, and helps inform consumer choice, by identifying the breast movement reduction of a large sample of sports bras, and the characteristics which impact sports bra performance. Abbreviations: A-P: anterior-posterior; BMI: body mass index; C7: 7th cervical vertebrae; LNIP: left nipple; M-L: medial-lateral; PX: xiphoid process; ROM: range of motion; S-I: superior-inferior; SD: standard deviation; STN: suprasternal notch; T8: 8th thoracic vertebrae

Anatomical guide for botulinum neurotoxin injection: Application to cosmetic shoulder contouring, pain syndromes, and cervical dystonia.

This study proposes an ideal botulinum toxin injection point of the trapezius muscle for shoulder line contouring, pain management, and functional impairment. This study describes the intramuscular nerve branching in the trapezius muscle, providing essential information for botulinum neurotoxin injection. A modified Sihler's method was performed on the trapezius muscles (16 specimens). The intramuscular arborization areas were elucidated regarding the external occipital protuberance superiorly, spinous process of the 12th thoracic vertebra inferiorly and acromion of the scapula. The intramuscular neural distribution for the superior, middle, and inferior regions of the trapezius muscle had the greatest arborized patterns in the horizontal 1/5-2/5 and vertical 2/10-4/10 sections, the horizontal 1/5-3/5 and vertical 4/10-5/10 sections, and the horizontal 1/5-2/5 and vertical 5/10-7/10 sections, respectively. We propose that BoNT treatments should be directed to the horizontal 1/5-2/5 and vertical 2/10-4/10 sections of the superior trapezius, the horizontal 1/5-3/5 and vertical 4/10-5/10 sections of the middle trapezius and the horizontal 1/5-2/5 and vertical 5/10-7/10 sections of the inferior trapezius. Additionally, injective treatment at the horizontal 2/5-3/5 and vertical 2/10-4/10 nerve entry points should be avoided to prevent nerve trunk damage causing paralysis. According to our guidelines, clinicians can ensure minimal dose injections and fewer adverse effects in botulinum neurotoxin injective treatment.