Abnormalities Type Research Articles

Osteotomy around the knee is planned toward an anatomical bone correction in less than half of patients

IntroductionIn cases where the femur or tibial deformity is not correctly analysed, the corrective osteotomies may result in an oblique joint line. The aim of this study was to assess the preoperative deformity of patients due to undergo corrective osteotomy and the resulting abnormal tibial and femoral morphologies after the planned correction using 3D software. MethodsCT scans of 327 patients undergoing corrective osteotomy were retrospectively included. Each patient was planned using a software application and the simulated correction was validated by the surgeon. Following the virtual osteotomy, tibial and femoral coronal angular values were considered abnormal if the values were outside 97.5% confidence intervals for non-osteoarthritis knees. After virtual osteotomy, morphological abnormalities were split into two types. Type 1 was an under/overcorrection at the site of the osteotomy resulting in abnormal bone morphology. A type 2 was defined as an error in the site of the correction, resulting in an uncorrected abnormal bone morphology. ResultsThe global rate of planned abnormalities after tibial virtual osteotomy was 50.7% (166/327) with abnormalities type 1 in 44% and type 2 in 6.7%. After femoral virtual osteotomy the global rate was 6.7% (22/327) with only abnormalities type 1. A lower preoperative HKA was significantly associated with a non-anatomical correction (R2=0.12, p<0.001) for both femoral (R2=0.06, p<0.001) and tibial (R2=0.07, p<0.001) abnormalities. ConclusionNon-anatomical correction was found in more than half the cases analysed more frequently for preoperative global varus alignment. These results suggest that surgeons should considered anatomical angular values to avoid joint line obliquity. Level of evidenceIII; retrospective cohort study.

Utility of Liver Function Tests and Fatty Liver Index to Categorize Metabolic Phenotypes in a Mediterranean Population.

The aim of this study was to analyze the utility of liver function tests (LFT) and fatty liver index (FLI), a surrogate marker of non-alcoholic fatty liver disease, in the categorization of metabolic phenotypes in a Mediterranean population. A cross-sectional study was performed on a random representative sample of 2233 adults assigned to a health center in Málaga, Spain. The metabolic phenotypes were determined based on body mass index (BMI) categorization and the presence or absence of two or more cardiometabolic abnormalities (high blood pressure, low high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, pre-diabetes) or type 2 diabetes. No difference was observed between metabolically healthy and metabolically abnormal phenotypes on LFT. The mean FLI of the population was 41.1 ± 28.6. FLI was significantly higher (p < 0.001) in the metabolically abnormal phenotypes in all BMI categories. The proportion of individuals with pathological FLI (≥60) was significantly higher in the metabolically abnormal overweight and obese phenotypes (p < 0.001). On a multivariate model adjusted for sex, age, and waist circumference, a significant correlation was found between pathological FLI and metabolically abnormal phenotypes in the overweight and obese BMI categories. Area under the curve (AUC) of FLI as a biomarker was 0.76, 0.74, and 0.72 for the metabolically abnormal normal-weight, overweight, and obese groups, respectively. Liver biochemistry is poorly correlated with metabolic phenotypes. Conversely, a good correlation between FLI, as a marker of non-alcoholic fatty liver disease (NAFLD), and metabolically abnormal phenotypes in all BMI ranges was found. Our study suggests that FLI may be a useful marker for characterizing metabolically abnormal phenotypes in individuals who are overweight or obese.

The Abnormality of Spermatozoa Goat after Freezing on -80°C Using Tris Diluent Added Combination Hatching Egg Yolk and Amnion Fluid

This study aims to determine the combination of the hatching egg yolk (HEY) and amniotic fluid (AF) in Tris diluent to the type of goat spermatozoa abnormalities after frozen at temperature -80°C. This study used four treatments and 6 replications. The semen is diluted using tris extender and added treatment, there are control group (T 0 ) (Tris egg yolk 20%), T 1 (15% HEY + 5% AF), T 2 (10% HEY + 10% AF), and T3 (5% HEY + 15% AF). After dilution, the semen was equilibrated for 2 hours, then stored using Mr. Frosty and frozen at temperature -80°C in the ultra-freezer for 24 hours. The type of spermatozoa abnormalities type was evaluated on fresh semen and after thawing. The data were analyzed using ANOVA (P<0.05). The results showed that there is no significant difference among treatments. The primary abnormalities in fresh semen, there were macro-cephalic, amorphous, and the secondary spermatozoa abnormalities such as detached head, mid-piece defect, coiled tail, loosehead, shoe-hook tail, and a broken tail. The secondary abnormalities in post-thawing were found both in the control group and treatment, which are detached head, loosehead, coiled tail, shoe-hook tail, and broken tail. The conclusion of this study was the percentage of secondary abnormalities after thawing was increasing both in the control and treatment groups. Keywords: Amniotic Fluid, Hatching Egg Yolk, Mr. Frosty , Type of Spermatozoa Abnormality.

Changes of the level of plasma acetylcholine and its relationship with gait abnormalities type of Parkinson's disease

Objective To study the changes of acetylcholine(ACh) level in plasma of Parkinson's disease(PD), and to discuss its relationship with posture and gait abnormalities type of PD. Methods 51 patients with idiopathic PD were included in the study group, 51 healthy people were selected from the same period as control group.The Ach in plasma of two groups were detected by enzyme-linked immunosorbent assay (ELISA), factors of abnormal gait type PD were analyzed by binary Logistic regression multivariate. Results The Ach in plasma of the study group was (243.56±82.14)ng/L, which was significantly lower than (327.81±109.54)ng/L in the control group, the difference was statistically significant (t=4.394, P<0.05). The Ach in plasma of PD patients with newly diagnosed and untreated withdrawal 7 days of PD patients were (239.51±79.16)ng/L and (262.85±97.22)ng/L, which were significantly lower than the control group (t=3.858, 2.360, all P<0.05). The Ach in plasma of abnormal gait type PD was (338.25±112.41)ng/L, which were significantly higher than the type of tremor, rigidity and less dynamic type of hybrid PD patients, the differences were statistically significant (t=4.062, 2.942, 3.033, all P<0.05). After two classification multivariate Logistic regression analysis, the results showed that plasma levels of ACh was PD gait anomaly occurs independent risk factor (OR=1.353, 95% CI: 1.212-1.509, P<0.05). Conclusion Plasma levels of ACh in PD patients is lower than the control group, plasma level of ACh in abnormal gait type PD is higher than other subtypes, and plasma level of Ach is risk factor. Key words: Parkinson's disease; Acetylcholine; Gait anomaly; Risk factors

Spinal cord injury without radiologic abnormality in children: a systematic review and meta-analysis.

Spinal cord injury in children is associated with severe morbidity and immense socioeconomic burden. In spinal cord injury without radiologic abnormalities (SCIWORA), magnetic resonance imaging (MRI) can detect intramedullary or extramedullary pathologies or show absence of neuroimaging abnormalities. However, the prognostic and therapeutic consequences of specific MRI patterns are unclear. A comprehensive systematic literature search was performed to examine patient characteristics and imaging patterns of pediatric SCIWORA and to evaluate the prognostic value of a MRI-based classification system. MEDLINE, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for studies on SCIWORA in children. Inclusion criteria were (1) traumatic spinal cord injury with acute neurologic deficit, (2) absence of fractures and/or dislocations of the spine, and (3) an immature skeleton or age of less than 18 years. MRI patterns and clinical course were correlated. Forty articles reporting 114 patients were identified. At admission, neurologic deficit assessed by the American Spinal Injury Association impairment scale was A in 28%, B in 17%, C in 31%, and D in 25%. At final follow-up, these were 19%, 6%, 10%, and 16%, respectively. In 43%, no MRI abnormalities (Type I) were detected, and 57% exhibited abnormal scan results (Type II): 6% revealed extraneural (Type IIa), 38% intraneural (Type IIb), and 13% combined abnormalities (Type IIc). At admission and follow-up, American Spinal Injury Association impairment scale differed significantly between the imaging types. This systematic review emphasizes the prognostic value of spinal MRI for children with SCIWORA. It highlights the role of the MRI classification system in improving the comparability and interpretability. Systematic review, level IV.

Ultrasound Nail Imaging on Patients With Psoriasis and Psoriatic Arthritis Compared With Rheumatoid Arthritis and Control Subjects

The objective of this study was too show findings at finger nails level revealed by high-frequency gray-scale ultrasound (US) and power Doppler in patients with psoriatic arthritis (PsA),and cutaneous psoriasis compared with rheumatoid arthritis and control subjects. We studied 35 patients with PsA, 20 with cutaneous psoriasis, and control groups (28 control subjects and 27 patients with rheumatoid arthritis). All nails of both hands were observed (1097 nails, 3 excluded because of trauma). In every patient, we classified the morphologic abnormalities disclosed in ventral and dorsal nail plates. We also measured the distance between ventral plate and the bone margin of the distal phalanx at the right index finger. All patients and control subjects presented abnormalities in the US imaging. Those with psoriatic arthritis and cutaneous psoriasis showed a higher number of compromised nails. When classifying those abnormalities using the typology of Wortsman et al, patients with psoriatic arthritis showed loosening of the borders of the ventral plate (type II), whereas patients with cutaneous psoriasis showed focal hyperechoic involvement of the ventral plate without involvement of the dorsal plate (type I). Patients of the control group could not be classified, although 31 of 55 showed thinning of the ventral plate without hyperechoic deposits. Nineteen of 35 patients with psoriatic arthritis, and 10 of 20 patients with cutaneous psoriasis did not show any nail clinical alterations. Nevertheless, the US detected type II alterations in the first group and type I in the second group. Patients with psoriatic arthropathy had power Doppler increases in distal interphalangeal joints and nail beds in a statistically significant form (P = 0.0001).When measuring the distance between the ventral plate and the bone margin of the distal phalanx, there was homogeneity among samples in patients and control subjects. A receiver operating characteristic curve analysis determined that a cut point of 2 mm clearly defined these 2 groups. There was a significant difference (P < 0.0001) between the mean distance ventral plate-osseous margin of the distal phalanx in psoriatic arthritis patients (P = 0.001) and patients with cutaneous psoriasis (P = 0.005) versus rheumatoid arthritis patients (P = 0.548). As a predominant finding in our study, we observed abnormalities of the ventral plate in patients with PsA (type II) and abnormalities (type I) in patients with cutaneous psoriasis. We found a significant difference between the mean distance ventral plate-osseous margin of the distal phalanx in patients with PsA and patients with cutaneous psoriasis versus control subjects. Ultrasound imaging could be a feasible and sensitive tool to describe, measure, and follow morphologic characteristics and changes of the nail in psoriatic and/ or psoriatic arthritis patients with or without clinical nail lesions.

Spinal cord injury without radiologic abnormalities in adults

There is increasing evidence that spinal cord injury without radiologic abnormalities (SCIWORA) is underreported in adults. The increasing availability of magnetic resonance imaging (MRI) has added substantial information, but there remains considerable disagreement concerning definition as well as diagnostic and therapeutic measures. Furthermore, the interpretability of the literature is constrained by the lack of a reliable classification system based on the morphologic abnormalities visualized by MRI. A comprehensive systematic review was performed to identify all the data published concerning adults experiencing SCIWORA. To assess a potential correlation between clinical and imaging findings, we developed a novel MRI classification system. Database searches were conducted for studies on SCIWORA in adults using PubMed and OvidSP. Inclusion criteria were (1) traumatic spinal cord injury with neurologic deficit, (2) absence of fractures and/or dislocations of the spinal column, and (3) a mature skeleton. Data collected included clinical and radiologic findings. MRI patterns and clinical course were correlated. Sixty-three articles reporting 1,393 patients were identified, of which 44 studies reported 1,132 cases with MRI imaging. At admission, neurologic deficit assessed by the American Spinal Injury Association impairment scale (AIS) in 567 patients was A in 19.1%, B in 18.5%, C in 39.7%, and D in 22.8%. At final follow-up, these were 6.5%, 4.8%, 20.1%, and 44.3%, respectively. In 7.1%, no MRI abnormalities (Type I) were detected, and 92.9% exhibited abnormal scan results (Type II). Of the latter, 11.7% revealed extraneural (Type IIa), 36.9% revealed intraneural (Type IIb), and 44.3% revealed combined abnormalities (Type IIc). Statistical analysis of neurologic impairment at admission and follow-up revealed significant differences in outcome between patients with different imaging findings. This review emphasizes the prognostic value of spinal MRI for adults with SCIWORA. Using the MRI classification system in future reports will enhance comparability and interpretability and might improve our understanding of the condition.

New Insights into the “Obesity Paradox” and Cardiovascular Outcomes

Overweight and obesity are increasing in epidemic proportions both in the United States (US) and throughout the Western World [1]. A considerable burden from cardiovascular disease (CVD) in the US has been “heavily” impacted by the obesity epidemic, with the current estimation of obesity prevalence in US children and adolescents being just under 20%, with a prevalence >33% in adults 24-74 years of age [2]. Alarmingly, the proportion of patients with either severe or morbid obesity is increasing even more so than are overweight and obesity per se [1]. Almost all of the major CVD risk factors, including glucose abnormalities (impaired fasting glucose, metabolic syndrome, and type 2 diabetes mellitus), lipid disorders (especially elevated levels of triglycerides and low levels of high-density lipoprotein cholesterol), hypertension (HTN) and left ventricular hypertrophy, and physical inactivity ,as well as sleep apnea, are all adversely impacted by overweight and obesity [1,3-5]. In addition, overweight and obesity may be independent risk factors for coronary heart disease (CHD) and have adverse impacts on almost all CVD, including HTN, heart failure (HF), atrial fibrillation (AF), and sudden cardiac death [1,3-5].Despite the powerful impact, however, that overweight and obesity have on CHD risk factors, CHD, and other CVD, numerous studies and meta-analyses have addressed the “obesity paradox,” which indicates that once CVD becomes established, including CHD, HF, HTN, and AF, overweight and obese have a better prognosis than do their lean counterparts with the same CVD [1,3-7]. The obesity paradox has been discounted by some experts who have suggested that this may be due to such factors as sample size errors or by unmeasured confounding factors, as was also suggested in a recent major study of in-hospital mortality in acute myocardial infarction [3,8,9]. However, even very large meta-analyses have demonstrated this paradox in CHD and HF [6,7]. In fact, Romero-Corral and colleagues [6] evaluated 40 studies of more than 250,000 patients with CHD and demonstrated that in patients grouped according to body mass index (BMI), those in the lowest or “normal” BMI group had the highest all-cause mortality, whereas better survival was observed in higher BMI groups. The overweight had the lowest relative risk, whereas obesity and severe obesity have no increased mortality risk. Likewise, in HF, Oreopoulos and colleagues [7] reviewed 29,000 patients from 9 major HF studies and demonstrated reductions in CV and total mortality of 19% and 16%, respectively in the overweight and 40% and 33%, respectively in the obese compared with normal-weight patients with HF. Many have blamed the obesity paradox on relatively poor accuracy of BMI to reflect true body fatness, and we agree that other measures of body composition [including waist circumference (WC), waist-to-hip ratio, and measures of visceral and peripheral adiposity] may all be superior to BMI in the assessment of body fatness [1,3-6,10-15]. We have demonstrated the obesity paradox, however, in both HF [14,16] and CHD [13,15,17-19] with both BMI and percent body fat (BF), demonstrating that BF was an independent predictor of better event-free survival. In CHD, we have demonstrated that low BF (≤ 25% in men and ≤ 35% in women) predicted a nearly three-fold increase in mortality compared with high BF [10,12,14]; also, we demonstrated that the combination of low BF and low BMI (< 25 kg/m

Estimación de la agregación de factores de riesgo metabólico en niños obesos

The purpose of this study was to apply the new approach for Metabolic Individual Risk-factor And Clustering Estimation (MIRACLE) score in a group of Spanish obese children and adolescents and to describe its relationship with other metabolic risk factors. 153 children with simple obesity were studied: 79 males and 74 females, mean age 11.2 +/- 2.2. Obesity was defined when BMI was higher than the age and sex specific equivalent to 30 kg/m2 in adults. MIRACLE score included: family history (early cardiovascular disease, type 2 diabetes, and hypertension), individual history (small for gestational age and ethnic origin), clinical features (BMI, waist circumference > 90th percentile and blood pressure > 95th percentile) and metabolic abnormalities (glucose intolerance or type 2 diabetes). It was assigned a value of 1 to "presence" and 0 to" absence" in every patient. The children were considered as having metabolic risk when at least 5 items were present. Triglycerides, HDL-cholesterol, apolipoprotein B, apolipoprotein A1, glucose and HOMA index, were measured too. The most frequent clinical features of MIRACLE score were: excess waist circumference (95.4%) and hypertension (41.8%). Family history criteria were frequent (55.3% for type 2 diabetes, 39.1% for hypertension and 31.3% for early cardiovascular disease). Individual risk factors were not frequent. Glucose intolerance was detected in 22.2% of the obese patients. A MIRACLE score > or = 5 was found in 37.4% of the children studied, being associated with a significant risk of dyslipidemia (triglycerides, p = 0.040; HDL-cholesterol, p = 0.006; LDL-cholesterol p = 0.038; apolipoprotein B, p = 0.008) only in females. In conclusion, the MIRACLE score is useful in order to detect metabolic risk in obese children but it seems necessary to improve the score, by including other features of the metabolic syndrome like lipid profile or indirect indicators of insulin resistance.

Glucose Abnormalities Are an Independent Risk Factor for Nonresponse to Antiviral Treatment in Chronic Hepatitis C

The influence of glucose abnormalities on the efficacy of antiviral treatment is unknown. This study investigated whether glucose abnormalities (impaired fasting glucose and type 2 diabetes) influence the response to antiviral therapy with interferon plus ribavirin in patients with chronic hepatitis C. A total of 178 treatment-naïve patients with chronic hepatitis C treated with combination therapy were retrospectively studied. SVR was assessed after completing treatment. Fasting plasmatic glucose was measured prior to therapy. Compared with nonresponders (N = 111), patients with SVR (N = 67) had lower plasma glucose (94.1 +/- 12.7 vs 104.4 +/- 25.8 mg/dL, P= 0.001) and a lower prevalence of glucose abnormalities (24.24%vs 44.14%, P= 0.012). The SVR rate was 45.13% in patients with normoglycemia (N = 113), 28.26% in patients with impaired fasting glucose (N = 46), and 15.78% in type 2 diabetic patients (N = 19) (P < 0.001). Multivariate logistic regression identified genotype 1 (OR 1.55, 95% CI 1.01-2.41, P= 0.05), gamma-glutamyltranspeptidase level (OR 6.41, 95% CI 1.86-22.07, P= 0.003), and presence of glucose abnormalities (OR 2.33, 95% CI 1.04-5.20, P= 0.039) as being independently associated with the absence of an SVR. In addition, patients with glucose abnormalities (N = 65) showed a lower virological response rate when compared with a subgroup of normoglycemic patients (N = 65) matched for sex, age, and liver fibrosis (24.6%vs 44.6%, P= 0.001). Glucose abnormalities are an independent predictor of poor virological response to combined therapy in hepatitis C virus infected patients.

Late-onset multiple acyl-CoA dehydrogenase deficiency: A frequently missed diagnosis?

Multiple acyl-CoA dehydrogenase (MAD) deficiency is caused by inherited deficiency of electron transfer flavoprotein (ETF) or ETF:ubiquinone oxidoreductase.1 The disease course is highly variable ranging from the neonatal (lethal) form with congenital abnormalities (type I), hypoglycemic encephalopathy without congenital abnormalities (type II), to myopathy (type III).1 Homozygosity for null mutations is usually associated with type I, whereas little residual activity is found in type II, and a relatively high residual activity in type III.2 Some patients with late-onset MAD deficiency have been reported previously but few have been described in detail.3,4 A 56-year-old man presented with progressive proximal myopathy of unknown origin. His family history and development were unremarkable. Before the onset of symptoms his exercise tolerance was unimpaired. His nutrition was predominantly based on animal products and was rich in fat and protein; alcohol abuse was not reported. At age 42 years he started having intermittent weakness and pain predominantly of the proximal limbs which was …

Abnormalities of cerebellar foliation and fissuration: classification, neurogenetics and clinicoradiological correlations.

Several genes have been found to influence the different cells involved in the processes of foliation and fissuration in the mouse and rat cerebellum. In the light of these new concepts and on the basis of the imaging findings in 42 patients, a classification is proposed for abnormalities of foliation and fissuration. On the basis of recent genetic and experimental evidence on mechanisms which control the origin of the cerebellum, it is suggested that abnormalities of foliation and fissuration form a single group, with a spectrum of severity. Some patients have only abnormal fissuration of the anterior lobe (type 1a) and others additional dysplasia of the anterior and part of the posterior lobe (type 1b). Extension of abnormalities into the hemispheres is often seen in the latter group. A second group has vermian and hemisphere abnormalities (type 2). In addition to the malformation of the anterior lobe of the vermis, three different hemispheric lesions can be seen in this group: cortical dysgenesis, hypertrophy of the cerebellar cortex, and malorientation of the folia. The mild abnormalities (type 1a) can be considered an incidental observation without clinical relevance. The moderate and severe cerebellar anomalies (type 1b and 2) are always associated with cerebellar symptoms and/or signs.

Liver Abscess after Transcatheter Oily Chemoembolization for Hepatic Tumors: Incidence, Predisposing Factors, and Clinical Outcome

To evaluate the incidence of, predisposing factors for, and clinical outcome of liver abscess developing in patients with hepatic tumors after transcatheter oily chemoembolization (TOCE). During the past 6-year period, 2,439 patients with hepatic tumors underwent a total of 6,255 TOCE procedures. With a retrospective review of medical records, the authors evaluated the occurrence of liver abscess, the statistical significance of potential predisposing factors including portal vein obstruction, metastatic tumors, biliary abnormalities (type 1, simple biliary obstruction; type 2, status prone to ascending biliary infection), malignant gastrointestinal mucosal lesions, and additional gelatin sponge particle embolization in liver abscess formation, and the clinical outcome of abscess. Fifteen liver abscesses occurred in 14 patients (0.2%). Liver abscesses developed in three of 987 (0.3%) TOCE procedures for portal vein obstruction, three of 114 (2.6%) procedures for metastatic tumors, one of 49 (1.8%) for type 1 biliary abnormality, four of 55 (7.4%) for type 2 biliary abnormality, two of 18 (11.1%) for malignant gastrointestinal mucosal lesion, and nine of 2,108 (0.4%) for additional gelatin sponge particle embolization. Univariate and multivariate statistical analysis showed that type 2 biliary abnormality was a significant predisposing factor. The mortality related to liver abscess occurred in two patients (13.3%). Thirteen liver abscesses were successfully treated with parenteral antibiotics and percutaneous catheter drainage. However, irreversible deterioration of liver function occurred in two patients. Two of nine further TOCE procedures in three patients caused recurrent septicemia and liver abscess. The biliary abnormality prone to ascending biliary infection was the most important predisposing factor to the development of liver abscess after TOCE. Postembolic liver abscess could be effectively managed with percutaneous catheter drainage.