Changes In Body Habitus Research Articles

Nutritional Aspects of Spina Bifida Care: Optimizing Medical Management and Surgical Healing.

This review aims to highlight background of contributing factors for suboptimal nutrition in individuals with spina bifida and introduce strategies for amelioration. Recent studies demonstrate increased risk of metabolic syndrome by neurosegmental level, which is associated with truncal obesity and reduced mobility. From the neonatal intensive care stay, which may disrupt breast feeding and the developing microbiome of the gastrointestinal tract, to early childhood various insults may lead to suboptimal feeding practices, preferences and dietary intake. Family coping skills, financial stressors may lead to food insecurity and/or residence in an area with limited availability of fresh food. As children grow, weakness and challenging transfers may lead to more sedentary lifestyle and weight gain despite limited linear growth. Body habitus changes including atrophy of the lower extremities may lead to decreased muscle mass and reduced energy expenditure, with predisposition to truncal obesity and metabolic syndrome.

Technical feasibility of novel immunostimulatory low-dose radiation for polymetastatic disease with CBCT-based online adaptive and conventional approaches.

A workflow/planning strategy delivering low-dose radiation therapy (LDRT) (1Gy) to all polymetastatic diseases using conventional planning/delivery (Raystation/Halcyon="conventional") and the AI-based Ethos online adaptive RT (oART) platform is developed/evaluated. Using retrospective data for ten polymetastatic non-small cell lung cancer patients (5-52 lesions each) with PET/CTs, gross tumor volumes (GTVs) were delineated using PET standardized-uptake-value (SUV) thresholding. A 1cm uniform expansion of GTVs to account for setup/contour uncertainty and organ motion-generated planning target volumes (PTVs). Dose optimization/calculation used the diagnostic CT from PET/CT. Dosimetric objectives were: Dmin,0.03cc ≥ 95% (acceptable variation (Δ) ≥ 90%), V100% ≥ 95% (Δ ≥ 90%), and D0.03cc ≤ 120% (Δ ≤ 125%). Additionally, online adaptation was simulated. When available, subsequent diagnostic CT was used to represent on-treatment CBCT. Otherwise, the CT from PET/CT used for initial planning was deformed to simulate clinically representative changes. All initial plans generated, both for Raystation and Ethos, achieved clinical goals within acceptable variation. For all patients, Dmin,0.03cc ≥ 95%, V100% ≥ 95%, and D0.03cc ≤ 120% goals were achieved for 84.8%/99.5%, 97.7%/98.7%, 97.4%/92.3%, in conventional/Ethos plans, respectively. The ratio of 50% isodose volume to PTV volume (R50%), maximum dose at 2cm from PTV (D2cm), and the ratio of the 100% isodose volume to PTV volume (conformity index) in Raystation/Ethos plans were 7.9/5.9; 102.3%/88.44%; and 0.99/1.01, respectively. In Ethos, online adapted plans maintained PTV coverage whereas scheduled plans often resulted in geographic misses due to changes in tumor size, patient position, and body habitus. The average total duration of the oART workflow was 26:15 (min:sec) ranging from 6:43 to 57:30. The duration of each oART workflow step as a function of a number of targets showed a low correlation coefficient for influencer generation and editing (R2=0.04 and 0.02, respectively) and high correlation coefficient for target generation, target editing and plan generation (R2=0.68, 0.63 and 0.69, respectively). This study demonstrates feasibility of conventional planning/treatment with Raystation/Halcyon and highlights efficiency gains when utilizing semi-automated planning/online-adaptive treatment with Ethos for immunostimulatory LDRT conformally delivered to all sites of polymetastatic disease.

A new formula for estimating gestational age by crown-rump length

The accurate estimation of gestational age by ultrasound is crucial in prenatal care for the monitoring of fetal growth and development. As changes in maternal childbearing age, body habitus, and ultrasound technology occur, previously published formulas may not be accurate for today's population. This study aimed to develop new formulas for calculating the gestational age based on a first-trimester ultrasound scan and to compare the new formulas with preexisting formulas. This study was a single-center, retrospective observational study that included pregnancies conceived using in vitro fertilization. The pregnancies had known dates of embryo transfer and multiple standard ultrasound examinations in the first trimester of pregnancy. Pregnancies ending with a miscarriage or termination in the first trimester of pregnancy were excluded. A polynomial regression analysis was performed to determine the optimal model that represented the relationship between gestational age and crown-rump length. The models were evaluated using systematic error, random error, absolute difference of the calculated gestational age and actual gestational age, and proportion of estimation within 0 and 2 days of the known gestational age. The optimal model was chosen and compared with preexisting formulas. Overall, 1436 ultrasound results were included in the analysis. The analysis produced 3 models: linear, cubic, and quadratic models with correlation coefficients of 0.968, 0.989, and 0.991, respectively. The cubic formula was superior to the linear and quadratic formulas concerning systematic error, random error, absolute difference, and proportion of estimation within 0 and 2 days. The new formula had a lower systematic error, random error, and mean absolute difference (0.06%, 2.43%, and 0.97 days, respectively) and the highest proportion of estimation within 0 and 2 days (37.4% and 93.5%, respectively) than previously published formulas. The formula proposed in this study followed a cubic model and seemed to be able to more accurately estimate gestational age in the first trimester of pregnancy based on crown-rump length compared with previously published formulas.

PO-04-058 AN UNUSUAL CASE OF ATRIAL SENSING BY A DEFIBRILLATOR LEAD CAUSING ASYSTOLE

Integrated bipolar transvenous defibrillator leads (IL) offer advantages over dedicated bipolar defibrillator leads (BL): IL have a simplified construction and are less prone to anodal stimulation. A potential problem for the IL is oversensing due to a large sensing area. We present a case of an IL with intermittent asystole treated by exchange of the IL for a BL. N/A N/A A 51-year-old female with hypertrophic cardiomyopathy received a Boston Scientific (BS) dual chamber ICD in 2011 with a IL (BS 0185) for VT and intermittent heart block. In May 2022, she underwent an uncomplicated generator change. Six months later she presented with presyncopal events. Hospital telemetry showed DDD pacing with intermittent lack of ventricular output and no escape rhythm. There was no evidence of lead dislodgement and manipulation of the pocket did not reproduce an event. Device interrogation showed normal and stable lead thresholds and impedances. She was now pacemaker dependent. Spontaneous asystole was captured by the intracardiac electrogram (IEGM) demonstrating atrial far-field sensing with inhibition of RV pacing. Decreasing the RV sensitivity did not resolve the issue. We urgently turned on “Electrocautery Protection Mode” (DOO 60 and V Tachy Mode-OFF) restoring 100% dual chamber pacing and capture. We suspected that atrial far field sensing was due to the IL design. The size and position of the sensing anode can allow for far-field atrial sensing and inhibition of RV output. Intraoperative manipulation and testing of the generator and leads showed normal parameters. The patient underwent extraction of the IL, and a BL (Medtronic 6935m) was implanted. A BL was selected due to its distal, and closely spaced, pace/sense electrode design. The device was reprogrammed to her prior settings with no further episodes or symptoms occurring. This case shows an unusual problem with the IL design. Capturing this event by IEGM was diagnostic. Reducing the IL sensitivity is not optimal, making the patient vulnerable to undersensing of ventricular fibrillation. Discussion with BS Technical Services confirms that this phenomenon is rarely seen and more likely to occur in patients with a small RV. We suspect that changes in body habitus, a small RV cavity, and progression of heart block exposed the problem years after implant. Exchange of a IL with a BL provided a lasting solution.

Electrocardiographic changes after breast reduction surgery

Macromastia is associated with symptoms related to postural changes and decreased mobility. Breast reduction surgery (BRS) is the treatment of choice for these patients. Anatomical and structural changes in body posture and habitus might cause changes in electrocardiography (ECG). In this study, we aimed to evaluate the outcome of BRS on ECG changes of the patients after surgery. Study population included 33 female patients who had undergone BRS. ECG records of every patient before procedure and 6 months after procedure were analyzed retrospectively. Patients were naïve of known cardiac diseases and the patients did not have any known arrhythmia. The mean age of the study population was 40.8 ± 9.6. Total removed breast tissue from both sides was 1493 (1052–2138) mL, as 800 (513–1093) mL removed from right side and 740 (519–1050) mL removed from left side. There were significant changes in ECG of the patients in post-operative period. Atrial conduction parameters such as, PR duration (p<.001), Pmax duration (p<.001) and P wave dispersion (p<.001) were significantly decreased post-operatively. Additionally, ventricular conduction parameters such as, TPe duration (p<.001), TPe/QT (p=.013) and TPe/QTc (p=.005) ratios were found significantly decreased in ECGs of the patients. BRS as a treatment for macromastia does not only improve posture and mobility of the patients and also have positive impact on cardiac conductions. In patients those had BRS, atrial and ventricular conductions detected by ECG recordings were improved after surgery.

Impact of a targeted volume‐increase nutrition guideline on growth and body mass index in premature infants: A retrospective review

The negative impact of disproportionate growth in premature infants is well documented, but optimal nutrition practices needed to prevent an unhealthy body mass index (BMI) remain unclear. An evidence-based, volume-increase guideline that advanced feeding volumes from 150-160 to 170-180 ml/kg/day between the postmenstrual age (PMA) of 31 0/7 and 34 0/7 weeks was implemented in October 2017 for infants born at ≤32 0/7 weeks' gestational age. Data were collected on 262 infants' weight and length at birth and at discharge for 20 months before and 21 months after guideline implementation, and retrospective analysis was conducted to determine disproportionate growth by comparing BMIs (in g/cm2 ) at birth and at discharge. Changes in infants' body habitus were determined through bivariate analysis of weight and length z-scores from the Fenton growth curve. Implementation of a targeted volume nutrition guideline resulted in fewer infants with growth failure, defined as weight <10th percentile (19.5% vs 11.2%; P = .06) at discharge. Infants who received treatment according to the targeted nutrition guideline had a statistically significant reduction in disproportionately low BMI (8.6% vs 2.5%; P = .0380) and an increase in disproportionately high BMIs (4.3% vs 12.3%; P = .025). There was minor change in the percentage of disproportionately large infants who received the guidelines from birth to discharge (11.5% vs 12.3%). A targeted volume-increase nutrition guideline may prevent growth failure, with some effects on disproportionate growth in preterm infants born at ≤32 0/7 weeks' gestational age.

Women's Health: Most Common Physiologic and Pathologic Cutaneous Manifestations During Pregnancy.

Pregnant women are susceptible to various physiological and pathological skin and body habitus changes during pregnancy due to the alterations that occur in a multi-organ-system fashion. Pregnancy can be the onset of different dermatological diseases and can exacerbate pre-existing cutaneous conditions. Moreover, management of dermatologic diseases during pregnancy might be challenging as it requires special attention to both mother and fetus. We aim to assess the most common cutaneous changes and conditions that occur during pregnancy by reviewing the previous studies conducted on this subject.The medical literature was explored through PubMed and Google scholar databases starting from 2015 to 2021. The included searching terms were a combination of "Cutaneous changes and pregnancy," Dermal conditions and pregnancy," Pregnancy-associated dermal conditions," and "Dermatological changes and pregnant women." The inclusion criteria included original articles conducted on pregnant women and full text- articles.A total of 134 articles were obtained, 11 articles were eligible for the inclusion criteria. The 11 studies included a total number of 14,813 pregnant women and covered four countries. The most common cutaneous conditions experienced by pregnant women were primarily physiological skin changes, pregnancy-specific dermatopathologies, and exacerbations of other common skin diseases.All in all, this systematic review concluded that pregnant women are more vulnerable to various dermatological conditions during pregnancy. These changes were more commonly physiological such as hyperpigmentations. However, pathological pregnancy-specific skin conditions and exacerbations of pre-existing dermatoses like atopic eruptions were also reported.

Fat grafting: A novel technique for difficult ostomy management

The creation of fecal or urinary stomas are common surgical procedures. However, even when the operation is done technically well, a spectrum of morbidities can result from contour deformities of the peristomal skin. These often result in poor appliance fitting with leakage, skin erosion, pain, discomfort, and embarrassment. Irregularities in parastomal skin contour can be secondary to scarring, wound contraction, and change in body habitus.

The Effect of a Combination of Autogenic and Benson Relaxation on Sleep Quality among Pregnant Women with Hypertension

Physical changes, such as changes in body habitus, and hormonal changes, including dramatic increases in estrogen and progesterone, are recognized contributors to sleep disturbance in pregnancy. The study aimed to examine the effect of combined Autogenic and Benson relaxation on sleep quality in pregnant women with hypertension. A quasi-experimental, pre-test, and post-test with a control group was applied in this study. Forty-six samples were recruited using a non-probability sampling such as consecutive sampling and assigned to the intervention group (n=23) and the control group (n=23). The intervention group did the relaxation two times per day for two weeks, then no intervention for the control group. Significant findings were analyzed using chi-square. There was a statistically significant difference between groups regarding daily sleep time, Pittsburgh Sleep Quality Index (PSQI) score, and sleep quality after the intervention. The results (p<0,05) showed that the mean intervention group PSQI score decreased from indicating significant differences in the decline PSQI score between the intervention and the control group. It was found that combined autogenic, and Benson relaxation as one of the non-pharmacological interventions effectively improved participants' sleep quality. Instruct pregnant women about appropriate non-pharmacological interventions which have no side-effects to enhance the quality of sleep Results: there was a statistically significant difference between groups regarding daily sleep time, Pittsburgh Sleep Quality Index (PSQI) score and sleep quality after intervention. The results (p<0,05) showed that the mean intervention group PSQI score decrease from indicating that there were significant differences in the decrease PSQI score between the intervention and the control group. Conclusion: It was found that combined autogenic and benson relaxation as one of the non-pharmacological interventions was effective in improving participants sleep quality. Instruct pregnant women about appropriate non-pharmacological interventions which have no side-effects to improve sleep quality.

Complications in adulthood for patients with paediatric genitourinary reconstruction.

Caring for adults with prior paediatric genitourinary reconstruction remains a challenge for adult providers. Reconstructions typically have occurred decades before; surgical records are not always available and patients and families may be unable to convey procedures performed. Spina bifida (SB) patients are vulnerable to cognitive decline which may compound these challenges. Changes in patient body habitus and loss of function may contribute to problems with previous reconstructions. This is a non-systematic review of the literature and represents expert opinion where data are non-existent. This review focuses on the evaluation and management of complications arising from genitourinary reconstruction in congenital neurogenic bladder patients. Common complications experienced by congenital neurogenic bladder patients include recurrent urinary tract infection, incontinence of catheterizable channel and urinary reservoir as well as malignancy as this population ages. Preservation of renal function and prevention of urinary tract infection while optimizing continence are essential guiding principles in the care of these patients. Many of the recommendations, however, are gleaned from available data in the adult spinal cord patient (a more commonly studied population) or the paediatric urologic literature due to limited studies in adult management of such patients. Close follow-up and vigilance is warranted to monitor for infectious, mechanical and malignant complications while optimizing preservation of the upper urinary tracts and patient quality of life.

Individual variation in simulated fetal SAR assessed in multiple body models.

We generate 12 models from 4 pregnant individuals to evaluate individual differences in local specific absorption rate (SAR) for differing body habitus and fetal and maternal positions. Structural MR images from 4 pregnant subjects (including supine and left-lateral maternal positions) were manually segmented to create 12 body models by rotating the fetus, modifying the fat content, and altering the maternal arm position in 1 of the subjects. Electromagnetic simulations modeled at 3 Tesla determined the average and peak local SAR in the maternal trunk, fetus, fetal brain, and amniotic fluid. We observed a significant range of fetal and maternal peak local SAR across the models (maternal trunk: 19.14-44.03 watts/kg, fetus: 9.93-18.79 watts/kg, fetal brain 3.36-10.3 watts/kg). We found that maternal body habitus changes introduced a significant variation in the maternal peak local SAR but not the fetal local SAR. However, the maternal position (either rotating the mother to left-lateral position or altering the arm position) introduced changes in fetal peak local SAR (range: 11.9-17.9 watts/kg). Rotating the fetus also introduced variation in the fetal and fetal brain peak local SAR. The observed variation in SAR emphasizes the need for more anatomical models to enable better safety management of individuals during fetal MRI, including a wider range of gestational ages.

The Effects Of Aerobic, Resistance, And Combination Training On Satisfaction With Physical Function And Appearance

PURPOSE To determine the effects of aerobic training (AT), resistance training (RT), and combination training (AT/RT) on personal satisfaction with physical function (SPF) and appearance (SPA). We also examined the sex-specific relationships between objective measures of body habitus and cardiorespiratory fitness with changes in these satisfaction scores. METHODS Participants (n=130 from the STRRIDE AT/RT randomized trial) completed one of four 8-month exercise programs: 1) AT: 14 kcal exercise expenditure per kg per week (KKW) at 75% VO2peak; 2) RT: 3 days per week, 8 exercises, 3 sets per exercise, 8-12 repetitions per set; 3) AT/RT: full combination of the AT and RT programs; 4) AT-High Amount (AT-H): 21 KKW at 75% VO2peak. The Satisfaction with Physical Function and Appearance Questionnaire [7-point integer scale ranging from -3 (very dissatisfied) to +3 (very satisfied)] was administered at baseline and post-intervention. We also assessed measures of body habitus (weight, lean and fat mass, and minimal waist and hip circumferences) and cardiorespiratory fitness (VO2peak). Paired t-tests determined post- minus pre-intervention change score significance within training groups (p<0.05). Sex-specific correlations examined the relationship between changes in SPF and SPA with changes in body habitus and fitness. RESULTS After 8 months of training, all groups significantly improved their SPF scores, ranging from 1.8 (AT) to 2.8 points (AT-H), and their SPA scores, ranging from 0.8 (RT) to 2.4 points (AT-H). Change in SPF was significantly correlated with change in fat mass (r = -0.34) in women and change in VO2peak (r = 0.29) in men. Change in SPA was significantly correlated with change in fat mass (r = -0.39), waist circumference (r = -0.25), and weight (r = -0.30) in women and change in hip circumference (r = -0.28), weight (r = -0.32), and lean mass (r = -0.45) in men. CONCLUSIONS On average, all of the STRRIDE AT/RT training groups improved their self-reported satisfaction with physical function and appearance. We observed sex-specific differences in the relationships between changes in SPF and SPA with changes in body habitus and fitness. These correlative results can help inform future research targeting the mediating effects of exercise on self-perception of body image and function.

SCUBA Diving in Pregnancy.

Obstetrical care providers may occasionally encounter women with questions about the safety of Self-Contained Underwater Breathing Apparatus (SCUBA) diving in pregnancy. This article provides an overview of safety issues associated with basic SCUBA diving and offers guidance to practitioners about how to evaluate and counsel pregnant women about the associated maternal and fetal risks. Basic diving physiology is reviewed and the implications of SCUBA diving during pregnancy are discussed. A literature review examined available animal and human data about the potential adverse effects of the physiological changes of pregnancy on divers, the impact of pressure changes during diving, and possible consequences of hyperbaric gas exposure and rapid decompression on mother and fetus. Studies were found by searching the terms "scuba diving," "pregnancy," "fetus," "decompression illness," "hyperbaric medicine," and "animal studies" in the databases Medline, Pubmed, and Embase. Reference lists from existing articles and reports from identified diving magazines were also reviewed. Studies were limited to the English language and included publications until 2016. All relevant human studies were selected. Five retrospective studies and one prospective study assessing the antenatal and postnatal outcomes of women who participated in SCUBA diving while pregnant were reviewed. Published data was limited in both quantity and quality. The authors' experience with SCUBA diving together with a background in obstetrics allowed themes to be explored and recommendations developed. In addition to established risks of SCUBA diving, pregnant women are at increased risk due to changes in body habitus (affecting equipment fitting and balance). Animal data suggest possible adverse fetal effects due to fetal decompression illness (DCI) and hyperbaric oxygen exposure. Human data, though generally reassuring, are of poor quality and thus do not completely exclude adverse outcomes. In general, women should be cautioned to avoid diving during pregnancy, but inadvertent exposure to recreational diving in early pregnancy is not a reason for pregnancy termination.

Quantification of Volumetric Changes Occurring During Radiation Therapy for Esophageal Cancer

Many patients undergoing radiation therapy for esophageal cancer have marked anatomic changes during their course of treatment including shrinking of the primary tumor, edematous changes of the treated esophagus, and changes in body habitus. Changes in contour, volume, and location of the esophageal tumor over the total course of radiation therapy could have a potential dosimetric impact if highly conformal treatment techniques are used. We conducted a retrospective repeated measures analysis on daily cone-beam CT imaging to quantify the magnitude of these volumetric changes. Utilizing an institutional retrospective database, fourteen patients were identified for this study. All patients were treated using a linear accelerator with integrated on-board cone beam CT imaging that allows CT imaging during the daily treatment sessions while the patient is immobilized in the treatment position. Gross tumor volumes of the primary tumor were contoured on every axial slice on the primary planning CT and the CT acquired on treatment days 1, 6,11,16,21, and 25. The changes in primary tumor volume over time were analyzed with a repeated measures ANOVA analysis. Gross tumor volumes generally decreased at an average rate of roughly 6% volume loss per week which ultimately resulted in a 23% total average reduction in volume over the total course of therapy. Analysis of variance revealed a statistically significant reduction in tumor volume occurring by cone beam CT 11 with a mean volume of 91% of original (p=0.0011 95% CI 0.89-0.98).The volumes measured on cone beam CTs taken on treatment days 16, 21, and 25 were also statistically significant (p<0.0001) with mean residual volumes of 89% (95% CI = 0.83-0.96), 83% (95% CI=0.79-0.89), and 77% of original volume (95% CI= 0.72-0.83) respectively. Statistically significant volume reductions were noted to begin by radiation treatment day 11 with meaningful dosimetric implications. These data may, therefore, be useful in the implementation of an adaptive radiation therapy planning scheme that periodically adjusts the conformal treatment plan to match these anatomic

Sleep-disordered breathing and the menopausal transition among participants in the Sleep in Midlife Women Study

Menopause is widely believed to be an established cause of sleep disorders, but evidence for this theory is inconclusive. Attributing any sleep problem to normal processes of menopause may lead to underdiagnosis of treatable sleep disorders in midlife women. This study uses detailed longitudinal data on sleep and menopausal health from participants in the Sleep in Midlife Women Study to investigate whether risk and severity of sleep-disordered breathing increase with progression through menopause, accounting for changes in age and body habitus. A total of 219 women aged 38 to 62 years were recruited from participants in the Wisconsin Sleep Cohort Study. Menopause status was determined from daily diaries in which participants reported menstrual flow, hot flashes, and use of hormonal medications. Each participant underwent in-home polysomnography studies every 6 months, to measure the apnea-hypopnea index (AHI) (N = 1,667 studies). Linear models with empirical standard errors were fit for logarithm of AHI on menopause status and years in menopause, adjusting for age, body mass index, waist girth, and neck girth. Compared with women in premenopause, AHI was 21% higher among participants in perimenopause (95% CI, -4 to 54), 31% higher among participants in postmenopause (95% CI, 2-68), and 41% higher among participants whose menopausal stage could not be distinguished between peri- and postmenopause (95% CI, 8-82). Among women who had begun perimenopause, each additional year in menopause was associated with 4% greater AHI (95% CI, 2-6). Progression through menopause is associated with greater sleep-disordered breathing severity. This association is independent of aging and changes in body habitus.

Association of the Composite Inflammatory Biomarker GlycA, with Exercise-Induced Changes in Body Habitus in Men and Women with Prediabetes.

GlycA is a new composite measure of systemic inflammation and a predictor of many inflammatory diseases. GlycA is the nuclear magnetic resonance spectroscopy-derived signal arising from glucosamine residues on acute-phase proteins. This study aimed to evaluate how exercise-based lifestyle interventions modulate GlycA in persons at risk for type 2 diabetes. GlycA, fitness, and body habitus were measured in 169 sedentary adults (45–75 years) with prediabetes randomly assigned to one of four six-month exercise-based lifestyle interventions. Interventions included exercise prescription based on the amount (energy expenditure (kcal/kg weight/week (KKW)) and intensity (%VO2peak). The groups were (1) low-amount/moderate-intensity (10KKW/50%) exercise; (2) high-amount/moderate-intensity (16KKW/50%) exercise; (3) high-amount/vigorous-intensity (16KKW/75%) exercise; and (4) a Clinical Lifestyle (combined diet plus low-amount/moderate-intensity exercise) intervention. Six months of exercise training and/or diet-reduced GlycA (mean Δ: −6.8 ± 29.2 μmol/L; p = 0.006) and increased VO2peak (mean Δ: 1.98 ± 2.6 mL/kg/min; p < 0.001). Further, visceral (mean Δ: −21.1 ± 36.6 cm2) and subcutaneous fat (mean Δ: −24.3 ± 41.0 cm2) were reduced, while liver density (mean Δ: +2.3 ± 6.5HU) increased, all p < 0.001. When including individuals in all four interventions, GlycA reductions were associated with reductions in visceral adiposity (p < 0.03). Exercise-based lifestyle interventions reduced GlycA concentrations through mechanisms related to exercise-induced modulations of visceral adiposity. This trial is registered with Clinical Trial Registration Number NCT00962962.

Improved donor safety in high-volume apheresis collections.

Separators use 1960s sex-based nomograms to estimate apheresis donor blood volume and to calculate the 15% maximum extracorporeal and collection volumes. As US body habitus changes, proportional overestimation of the maximum safe collection volume may become clinically significant with large-volume collections. We correlated 2 years of vasovagal reaction (VVR) data with 148,416 Trima apheresis procedure parameters to identify trends. Only platelet/plasma with or without red blood cell (RBC) procedures yielded collection volumes of at least 900 mL with no saline replacement. Vasovagal events of any severity were correlated by sex with actual collection volume and donor estimated blood volume (EBV). We performed multivariable analysis incorporating the factors that influence VVR rates to assess the significance of EBV and collection volume. VVR rates nearly doubled in male donors who had collection volumes greater than 1050 mL. No reaction threshold could be identified in female donors. This was confirmed in multivariable analysis that included donor sex, age, donation experience, draw time, and reporting location. Limiting apheresis collections to the lesser of 1050 mL or 15% EBV may reduce VVR rates. Further confirmation of this finding by other collection centers is desirable.

A Qualitative Examination of the Ward Region of Interest as Imaged on Dual-Energy X-ray Absorptiometry Examinations: The “Wandering Ward Sign”

While analyzing dual-energy X-ray absorptiometry (DXA) examinations, we observed that, on occasion, the Ward region of interest (ROI) was positioned either unexpectedly or differently between successive examinations. When this occurred, it appeared to be either a marker of a compromised examination or of incident disease. This prompted a systematic inquiry. It became apparent that, while in general seeking the region of least areal density, the Ward ROI is positioned differently by the machines available to us from 2 particular manufacturers (General Electric Co. and Hologic Inc.). Three reviews were thus undertaken: (1) a prospective systematic examination of 200 unselected consecutive DXA examinations made with a General Electric Co. machine, 80 having had follow-up examinations and 245 made with a Hologic Inc. device; (2) a prospective systematic examination of 625 consecutive, unselected DXA examinations that were repeat examinations; and (3) a retrospective examination of a file of 86 cases collected for pedagogical purposes, predominantly made with a Hologic Inc. device. The commonest cause of an unusual position of the Ward area was compromised patient positioning or change in body habitus. Changes between examinations were, in addition if less often, apt to reflect physiological change or disease. Unusual positioning or a change in position of the Ward ROI is easily observed. It does not occur frequently, but, when it does, it may be useful in directing attention to either technical factors or incidental diseases. Observation of the position of the Ward ROI may thus be a quality assurance, and occasionally a diagnostic, tool.

Sleep-disordered Breathing and the Menopausal Transition Among Participants in the Sleep in Midlife Women Study

ABSTRACT Objective Menopause is widely believed to be an established cause of sleep disorders, but evidence for this theory is inconclusive. Attributing any sleep problem to normal processes of menopause may lead to underdiagnosis of treatable sleep disorders in midlife women. This study uses detailed longitudinal data on sleep and menopausal health from participants in the Sleep in Midlife Women Study to investigate whether risk and severity of sleep-disordered breathing increase with progression through menopause, accounting for changes in age and body habitus. Methods A total of 219 women aged 38 to 62 years were recruited from participants in the Wisconsin Sleep Cohort Study. Menopause status was determined from daily diaries in which participants reported menstrual flow, hot flashes, and use of hormonal medications. Each participant underwent in-home polysomnography studies every 6 months, to measure the apneahypopnea index (AHI) (N = 1,667 studies). Linear models with empirical standard errors were fit for logarithm of AHI on menopause status and years in menopause, adjusting for age, body mass index, waist girth, and neck girth. Results Compared with women in premenopause, AHI was 21% higher among participants in perimenopause (95% CI, −4 to 54), 31% higher among participants in postmenopause (95% CI, 2-68), and 41% higher among participants whose menopausal stage could not be distinguished between peri- and postmenopause (95% CI, 8-82). Among women who had begun perimenopause, each additional year in menopause was associated with 4% greater AHI (95% CI, 2-6). Conclusions Progression through menopause is associated with greater sleep-disordered breathing severity. This association is independent of aging and changes in body habitus.

Quantifying the performance of in vivo portal dosimetry in detecting four types of treatment parameter variations.

To quantify the ability of electronic portal imaging device (EPID) dosimetry used during treatment (in vivo) in detecting variations that can occur in the course of patient treatment. Images of transmitted radiation from in vivo EPID measurements were converted to a 2D planar dose at isocenter and compared to the treatment planning dose using a prototype software system. Using the treatment planning system (TPS), four different types of variability were modeled: overall dose scaling, shifting the positions of the multileaf collimator (MLC) leaves, shifting of the patient position, and changes in the patient body contour. The gamma pass rate was calculated for the modified and unmodified plans and used to construct a receiver operator characteristic (ROC) curve to assess the detectability of the different parameter variations. The detectability is given by the area under the ROC curve (AUC). The TPS was also used to calculate the impact of the variations on the target dose-volume histogram. Nine intensity modulation radiation therapy plans were measured for four different anatomical sites consisting of 70 separate fields. Results show that in vivo EPID dosimetry was most sensitive to variations in the machine output, AUC = 0.70 - 0.94, changes in patient body habitus, AUC = 0.67 - 0.88, and systematic shifts in the MLC bank positions, AUC = 0.59 - 0.82. These deviations are expected to have a relatively small clinical impact [planning target volume (PTV) D99 change <7%]. Larger variations have even higher detectability. Displacements in the patient's position and random variations in MLC leaf positions were not readily detectable, AUC < 0.64. The D99 of the PTV changed by up to 57% for the patient position shifts considered here. In vivo EPID dosimetry is able to detect relatively small variations in overall dose, systematic shifts of the MLC's, and changes in the patient habitus. Shifts in the patient's position which can introduce large changes in the target dose coverage were not readily detected.