Cm In Female Patients Research Articles

Sex-specific criteria for repair should be utilized in patients undergoing aortic aneurysm repair

ObjectiveFemale patients are more likely to undergo repair of intact and ruptured abdominal aortic aneurysm (AAA) at smaller aortic diameter compared with male patients. By adjusting for inherent anatomic differences between sexes, aortic size index (ASI) and aortic height index (AHI) may provide an additional method for guiding treatment. We therefore analyzed sex-specific criteria for AAA repair using aortic diameter, ASI, and AHI. MethodsWe identified all patients who underwent AAA repair between 2003 and 2019 in the Vascular Quality Initiative database. The Dubois and Dubois formula was used to calculate body surface area; aortic diameter was divided by body surface area to calculate ASI. Aortic diameter was divided by height to calculate AHI. Cumulative distribution curves were used to plot the proportion of patients who underwent repair of ruptured aneurysm according to aortic diameter, ASI, and AHI. Multivariable logistic regression modeling was used to identify the association of female sex with perioperative mortality and any major postoperative complication. ResultsWe identified 55,647 patients, of whom 12,664 were female (20%). For both intact and rupture repair, female patients were older, less likely to undergo endovascular aneurysm repair, and more likely to have comorbid conditions. Female patients underwent repair at smaller median aortic diameter compared with male patients for intact (5.4 vs 5.5 cm; P < .001) and rupture repair (6.7 vs 7.7 cm; P < .001). However, ASI was higher in female patients for both intact (3.1 vs 2.7 cm/m2; P < .001) and rupture repair (3.8 vs 3.7 cm/m2; P < .001), whereas AHI was higher in female patients for intact repair (3.3 vs 3.1 cm/m; P < .001) but lower for rupture repair (4.1 vs 4.3 cm/m; P < .001). When analyzing the cumulative distribution of rupture repair in male patients, 12% of rupture repairs were performed at an aortic diameter below 5.5 cm. To achieve the same proportion of rupture repair in female patients, the repair diameter was only 4.9 cm. However, when ASI and AHI were used, female and male patients both reached 12% of rupture repair at an ASI of 2.7 cm/m2 and an AHI of 3.0 cm/m. ConclusionsOur study provides data to strongly support the sex-specific 5.0-cm aortic diameter threshold suggested for repair in female patients by the Society for Vascular Surgery. The high percentage of patients undergoing rupture repair below 5.5 cm in male patients and 5.0 cm in female patients highlights the need to better identify patients at risk of rupture at smaller aortic diameters.

A Cross-Sectional Study of GLIM-Defined Malnutrition Based on New Validated Calf Circumference Cut-off Values and Different Screening Tools in Hospitalised Patients over 70 Years Old.

The Global Leadership Initiative on Malnutrition (GLIM) is new criteria for diagnosing malnutrition that need validation adjusted to race. Our aim is to determine the optimal reference values of calf circumference (CC), investigate the prevalence of GLIM-defined malnutrition based on different screening tools in inpatients over 70 years old in China and assess its relationship with clinical outcomes. We designed two continuity studies by analyzing a prospective multicenter database. First, we estimated and validated the CC cut-off values by receiver operating characteristic analyses against in-hospital mortality. Then the patients who were at risk by NRS 2002, MNA-SF and MUST were assessed by the GLIM criteria using the new CC values. Some clinical parameters and outcome data were evaluated. The optimal cut-off values of CC were 29.6 cm for male patients and 27.5 cm for female patients. The prevalence of GLIM-defined malnutrition was 27.5% by using NRS2002, 32.6% by using MNA-SF and 25.4% by using MUST. Patients with GLIM-defined malnutrition showed significantly worse values in BMI, total protein, albumin, neutrophil/lymphocyte ratio, CC, rate of complication, in-hospital mortality, length of stay, and total hospital cost than normal patients. Multivariate logistic regression showed the odds ratio of in-hospital mortality was significantly associated with GLIM defined malnutrition by using MNA-SF [OR = 1.231, 95%CI (1.022, 1.484), P = 0.029]. The Chinese reference values of CC for inpatients over 70 years old were validated by in-hospital mortality, which could be implemented in GLIM criteria. And this population possessed a high prevalence of nutrition risk and malnutrition. GLIM criteria with MNA-SF seems to be the first choice to diagnose malnutrition.

Functional outcome in patients following cartilage regenerative treatement: outcome at minimum follow-up of 12 months

Aims and Objectives:Full thickness cartilage defects may be devastating for the patients. Even though, the surgical options have improved, only limited information for returning to sports. Aim of this study was therefore to compare the functional outcome and the return to sports rate of patients following cartilage regenerative treatment at a minimum follow up of 12 months.Materials and Methods:A total of 50 Patients (32 male, 18 female) undergoing cartilage regeneration using a Matrix-associated chondrocyte transplantation (MACT, Novocart, TETEC, Aesculap) (27 femorotibial, 23 patellofemoral) were evaluated at a minimum follow-up of 12 months. Follow-up was performed using a multifactorial functional analysis including isokinetic strength measurements (BTE-primus), proprioceptive tests (MTF tests), a tapping test and a 3d-motion analysis (myomotion, Noraxon) during single leg squats, bilateral drop jumps and single leg hop tests. Agility was assessed using a lateral speedchase (Globalspeed, Hemsbach). Clinical results were recorded using Tegner and Lysholm score.Results:Patients showed a Lysholm score of 86,3 +/-10,3 and 84,0 +/-13,9 for male and female, respectively. The tegner score was significantly reduced when compared to preoperatively (male 4,72 +/-1,6, female 4,75 +/-1,5). Thigh circumference was reduced by an average of 3,6 cm for male and 4,4 cm for female patients. The tapping test revealed no differences between male and female patients providing a leg symmetry index (LSI) of 102,0 (+/-8,4) with an overall average frequency of 10,14 (+/-1,27). During single leg squat male patients had a significantly lower knee flexion of 55,8 (+/-8,5) of the postoperative leg compared to the non-injured leg (62,2 +/-8,2) whereas the knee abduction was -6.8 (+/-15,1) and -11,8 -11,82 (+/-16,6) for the postoperatively and non-injured leg, respectively. Evaluating the single leg hop, the LSI of distance values was 90,8 (+/-11,9) and for height values 84,0 (+/-16,0) for the male patients. There was a trend towards reduced ROM with regard to knee flexion of the injured leg to the non-injured. Cutting time during lateral speedchase showed a LSI of 98,29 (+/-13,8) and 99,44 (+/-8,2) for male and female patients, respectively.Conclusion:This prospective analysis of patients following cartilage regeneration implicates that the use of a multifactorial “return-to-sports” analysis 12 months postoperatively provides a good correlation to the clinical outcome and scores. At this FU point, Patients following MACT show knee joint function that is close to normal.

Clinical Implications of Vocal Cord-Carina Distance and Tracheal Length in the Indian Population.

Securing the tracheal tube (TT) at a fixed recommended depth of 21/23 cm in female and male patients, respectively, may result in inappropriate placement of the TT in some patients. The aim of the present study was to determine the vocal cord-carina distance (VCD) and tracheal length (TL) to ascertain the optimal depth of TT placement during orotracheal intubation in the adult Indian population. A total of 92 adults undergoing elective surgery under general anaesthesia with orotracheal intubation were studied. Surface anatomy airway measurements were noted. A cuffed TT (female size 7 mm ID and male size 8 mm ID) was inserted with the intubation guide mark at level with the vocal cords (VCs). Fiberoptic bronchoscopy-guided measurements were obtained for VCD, TL, TT tip-carina distance, VC-cricoid distance and lip-carina (L-C) distance. The mean±SD VCD was 12.82±2.05 and 12.02±1.44 cm, and TL was 10.14±2.04 and 9.37±1.28 cm in male and female patients, respectively. Statistically significant differences were observed between male and female patients in VCD (p=0.033), TL (p=0.032), L-C distance (p<0.001) and lip-TT tip distance (p<0.001); lip-TT tip distance was 19.50±1.39 cm in male patients and 18.17±1.28 cm in female patients. The L-C distance correlated with patient height, weight and neck length. L-C distance=7.214+0.049×Height+0.320×Neck length+0.033×Weight. We recommend placing the TT with its proximal guide mark at the level of VCs in the Indian population. The 21/23 cm rule for tube placement depth in female and male patients, respectively, cannot be routinely followed in the Indian population.

Imaging study of second sacral alar-iliac screw placement in adult degenerative scoliosis

Objective To discuss the imagingcharacteristics of S2AI screw trajectory in ADS patients. Methods Forty patients with degenerative scoliosis were scanned with Simens Sliding 40-slice spiral CT scanner. Three-dimensional scanning and reconstruction were performed in these patients with the scanning range including thoracolumbar spine, lumbar spine, lumbosacral region, pelvis and bilateral hip joints. The base of the lateral sacral crest on the midline between the lower edge of S1 dorsal foramina and the upper edge of S2 dorsal foramina was the starting point. The placement plane of S2AI screw trajectory was determined from the starting point to the lower margin of anterior inferior iliac spine. A 10mm diameter screw was the design template. A circle with a diameter of 5 mm as the center of the lowest point of the ilium inner cortex was made, and a tangent line from the starting point to the outer diameter of the circle (the inner part of the ilium) was selected as the axis of the screw trajectory. The lateral angle and the length of the axis of the screw trajectory and iliac width were measured in transverse plane. The caudal angle, the distance from the axis of the screw trajectory to iliosciatic notch, and the caudal angle, the distance from the axis of the screw trajectory to the upper edge of the acetabulum were measured in sagittal plane. These parameters were recorded and analyzed. Results The trajectory length of S2AI screw in ADS patients was 12.00±0.99 cm, the lateral angle was 41.24°±3.92°, the caudal angle was 27.73°±6.45°, and the distance from the axis of the screw trajectory to iliosciatic notch was 1.05±0.81 cm, the distance from the axis of the screw trajectory to the upper edge of the acetabulum was 1.85 ± 0.33 cm, and the iliac width was 2.12±1.65 cm. The trajectory length, lateral angle, caudal angle, distance from the axis of the screw trajectory to iliosciatic notch, distance from the axis of the screw trajectory to the upper edge of the acetabulum and iliac width of S2AI screw was respectively 12.40±0.83 cm, 39.47°±1.76°, 28.00°±6.39°, 1.08±0.32 cm, 1.76±0.34 cm, 2.26±0.25 cm in male patients, and was respectively 11.75±1.01 cm, 42.30°±4.48°, 27.56°±6.61°, 1.21±1.00 cm, 1.90±0.32 cm, 2.04±0.18 cm in female patients. The screw length and lateral angle had statistically difference between male and female patients(P<0.05). Compared with non-ADS patients in previous studies, female patients with ADS had significant differences in increased lateral angle and decreased caudal angle of S2AI screw. Conclusion There is ideal trajectory of S2AI screws in ADS patients. There was no significant difference of the length of S2AI screws between ADS patients and non-ADS population. Different direction was noticed in the placement of S2AI screws, especially in female patients. Increased lateral angle and decreased caudal angle would be obtained in the procedure of placing S2AI screws in female ADS patients during operation. Key words: Adult; Lumbar vertebrae; Intervertebral disc degeneration; Scoliosis; Spinal fusion; Pelvis; Tomography scanners, X-ray computed

A study of the correlation of waist circumference with metabolic risks among non-obese populations.

To investigate the correlation of waist circumference with metabolic risks among non-obese populations. A retrospective analysis was conducted for the clinical information of 13,145 non-obese subjects who received physical examinations in the hospital from January 2015 to January 2018. Among them, 1,971 subjects were definitely diagnosed with diabetes mellitus, hypertension, and metabolic syndrome and set as the metabolic disorder group, with the remaining 11,174 cases as the control group. All metabolism-related indicators were compared between the patients in the two groups, the analysis was performed for the prevalence of diabetes, hypertension, and metabolic syndrome in patients with different waist circumference as well as males and females with different waist circumferences. Finally, the optimal cut-off points of waist circumference were determined. According to the comparison, there were no statistically significant differences in subjects with low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and total cholesterol between the metabolic disorder group and the control group (p>0.05). The subjects in the metabolic disorder group had higher waist circumference, waist-to-hip ratio, triglyceride, fasting insulin, fasting blood glucose, and insulin resistance index than those in the control group, displaying statistically significant differences (p<0.05). When waist circumference was more than 70 cm, as it increased, the prevalence rates of diabetes, hypertension, and metabolic syndrome gradually elevated. When waist circumference was 60-90 cm, hypertension took the leading place in metabolic disorders, so did the metabolic syndrome and diabetes, with a waist circumference of more than 90 cm. There were no remarkable differences in the prevalence rates of diabetes, hypertension, and metabolic syndrome among male and female patients with different waist circumferences ((p>0.05). The patients with the waist circumference of over 90 cm exhibited gradually declined prevalence rates of diabetes, hypertension, and metabolic syndrome, while those in the patients with a waist circumference of 60-90 cm were gradually increased. The optimal cut-off points of waist circumference were calculated according to the prevalence rates of diabetes, hypertension, and metabolic syndrome among patients, and the calculation results were 78 cm, 79 cm, and 77 cm for male patients and 73 cm, 78 cm, and 73 cm for female patients. Based on the weight combined with the optimal cut-off points of waist circumference, the optimal waist circumference cut-off points for males and females were 78 cm and 74 cm, respectively. There is a correlation between the waist circumference and metabolic risks among non-obese populations, but the screening for metabolic diseases should be conducted among males with a waist circumference of over 78 cm and females with a waist circumference of over 74 cm. The treatment measures are supposed to be taken promptly to improve the prognosis.

Tracheal tube fixation: the effect on depth of insertion of midline fixation compared to the angle of the mouth*

Following successful placement of a tracheal tube (TT), it is frequently moved from the midline to the angle of the mouth. This study investigates the tracheal tube tip position in the two fixation positions in 200 adult patients. Following tracheal intubation, a fibreoptic bronchoscope (FOB) was introduced through a swivel connector and the distances from the swivel connector to the lips, carina, tip of TT and the crico-tracheal membrane were measured with the TT in the midline and at the right angle of the mouth. The mean (SD) TT tip to carinal distance decreased from 3.60 (1.50) cm to 2.28 (1.55) cm in female patients, and 5.04 (1.43) cm to 3.69 (1.65) cm in male patients on moving the tracheal tube to the angle of the mouth. We conclude that there is a significant movement of the tracheal tube towards the carina on moving the TT from midline to angle of mouth and the depth of insertion of the tube should be adjusted accordingly.

Model for end-stage liver disease (MELD) exception for polycystic liver disease

Polycystic liver disease (PLD) is commonly associated with polycystic kidney disease, but is unaccompanied by renal cysts in 10% of cases. Symptomatic PLD is mainly limited to adults and rarely, if ever, presents in childhood. There is currently no effective medical therapy for PLD. Most patients who have PLD require no medical or surgical intervention. Patients with PLD rarely, if ever, experience biochemical hepatic deterioration, and classic symptoms of hepatic failure such as ascites, variceal hemorrhage, or encephalopathy are unusual.1-3 Although there is a typical lowering of the quality of life in these patients, to date, quality of life (although not well studied) has not been associated with decreased survival. Serious, life-threatening complications related to multiple hepatic cysts may occur, including cyst infection, hepatic vein outflow obstruction, portal hypertension, refractory ascites after cyst fenestration, cyst carcinoma, cholangiocarcinoma, and most importantly, pain and/or chronic wasting with malnutrition.2-4 Symptomatic PLD only occurs in patients with massive hepatic cystic disease in which the total cyst:parenchyma ratio is >1.5 Patients with PLD on hemodialysis are at greatest risk of life-threatening complications due to hepatic cysts complicated by infection, hemorrhage, and carcinoma. In one center, 10% of the mortality in patients with PLD on hemodialysis was attributed to these complications. However, this observation has not been confirmed by other centers. Nontransplant interventions that can relieve symptoms of massive hepatic cystic disease include percutaneous cyst puncture and sclerotherapy, laparoscopic cyst decompression, open laparotomy with fenestration, and liver resection.3, 6-10 These interventions can provide temporary or prolonged relief of symptoms but may be associated with significant morbidity and even mortality. Open surgical decompression is associated with a very low mortality rate but is associated with substantial morbidity. Laparoscopic decompression reduces hospital length of stay but is also associated significant morbidity.6 Liver resection is indicated only in highly selected patients and is associated with the potential for frequent morbidity and significant mortality. Liver transplantation (LT), the ultimate treatment for PLD, eliminates the disease and its complications and provides long-lasting relief of symptoms.11-14 Approximately 40% of those undergoing LT will require simultaneous kidney transplantation. Five-year survival after LT or liver-kidney transplantation is approximately 70 to 75%, and much of the mortality is in the first year. LT with or without kidney transplantation should be avoided in severely malnourished or debilitated patients. Patients with PLD may be candidates for living-donor LT. Patients with PLD generally have preserved liver function and normal Model for End-Stage Liver Disease (MELD) scores if they do not have renal involvement. Satisfy criteria for massive PLD (total cyst:parenchyma ratio >1) and have a complication of the PLD that is likely to resolve after LT. Are not candidates for, or have disease that has failed to respond to, nontransplant interventions for relief of symptoms; malnutrition may be considered a primary contraindication to nontransplant surgery. Have clinically significant manifestations of liver disease that can be attributed to massive PLD, which may include cachexia, ascites, portal hypertension (variceal bleeding), hepatic venous outflow obstruction, biliary obstruction, cholestasis, or recurrent cyst infection. Have severe malnutrition (assessment made on the basis of hypoalbuminemia or decreased lean body mass). Have serum albumin <2.2 mg/dL. Have lean body mass reflected by decreased midarm circumference, measured in the nondominant arm midway between the acromion and the olecranon process: <23.1 cm in female patients and <23.8 cm in male patients. PLD, polycystic liver disease; LT, liver transplantation; MELD, Model for End-Stage Liver Disease. There are insufficient data to justify automatic priority for patients with PLD. Patients without renal insufficiency may receive a MELD score of 15. The score may be increased by an additional 3 points every 3 months upon reapplication with submission of current clinical data. Patients with renal insufficiency (defined as glomerular filtration rate or creatinine clearance < 30 mL/min) may receive a MELD score of 20. The score may be increased by an additional 3 points every 3 months upon reapplication. Clinical data that need to prospectively collected and be submitted to the Regional Review Boards include documentation of recurrent cyst infection by culture reports, and weight of the explant liver and the ratio of the liver weight to patient height to determine whether these parameters correlate with patient outcome. In addition, the Regional Review Boards may require vascular studies (full reports with computed tomographic scans, magnetic resonance imaging, or angiography) to document cases of vascular occlusion.

Long-term social outcome of children after kidney transplantation.

There are few data concerning the social outcome at adult age of children who received a kidney transplant. The aim of this study was to collect information on this outcome in a cohort of 366 children who underwent transplantation between 1973 and 1985. Information was obtained through a simple questionnaire in 244 patients. The mean age of the patients was 31.7 years, and they had undergone grafting at a mean age of 11.9 years. As of December 2000 or at last visit, 77% had a functioning graft. The mean height was 156.6 cm for male patients and 147.4 cm for female patients. The distribution of educational level was lower than national averages: 27.4% were at the lowest level versus 3% of the general population, 41.4% were at the middle level, 31.2% had reached the baccalaureate level, and 11% had followed a university cursus. Activity was similar to the general population: 73% had paid employment versus 72%, 6.5% were unemployed versus 10.5%, and 18.7% received a disablement pension. Among the 149 male patients, 39 (27%) had a marital life and 12 (8.3%) had children, whereas among the 95 female patients, 48 (50%) had a marital life and 26 (27%) had at least one child. Lodging was the parent's home in 46% and independent in 54%. Multivariate analysis showed a significant correlation between educational level, paid activity, marital life, and independent housing with final height. The long-term social outcome of patients who underwent grafting in childhood more than 15 years previously is encouraging. The importance of reaching a normal height is stressed.

The role of lymphangiography in designing fields for elective pelvic node irradiation in Hodgkin's disease

Purpose: We attempted to design a standard pelvic nodal treatment field such that all lymph nodes usually visualized on lymphangiogram would be irradiated with optimal midline blocking of normal tissues. Methods and Materials: Two standard fields for treatment of pelvic lymph nodes were designed, based on bony landmarks. The standard fields were applied to the anterior-posterior view of 35 pretherapy lymphangiograms, and the fields were then assessed for inclusion of visible lymph nodes. Measurements were done on the lymphangiograms to assess the amount of additional midline blocking that could be added. Results: All visualized nodes were included in 30 patients (86%) using Standard Field I and in 33 patients (94%) using Standard Field 11, but visualized nodes plus a 1.5-cm minimum margin were included in only two patients (6%) with Field I and 24 patients (69%) with Field 11. The most frequent sites of close margins were the lateral and medial borders adjacent to the external iliac nodes. Based on the lymphangiograms, a mean of 1.6 cm in male patients and 3.1 cm in female patients could be added to the width of the midline blocks. Conclusion: Lymph angiography is useful in designing fields for pelvic node irradiation, both to improve coverage of nodes with a 1.5 cm margin and to increase the amount of central shielding of normal tissues.