L3 Level Research Articles

Glenoid lateralization and subscapularis repair are independent predictive factors of improved internal rotation after reverse shoulder arthroplasty.

Reverse shoulder arthroplasty (RSA) has shown improvement in clinical outcomes for various conditions, although some authors expressed concern about the restoration of active internal rotation (AIR). The current study assesses preoperative and intraoperative predictive factors of AIR in patients having a Grammont-style RSA with a minimum five year follow-up. We conducted a retrospective multicentric study, including patients operated on with a 155° Grammont-style RSA for cuff-related pathology or primary osteoarthritis with posterior subluxation or an associated cuff tear. Patients were clinically evaluated at a minimum of fiveyear follow-up. Patients with previous surgery or those who had a tendon transfer with the RSA were excluded. Demographic parameters, BMI, preoperative notes, and operative reports were obtained from medical records. AIR was graded according to the constant score system from 0 to 10. A total of 280 shoulders in 269 patients (mean age at surgery, 74.9 ± 5.9 years) met the inclusion criteria and were analyzed. The average follow-up was 8.1 years (range, 5-16 years). Overall, AIR increased from 4.2 (SD 2.5, range 0 to 10) preoperatively to 5.9 (SD 2.6, range 0 to 10) at final follow-up. At the last follow-up, AIR increased in 56% of cases, was unchanged in 26% and decreased in 18%. In 188 shoulders (67%), internal rotation was functional and allowed patients to reach the level of L3 or higher. Multivariable linear regression found the following preoperative clinical factors predictive of worse AIR after RSA: male gender (ß = -1.25 [-2.10; -0.40]; p = 0.0042) and higher values of BMI (ß = -0.085 [-0.17; -0.0065]; p = 0.048). Two surgical factors were associated with better AIR after RSA: glenoid lateralization with BIO-RSA technique (ß = 0.80 [0.043; 1.56]; p = 0.039) and subscapularis repair (ß = 1.16 [0.29; 2.02]; p = 0.0092). With a mean of eightyear follow-up (5 to 16 years), internal rotation was functional (≥ L3 level) in 67% of operated shoulders after Grammont-style RSA; however, two patients out of ten had decreased AIR after surgery. Male patients and those with higher BMIs had worse AIR, with glenoid lateralization (using the BIO-RSA technique) and subscapularis repair, as they are predictive of increased AIR after RSA. Case series, Level IV.

The Association among Physical Activity, Sociodemographic, Trunk Muscles Thickness and Low Back Pain-Related Disability in Amateur Soccer Players: An Observational Study

Abstract Objective Although low back pain (LBP) is one of the most common musculoskeletal disorders, there is limited evidence assessing which factors contribute LBP severity in amateur athletes. We aimed to analyze relationships between sociodemographic, clinical, lifestyle and lumbar multifidus (LM) at L4 and L5 levels, rectus abdominis (RA), external and internal obliques (EO and IO) and transversus abdominis (TrA) muscles thickness assessed with ultrasound imaging (US) variables with lumbar disability in amateur athletes with LBP and lumbar disc herniation. Methods Eighty-two male amateur soccer athletes were analyzed. Demographic data, internal hip rotation, finger-floor distance, pain intensity, number of LBP episodes within the last year, metabolic equivalent of tasks for physical activity, sitting time, muscle thickness and disability caused by LBP were collected. Results Pain intensity showed significant associations with LBP recurrence, disability, sedentarism, trunk and hip flexibility, vigorous physical activity and TrA, EO and RA muscles thickness (p<0.05). Similarly, disability was associated with number of LBP episodes, vigorous activity, sitting time, finger floor distance, and RA, EO and IO muscles thickness (p<0.05). TrA thickness and internal hip rotation were not associated with lumbar disability (p>0.05). Conclusion LBP intensity and pain-related disability were significantly associated with LBP episodes, vigorous activity, sitting time, finger floor distance, and thickness of abdominal muscles were associated with pain intensity and disability. However, lumbar multifidus thickness at rest, ankle dorsiflexion and walking time were not associated with clinical severity.

A nomogram based on psoas muscle index predicting long-term cirrhosis incidence in non-cirrhotic patients with HBV-related acute‑on‑chronic liver failure

There is a lack of scoring system to predict the occurrence of cirrhosis in individuals with acute-on-chronic liver failure (ACLF) in the absence of cirrhosis. The goal of this study was to develop a psoas muscle index (PMI)-based nomogram for cirrhosis risk in non-cirrhotic patients with HBV-related ACLF. We included 274 non-cirrhotic HBV-ACLF patients who were randomly assigned to training and validation groups. Logistic analyses were performed to identify risk factors for cirrhosis. A nomogram was then constructed. The predictive performance of the nomogram was assessed using the area under the receiver operating characteristic curve (AUROC), calibration curve, and decision curve analysis (DCA). During the 360-day follow-up, 44.5% (122/274) of non-cirrhotic HBV-ACLF patients developed cirrhosis. A higher PMI at the L3 level was correlated with a decreased risk of long-term cirrhosis occurrence (OR 0.677, 95% CI 0.518–0.885, P = 0.004). The nomogram incorporating PMI, age, neutrophil-to-lymphocyte ratio (NLR), and international normalized ratio (INR), indicated satisfactory predictive performance for cirrhosis risk stratification in ACLF population. The nomograms had an AUROC of 0.812 (95% CI 0.747–0.866) and 0.824 (95% CI 0.730–0.896) in the training and validation cohorts, respectively. The calibration curves displayed excellent predictive accuracy of the nomogram in both sets. In both cohorts, the DCA verified the nomogram's clinical efficacy. In non-cirrhotic HBV-ACLF patients, a greater PMI appears to protect against long-term cirrhosis occurrence. Strong predictive performance has been demonstrated by PMI-based nomograms in assessing the likelihood of 1-year cirrhosis in those with HBV-ACLF.

Sarcopenia in paraspinal muscle as a risk factor of proximal junctional kyphosis and proximal junctional failure after adult spinal deformity surgery.

The aim of this study was to identify the risk factors for proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), including paraspinal muscle atrophy. Fifty-seven consecutive patients who underwent a long-instrumented fusion for adult spinal deformity (ASD) with a minimum follow-up of 2 years were included in the study. Patient, surgical, and radiological factors were evaluated. Muscle volume was measured using the muscle/vertebra ratio of the multifidus, erector spinae (ES), and psoas muscles, and muscle function was evaluated using the degree of fat infiltration at the L4-5 level. The study included 57 consecutive patients: 25 patients in the combined PJK/PJF group (13 with PJK and 12 with PJF) and 32 in the control group (without PJK or PJF). The mean time to onset of PJK and PJF was 15.7 and 1.7 months, respectively. Multivariate analysis showed that greater pre- and postoperative sagittal vertical axis was associated with the occurrence of PJK/PJF. ES muscle atrophy was more significant in the PJK/PJF group than in the control group, and more severe in the PJF than in the PJK group. This study showed that PJF occurred much earlier than PJK after ASD surgery. Paraspinal muscle atrophy was identified as a significant risk factor for PJK and PJF, especially PJF. The possibility of PJK and PJF development should be considered when long-segment fusion is planned for patients with paraspinal muscle atrophy.

The articular surface technique for lumbar pedicle screw placement: a 3D feasibility study.

Traditional pedicle screws (TPSs) and cortical based trajectory pedicle screws each apply stability with fusions of the lumbar spine and have shown good success. However, the technical considerations of each technique imply complications of loosening and failure that either technique is uniquely prone to having. The current study proposes a new pedicle screw technique through the articular surface of the vertebral superior facet. It is hypothesized that this path will allow utilization of a larger screw that rivals that of the TPS technique, while also maintaining the high-density bone encountered in the cortical based trajectory technique. Retrospective review of 50 consecutive trauma patients that underwent lumbar computed tomography (CT) scans at a Level 1 Trauma Center in the age range 18-45. These scans were uploaded to Brainlab software for ideal starting point and trajectory mapping of pedicle screws coursing through each superior facet and pedicle of vertebral levels L1-S1 without cortical breach. Satisfactory pedicle screw variables consisted of a medial angle <10 degrees, screw length at least 30 mm, screw width at least 5.0 mm, and starting point measurements such as distance to the inferior articular surface and distance to the lateral articular surface. A total of 600 virtual pedicle screws were placed, in which 525 were satisfactory and measured with the above variables. The pedicle widths were shown to significantly widen with lower-level vertebra in the lumbar spine. Approximately 72% of unsuccessful pedicle screws were placed in levels L1 and L2 allowing wider pedicle screws to be placed more further down the vertebral column. The articular surface technique (AST) for pedicle screw placement is a viable alternative in lumbar spinal fusions that offers decreased soft tissue dissection. However, the technique is likely better suited for lower lumbar fusions in L3 to S1.

Unilateral interlaminar fenestration on the convex side provides a reliable access for intrathecal administration of nusinersen in spinal muscular atrophy: a retrospective study

BackgroundAs the first gene therapy for spinal muscular atrophy (SMA), nusinersen is supposed to be administrated via intrathecal injection regularly for a lifetime. However, for SMA patients with severe spinal deformities, bony fusion following posterior spinal instrumentation sets great obstacles for the application of nusinersen. Therefore, efforts have been devoted to the exploration of appropriate approach for nusinersen administration. This study aims to evaluate the safety and reliability of unilateral interlaminar fenestration on the convex side during spinal fusion surgery for intrathecal nusinersen injection in SMA.ResultsSMA patients receiving posterior spinal fusion and interlaminar fenestration in Peking Union Medical College Hospital from January 2020 to October 2021 were retrospectively analyzed. 13 patients were included. Of the 13 patients, 10 were classified into SMA type II and 3 into SMA type III. Distal fusion to pelvis was undertaken in 11 patients; while L5 was selected as the lowest instrumented vertebra in the other 2 patients. All patients received interlaminar fenestration on the convex side only with an area of about 15 mm × 20 mm. Fenestration at L2–L3 level was performed in 6 patients; while L3–L4 level was selected for windowing in the remaining 7 patients. 9 of the 13 patients received lumbar puncture and intrathecal nusinersen administration during the 1-year follow-up, with an accumulative total of 50 times. All injections were performed successfully under ultrasound guidance, with no one transferred to radiographic assistance. No severe complications occurred after injection.ConclusionsIn SMA with severe scoliosis planning to receive posterior spinal fusion, unilateral lumbar interlaminar fenestration on the convex side provides a feasible and reliable access for intrathecal nusinersen administration after surgery.

Skeletal Muscle Index, As a Measure of Muscle Mass, Is a Significant Prognostic Factor for Newly Diagnosed Diffuse Large B-Cell Primary CNS Lymphoma Patients

Background: Primary cerebral lymphoma (PCNSL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL) with a particularly poor outcome compared to systemic DLBCL. Several prognostic scores have been developed for PCNSL. These include the International Extranodal Lymphoma Study Group (IELSG) score with five prognostic factors (patient age, serum lactate dehydrogenase [LDH] level, Eastern Cooperative Oncology Group performance status [PS], deep brain involvement and cerebrospinal fluid [CSF] protein level), and the Memorial Sloan-Kettering Cancer Center (MSKCC) score, which is based on age and the Karnofsky Performance Score (KPS). However, the reproducibility of these two scoring systems is low, and the IESLG score requires CSF protein and LDH levels evaluation, which are not often available. None of these scores incorporate data on nutritional status, in particular albumin, which has been shown to be an important prognostic factor in systemic DLBCL. In addition, a recent study demonstrated that the muscle density and mass determined by imaging segmentation, were strong prognostic factors for newly diagnosed systemic DLBCL patients (Jullien et al. Cancers 2021). Our aim was to determine whether these imaging data were also predictive factors for outcome in newly diagnosed diffuse large B-cell PCNSL patients. Methods: For each patient included in the study, muscle mass and density were estimated using skeletal muscle index (SMI) and mean skeletal muscle radiation attenuation (SMRA), respectively. SMI and SMRA were computed at L3 level using the whole-body scan (WBS) performed at the diagnosis of PCNSL, by the mean of an automated segmenting algorithm. Muscle characteristics were then classified as normal or low using already validated cut-off according to patients' age and body mass index (Westenberg et al. Sci Rep 2023). Patients' outcomes were then compared based on their muscle quality, albumin level at diagnosis and other clinical variables commonly included in PCNSL prognostic scores. Results: Between 2015 and 2022, 98 consecutive diffuse large B-cell PCNSL patients were newly diagnosed at Hematology Department of Hospital Lyon Sud, France. Among them, 77 had WBS at diagnosis with available data for this study. The median age was 69 years (range 24-87) and 22 patients (29%) presented an altered ECOG PS (PS 3-4 score). All patients were treated with first-line high-dose methotrexate-based chemotherapy in combination with rituximab. SMI was normal in 64 patients (83%) and 17 patients (17%) had low SMI. Patients with low SMI had more frequently an altered PS (p=0.07) and had lower albumin level (mean 36.7 g/L vs 32.0 g/L, p=0.007). SMRA was normal in 30 patients (39%) and 47 patients (61%) had low SMRA. Patients with low SMRA were older (60 vs 70 years old, p=0.001). In univariate analysis, patients with low SMI had worse outcome with significantly shorter overall survival (p=0.002, median OS, 21.4 months vs not reached) and a trend towards shorter event-free survival (p=0.055, median EFS, 11.9 months vs 42.3 months, Figure 1). No significant prognostic difference was seen for SMRA for EFS or OS. The multivariate analysis showed that SMI (Hazard ratio [HR]=3.33, 95% confidence interval [95%CI]= 1.21-9.20, p=0.02) and age (HR =1.86, 95%CI =1.15-3.0, p=0.012) were strongly associated with OS but not tumor localization (HR =1.46, 95%CI =0.60-3.55, p=0.4), PS (HR = 1.54, 95%CI =0.65-3.65, p=0.32) and albumin level (HR =1.05, 95%CI =0.47-2.32, p=0.91). Age was significantly associated with EFS (HR=1.4, p = 0.04) with a more limited association of SMI with EFS (HR=2.03, p=0.095). In exploratory subgroup analyses, we showed that SMI still influenced OS in patients with PS 4 (10 months vs not reached, p= 0.002), suggesting that SMI may be a more appropriate prognostic factor than PS, especially for patients with motor deficit for whom PS is difficult to estimate. Conclusions: This retrospective analysis of newly diagnosed PCNSL patients showed a significant association between decreased muscle mass, measured by SMI and overall survival, after controlling for other prognostic variables. These findings warrant confirmative analyses to explore the relationship between muscle mass/density and diffuse large B-cell PCNSL patient's outcome and integrate SMI in PCNSL prognostic scores.

Axilofemoral bypass in aortoiliac diseases: a case report

Introduction: In patients presenting with severe comorbid conditions and infra-renal aortic occlusion, an extra-anatomic bypass stands as one of the viable revascularization options for limb preservation. Axillofemoral bypass offers a valuable alternative in cases involving hostile abdominal environments or infectious aortic aneurysms. To our knowledge, this is the first report from Indonesia of a case of Aortoiliac Occlusive Disease (AIOD). This case report presents a 39-year-old female patient with complaints of left leg pain persisting for the past seven months. Case Description: A 39-year-old female patient sought care at our hospital, reporting left leg pain persisting for the past seven months. The pain worsened during physical activity and subsided during rest. She had a history of hypertension for the last eight years but no diabetes or smoking history. The previous hospital had diagnosed her with peripheral arterial disease, prescribing cilostazol and rivaroxaban, which provided only temporary relief. A computed tomography (CT) angiogram revealed occlusion of the abdominal aorta at the level of L2, extending to the left common iliac and right iliac arteries. We elected to perform an axilla-femoral bypass using a polytetrafluoroethylene (PTFE) graft, which yielded satisfactory results. The patient's progress was monitored for three months postoperatively. This report details the case of a female patient with aortoiliac occlusive disease. Given the absence of insurance coverage for endovascular treatment at our facility, we opted for an axilla-femoral bypass using a PTFE graft, which produced satisfactory outcomes during a three-month follow-up period. Conclusion: The axillofemoral bypass procedure is fairly safe and easy, especially in patients with a high risk of direct aortofemoral bypass and difficult anatomy. The number of collateral vessels in our patients based on CT scans and endovascular procedures that have not been supported by insurance in our hospital makes us choose the axillofemoral bypass option is the action we decided.

A predictive model of motor deficit in civilian ballistic lumbosacral spine injuries

BACKGROUND CONTEXTCivilian gunshot wounds to the spine are an increasingly common injury in the USA. A majority of the available research is focused on a military population suffering high energy missile injury. Minimal research has focused on civilian ballistic injuries to the lumbosacral spine as the available studies focus on the entire spine due to limited numbers. PURPOSECharacterize ballistic injuries to the lumbosacral spine and develop a model to predict the presence of neurological deficit based upon a patients presenting fracture morphology. STUDY DESIGNRetrospective chart review. PATIENT SAMPLEOne hundred forty-eight consecutive patients that were presented to an urban level 1 trauma center with ballistic injures to the spine involving the levels L1–S2. OUTCOMES MEASURESNeurological status at presentation and final follow up using the American Spinal Injury Association (ASIA) Impairment Scale. METHODSIRB approval was obtained, and retrospective chart review was performed. Extracted data included patient demographics, neurological status on presentation and final follow-up, fracture morphology, assessment of stability, other associated injuries, and surgical procedures performed. Proportional analysis was performed to characterize the fractures and their associated neurological injuries. Chi-square testing was done to identify fracture characteristics associated with neurologic injury. A multiple logistical regression was performed using fracture characteristics highly associated with neurological deficit to develop a model to predict neurologic deficit. The model was then validated with a receiver operator curve. RESULTSOf the 148 patients, 14 patients underwent spinal surgery with the most common indication being decompression and foreign body removal. There was a high incidence of intra-abdominal injury (73.6%). Fractures were characterized by level, affected vertebral component, and spinal canal involvement. Neurological injury was classified using the ASIA scale at presentation and final follow up. Odds-ratios of vertebral fracture characteristics showed neurologic deficit was highly associated with pedicle fractures (OR=9.07 [4.14–21.54] – 95% CI), lamina fractures (OR=6.42 [3.16–13.62] – 95% CI), facet fractures (OR=5.95 [2.90–12.79] – 95% CI), intra-canal bone (OR=12.79 [5.98–29.05] – 95% CI), and an intra-canal trajectory (OR=1078 [4.48–28.98]) – 95% CI. Multiple logistic regression was performed to construct a predictive model of neurologic deficit which showed that intra-canal trajectory, pedicle fracture and facet fracture are associated with neurologic deficit. An ROC curve was made with an area of 0.849 ([0.7853 to 0.9128 – 95% CI], p<.0001) demonstrating a good model fit. CONCLUSIONSBallistic injuries to the lumbosacral spine involve complex injury patterns in an often polytraumatized patient. Fractures involving the pedicle, lamina, and facet are highly associated with neurologic injury, as is a trans-canal trajectory. A patients fracture morphology can be used to predict if a neurologic deficit is present.

Preoperative examination and intraoperative cerebrospinal fluid leakage test for minimally invasive surgery of spinal extradural arachnoid cysts: illustrative case.

Spinal extradural arachnoid cysts (SEACs) are rare and can cause spinal dysfunction. Total cyst removal and duraplasty via multiple laminectomies are commonly performed. However, to avoid postoperative spinal deformity and axial pain, a minimally invasive surgery via selective laminectomy may be optimal. Therefore, preoperative detection of the dural fistula site is required. A 25-year-old male presented with a 2-month history of progressive gait disturbance and back pain. Conventional magnetic resonance imaging (MRI) revealed SEACs at the T9 to L2 level but did not reveal the dural fistula. Further examinations were performed using sagittal time-spatial labeling inversion pulse MRI and cone-beam computed tomography myelography with a spinal intrathecal catheter, which indicated a dural fistula on the left side at the T12 level. On the basis of these results, dural repair was performed via selective laminectomy. Furthermore, an intraoperative cerebrospinal fluid leakage test by intrathecally injecting saline via a spinal catheter confirmed complete closure of the dural fistula, with no other fistulas. These comprehensive pre and intraoperative examinations may be useful for minimally invasive and selective surgeries in patients with SEACs.

Rehabilitation of a patient with spinal cord lesion due to surgical removal of the spinal tumor with chronic idiopathic demyelinating polyneuropathy (CIDP): A case report

Aims: The literature provides numerous medical therapies for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and spinal cord lesion following spinal tumor surgery separately. Spinal cord injuries from CIDP-related spinal tumors have no evidence-based rehabilitation methods. This case report discusses CIDP, spinal cord lesion owing to a spine tumor, and tertiary care interdisciplinary rehabilitation. It shows how medical knowledge, clinical reasoning, and evidence guide outcome measures, care plans, and clinical decisions help to overcome CIDP. Methods: In this report, we follow a 27-year-old male who began experiencing gradual paresthesia and mild weakening in his lower extremities for six weeks. After two months, the lumbar spine had the initial operation (laminectomy) because of the extreme pain. After the operation, he was pain-free, able to walk, and even started riding again. Pain in his lower midback, similar to cramping, and moderate swelling in his left ankle forced him into a wheelchair three years after his initial operation (intradural-extramedullary spinal space-occupying lesion at L2–L5 level). After the second operation (laminectomy), he had trouble in walking, lost sensation below the knees on both legs, and experienced mild incontinence. As the patient was confined to a wheelchair, he was standing with the help of two people. Significant main muscle group weakening was one of the first noticeable symptoms. Therapeutic exercise, balance training, functional training, and progressive endurance activities were the main components of the intervention. Berg balance score increased from 5 to 23, which is an eligible score for discharge. Results: Clinical outcomes for the man with spinal cord lesion and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) were improved with interdisciplinary therapy. The patient underwent a first lumbar spine operation, which initially eased pain and allowed him to walk and ride again after feeling gradual paresthesia and minor weakened in his lower extremities. Conclusion: For this patient with CIDP with spinal cord lesion due to spinal tumor, effective collaborative team communication and interdisciplinary management worked to optimize clinical decision making and recovery.

Should a Narrow Corridor Be a Contraindication for Performing Oblique Lateral Interbody Fusion Procedure or Not?

Retrospective study. We investigated the effect of corridor width on the postoperative outcomes of patients who underwent the OLIF procedure. Patients who underwent OLIF surgery, which included L4-5, between 2015 and 2021 were retrospectively studied. The patients were divided into three groups by the width of the corridor: not more than 10mm, between 10 and 20mm, and 20mm or more. We compared clinical and radiographic outcomes and complications between these groups. A total of 81 patients were included. There were no significant differences in VAS leg and back pain scores, ODI scores, or complications between each group. The radiographic findings, including cage position, anterior and posterior disc height, segmental Cobb angle, and foraminal height, also showed no significant differences between each group. The only radiographic finding that showed a significant difference between each group was the angle of the cage. We found significantly less degree of angle in the wider than 20mm group when compared to the other two groups. (P-value = .01). There was no recorded incidence of major vascular complications. The width of oblique corridor does not affect clinical outcomes, complications, or radiographic findings, including position of the cage, anterior and posterior disc height, segmental angle, and foraminal height after OLIF procedure, including L4-5 level. Thus, the OLIF procedure can be performed safely even in patients with limited oblique corridors, especially at L4-5.

Atypical presentation of syringomyelia mimicking as motor neuron disease: A case report

This is a case involving a 27-year-old Filipino female who presented with a chief complaint of progressive weakness in all extremities. The initial assessment of the patient’s clinical history and the neurologic examination revealed the presence of a motor neuron disease. This conclusion was drawn based on the observation of both upper and lower motor neuron signs. Furthermore, the findings from the Electromyography (EMG) Nerve Conduction Velocity (NCV) findings suggest active and chronic generalized disorder of motor neurons. However, craniospinal MRI revealed the presence of a long segment C1-T12 syringomyelia, accompanied by an extradural, extramedullary cystic mass at the T12 to L1 level. This paper is the first one to report an atypical presentation of syringomyelia as a motor neuron disease secondary to a non-chiari malformation.

LDL electronegativity and male predominance in early ventricular tachyarrhythmias following ST-elevation myocardial infarction: evidence of sexual dimorphism associated reduction of sodium currents

Abstract Background Early ventricular tachycardia/fibrillation (VT/VF) in patients with ST-elevation myocardial infarction (STEMI) was associated with a higher morbidity and mortality rate. We sought to investigate the gender-specific risk and explore the underlying mechanisms of early VT/VF in STEMI patients. Methods We analyzed the clinical and laboratory data among 2965 consecutive STEMI patients between Jan 1, 2008 and Dec 31, 2021. Early VT/VF was defined as occurrence of spontaneous VT/VF of ≥30 seconds or requirement of immediate cardioversion/defibrillation due to hemodynamic compromise within the first 48 hours after onset of symptoms. To explore the mechanisms underlying early VT/VF, ex vivo ischemic-reperfusion experiments were conducted in 8-week-old ApoE-/- mice fed a high-fat diet for 8 weeks to promote atherogenesis. Results Of the 2965 STEMI patients studied, 256 (8.6%) experienced early VT/VF. Patients who developed early VT/VF were younger (58±13 vs. 61±13 years old, P=0.012) and had a higher proportion of males (87% vs. 83%, P=0.043). Notably, some patients with early VT/VF had significantly higher plasma levels of L5, the most electronegative subclass of low-density lipoprotein (LDL), compared to those without early VT/VF (n=19, L5: 10.14±3.09% vs. n=43, L5: 2.11±0.23%, P=0.006). In animal study, we have previously showed that male mice have higher plasma L5 concentrations than female mice. In this study, all male mice (n=4) developed VT/VF following the sham operation, whereas none of the female mice (n=3) did. Moreover, male mice had significantly slower heart conduction velocity than female mice in whole heart preparations (13.37±3.81 cm/s vs. 40.70±4.97 cm/s, P&amp;lt;0.001), despite having similar action potential duration (61.00±7.07 vs. 50.33±4.16 ms, P=0.999). In addition, isolated ventricular myocytes from male mice exhibited markedly lower sodium current density (-29.20±3.04 pA/pF, n=6) compared to those from female mice (-114.05±6.41 pA/pF, n=6, P&amp;lt;0.001). The reduced sodium current density was accompanied by lower membranous Nav1.5 protein expression (0.38±0.06 vs. 0.89±0.09 A.U., P&amp;lt;0.001) and higher cytosolic Nav1.5 levels (0.59±0.06 vs. 0.29±0.04 A.U., P&amp;lt;0.01) in male mice. Conclusions Our study demonstrates that male STEMI patients with early VT/VF have higher levels of L5, the most electronegative LDL subclass. This gender disparity in the susceptibility of early VT/VF may be caused by compromised sodium channel trafficking, likely linked to increased LDL electronegativity.

The effect of bariatric surgery type on cardiac reverse remodelling

Abstract Introduction Bariatric surgery has been shown to improve adverse cardiac remodelling associated with obesity. Three operations are commonly performed: Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Adjustable Gastric Band (LAGB). Whilst all three of these procedures result in weight loss, it is currently unclear as to which procedure is most effective at reversing cardiac remodelling. Purpose We assessed differences in cardiac remodelling following each type of surgery using cardiac magnetic resonance (CMR) imaging. Methods 58 patients underwent bariatric surgery (26 RYGB, 22 LSG and 10 LAGB) with CMR before and after surgery, including 46 with short-term (median 251, 219 and 273 days) and 43 with long-term (median 1026, 983 and 1027 days) follow-up. CMR was used to assess cardiac volumes, LV mass (LVM) and LV mass:volume ratio (LVMVR – a marker of concentric remodelling). Adipose tissue depots were also assessed during the scan, including visceral adipose tissue (VAT) at L5 level and epicardial adipose tissue (EAT) (manual contouring in end-ventricular systole on short axis slices from the mitral valve to the apex). Results Changes in percentage body weight were similar between surgery groups in the short term, but appeared to diverge in the longer term (LSG vs LAGB, p=0.039; RYGB vs LAGB, p=0.341) (Figure 1A). Percentage change in VAT and EAT however where significantly greater following RYGB and LSG compared to LAGB at both short- and long-term time points (Figure 1B). Changes in left ventricular end diastolic volume (LVEDV) were similar between groups in both the short term and long term (Figure 2A). We observed a significant difference in LVM change following RYGB or LSG versus LAGB (Figure 2B). This change in LVM at the long-term time point correlated with change in VAT normalised to body weight (r=0.3399, p=0.0368, Figure 2C). Finally, there was a significant decrease in LVMVR at the long-term time point following both RYGB (p=0.006) and LSG (p=0.021), whereas no such change was observed following LAGB (p=0.912). Conclusions Our results suggest that RYGB and LSG are significantly better at decreasing body adipose depots than LAGB. This greater reduction in visceral adipose tissue may account for the greater cardiac reverse remodelling seen with RYGB and LSG compared to LAGB.Figure 1Figure 2

Abstract 14435: Psoas Muscle Index as a Tool to Predict Outcomes in a Pulmonary Hypertension Population Undergoing Pulmonary Thromboendarterectomy

Introduction: Sarcopenia is defined as an overall decline in skeletal muscle mass and has been associated with a range of cardiac pathologies. Psoas Muscle Index (PMI) has emerged as a metric of sarcopenia. We investigated the prognostic value of PMI on six-minute walk distance (6MWD), and length of stay (LOS) in pulmonary hypertension patients following Pulmonary Thromboendarterectomy (PTE). Hypothesis: Sarcopenic patients will have lower 6MWD meters and increased LOS compared to non-sarcopenic patients. Methods: Retrospective chart review of 65 patients with CTEPH who had undergone PTE with CT scans of the abdomen between 2017-2022. Psoas muscle area was measured at the L3 level on CT scan. PMI was calculated using the formula (left psoas area + right psoas area)/height 2 . Patients in the 1 st quartile PMI for their gender were classified as sarcopenic. 1 st quartile PMI values were calculated as 5.34 cm 2 /m 2 for males, and 3.30 cm 2 /m 2 for females. Results: 17 (26%) patients were classified as sarcopenic. There were no significant differences between sarcopenic and non-sarcopenic groups comparing hemodynamics (mean PA 45 vs 42 mmHg, PVR 9 vs 8 WU, CI 2 vs 2.1-l/min/m 3 ), age (61.2 vs 59.7-years), female sex (52.9 vs 55.3%), ethnicity or comorbidities. Regarding 6 minute walk distance (6MWD), the sarcopenic group had significantly lower meters walked than the non-sarcopenic group pre-PTE (220 vs. 322-meters, p=0.049). Following PTE, there was less distinction between groups in 6MWD (347.1 meters vs 345.1, p=0.970). The sarcopenic group increased their 6MWD more than the non-sarcopenic group (137.3 meters vs 43.7, p=0.055). The sarcopenic group had significantly longer overall length of stay (LOS) (27 vs 14-days, p=0.001), and intensive care unit stay (19 days vs. 6-days, p=0.002) than the non-sarcopenic group. Conclusions: Sarcopenia is prevalent in patient with CTEPH. Sarcopenic patients with CTEPH had lower pre-PTE 6MWD, longer ICU stays and overall hospital LOS.

Percutaneous removal and replacement of a novel percutaneous interspinous device.

Objective: The aim of this study is to explain the technique used for removing and replacing a novel percutaneous interspinous device (PID).Procedure: Three male patients, with a mean age of 66years (range 62-72), were included in the study due to displacement (N = 2) or misplacement (N = 1) of the novel PID. This occurred after a mean of 23.3 ± 10.5 days from the initial placement (range 13-34) at the L4-L5 level (N = 1) and L3-L4 level (N = 2). Following the removal of the PID, four new devices were implanted.Conclusion: The novel PID can be safely removed either immediately after its placement during the procedure or after a certain period of days or months from its implantation. The removal procedure can be performed percutaneously under imaging guidance, by closing the four retractable wings, using the same instrumentation as utilized during the initial implantation.

The Prognostic Impact of Body Composition Assessment By Computed Tomography in Adult Patients with Newly Diagnosed Acute Lymphoblastic Leukemia

The Prognostic Impact of Body Composition Assessment By Computed Tomography in Adult Patients with Newly Diagnosed Acute Lymphoblastic Leukemia

Pediatric CHANCE fracture treated by lumbar lacing technique: a case report

This paper presents the case of an 7-year-old girl victim of a road accident. The neurological examination revealed a conscious patient without any sensory or motor deficit and she had intense lumbar pain. The lumbar computed tomography scan found a chance fracture at the level of L3. the patient was operated under general anaesthesia with a sublaminar lacing fixation of L2–L3 similar to the lacing of C1C2 in upper cervical trauma. The follow-up was good The control X-ray was satisfied with a complete reduction and restoration of the lumbar lordosis and the patient was discharged from the hospital on the fifth day following the intervention. this article shows that sublaminar lacing can be as effective as pedicle screw fixation, thus preserving bone growth

The Importance of Spinopelvic Parameters in Recurrent Lumbar Disk Herniation.

Retrospective clinical study. We aimed to investigate preoperative spinopelvic mismatch as a risk factor for recurrent lumbar disk herniation (RLDH) in patients undergoing lumbar disk herniation (LDH) surgery. Spinopelvic parameters have been associated with lumbar degenerative diseases, particularly LDH. However, the relationship between these parameters and RLDH has yet to be studied. Data of 1453 patients aged ≥18 who underwent single-level, unilateral fenestration microdiscectomy for the first time in our hospital between 2013 and 2019 were reviewed. The study group comprised 88 patients who underwent surgery for RLDH. The control group comprised 101 randomly selected patients who underwent surgery for LDH but not RLDH. Age, sex, body mass index, occupational activity level, operative level, Roussouly classification type, and time to recurrence were recorded. Moreover, pelvic incidence, lumbar lordosis (LL), interverteberal disk height (IDH), segmental lordosis, sacral slope (SS), pelvic tilt (PT), and sacral table angle (ST) were measured for each patient. Pelvic mismatch was calculated. Mean age was 46.5±11.4y (range, 20-70). Both groups were similar concerning age, sex, body mass index, occupational activity level, and level of surgery. The mean time to recurrence was 167.3±36.6d (range, 62-363). Measurements in the RLDH group were as follows: IDH=7.6±1.5mm, pelvic incidence =54.4°±10.1°, LL=47.3°±13°, segmental lordosis =9.3°±5°, SS=35.1°±9.9°, and PT=19.3°±7.3°. Mean IDH was significantly lower in the RLDH group ( P =0.02). Less LL and lower PT at L3-4 level and increased SS at L5-S1 level were considered risk factors for RLDH. This study showed that preoperative low IDH is at higher risk for RLDH in patients undergoing LDH surgery. LL, PT, and SS may be risk factors for specific levels.