L3 Level Research Articles

Elevated Cerebrospinal Fluid Ubiquitin Carboxyl-Terminal Hydrolase Isozyme L1 in Asymptomatic C9orf72 Hexanucleotide Repeat Expansion Carriers.

To identify biochemical changes in individuals at higher risk of developing amyotrophic lateral sclerosis (ALS) or frontotemporal dementia (FTD) via C9orf72 hexanucleotide repeat expansion (HRE) heterozygosity. Cross-sectional observational study of 48 asymptomatic C9orf72 HRE carriers, 39 asymptomatic non-carrier controls, 19 people with sporadic ALS, 10 with C9orf72 ALS, 14 with sporadic FTD, and 10 with C9orf72 FTD. Relative abundance of 30 pre-defined cerebrospinal fluid biomarkers of ALS and FTD were compared in asymptomatic C9orf72 HRE carriers and age-matched non-carrier controls. Differential abundance of these proteins was quantified using data independent acquisition mass spectrometry or electro chemiluminescent assay for neurofilament light chain. Unbiased analysis of the entire cerebrospinal fluid proteome was then carried out. Ubiquitin carboxyl-hydrolase isozyme L1 levels were higher in asymptomatic C9orf72 HRE carriers compared with age-matched non-carriers (log2fold change 0.20, FDR-adjusted p-value = 0.034), whereas neurofilament light chain levels did not significantly differ. Ubiquitin carboxyl-hydrolase isozyme L1 levels remained elevated after matching of groups by neurofilament levels (p = 0.011), and after adjusting for age, sex, and neurofilament levels. A significant difference was also observed when restricting analysis to younger participants (<37) matched by neurofilament level (p = 0.007). Elevated cerebrospinal fluid ubiquitin carboxyl-hydrolase isozyme L1 levels in C9orf72 HRE carriers can occur in the absence of increased neurofilament levels, potentially reflecting either compensatory or pathogenic mechanisms preceding rapid neuronal loss. This brings forward the window on changes associated with the C9orf72 HRE carrier state, with potential to inform understanding of penetrance and approaches to prevention. ANN NEUROL 2024.

Integrating 18F-FDG PET/CT radiomics and body composition for enhanced prognostic assessment in patients with esophageal cancer.

This study aimed to develop a predictive model utilizing radiomics and body composition features derived from 18F-FDG PET/CT scans to forecast progression-free survival (PFS) and overall survival (OS) outcomes in patients with esophageal squamous cell carcinoma (ESCC). We analyzed data from 91 patients who underwent baseline 18F-FDG PET/CT imaging. Radiomic features extracted from PET and CT images and subsequent radiomics scores (Rad-scores) were calculated. Body composition metrics were also quantified, including muscle and fat distribution at the L3 level from CT scans. Multiparametric survival models were constructed using Cox regression analysis, and their performance was assessed using the area under the time-dependent receiver operating characteristic (ROC) curve (AUC) and concordance index (C-index). Multivariate analysis identified Rad-scorePFS (P = 0.003), sarcopenia (P < 0.001), and visceral adipose tissue index (VATI) (P < 0.001) as independent predictors of PFS. For OS, Rad-scoreOS (P = 0.001), sarcopenia (P = 0.002), VATI (P = 0.037), stage (P = 0.042), and body mass index (BMI) (P = 0.008) were confirmed as independent prognostic factors. Integration of the Rad-score with clinical variables and body composition parameters enhanced predictive accuracy, yielding C-indices of 0.810 (95% CI: 0.737-0.884) for PFS and 0.806 (95% CI: 0.720-0.891) for OS. This study underscored the potential of combining Rad-score with clinical and body composition data to refine prognostic assessment in ESCC patients.

An unusual late complication of peridural anesthesia: The case of a subdural spinal epidermoid cyst: A case report and literature review

The peridural approach is primarily used today to provide analgesia in obstetrics and postoperative care. Peridural analgesia is not only more effective than systemic analgesia, but it also has benefits in terms of morbidity, particularly regarding postoperative respiratory complications and the shortened duration of postoperative ileus. Unlike dural tears, immediate and severe neurological complications such as hematomas or abscesses are very rare. Long-term sequelae are less well known because the relationship with epidural analgesia performed several months or years earlier is not always well established. We report a rare case of a 35-year-old patient with a history of epidural anesthesia five years ago during childbirth, who was admitted with cauda equina syndrome. MRI (magnetic resonance imaging) of the lumbar spine showed a subdural lesion at the level of L3. The patient underwent resection of the lesion, and the pathological examination of the surgical specimen concluded it was an epidermoid cyst.

Focal classic intradural extramedullary ependymoma near the conus medullaris: A case report and literature review

Rationale: To enhance clinicians’ comprehension of conus medullaris region ependymomas and elevate their diagnostic accuracy. Patient concerns: A 26-year-old female patient had 10 months of low back pain and right lower limb pain. Diagnoses: Lumbar magnetic resonance imaging (MRI) scan revealed a circular abnormal signal in the spinal canal at the level of L2. Pathological examination confirmed classic ependymoma. Interventions: The patient underwent tumor resection surgery. Outcomes: Postoperatively, the patient’s right lower limb soreness improved, and no new neurological deficits were observed. Lessons: Focal classic intradural extramedullary ependymomas near the conus medullaris are rare. Close follow-up with MRI of the craniospinal axis is necessary. Hormonal factors may influence the development of ependymomas in this unusual location. The appearance of these tumors on MRI and contrast-enhanced MRI scans is variable.

Deltopectoral approach without subscapularis detachment for reverse shoulder arthroplasty. Technique and results of a safe and reproducible subscapularis-sparing approach

AimsThe importance of the subscapularis for reverse total shoulder arthroplasty (rTSA) has been demonstrated, especially for internal rotation and stability. In a deltopectoral approach, a detachment of the subscapularis is performed (tenotomy, tuberosity peeling or osteotomy) but the tendon is not always repairable at the end. When it is repaired, healing is obtained in only 40% to 76% of the cases, with potential consequences for the outcomes. The Anterior Muscle-Sparing (AMS) approach is a deltopectoral approach with preservation of the subscapularis, providing a solution to these problems. We present the surgical technique and results. MethodsIn a retrospective study, we included our first 45 cases of rTSA performed with the AMS approach for a degenerative affection of the shoulder (massive rotator cuff tear, cuff tear arthropathy, primary glenohumeral arthritis, rheumatoid arthritis), excluding traumatic and revision cases. The subscapularis was intact in all the cases. The mean age at inclusion was 74.1 years. No patients were lost at the minimum 24-month follow-up. All the patients underwent a clinical evaluation preoperatively and at the last follow-up, including Constant score, simple shoulder value (SSV), pain scale, and range of motion. An X-ray evaluation was conducted postoperatively and at the last follow-up to assess implant positioning and evolution. ResultsThere was no intraoperative complication, and the mean operative time was 62 minutes. We observed a significant improvement in Constant score (from 36 to 70, p <.001), SSV (from 33 to 81, p <.001), pain (from 6.3 to 0.7, p <.001), strength (from 0.5 to 3.5, p <.001), and most of the active mobilities. Regarding internal rotation, 95% of the patients reached level L3 or higher. Glenoid positioning was considered optimal in more than 90% of the cases (inferior tilt and low position) without any occurrence of superior tilt or high position. The osteophytes could be totally removed in 8 out of 9 cases (88.9%). Six postoperative complications (13.3%) were reported: 1 infection (2.2%), 2 cases of traumatic glenoid loosening (4.4%), 2 acromion fractures (4.4%), and 1 hematoma (2.2%). There was no instability. Eighty percent of the patients could return home, with a mean hospital stay of 1.8 days. ConclusionThe AMS approach is a safe and reproducible technique. The preservation of the subscapularis has potential benefits regarding internal rotation and stability. In the absence of tendon suture, rehabilitation can be started immediately without motion restriction, allowing for a fast recovery and return to autonomy.

Spinal muscle characteristics during three different types of locomotion activities among college students with idiopathic scoliosis

Background contextPhysical activities such as walking and climbing stairs are pervasive in human daily life. Individuals with scoliosis frequently encounter dysfunction in their muscle recruitment. Multiple studies have corroborated the presence of muscle dysfunction in individuals diagnosed with scoliosis. However, there is currently a noteworthy research gap regarding the exploration of changes in muscle characteristics and disparities from those observed in individuals without scoliosis during everyday activities, specifically stair climbing.PurposeThis study aims to examine the unique patterns of muscle activity during daily life in individuals with scoliosis and distinguish the specific differences between scoliosis patients and the healthy controls. The findings of this study are significantly important for the future accurate assessment of scoliosis and the development of rehabilitation treatment plans.Study designCase–control study.Sample sizeTwenty eight idiopathic scoliosis patients and twenty eight controls.Outcome measuresRoot Mean Square(RMS), Maximum Voluntary Isometric Contraction(MVIC)%, RMS ratio(RMS convex / RMS concave).MethodsThe surface electromyography (sEMG) device used in this study was the Delsys Trigno, with a sampling frequency of 1500 Hz. It recorded the activation level, peak contraction, and average activation level of the erector spinae (at T6, T10, and L3 levels), gluteus maximus, gluteus medius, external oblique, and rectus abdominis muscles during three different types of locomotion for both the 28 individuals with idiopathic scoliosis and the 28 control participants.ResultsThe movement patterns of the idiopathic scoliosis patients significantly differ from those of the normal population during level walking and ascending or descending stairs. In level walking, there is an asymmetry in the activation levels of the T6 and L3 erector spinae muscles, with lower activation on the convex side compared to the concave side. Similarly, during stair ascent, the activation of the T6 and T10 erector spinae muscles is asymmetric, with higher activation on the convex side than the concave side. Moreover, during stair descent, the activation of the T6 erector spinae muscle is asymmetric, with higher activation on the convex side than the concave side.ConclusionsDuring level walking and stair activities, idiopathic scoliosis patients exhibit pronounced abnormal movement patterns that significantly differ from those of the control group. Under different activity conditions such as level walking, ascending and descending stairs, idiopathic scoliosis patients demonstrate abnormal muscle activation in different segments of the spine. It is crucial for clinicians to prioritize the symmetry of muscle activation in the spinal region of idiopathic scoliosis patients and consider incorporating symmetry training for these muscles.

Lumbar Spinal Meningioma- A common tumor in an uncommon location: A case report

Meningioma in the spinal canal commonly appears as intradural extramedullary spinal tumors at the dorsal and cervical region but is rare in the lumbar area. A 36-year-old man presented to us with complaints of left sciatica, weakness, and difficulty in movements of his left toes for a couple of months. Magnetic Resonance Imaging revealed an enhancing oval-shaped lesion at the level of L4, and histopathology revealed a meningioma. The complete removal has been done with hemilaminectomy for this common tumor in an uncommon location. J Shaheed Suhrawardy Med Coll 2023; 15(1): 78-82

Effects of pedicle subtraction osteotomy on aortic morphology and hemodynamics in ankylosing spondylitis with kyphosis: a finite element analysis study

Osteotomy can correct kyphosis, restore the spinal sequence, and restore the healthy appearance of a patient. However, the aorta is stretched during pedicle subtraction osteotomy (PSO), and some surgeons are concerned about aortic injury. We used finite element analysis to construct an aortic model to simulate hemodynamic changes during osteotomy. 16 patients with ankylosing spondylitis kyphosis who had undergone a two-level osteotomy at the L1 and L3 levels was included in this study. Aortic computed tomography angiography (CTA) was performed, and a 3D image model was constructed. The length, transverse diameter, and curvature of the aorta were used to evaluate morphological changes. Finite element analysis was used to analyze the changes in aortic fluid dynamics. Blood pressure, wall shear stress, and blood flow velocity were compared pre- and postoperatively. The overall length of the aorta before surgery was 424.3 ± 42.9 mm, and the overall length of the aorta after surgery was 436.2 ± 54.8 mm. The aortic curvature decreased from 0.27 ± 0.13 to 0.17 ± 0.09. The mean transverse diameter of the aorta did not change (19.3 ± 6.6 vs. 19.2 ± 7.4 mm, P > 0.05). The blood flow velocity (2.8 ± 1.1 vs. 1.5 ± 0.8 m/s, P < 0.05), blood pressure (6.6 ± 1.7 vs. 4.3 ± 1.2 Kpa, P < 0.05), and wall shear stress (47.6 ± 17.3 vs. 22.3 ± 8.6, P < 0.05) at the T10-L4 level decreased postoperatively. Changes in LL were significantly correlated with changes in ld, dc, blood flow velocity, blood pressure and wall shear stress (ld : r = 0.713, P < 0.001; dc: r = 0.626,P = 0.010; blood flow velocity: r= − 0.541, P = 0.041; blood pressure: r = − 0.601, P = 0.016; wall shear stress: r= − 0.594, P = 0.027). The aorta was stretched, and its curvature decreased. The mean transverse diameter of the aorta did not change. Blood flow velocity, blood pressure, and wall shear stress decreased after surgery. Our study provides hemodynamic support for the possible cardiovascular benefits of osteotomes.

Platinum‐Metformin Conjugates Acting as Promising PD‐L1 Inhibitors through the AMP‐Activated Protein Kinase Mediated Lysosomal Degradation Pathway

AbstractWith the development of metalloimmunology, the potential of platinum drugs in cancer immunotherapy has attracted extensive attention. Although immunochemotherapy combining PD‐1/PD−L1 antibodies with platinum drugs has achieved great success in the clinic, combination therapy commonly brings new problems. Herein, we have developed a platinum‐metformin conjugate as a promising alternative to antibody‐based PD−L1 inhibitors, not only disrupting PD‐1/PD−L1 axis on cell surface but also down‐regulating the total PD−L1 levels in non‐small cell lung cancer (NSCLC) cells comprehensively, thus achieving highly efficient immunochemotherapy by a single small molecule. Mechanism studies demonstrate that Pt‐metformin conjugate can selectively accumulate in lysosomes, promote lysosomal‐dependent PD−L1 degradation via the AMPK‐TFEB pathway, and modulate the upstream regulatory proteins related to PD−L1 expression (e.g. HIF‐1α and NF‐κB), eventually decreasing the total abundance of PD−L1 in NSCLC, overcoming tumor hypoxia, and activating anti‐tumor immunity in vivo. This work suggests an AMPK‐mediated lysosomal degradation pathway of PD−L1 for the first time and provides a unique design perspective for the development of novel platinum drugs for immunochemotherapy.

Quantitative magnetic resonance imaging of paraspinal muscles for assessing chronic non-specific low back pain in young adults: a prospective case-control study.

This study aimed to investigate the application of quantitative magnetic resonance imaging of paraspinal muscles in assessing the young CNLBP with unilateral symptom. This prospective study enrolled 107 young individuals with unilateral symptomatic CNLBP (56 cases) and a normal cohort (51 cases). All subjects underwent conventional lumbar sequences, T2 mapping, and IDEAL-IQ scans at 3T. T2 values and fat fraction (FF) of bilateral multifidus (mid-levels of L2-L5 vertebrae) and erector spinae (mid-levels of L1-L4 vertebrae) were measured. CNLBP severity, Japanese Orthopedic Association (JOA) score, and Visual Analogue Scale (VAS) score were recorded. Wilcoxon signed-rank tests were used to compare parameter differences between painful and non-painful sides in the case group. Mann-Whitney U tests were employed to evaluate differences between the case and normal group. Logistic regression analysis was conducted to identify predictive factors and to establish a combined model. In the case group, erector spinae FF values (L4 level), erector spinae T2 values (L1, L2, and L4 levels), and multifidus T2 values (L4 and L5 levels) were higher on the painful side (P<0.05). Multifidus T2 values (L5 level) and FF values (L2-L5 levels) were higher in the case group compared to the normal group (P<0.05). The optimal performance in differentiating young CNLBP was the combination of L5 level multifidus T2 value with FF (AUC = 91.81%). Negative correlation existed between T2 values and FF of multifidus at L5 level and JOA scores (r=-0.41, P < 0.05), and positive correlation with VAS scores (r = 0.46, P < 0.05). The combination of T2 value and FF may provide deeper insights into the pathological alterations of paraspinal muscles in young CNLBP, providing an important imaging basis for clinical judgment and preventive treatment of non-painful side in unilateral symptomatic patients.

Morphological Changes in the Lumbar and Abdominal Muscles in Individuals with Sacralization

Although sacralization is one of the most common congenital anomalies of the spine, its effect on surrounding muscles is still not well known. This study was conducted to determine the size of the lumbar and abdominal muscles of the individuals with sacralization and to compare with the control group. Eighty-five participants with sacralization phenomena and fifty-six asymptomatic participants were included in this study. Sacralization was classified according to the Castellvi classification. The cross-sectional area of the multifidus lumborum, erector spinae and rectus abdominis muscles, and the section thicknesses of external abdominal oblique, internal abdominal oblique and transversus abdominis muscles were measured bilaterally on axial computed tomography images at the L1-2 and L4-5 levels. ANCOVA revealed that there is no any significant group*side interaction effect regarding muscles sizes in terms of two groups in L1-L2 and L4-L5. In addition, ANCOVA revealed a both side effect [(p=.020; η2p=.038)] and group*side interaction effect [(p=.010; η2p=.049)] regarding length of the L5 transverse process (p˃.05). Regardless of low back pain, muscle sizes are not associated with the sacralization phenomenon.

Skeletal muscle size and quality in healthy kidney donors, normal range and clinical associations

The gold standard to estimate muscle mass and quality is computed tomography (CT) scan. Lower mass and density (intramuscular fat infiltration) of skeletal muscles are markers of sarcopenia, associated with increased mortality risk, impaired physical function, and poorer prognosis across various populations and medical conditions. We aimed to describe standard reference values in healthy population, prospective kidney donors, and correlate clinical parameters to muscle mass and density. Included in the cohort 384 consecutive kidney donors. Mean age was 44.6 ± 11.5 (range 18.4–74.2), 46% were female and mean BMI was 25.6 ± 3.8 kg/m2. Our quantified reference values for psoas cross -sectional area (CSA) index at L3 level (males/females respectively) were 6.3 ± 1.8 and 4.8 ± 1.9 cm2 /m2, and density was 46.1 ± 5 and 41 ± 5 HU at that level. Older age (standardized beta coefficient − 0.12, p = 0.04), sex (− 0.32, p < 0.001) and BMI (0.17, p = 0.002) were significantly associated with CSA index of psoas at L3. Density, however, was associated with triglycerides level (− 0.21, p < 0.001), in addition to age (− 0.22, p < 0.0001), sex (− 0.27, p < 0.001) and BMI (− 0.1, p = 0.05). Our study validates the normative values of psoas muscle mass and density in healthy individuals and suggests correlations with clinical parameters. We demonstrate the significance of measuring not only the mass of the muscle, but also its density, as it has a valid association with metabolic parameters, including BMI and lipid level, even in healthy individuals and in the normal range of the tests.

Magnetic Resonance Imaging - Derived Psoas Muscle Area and Survival in Patients Treated Invasively for Peripheral Arterial Disease.

Psoas muscle parameters estimated from computed tomography images, as surrogates for sarcopenia, have been found to be associated with post-interventional outcomes after a wide range of cardiovascular procedures. The pre-interventional assessment in patients undergoing invasive treatment for peripheral arterial disease is increasingly often carried out with magnetic resonance imaging (MRI), and we therefore sought to investigate the predictive potential of MRI-derived psoas muscle area in this cohort. A total of 899 patients with available sufficient quality pre-interventional MRI conducted within 6 months prior to treatment undergoing open, endovascular, or hybrid revascularization procedures for claudication and/or limb-threatening ischemia at Tampere University hospital between 2010 and 2020 were retrospectively studied in this single-center cohort study. The follow-up lasted until 17 June 2021. Psoas muscle areas were measured from the magnetic resonance images at the L4 level, and the reliability of muscle parameter measurements was tested with intraclass correlation coefficient analysis. The average psoas muscle area values (mean of left and right psoas surface areas) were z-scored and analyzed separately for men and women. The median follow-up time was 5.9 years (interquartile range (IQR) = 2.7-7.8), and the overall mortality count was 259 (28.8%) (29.5% n = 168/569 for men and 27.6% n = 91/330 for women). The intraclass correlation coefficient analysis showed excellent interrater reliability for psoas muscle measurements. The muscle surface areas were larger in men (mean = 7.58 cm2) compared to women (mean = 5.27 cm2) (p < 0.001). Higher psoas muscle area was associated with better survival in women (p = 0.003, hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.6-0.9 per 1 SD), whereas in men, an independent association of the muscle parameter with mortality was not found. MRI-derived psoas muscle area may be a prognostic factor for clinical use.

Sensory assessment of intramuscular quadratus lumborum block at the L2 level in open inguinal hernia repair patients

BackgroundThe effectiveness of the quadratus lumborum block (QLB) for postoperative pain management depends on the injection pathway used. There is limited research on the block area produced by intramuscular injection of local anesthesia in the quadratus lumborum muscle. This study aimed to determine the cutaneous sensory blockade area produced by an intramuscular quadratus lumborum block (QLBi) at the L2 level.MethodsTwenty patients aged 18–60 years with ASA grade I-II and a BMI of 18–30 kg/m2 who were scheduled for open inguinal hernia repair with mesh underwent ultrasound-guided QLBi injection of 20 ml of 0.5% ropivacaine. The cutaneous sensory blockade area was measured by applying a cold stimulus 1 h after the block and then measured every hour after surgery until the sensation returned to normal. The duration of a blockade is defined as the time it takes for all affected areas to fully regain normal sensation following a blockade. Pain scores (numeric rating scale, NRS) were recorded at 2, 4, 8, 12, and 24 h after surgery. Adverse reactions to QLBi were recorded 24 h after surgery.ResultsAll 20 patients had reduced or lost cold sensation areas. The greatest extent of cold sensation reduction occurred at T7 (10%), and the least amount of cold sensation reduction occurred at L3 (10%). The block level covered T8 (20%), T9 (30%), T10 (45%), T11 (90%), T12 (95%), L1 (100%), and L2 (15%). Eighteen patients experienced areas of sensory loss, with the highest range at T11 and the lowest at L2. The duration of the blockade was 8.9 ± 3.8 h, with a maximum of 24 h and a minimum of 5 h. One patient experienced quadriceps weakness after surgery.ConclusionQuadratus lumborum block of intramuscular pathway can produce effective cutaneous sensory blockade, which can be used for postoperative analgesia of indirect inguinal hernia operation, and may also be beneficial to analgesia of other lower abdominal operations. However, the best method needs further confirmation to determine specific anesthesia methods for various operations.Chinese clinical trial registryJune 2, 2018; ChiCTR1800016457.

Relationship of the Iliac Crest Height with Subsidence After Oblique Lateral Interbody Fusion at L4-5: A Quantitative and Categorical Analysis.

Background: This study aimed to evaluate the impact of iliac crest height on clinical and radiological outcomes following oblique lateral interbody fusion (OLIF) at the L4-5 level. Methods: Data of patients who underwent single-level OLIF at the L4-5 level for degenerative spinal stenosis were retrospectively analyzed. The patients were categorized into three groups based on their iliac crest height measured relative to the L4 and L5 pedicles. Categorical and quantitative analyses, including univariate and multivariate logistic regressions, were performed to identify subsidence predictors. Clinical outcomes, including visual analog scale scores for back and leg pain, were assessed over a minimum 2-year follow-up. Results: No significant differences in cage obliquity were observed across the iliac crest height groups (axial angles, p = 0.39; coronal angles, p = 0.79). However, subsidence was significantly more common in patients with higher iliac crest heights, particularly at crest level III, where the subsidence rate reached 43% (p = 0.01). Subsidence was predominantly associated with damage to the L5 endplate, which occurred in 83% of subsidence cases at crest level III. A cutoff value of 12 mm for iliac crest height, above which the risk of subsidence significantly increased, was identified (AUC = 0.688, p = 0.042). Conclusions: Iliac crest height is a critical factor for predicting subsidence following OLIF at the L4-5 level. Surgeons should consider alternative strategies and meticulous preoperative planning in patients with an iliac crest height ≥ 12 mm to reduce the risk of adverse outcomes. Further studies are needed to validate these findings and to explore their long-term implications.

Multiparametric Approach to the Colorectal Cancer Phenotypes Integrating Morphofunctional Assessment and Computer Tomography.

(1) Background: Accurate body composition assessment in CCR patients is crucial due to the high prevalence of malnutrition, sarcopenia, and cachexia affecting survival. This study evaluates the correlation between body composition assessed by CT imaging as a reference technique, BIVA, nutritional ultrasound, and handgrip strength in CCR patients. (2) Methods: This retrospective study included CCR patients assessed by the Endocrinology and Nutrition Services of Virgen de la Victoria in Malaga and Vall d'Hebron in Barcelona from October 2018 to July 2023. Assessments included anthropometry, BIVA, NU, HGS, and AI-assisted CT analysis at the L3 level for body composition. Pearson's analysis determined the correlation of CT-derived variables with BIVA, NU, and HGS. (3) Results: A total of 267 CCR patients (mean age 68.2 ± 10.9 years, 61.8% men) were studied. Significant gender differences were found in body composition and strength. CT-SMI showed strong correlations with body cell mass (r = 0.65), rectus femoris cross-sectional area (r = 0.56), and handgrip strength (r = 0.55), with a Cronbach's alpha of 0.789. CT-based adipose tissue measurements showed significant correlations with fat mass (r = 0.56), BMI (r = 0.78), A-SAT (r = 0.49), and L-SAT (r = 0.66). Regression analysis indicated a high predictive power for CT-SMI, explaining approximately 80% of its variance (R2 = 0.796). (4) Conclusions: Comprehensive screening of colorectal cancer patients through BIVA, NU, HGS, and CT optimizes the results of the evaluation. These methods complement each other in assessing muscle mass, fat distribution, and nutritional status in CCR. When CT is unavailable or bedside assessment is needed, HGS, BIVA, and NU provide an accurate assessment of body composition.

Does Restoration of Lumbar and Segmental Cobb Angle Affect Fusion Outcome in Short-Segment Posterior Lumbar Fusion?

To study the effect of lumbar lordosis change and pelvic parameters on surgical outcomes such as fusion vs. non-fusion (pseudarthrosis), Adjacent Segment Pathology (ASP), and re-operation in patients undergoing 1-, 2- and 3-level PLF. Adult patients with degenerative spine pathologies who had undergone PLF between L2 and L5 levels at an academic center between 2010 and 2020 were included. Pre-operative and early post-operative lateral standing X-Rays of the lumbar spine were used to measure pre-operative lumbar Cobb angle, Postoperative lumbar Cobb angle, pre-operative segmental Cobb angle (measured from the superior endplate of the upper instrumented vertebra to the inferior endplate of the lower instrumented vertebra), postoperative segmental Cobb angle, preoperative pelvic incidence (PI) and pelvic tilt (PT). Change in lumbar and segmental Cobb was calculated as postoperative Cobb angle (lumbar and segmental) minus preoperative Cobb angle. A total of 243 patients met our inclusion and exclusion criterion. Patients who had pseudarthrosis had a significantly less restoration of lumbar lordosis compared to those who did not, both for lumbar cobb angle change (-5.2±8.2 vs. -0.2±8.2; p=0.01) and segmental cobb angle change (-5.4±6.6 vs. -1.5±6.0; p=0.01). Moreover, PI was lower in patients who developed ASP vs. those who didn't. There was no significant difference in these measures (lumbar cobb angle changes and segmental cobb angle change) in patients who experienced ASP and those who did not. Better restoration of lumbar lordosis reduces rates of pseudarthrosis after short-segment PLF but has no association with rates of ASP.

Adjuvant Radiotherapy in Bladder Cancers: A Dosimetric Study Focusing on Ileal Conduit Sparing

PurposeTo compare ileal conduit (IC) and other organ at risk (OAR) dosimetry between treatment techniques in a prospective cohort of patients planned for adjuvant radiotherapy (RT) after radical cystectomy and IC reconstruction. Methods and materialsComputed tomography (CT datasets of twenty patients who underwent adjuvant RT were obtained and used prospectively for delineation of target volumes (primary and nodal) and OARs, including IC, uretero-ileal anastomosis and ileal stoma using a specified protocol for simulation including a delayed CT to identify IC. Three RT plans were generated for each patient for a dose of 54 gray (Gy) in 27 fractions (PTV V95% >95%): 3-dimensional conformal radiotherapy (3DCRT) with (3DCRT_S) and without (3DCRT_N) stoma shielding, and volumetric modulated arc therapy (VMAT), with OAR constraints specified for VMAT plans (IC: Dmax<54Gy, V50Gy < 20 cc). Constraints were given for other pelvic OARs (bowel, rectum, femur heads) as per published literature. Plans were evaluated for target coverage as well as OAR doses; in particular, IC and ileal stoma). ANOVA test was used to compare medians of achieved doses, and a p-value <0.05 was statistically significant. ResultsThe median IC volume was 63.34 (55.29–82.93) cc. The cranial end of IC was at L5 or L4 vertebral level in 95% of patients and caudal level at S2 or S3 in 80% of patients. In contrast, the ileal stoma spanned from L4 or L5 vertebral level cranially (100%) to L5 level caudally (80%). PTV V95% was similar for 3DCRT_N and VMAT plans while it was significantly lower for 3DCRT_S in areas of ileal stoma shielding (99.95% vs 99.01% vs 96.29%, p < 0.01). Median IC V50Gy was comparable in 3DCRT_N (38.81 cc) and 3DCRT_S (35.62 cc) while it was significantly lower in the VMAT plan (17.05 cc, p < 0.01). IC Dmax did not differ significantly between the three plans. On the other hand, when 3DCRT_N, 3DCRT_S, and VMAT plans were compared for ileal stoma doses, Dmean was comparable (11.93 Gy vs 7.41 Gy vs 9.54 Gy, p = 0.06) while Dmax was significantly higher for 3DCRT_N plan and least for VMAT plan (35.32 Gy vs 27.57 Gy vs 24.22 Gy, p < 0.01). VMAT plans fared significantly better than both 3DCRT plans for uretero-ileal anastomosis, bowel, and rectal dosimetry. ConclusionsIleal stoma shielding in 3DCRT compromises PTV coverage but does not spare IC effectively. Sparing IC with VMAT is feasible without compromising PTV coverage. Dosimetric gains with VMAT are expected to benefit patients needing higher pelvic RT doses and nodal RT by reducing the risk of anastomotic and mucosal complications. Clinical benefits should be evaluated in a prospective protocol.

The relation between preoperative radiological sarcopenia and postoperative recovery of physical activity in older surgical cancer patients; an explorative study

To identify older surgical cancer patients at risk of decreased postoperative recovery of physical activity (PA), this study assesses whether preoperative radiological sarcopenia (RS) is associated with a decreased ability to return to baseline PA. RS was defined as decreased psoas muscle mass or -density by gender-specific cut-offs on CT-scans at level of vertebra L3. PA was assessed as steps/day measured with PA tracker and recovery of PA was defined as >90% of preoperative steps/day at 3 months postoperatively. Of 44 included patients aged 65 and over undergoing oncologic surgery, 18 patients (41%) showed RS. Seventeen patients (39%) returned to baseline PA, of which eight patients had RS (47%). RS was not associated with a return to baseline PA (OR: 1.38, 95%CI 0.39–4.92, p = 0.61). In this exploratory study, no association was found between preoperative RS and recovery of PA postoperatively.

Clinical impact of visceral adiposity on long-term mortality in patients undergoing coronary artery bypass grafting

Introduction and objectivesAlthough visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat. MethodsA total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm2)/height2 (m2) at the L3 level. The primary outcome was all-cause mortality during follow-up. ResultsPatients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%CI, 0.91-0.97; P<.001). Patients in the low VFAI group had a higher incidence of long-term mortality than those in the intermediate and high VFAI groups (T1 36.1%, T2 27.2%, and T3 29.1%; T1 vs T2; adjusted HR, 1.36; 95%CI, 1.15-1.61; P<.001; T1 vs T; adjusted HR, 1.37; 95%CI, 1.16-1.62; P<.001). Similar results were obtained after inverse probability treatment-weighting analysis. ConclusionsLow visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG.