Median Body Mass Index Research Articles

Interim analysis of single - centre randomised controlled trial on incisional hernia repair with vs without synthetic mesh fixation.

In a prospective randomised trial, we aimed to compare incisionalhernia repair with mesh fixation versus incisionalhernia repair without mesh fixation. The study was performed from June 2018 to August 2024 at a single centre in Vilnius, Lithuania. Fifty-seven patients with incisional abdominal wall hernia were randomly included into two groups: group one-"sublay" hernia repair with mesh fixation and the second - without mesh fixation. The duration of surgery, hospital stay, pain levels, quality of life and rate of complications were compared. Of the 38 women and 19 men who were included in the study, 30 were with mesh fixation and 27 without mesh fixation. The median patient's body mass index was 31.57 ± 5.96 (19.5-49.6). The most common hernia width was W2 according to the European Hernia Society (EHS) classification. A significant difference between the groups was found in duration of surgery - 108.00 ± 47.35 (40-235) minutes in the mesh fixation group vs. 75.74 ± 30.25 (35-150)-without the mesh fixation group (p < 0.05). A higher pain level was observed on the 10th postoperative day-3.03 ± 2.54 in the mesh fixation group versus 1.67 ± 2.22 in the group without the mesh fixation group (p < 0.05). A statistically significant difference was also observed in seroma rate after 6months (16.6% versus 0%, p < 0.05). There have been no hernia recurrences in either group so far. No mesh fixation on "sublay" hernia repair does not worsen the patient's postoperative condition. It does not increase postoperative pain, worsen the quality of life, or increase the risk of postoperative complications. On the 10th postoperative day, the non-fixed mesh group had less postoperative pain, however, later the pain was equal. A lower number of seromas was also observed in this group after 6months. However, the operative time in the group without mesh fixation was significantly shorter.

Using Nomograms to Predict Patient Tolerance to High-Dose Cisplatin During Concurrent Chemoradiotherapy in Locoregionally Advanced Head and Neck Cancer.

Concurrent chemoradiotherapy (CCRT) with high-dose cisplatin is the standard treatment for locally advanced head and neck cancer (LA-HNC). However, some patients experience underdosing or severe side effects due to intolerance. That is, identifying patients who can tolerate high-dose cisplatin remains challenging. This study aims to develop a prediction nomogram to identify patients tolerating high cumulative cisplatin dose (CCD ≥ 200 mg/m2) during CCRT. The collected data of 1020 patients who received cisplatin-based definitive CCRT between 2010 and 2019 in a Taiwanese medical center were retrospectively reviewed. A prediction model was developed using stepwise multivariable logistic regression and evaluated for accuracy. A nomogram was created to predict the likelihood of completing a CCD ≥ 200 mg/m2, and its performance was assessed using various measures. The higher CCD group had better-experienced status and median body mass index than the lower CCD group (p < 0.001 for both comparisons). Univariate analysis identified several risk factors for high-dose cisplatin intolerance, including old age, tumor site, the nasopharynx, stage IV disease, Charlson Comorbidity Index (CCI) ≥ 3, and weekly cisplatin (p < 0.001 for all). Multivariate logistic regression analysis revealed that age, tumor site, stage IV disease, and hemoglobin level strongly predicted high-dose cisplatin intolerance. The nomogram showed good predictive accuracy with a Brier score of 0.18, C-index of 0.71, calibration curve slope of 0.95, and intercept of 0.2. Similar values were observed in the non-nasopharyngeal carcinoma subgroup. Our nomogram model identified patients who can tolerate higher cisplatin doses, showing predictive accuracy after internal validation. Developed using pretreatment characteristics like age, clinical stage, tumor size, and hemoglobin level, it predicts tolerability for CCD ≥ 200 mg/m2. This method helps select patients for high-dose cisplatin, enabling confident prescription of three-weekly or weekly dosing to improve survival outcomes. Further prospective research is needed for a comprehensive nomogram.

Quantification and comparison of anti-AAV9 and anti-AAVrh74 antibodies in plasma and human milk: Implications for AAV-based gene therapy candidacy.

BackgroundThe application of recombinant adeno associated virus (rAAV) in gene therapy is accepted as an effective strategy for the treatment of monogenic diseases. However, eligibility for such therapies is contingent upon the absence or minimal presence of antibodies against adeno-associated virus (AAV) capsid protein. While the passive transfer of maternal immunoglobulins in utero is well established, the potential impact of maternal antibodies transferred via breastfeeding remains less explored.ObjectiveThis study aims to quantify and compare the levels of anti-AAV9 and anti-AAVrh74 immunoglobulin G (IgG) and M (IgM) in both plasma and human milk from a group of healthy lactating mothers.MethodsIn this cross-sectional study, we analyzed plasma and human milk samples from healthy lactating mothers. We used an enzyme linked immunosorbent assay (ELISA) to determine the levels of circulating IgG and IgM antibodies against AAV9 and AAVrh74 capsids and compared their concentrations in the paired samples.ResultsThirty-one paired plasma and human milk samples were analyzed. The median age at participation was 34 years (range: 25-43), median duration of breastfeeding at the time of sample collection was 7.5 months (range:0.7-33), and median body mass index was 23 Kg/m2 (range: 19.7-35.4). Median anti-AAV9 IgG in plasma and human milk, were 183 U/mL (range: 29-7214) and 1 U/mL (range: 1-33), respectively. Median anti-AAVrh74 IgG, in plasma and human milk were 138 U/mL (range: 23-8725) and 1 U/mL (range: 1-27), respectively. The differences in anti-AAV9 and anti-AAVrh74 IgG levels between plasma and human milk were statistically significant (p < 0.0001). Additionally, a strong correlation (r: 0.97, p: < 0.0001) was observed between anti-AAV9 and anti-AAVrh74 IgG levels in plasma.ConclusionsThe levels of anti-AAV9 and anti-AAVrh74 antibodies in human milk are remarkably lower than those in plasma. Consequently, breastfeeding should not be restricted for term infants who are potential candidates for AAV-related gene therapy products.

Prevalence of Popliteal Artery Variants in Free Tissue Transfer for Limb Salvage: A 12-Year Vasculoplastic Experience.

Popliteal artery variants (PAVs) are anatomical deviations of the popliteal artery's branching pattern and should be considered in microsurgical planning for patients undergoing lower extremity (LE) free tissue transfer (FTT). However, there is a significant lack of FTT literature in this patient population. Thus, this study presents our 12-year experience with LE FTT in patients with PAV.Patients receiving LE FTT reconstruction from July 2011 to March 2024 were reviewed. Preoperative angiograms were reviewed by a single vascular surgeon, and the presence of PAV was identified and classified as IIIA, IIIB, or IIIC. Primary outcomes were flap success and limb salvage.A total of 339 LE FTT were performed in 331 patients. A total of 32 patients (9.4%) had PAV, accounting for a total of 34 LE FTT. Class IIIA was the most common category (n = 20, 58.8%) followed by IIIB (n = 8, 23.5%) and IIIC (n = 6, 11.7%). Median age and body mass index were 63.5 (interquartile range [IQR]: 22.5) years and 27.4 (IQR: 10.3) kg/m2. The median Charlson Comorbidity Index was 5 (IQR: 2.5), with prevalent rates of diabetes (n = 18/32, 56.3%) and peripheral artery disease (n = 16/32, 50.0%). Median wound area was 71.0 (IQR: 80.0) cm2. Flap success rate was 100% (n = 34/34). At a median follow-up of 12.8 (IQR: 22.6) months, limb salvage was 97.1% (n = 33/34) and mortality was 6.3% (n = 2/32).In this large population of LE FTT, PAV occurs in almost 1 out of 10 patients. Essential to flap success and limb salvage is appropriate preoperative vascular imaging with arteriography, as the presence of PAV changes microsurgical intraoperative planning and technical considerations.

Implementation of a prehabilitation program before abdominal wall surgery: a pilot and feasibility study

PurposePrehabilitation in abdominal wall surgery (AWS) might improve postoperative outcomes, but current data are scant. A prehabilitation program before AWS, including specific hypopressive abdominal exercises, was recently implemented in our department. This study aimed to present the characteristics of the implemented program and to assess the adherence rate to hypopressive abdominal exercises.MethodsA retrospective study of all consecutive patients included in the pathway from October 2021 to October 2024 was performed. The multimodal prehabilitation program included nutritional support, physical activities (cardiorespiratory training, muscular strengthening, hypopressive abdominal exercises, and relaxation), and psychological support. Adherence rate was defined as the number of patients who performed the proposed abdominal exercises divided by the total number of included patients.ResultsA total of 103 patients were included (43% women, median age: 64, IQR 55–72, median body-mass index: 29 kg/m2, IQR 26–33). Most of them had a midline hernia (n = 79, 77%) and underwent a retromuscular mesh repair (n = 93, 90%). Ninety-six patients were adherent to the hypopressive abdominal exercises (adherence rate: 93%). Obese patients had a significantly lower adherence rate to hypopressive abdominal exercises than non-obese patients (29/34 = 85% vs. 67/69 = 97%, p = 0.025). Median length of hospital stay was 3 days (IQR 2–5) and postoperative complications occurred in 29 patients (28%).ConclusionThe implementation of a prehabilitation program in AWS was feasible. Moreover, adherence to the hypopressive abdominal exercises was high. Obese patients might require more attention to improve their adherence to the program.

Backscattered Ultrasonographic Imaging of the Tongue and Outcome in Hypoglossal Nerve Stimulation

Backscattered Ultrasonographic Imaging of the Tongue and Outcome in Hypoglossal Nerve Stimulation

The Effect of Preadmission Energy Balance on Short-Term Medical Outcomes: Findings From the Study of Refeeding to Optimize Inpatient Gains.

Caloric restriction and excessive exercise create an energy imbalance with medical sequelae in restrictive eating disorders. We examined the effect of acute and chronic energy imbalance on admission illness severity and refeeding outcomes in adolescents and young adults with anorexia nervosa (AN) and atypical AN. Secondary data analysis from the Study of Refeeding to Optimize Inpatient Gains, a multicenter randomized trial comparing higher- versus lower-calorie refeeding in 120 youth with AN or atypical AN hospitalized with medical instability. Vital signs were measured daily. Acute energy balance was calculated as caloric output (exercise recall plus estimated resting energy expenditure) subtracted from caloric input (dietary recall) before admission. Chronic energy imbalance variables included magnitude, rate, and duration of weight loss before admission. Regression analyses examined associations among energy balance, illness severity, and refeeding outcomes; dominance analyses examined the relative importance of energy balance. Among 82 participants (91% female), admission mean (SD) age was 16.5 (2.5) years, %median body mass index was 85 (10) and acute energy balance was-898 (678) kilocalories. Those with more negative acute energy balance before admission required more days (-0.18, [95% CI,-0.35,-0.02] p= .03) and kilocalories to restore medical stability (-431.10, [95% CI,-857.06,-5.13] p= .047). Acute energy balance was a more important predictor than weight suppression in determining these outcomes. More acute negative energy balance was associated with a need for more intensive refeeding, which supports the inclusion of preadmission dietary recall and exercise assessments, alongside weight history, to inform individualized refeeding protocols.

Effects of naloxegol on transit recovery in patients undergoing cardiac surgery: A randomized, double-blind, placebo-controlled trial.

Effects of naloxegol on transit recovery in patients undergoing cardiac surgery: A randomized, double-blind, placebo-controlled trial.

USINE-PAMS Artificial Intelligence-Driven, Ultrasound-Guided Lumbar Puncture to Improve Procedural Accuracy: A Pilot Study Report.

Traditional lumbar punctures (LPs) often fail, leading to diagnostic delays and increased risks. Ultrasound guidance provides improved success rates but faces adoption barriers due to neuraxial-ultrasound training and implementation challenges. The Ultrasound-Guided Spinal Landmark Identification With Needle Navigation System and Position and Angular Marking System (uSINE-PAMS) were designed to address these issues: uSINE is a machine-learning software for neuraxial-ultrasound guidance; PAMS is a hardware that translates ultrasound data for accurate needle insertion. A pilot study with 10 patients showed that uSINE-PAMS-guided LP achieved an 80% first-pass success rate with no complication; the median patient age was 43 years, and the median body mass index was 24.5 kg/m2. The uSINE-PAMS system showed feasibility. This pilot study showed that uSINE-PAMS-guided LP is feasible with a promising first-pass success rate at 80%. An ongoing phase 2 study (NCT05824546) of uSINE-PAMS may alter future standard of practice for LPs. This pilot study is registered under ClinicalTrials.gov (ID: NCT05824546).

Incidental Thyroid Cancer in Patients With Graves' Disease: Not as Rare as We Previously Believed.

Incidental Thyroid Cancer in Patients With Graves' Disease: Not as Rare as We Previously Believed.

Long-term evolution of postpartum sacroiliac bone marrow oedema: a 5-year longitudinal follow-up study

IntroductionBone marrow oedema (BME) on MRI of the sacroiliac joints (SIJ) commonly occurs after pregnancy. Our goal was to assess the evolution of BME over a period of 5 years...

Cutaneous Manifestations of COVID-19: A Descriptive Analysis of a Southeastern USA Purposive Sample.

This study describes characteristics and factors associated with cutaneous manifestations of COVID-19 encountered across acute inpatient, and critical care units in a large Southeastern USA public hospital from March 1, 2020, through November 01, 2021. A retrospective descriptive analysis was conducted on a purposive sample of patients consulted for non-pressure injury related cutaneous wounds while positive for COVID-19. Patients were predominantly male (64.3%, n = 27), White (66.7%, n = 28) and Black (33.3%). No cutaneous wounds while positive for COVID-19 were observed for Hispanic patients. Patient mortality was 71.4% (n = 30). Gender distribution was proportionate by gender (67% were male) and race (65.5% were White) for deceased patients. Body mass index (BMI) ranged from 15.8 to 61.2 with a mean of 31.9 (SD = 10.76) and median BMI 28.7. Identification of cutaneous manifestations of COVID-19 and understanding of the retiform purpura pathophysiology could prove useful in guiding COVID-19 treatment regimens. Investigation into factors preventing complement cascading in those of Hispanic ethnicity may be useful in the prevention of CMC-19 and progression of severity of illness.

Analysis of the application of single-port laparoscopic appendectomy without holder assistance in patients with complicated appendicitis

Objective: The aim of this study was to explore the risk factors that affect implementation of the innovative technique of single-incision laparoscopic appendectomy (solo-SLA) without assistance in patients with complicated appendicitis, the goal being improving surgical success rates and reducing the incidence of complications. Methods: This was an observational study. Indications for solo-SLA surgery were as follows: (1) computed tomography or ultrasound findings suggestive of acute appendicitis, accompanied by a high white blood cell count and C-reactive protein concentration; (2) disease course exceeding 72 hours, standard anti-infection treatment ineffective, inflammatory reaction not localized, surgery mainly aimed at abscess drainage, and the appendix removed if indicated intraoperatively; (3) acute onset stabilized for more than 3 months after conservative treatment; and (4) recurrent chronic appendicitis. Relative contraindications comprised: (1) cardiopulmonary insufficiency, extremely high risk for general anesthesia for laparoscopic surgery; (2) severe coagulation dysfunction; and (3) imaging findings suggestive of formation of a peri-appendiceal abscess, stable after anti-infection treatment, and a tendency for the inflammatory reaction to localize. We retrospectively collected clinical data of 106 patients with complicated appendicitis who had undergone solo-SLA in the Department of Emergency Surgery, Peking University People's Hospital from February to October 2023. Preoperative computed tomography showed appendiceal fecaliths, blurring of the tissue surrounding fat, intra- and extra-luminal gas and exudate, peri-appendiceal abscess, ascites, and intestinal obstruction by appendicitis. The study cohort comprised 53 male and 53 female patients aged (41.4±17.4) years. The median body mass index was (24.2±3.6) kg/m2 and median preoperative body temperature (37.3±0.9)℃ Appendicitis had been present for >3 days in 21 of the patients (19.8%) and the maximum diameter of the appendix was (12.4±3.8) mm. The efficacy of the surgery was assessed and logistic regression analysis used to explore the factors affecting the duration of the procedure. The relationship between the maximum diameter of the appendix and duration of surgery was non-linear and was explored using a logistic regression model with restricted cubic spline (RCS). Results: Only one patient required conversion to open surgery; all the other patients successfully completed solo-SLA with a median intraoperative blood loss of 10 (1-100) ml and a surgical time of (65.4±31.7) minutes. Pain scores on postoperative Day 1 and 7 were (3.4±3.2) points and (1.5±1.7) points, respectively. There were no significant postoperative complications .The postoperative hospital stay was (3.5±1.5) days and the interval to resuming normal activities 14 (2-40) days. According to univariate and multivariate analyses, disease course >3 days (OR=5.19, 95%CI: 1.59-16.98, P=0.006) and C-reactive protein >10 mg/L (OR=1.01,95%CI: 1.00-1.02, P=0.003) were independent risk factors for surgical duration >60 minutes, whereas the maximum diameter of the appendix was not independently associated with duration of surgery (OR=1.10, 95%CI: 0.97-1.25, P=0.119). RCS analysis results showed a "U-shaped" association between the maximum diameter of the appendix and duration of surgery, the inflection point of the RCS curve being at a diameter of 10 mm. When the maximum diameter of the appendix was <10 mm, increases in diameter were not associated with longer duration of surgery (OR=1.15,95%CI: 0.55-2.58, P=0.710); whereas when the diameter was ≥10 mm, the maximum diameter of the appendix was associated with increased duration of surgery (OR=1.20, 95% CI: 1.04-1.42, P=0.022). Conclusion: The solo-SLA procedure can be performed to treat complicated appendicitis. A disease course >3 days, C-reactive protein concentration >10 mg/L, and maximum diameter of the appendix ≥10 mm are all associated with greater difficulty of solo-SLA surgery.

Dietary behaviour among adults in Northern Ghana: a polytomous logistic regression model approach

Objectives This study determined the predictors of dietary behaviour among adults living in an urban and rural location in northern Ghana. Design A cross-sectional study. Setting An urban and rural settlement in the Northern Region of Ghana. Outcome measures Dietary behaviour levels and their predictors. Subjects Adults aged ≥ 18 residing in the Tamale Metropolis and the Tolon District of the Northern Region of Ghana. Results The median age (25th–75th percentile) of all the respondents was 31 (25–39) years, with 44.8% (358) of the respondents aged 20–30 years. There was no statistically significant difference in the respondents’ ages in the two study areas. The median body mass index (BMI) (25th–75th percentile) was 22.0 (20.4–24.0) kg/m2 and did not differ significantly (p-value = 0.23) across the two study areas. Most (74.8%; 598) of the respondents were of normal nutritional status, with half (51.6%) exhibiting good dietary behaviour. Being married (OR = 0.64, p = 0.04) reduces the odds of being at higher dietary behaviour levels. Conversely, being employed (OR = 1.83, p = 0.003) and aged 50–60 years (OR = 2.80, p = 0.05) increases the odds of being in the higher dietary behaviour categories according to the partially proportional odds model (PPOM). These relationships come with various marginal effects. The relationship between the place of residence of participants and dietary behaviour levels is bidirectional at different dietary levels. Conclusions This study revealed a complex relationship between dietary behaviour levels and their predictors. This relationship should be considered during interventional and further investigations into dietary behaviours.

Comparison of the success rate of fascia lata graft and temporal muscle fascia graft in endoscopic treatment of anterior skull base cerebrospinal fluid rhinorrhea

Aim: The aim of this retrospective study is to describe our experiences of cerebrospinal fluid (CSF) rhinorrhea and assess success rate of fascia lata and temporal fascia of repairing the skull base defects Material and Methods: Patients with CSF rhinorrhea managed by department of otolaryngology from 2007 to 2021 were included. Demographic information, site of leak, etiology, body mass index (BMI), surgical approach, graft material, and any recurrence of leak of the patients was collected. Results: Out of the 66 patients included in the study, 25 were male and 41 were female and the median age was found to be 43.7 (ranging from 19 to 72). The median Body Mass Index (BMI) was found to be 27.5 (ranging from 19 to 46). The success rate of endoscopic method in repairing CSF rhinorrhea was found to be 90.4%. Fascia lata was used as graft material in 35 patients, while temporal muscle fascia was used in 31 patients. Recurrent rhinorrhea was detected in 5 of 31 patients (16.1%) in whom temporal muscle fascia was used as a graft, while recurrence was detected in 2 of 35 patients (5.7%) in whom fascia lata graft was used (p=0.170). While rhinorrhea recurrence was detected in 6 of 27 obese patients (22.2%), revision surgery was required in only 1 (2.6%) non-obese patient (p=0.011). Complications such as hematoma, alopecia and leg pain related to the graft site were seen in 4 operated patients. Conclusion: Patients presenting with CSF rhinorrhea can be successfully treated with endoscopic sinus surgery. The success rate of using temporal fascia graft and fascia lata graft in defect repair is similar in rhinorrhea repair. In our study, it was determined that the only factor affecting treatment success was high BMI.

The Feasibility and Safety of Robot-Assisted Vaginal Natural Orifice Transluminal Endoscopic Surgery (RA-vNOTES) for Gynecologic Disease: 298-Case Series.

Objectives: To explore the feasibility and surgical outcomes of robot-assisted vaginal natural orifice transluminal endoscopic surgery (RA-vNOTES) for women suffering from gynecologic disease. Methods: We performed an observational study reporting and analyzing the perioperative outcomes of 298 patients with gynecologic disease who underwent RA-vNOTES in a single institution from June 2019 to August 2024. Results: A total of 298 patients with a median age of 41 years and median body mass index of 29 kg/m2 underwent RA-vNOTES. The primary indications for surgery were endometriosis (43.62%), chronic pelvic pain (11.07%), abnormal uterine bleeding (20.81%), and uterine leiomyomata (14.77%). A total of 286 of 298 (95.97%) patients had a hysterectomy. The median total operating time was 138 min, with a port placement time of 5 min, dock time of 3 min, and robot console time of 63 min. The median estimated blood loss was 50 milliliters. Endometriosis resection of all stages was performed in 192 of 298 (64.43%) patients. Three cases (1.01%) were converted to laparoscopic surgery. One case was converted to robot-assisted single incision plus one port laparoscopic surgery (SILS plus one) and two cases were converted to robot-assisted multi-port surgery. The total complication rate was 17.45% (52 cases), of which 2.1% (6 cases) were intraoperative complications and 15.44% (46 cases) were postoperative complications. Conclusions: Our findings indicate that RA-vNOTES is a feasible and less invasive option for various gynecologic procedures, including complex endometriosis excision and sacrocolpopexy.

Clinical and Cellular Predictors of Outcomes in Autologous Conditioned Plasma Therapy for Knee Osteoarthritis: A Prospective Cohort Study.

IntroductionAutologous conditioned plasma (ACP) is a single-spin, leukocyte-poor platelet-rich plasma (PRP) that provides a plasma with a platelet concentration 2 to 3 times the blood platelet concentration. The objective of this study was to investigate the clinical effectiveness of ACP intra-articular injection in patients with knee osteoarthritis (OA) and to identify any demographic, disease-associated, or biological predictors of outcome.MethodsA prospective cohort study was conducted between 2022 and 2023 in a single high-volume tertiary center, including 42 patients (54 knees) who consented to be enrolled. Patients underwent a series of 3 injections of ACP at weekly intervals, prepared using the Arthrex ACP Double-Syringe System. Lysholm scores were collected at baseline, 3-months, and 6-months post-injection.ResultsForty patients (49 knees) completed the follow-up and were included in the final analysis. The mean age was 53.8 ± 10.16 years (range 35-76 years), and the median body mass index (BMI) was 29 (interquartile range [IQR]: 27-34). There were 22 females and 18 males. Treatment failure occurred in 12 out of 49 cases (24.49%). The mean platelet concentration in the ACP was 588.5 ± 183.2 × 106/ml, with a mean platelet fold increase of 2.14 ± 0.71 compared to the baseline. Multi-linear regression modeling showed that older age and higher mean platelet concentration were predictors of higher post-injection Lysholm scores, with beta coefficients of 0.34 and 0.28, respectively, and p values of 0.013 and 0.036, respectively.ConclusionAutologous conditioned plasma provided clinical benefits in this cohort study of knee OA patients for at least 6 months post-injection. Older age and a higher mean platelet concentration in the ACP were identified as predictors of a higher Lysholm score.

Macronutrient requirements and intake by professional male rugby players.

Rugby union is a high-contact team sport where professional rugby players are exposed to considerable training and game loads in pre-season and in-season. Some studies have shown that rugby players' dietary intake remains inadequate for the three macronutrients (carbohydrates [CHO], proteins and fats) required for optimal performance. This study aimed to describe the macronutrient intake of professional male rugby players at Zebre Rugby Club in Parma, Italy, during in-season, and to compare players' macronutrient intake to international recommendations. Thirty-four professional male rugby players participated in the cross-sectional study. A self-developed questionnaire, a food frequency questionnaire and food records (on training and competition days and off day) were used to investigate players' macronutrient intake. Anthropometric measurements were obtained using the International Society for the Advancement of Kinanthropometry (ISAK) standardized techniques. Descriptive statistics were calculated, and associations were investigated using chi-square, Fisher's exact and Wilcoxon rank tests as applicable. The players' median age was 25.8 years (range 20.6-33.0 years) and 47.5% were Italian. Most players (64.7%) held forward positions and had a median of 5 years (range 2-14 years) of professional experience. More than 75.0% of players lived with a spouse or partner and 30.3% earned between 4000-4999 euros per month. The median body weight and height of players were 106.9 kg and 186.3 cm, respectively. The forwards weighed heavier (p < 0.0001) than the backs, which was expected due to positional demands, with no significant difference in height distribution. The median body mass index (p < 0.0001), waist circumference (p < 0.001) and waist-to-height ratio (p < 0.03) of forwards were higher than the backs. Additionally, the median body fat percentage of all players exceeded the international recommendation of 8-17% for rugby union players. The American College of Sports Medicine (ACSM), International Olympic Committee (IOC) and International Society of Sports Nutrition (ISSN) recommend an intake of 5.0-8.0 g/kg body weight (BW)/day CHO, 1.5-2.0 g/kg BW/day proteins and 20-35% total energy (TE) from fats for rugby players. The overall median intake of the three-day food records for all the players was 2.7 g/kg BW CHO, 1.7 g/kg BW protein and 35.1% TE from fat. On each of the three reported days, 90.0% of players' CHO intake fell below the recommended range, with almost all players (>90.0%) consuming less than the recommended amount of carbohydrates and almost 30.0% of players consuming below the recommended amount of protein on competition day. At least 50.0% of players' protein and fat intake was within the recommended range on each of the three reported days. The study's findings can assist various stakeholders at Zebre Rugby Club to align rugby players' dietary requirements to their workload, and encourage players' adherence to dietary guidelines and recommendations. It is advised that attention be focused on accurate dietary education, intake and monitoring to promote individualization and optimal performance and recovery. Future research is needed to adapt standardized macronutrient recommendations for rugby-specific requirements and address obstacles that may impede the optimal intake of macronutrients.

Body Mass Index Affects Hospital-Associated Disability and Economic Burden in Elective Cardiovascular Surgery - JROAD/JROAD-DPC Database.

Both underweight and overweight are recognized as important factors influencing outcomes in patients undergoing cardiovascular surgery. This study investigated the effects of body mass index (BMI) on hospital-associated disability (HAD) and hospitalization costs in patients undergoing elective cardiovascular surgery (coronary artery bypass grafting, valve surgery, aortic surgery) by analyzing data from the Japanese Registry of All Cardiac and Vascular Diseases - Diagnosis Procedure Combination (JROAD-DPC) database. All patients in the JROAD-DPC database were categorized into 5 groups according to the World Health Organization BMI criteria for Asians. HAD was defined as a decrease of ≥5 points in the Barthel Index from admission to discharge. The primary outcome was the prevalence of HAD, and the secondary outcome was hospitalization costs. Among the 228,891 patients included in the study, the median BMI was 23.2 kg/m2. The prevalence of HAD was 8.7%, with a U-shaped relationship between BMI and HAD, indicating that both extremely low and high BMIs were associated with a higher incidence of HAD. Hospitalization costs also showed a U-shape relationship with BMI, with higher costs for patients with HAD. Low BMI in any age group was associated with HAD, and older people with a BMI considered too high also had HAD. BMI could be an important risk stratification tool for functional outcomes and economic burden in patients undergoing elective cardiovascular surgery.

A novel robotic technique for creating the retrosternal route in gastric conduit reconstruction

Background The optimal reconstruction route after esophagectomy remains controversial. The retrosternal route has the advantage of a lower risk of fatal complications. However, the blind maneuver to create a retrosternal route may cause bleeding and pleural injury. Herein, we report a novel robotic technique for creating a retrosternal route. Methods This study included 43 consecutive patients with esophageal cancer who underwent robot-assisted minimally invasive esophagectomy with robotic retrosternal route reconstruction between April 2021 and December 2023. Clinicopathological findings and perioperative outcomes, including the time required to create the retrosternal route, were retrospectively analyzed. The creation times were also compared among surgeons. Results The median age and body mass index of the patients were 68 years (range: 46–80) and 21.4 kg/m2 (range: 16.6–30.2 kg/m2), respectively. Twenty-six patients (60%) received neoadjuvant chemotherapy. The median time to create the retrosternal route was nine minutes (range, 5–14 min). No cases showed pleural injury or postoperative hemorrhage associated with this procedure. There was no significant difference in the time taken to create the retrosternal route between the four surgeons (p = 0.434). Conclusions Robotic creation of a retrosternal route for gastric conduit reconstruction is simple, easy to learn, and results in a safe and feasible procedure.