Mm In Women Research Articles

Abstract 4113942: Validation of Changes in the Cutoff Values of Achilles Tendon Thickness on Radiography in the Clinical Criteria of Heterozygous Familial Hypercholesterolemia in Japan

Background: To increase sensitivity and maintain specificity, the 2022 Japan Atherosclerosis Society familial hypercholesterolemia (FH) clinical criteria was modified. In particular, the cutoff value of Achilles tendon thickness (ATT) on radiography was changed from ≥9 mm in both men and women to ≥8.0 mm in men and ≥7.5 mm in women. The current study aimed to validate the efficacy of this modification in independent samples. Methods: Patients with FH were retrospectively reviewed. The proportions of patients with pathogenic FH mutation who had an ATT of <7.5/8.0 mm (group 1), ≥7.5/8.0 and <9.0 mm (group 2), and ≥9 mm (group 3) were assessed. Results: In total, 492 patients were included in group 1, 102 in group 2, and 263 in group 3. Approximately 14.0%, 55.9%, and 79.8% of patients in groups 1, 2, and 3, respectively, exhibited FH mutation. Further, 37.3%, 77.3%, and 86.5% of patients with a low-density lipoprotein cholesterol level of ≥180 mg/dL in groups 1, 2, and 3, respectively, harbored FH mutation. Moreover, the median low-density lipoprotein cholesterol levels (157, 182, and 253 mg/dL, respectively) and the proportion of patients with protein-truncating mutation (3.8%, 16.7%, and 53.2%, respectively) had a significant trend. Conclusions: There was a substantial number of patients with FH who had an ATT of ≥7.5/8.0 and <9.0 mm. These patients previously had a deferred diagnosis of FH. However, they were diagnosed with FH based on the new clinical guideline.

Small Left Ventricular Chamber Size and Mortality in a Large General Population

Enlargement of the left ventricle (LV) is an important marker of adverse cardiac remodeling and poor prognosis. Previous studies demonstrated increased cardiovascular risk in small subsets of patients with small LV chamber size, however, the prognostic implications of small chamber size in a general population remains unclear. The objective of this study was to examine the prognosis of a small LV chamber in a large general cohort. All consecutive subjects that underwent echocardiography examinations from 2011 to 2023 were retrieved for analysis. Small chamber size was defined as end-diastolic diameter less than 42 mm for men and 37.8 mm for women as per ASE guidelines. The primary endpoint for the study was all-cause mortality. 46,529 subjects (mean age 60 ± 19 years, 56% males) were included of whom 3,787 had small LV chamber size. Clinical variables associated with small chamber included increasing age and lower BSA. Echocardiographic variables included higher relative wall thickness, and E/e' ratio. On multivariable analysis, the presence of a small LV was significantly associated with mortality (HR 1.34 with 95% CI 1.22-1.46; p <0.001). This finding was significant in both older (over 65 years) (HR 1.30 95% CI 1.19-1.41; p <0.001) and younger (HR 2.09 95% CI 1.81-2.41; p <0.001) subjects and in both males and females. In conclusion, in this retrospective large cohort study, small LV chamber size was significantly associated with mortality in a broad range of patients. Further study is necessary to elucidate mechanisms and design preventive strategies.

Early diaphragm dysfunction assessed by ultrasonography after cardiac surgery: a retrospective cohort study.

Approximately 10%-70% of patients may develop diaphragmatic dysfunction after cardiac surgery, which may lead to delayed weaning from mechanical ventilation, increased ICU stays, postoperative hospitalization stays, and respiratory complications. However, its impact on prognosis and risk factors remain controversy. Therefore, we conducted a retrospective cohort study in which we evaluated diaphragmatic dysfunction in patients who underwent cardiac surgery via bedside diaphragm ultrasound to investigate its prognosis and possible risk factors. Data from the electronic medical records system included case records and ultrasound images of the diaphragm for 177 consecutive patients admitted to the ICU following cardiac thoracotomy surgeries performed between June and September 2020. Diaphragmatic dysfunction was defined as a diaphragmatic excursion of less than 9 mm in women and less than 10 mm in men at rest, with an average thickening fraction of less than 20%. SPSS 25.0 software was used to analyse the relationships between patients' general information, intraoperative and postoperative factors and diaphragmatic dysfunction, as well as the impact on patients' hospitalization days, mechanical ventilation time and respiratory system complications. The incidence of early postoperative diaphragmatic dysfunction after cardiac surgery was 40.7%. Patients with diaphragmatic insufficiency were more likely to sequentially use noninvasive ventilation within 24 h after weaning off mechanical ventilation (3.8% vs. 12.5%, P = 0.029) and to require more oxygen support (23.8% vs. 40.3%, P = 0.019). Although there was no significant difference, the diaphragmatic dysfunction group tended to have longer ICU stays and postoperative hospital stays than did the normal diaphragmatic function group (P = 0.119, P = 0.073). Univariate and multivariate logistic regression analyses both revealed that chest tube drainage placed during surgery accompanied by bloody drainage fluid was an independent risk factor for diaphragmatic dysfunction (univariate analysis: 95% CI: 1.126-4.137, P = 0.021; multivariate analysis: 95% CI: 1.036-3.897, P = 0.039). Eearly diaphragmatic dysfunction after cardiac surgery increased the proportion of patients who underwent sequential noninvasive ventilation after weaning from mechanical ventilation and who required more oxygen. Chest tube drainage placed during surgery accompanied by bloody drainage fluid was an independent risk factor for diaphragmatic dysfunction, providing evidence-based guidance for respiratory rehabilitation after cardiac surgery.

Prognostic value of pretreatment temporal muscle thickness after curative surgery for oral cavity squamous cell carcinoma.

Sarcopenia is a poor prognostic factor in various diseases. Temporal muscle thickness (TMT) has been reported to be associated with sarcopenia. We investigated the prognostic value of TMT in patients with oral squamous cell carcinoma. This study included 61 patients with oral squamous cell carcinoma. Two board-certified otolaryngologists measured TMT based on pre-treatment CT. The following sex-specific TMT cut-off values were used in accordance with previous reports: ≤ 6.3mm in men, and ≤ 5.2mm in women. We classified patients into normal TMT group and low TMT group according to the cutoff values. The correlation between the TMT measurements of the two readers was tested using the interclass correlation coefficient (ICC). Cox regression models were used to verify the association between TMT and prognostic factors. The low TMT group had a significantly lower BMI than the normal TMT group. Patients with low TMT at baseline had a significantly higher risk of death than those with normal TMT (hazard ratio 4.51; 95% confidence interval [CI] 1.49-13.61; p = 0.0076). There were no significant differences in disease-specific survival between the two groups. The correlation between the two evaluators' TMT measurements was excellent (ICC 0.988, 95% CI 0.981-0.933). Sex-specific TMT was associated with overall survival in patients with oral squamous cell carcinoma. TMT is easy to assess and its measurement is consistent between evaluators.

Diameter of Quadrupled Semitendinosus Autograft in Primary Anterior Cruciate Ligament Reconstruction Did Not Impact Early Revision Rate or Functional Outcome in a Large Cohort of Patients

To determine whether the diameter of the quadrupled semitendinosus tendon (ST) graft in primary anterior cruciate ligament reconstruction (ACLR) is related to the risk of revision ACLR within 2 years of primary ACLR, postoperative knee laxity and patient reported knee outcome. Furthermore, to investigate whether smaller graft than estimated is related to revision ACLR. Patients who underwent primary ACLR with a quadrupled ST autograft at our institution, from January 2005 to December 2017 were identified. Data from the Swedish National Knee Ligament Registry (SNKLR) were collected up to two years or until revision surgery was registered within two years after primary ACLR. Knee laxity was assessed, pre-operatively and at 6-months follow up using the KT-1000 arthrometer (134 N anterior tibial load). The Knee injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and at two years postoperatively from SNKLR. Based on anthropometric measurements (body height and weight) and sex the estimated quadrupled ST graft diameter was calculated. A total of 4,519 patients who underwent ACLR with a quadrupled ST autograft were included. The mean graft diameter was 8.3 mm± 0.7 mm; 8.0 mm± 0.6 mm for women and 8.6 mm ± 0.7 mm for men. The quadrupled ST graft diameter was not significantly correlated to revision ACLR. There was no significant difference in the ST graft diameter regarding post-operative knee laxity. The correlations between ST graft diameter and KOOS were weak, except for the "Sport and Recreation" subscale (P=.012). The quadrupled ST graft diameter was not significantly related to the need for early revision ACLR nor was related to postoperative knee laxity or patient reported outcome except for the KOOS "Sport and Recreation" subscale. Smaller ST graft than estimated was not a risk factor for revision ACLR. The outcome after ACLR is multifactorial and ST graft diameter is of no significant importance.

Role of Dapagliflozin in Prevention of Contrast Induced Nephropathy in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract Background Contrast induced nephropathy (CIN), is a known complication of any coronary intervention regardless the amount of contrast. Studies have shown that patients who develop CIN have a greater risk for death or prolonged hospitalization, as well as for other adverse outcomes, including early or late cardiovascular events especially if after percutaneous coronary intervention (PCI). Research is continuous to find pharmacological interventions to prevent CIN. While many therapies in prevention of CIN have been studied, only good hydration has been proven to be of benefit. This Abstractattempt to provide the role of dapagliflozin in prevention of CIN. Aim and objectives The aim of the study was to study the efficacy of dapagliflozin administration as a preventive tool for Contrast induced nephropathy (CIN), in diabetic patients undergoing primary percutaneous coronary intervention (PCI). Patients and Methods This study included 250 diabetic patients presented to emergency departments of Ain shams university hospitals from July 2021 till June 2022 and diagnosed with STEMI as being defined as Patients with ST elevation myocardial infarction defined as having symptoms of ischemia and ST-segment elevation of at least two contiguous leads with ST-segment elevation ≥ 2.5 mm in men &amp;lt; 40 years, ≥2 mm in men ≥ 40 years, or ≥ 1.5 mm in women in leads V2 – V3 and/or ≥ 1 mm in the other leads 1, that had been revascularized by primary PCI as per the recommendations of The European society of cardiology guidelines for diagnosis and management of ST elevation myocardial infarction published in 2017. CIN was defined by renal function impairment after IV contrast as mirrored by an absolute increase by 0.5mg/dL (or greater) or relative increase by 25% (or greater) of baseline serum creatinine over 48 hours or, better, by a decrease by 25% in the estimated glomerular filtration rate (eGFR(. The patients were randomized using dedicated software programme into two groups. Study group including 125 patients was the dapagliflozin group. Control group including 125 patients was the standard control group. Results Our study had demonstrated that a higher proportion of patients developed CIN in the control group (21 (16.8%)) vs (13 (10.4%)) in the study group (dapagliflozin group) but it didn’t reach a statistically significant difference with P-value =0.139. Conclusion Dapagliflozin failed to prove any statistically significant prevention against CIN.

Investigating the Morphology of the Nasolacrimal Canal in Cone Beam Computed Tomography Images and Its Relationship with Age and Gender.

Nasal and paranasal anatomical structures are closely related to the nasolacrimal canal (NLC). As a result of this anatomical relationship, several studies have reported that nasal and paranasal sinus pathologies often play a major role in the etiology of nasolacrimal duct obstruction. The purpose of this study was to investigate the anteroposterior diameter, transverse diameter, length and angle of the bony NLC with nasal floor on the right and left by using cone beam computed tomography (CBCT) and to explore the influence of gender and age on the above-mentioned parameters. The current study was conducted by examining the archive of primary CBCT images of patients who were referred for medical imaging to a private maxillofacial radiology clinic in Ahvaz, Iran, in 2020. In axial images, anteroposterior diameter and transverse diameter of the canal in the level of infraorbital were measured. In sagittal images, the length of the NLC was evaluated from the most proximal to the most distal part. Also, to examine the canal pathway, the angle between the canal and the floor of the nasal cavity was measured. Finally, all patient data, including age, gender and canal dimensions, diameter and path, was collected in the information form and referred to the statistics consultant for analysis. In the present study we included information of primary CBCT images of 126 patients who had been referred to a private maxillofacial radiology in Ahvaz, Iran, in 2020. Participants' average age was 28.22±8.13 years for women and 31.54±8.12 years for men, and a small age difference between sexes was seen. The average angle of the right canal with nasal floor was 108.29±7.96º for men and 113.70±7.57º for women, with a significant statistical difference by gender being observed. The mean values of the right channel length were 10.47±2.56 mm for women and 12.54±2.40 mm for men, and the difference between them was statistically significant. The mean values of the left canal length were 109.30±8.67 mm for women and 114.52±9.01 mm for men, and the difference between them was also statistically significant. This study provides useful information on the morphometric properties of the bony nasal canal. Careful anatomical knowledge about the morphology of the bony nasal canal may help physicians to plan the treatment options. As the present study raises some concerns related to the age and gender differences in nasopalatine canal morphology that may affect patients' diagnosis and treatment, dentists are recommended to use CBCT images as well as additional techniques with this regard.

Coxa valga and antetorta configuration leads to underestimation of the femoral component size: a matched case-control study of patients undergoing cementless total hip arthroplasty.

Total hip arthroplasty (THA) is the gold standard procedure for patients with end-stage osteoarthritis after failed conservative therapy. Digital templating is commonly employed in preoperative preparation for THA and contributes positively to its outcome. However, the impact of coxa valga and antetorta (CVA) configurations on stem size prediction accuracy remains not reported. Previous studies demonstrated that the size of the lesser trochanter (LT) can be used to determine femoral anteversion on pelvis radiographs. This study investigates the accuracy of preoperative digital templating in predicting stem size in patients with CVA undergoing cementless THA. Preoperative radiographs of 620 patients undergoing cementless THA were retrospectively investigated. Radiographs were standardized with patients standing and the leg internally rotated by 15°. A CVA group was established including patients with a CCD angle greater than 140° and a lesser trochanter (LT) size of at least 10mm for men and 8mm for women. For the control group, radiographs with a CCD angle ranging from 125-135° and LT size 3-10mm for men and 3-8mm for women were selected. Preoperative templating was performed using mediCAD. To reduce confounding factors, case-control matching was carried out for BMI and body height. After case-control matching, a total of thirty-one matches were analyzed. Stem size was underestimated in 74% (23/31) in the CVA and 13% (4/31) in the control group (p < 0.001). Moreover, patients with CVA were more likely to be underestimated by two sizes compared to controls (p < 0.004). In contrast, the exact stem size was predicted more frequently in the control group (p < 0.001). Stem size in patients with a CVA configuration are at high risk of being underestimated when using digital templating. These findings can be valuable for guiding in intraoperative decisions and lowering the risk of complications associated with an undersized femoral component.

ECG manifestations of occlusion of septal perforator of left anterior descending artery

The fourth universal definition of MI defines requires presence of j point elevation in two contiguous leads except v2–3 where the elevation should be equal to or >2 mm in men (2.5 mm in <40 years) and 1.5 mm in women.(1) We present two cases of patients who presented with electrocardiographic manifestations of occlusion of septal perforator of left anterior descending artery and discuss the salient feature of ECG in such patients. We also present the limitations of STEMI criteria given the dynamic nature of acute coronary occlusion and stress on early recognition of this MI.

Evaluation of Regio Temporalis in 3 Steps in Terms of Interventional Procedures.

Regio temporalis is a site where botulinum neurotoxin is applied for various medical reasons, such as migraine, bruxism, and myofascial pain syndrome. The region is also one of the target regions in flap surgery. This study aimed to define the region topographically. In addition, it was aimed to reveal the intramuscular nerve distribution of the temporalis.11 fixed cephalus (cadaver head) and 2 fresh cephalus were used. The lateral canthus of the eye was marked as point A, and the middle of the ear tragus as point B. The transverse and vertical distances of the branching point of the superficial temporal artery to the A and B points were measured. Transverse distances of the superficial temporal artery and superficial temporal vein to A and B points were measured. The muscle was examined in 5 equal parts (L0-L1-L2-L3-L4), and each part's vertical muscle and tendon lengths were examined. Intramuscular nerve density was demonstrated by applying the modified Sihler staining to fresh temporalis'. Superficial temporal artery had an average transverse distance of 8.56±1.9mm in women and 12.56±1.94mm in men from the middle of the ear tragus. The artery was 64.21±5.59mm posterior in females and 63.48±6.53mm in males from the lateral canthus of the eye. Our study determined that the branching point of the superficial temporal artery was below the upper level of the arcus zygomaticus in 10% of cases and above it in 90% of cases. In our study, the L2 point had the highest vertical muscle length at 45.67mm, while the L3 point had the highest vertical tendon length at 41.25mm. The point where the muscle length had the highest ratio with 1.49 compared to the tendon length, was the L2 point. The temporalis' for which the modified Sihler staining was applied was examined in 5 quadrants. It was determined that the nerve densities were in the second and third quadrants from anterior to posterior. The distance of superficial landmarks to neurovascular structures is extremely important in interventions to the regio temporalis. Considering the average distances given in our study is important in avoiding damage in surgical procedures and not injecting into vascular structures. The point where the muscle length had the highest ratio of 1.49 compared to the tendon length was the L2 point. The area in line with this point is the most suitable area for injection. The L2 point is also the most suitable area for injection as it has the highest muscle length. Since the nerve densities were observed in the modified Sihler staining applied temporalis' 2 and 3 quadrants from anterior to posterior, botulinum neurotoxin injections to these areas will give more effective results.

ELECTROCARDIOGRAPHIC DIAGNOSIS OF LEFT VENTRICULAR MYOCARDIAL HYPERTROPHY (LITERATURE REVIEW)

Left ventricular hypertrophy (LVH) is one of the most important predictors of cardiovascular events in patients with arterial hypertension (AH). Literature data on the role of electrocardiography (ECG) in diagnosing left ventricular (LV) myocardial hypertrophy are presented. Recommendations of the European Society of Cardiology and the European Society of Hypertension from 2018 and International Clinical Protocols "Duodecim" state the following LVH criteria: Sokolov-Lyon criteria: SV1 + RV5 &gt; 35 mm; wave R in lead aVL &gt; 11 mm; SV1 ≥ 25 mm, RV5–V6 &gt; 25 mm; Cornell voltage index: SV3 + RaVL &gt;20 mm in women and &gt;28 mm in men; Cornell product: the product of the Cornell voltage index and the duration of the QRS complex (RaVL + SV3) × QRS – for men and (RaVL + SV3 + 8) × QRS – for women. The criteria of LVH is the value of the Cornell product &gt; 2440 mm×ms. However, ECG criteria for detecting LVH are not sensitive enough. Peguero JG, Lo Presti S, et al. (2017) developed a more accurate method of diagnosing LVH by measuring the amplitude of the deepest S wave (SD) in any individual lead and adding it to the amplitude of the S wave in lead V4 (SV4) [SD+ SV4]. When the sum of [SD+ SV4] exceeds 28 mm in men or 23 mm in women (Peguero-Lo Presti criteria), LVH can be diagnosed.Objective: to systematize modern literary data on electrocardiographic diagnosis of left ventricular myocardial hypertrophy. Conclusion. Due to its low cost, easy availability, reproducibility and high specificity, electrocardiography remains the simplest and most common method of diagnosing myocardial hypertrophy. The Peguero-Lo Presti criteria for diagnosing left ventricular hypertrophy are more sensitive and specific than the voltage criteria of Sokolov-Lyon and Cornell.

A sonographic endometrial thickness

BackgroundThe prevalence of placenta accreta spectrum (PAS), a potentially life-threatening condition, has exhibited a significant global rise in recent decades. Effective screening methods and early identification strategies for PAS could enable early treatment and improved outcomes. Endometrial thickness (EMT) plays a crucial role in successful embryo implantation and favorable pregnancy outcomes. Extensive research has been conducted on the impact of EMT on assisted reproductive technology cycles, specifically in terms of pregnancy rates, live birth rates, and pregnancy loss rates. However, limited knowledge exists regarding the influence of EMT on PAS. ObjectiveThis study aims to evaluate association between pre-implantation EMT and the occurrence of PAS in women undergoing assisted reproductive technology cycles. Study DesignA total of 4637 women who had not undergone prior caesarean section, conceived by in vitro fertilization or intracytoplasmic sperm injection embryo transfer treatment and subsequently delivered at the Third Affiliated Hospital of Guangzhou Medical University between January 2008 to December 2020 were included in this study. To explore the relationship between EMT and PAS, we employed smooth curve fitting, threshold effect, and saturation effect analysis. Multivariate logistic regression analysis was performed to evaluate the independent association between EMT and PAS while adjusting for potential confounding factors. Propensity score matching (PSM) was performed to reduce the influence of bias and unmeasured confounders. Furthermore, we employed causal mediation effect analysis to investigate the mediating role of EMT in the relationship between gravidity and ovarian stimulation protocol and the occurrence of PAS. ResultsAmong the 4637 women included in this study, pregnancies with PAS (159, 3.4%) had significantly thinner EMT (non-PAS 10.08±2.04 vs PAS 8.88±2.21 mm，P<0.001) during the last ultrasound before embryo transfer. By smooth curve fitting, the saturated effect was found on EMT and PAS, with an inflection point at 10.9mm. Then the EMT was divided into four groups: ≤7mm, >7 to≤10.9mm, >10.9 to≤13mm, >13mm, and the absolute rates of PAS in each group was 11.91%, 3.73%, 1.35%, and 2.54%, respectively. When compared to women with an EMT ranging from between 10.9-13mm, the odds of PAS increased from adjusted odds ratio (aOR) of 2.27 (95% CI, 1.33-3.86) for EMT ranging from 7-10.9mm to aOR of 7.15 (95% CI, 3.73-13.71) for EMT <7mm after adjusting for potential confounding factors. Placenta previa remained as an independent risk factor for PAS (aOR, 11.80; 95% CI, 7.65-18.19). Moreover, EMT <7mm was still an independent risk factor for PAS (aOR, 3.91; 95% CI, 1.57-9.73) in the matched cohort after PSM. Causal mediation analysis revealed that approximately 63.9% of the total effect of gravidity and 18.6% of the total effect of ovarian stimulation protocol on PAS were mediated by the EMT. ConclusionsThe findings from our study indicate that thin EMT is an independent risk factor for PAS in women without prior caesarean section undergoing assisted reproductive technology treatment. The clinical significance of this risk factor is slightly lower than placenta previa. Furthermore, our results demonstrate that EMT plays a significant mediating role in the relationship between gravida or ovarian stimulation protocol and PAS.

Feasibility and metabolic outcomes of a well-formulated ketogenic diet as an adjuvant therapeutic intervention for women with stage IV metastatic breast cancer: The Keto-CARE trial.

Ketogenic diets may positively influence cancer through pleiotropic mechanisms, but only a few small and short-term studies have addressed feasibility and efficacy in cancer patients. The primary goals of this study were to evaluate the feasibility and the sustained metabolic effects of a personalized well-formulated ketogenic diet (WFKD) designed to achieve consistent blood beta-hydroxybutyrate (βHB) >0.5 mM in women diagnosed with stage IV metastatic breast cancer (MBC) undergoing chemotherapy. Women (n = 20) were enrolled in a six month, two-phase, single-arm WFKD intervention (NCT03535701). Phase I was a highly-supervised, ad libitum, personalized WFKD, where women were provided with ketogenic-appropriate food daily for three months. Phase II transitioned women to a self-administered WFKD with ongoing coaching for an additional three months. Fasting capillary βHB and glucose were collected daily; weight, body composition, plasma insulin, and insulin resistance were collected at baseline, three and six months. Capillary βHB indicated women achieved nutritional ketosis (Phase I mean: 0.8 mM (n = 15); Phase II mean: 0.7 mM (n = 9)). Body weight decreased 10% after three months, primarily from body fat. Fasting plasma glucose, plasma insulin, and insulin resistance also decreased significantly after three months (p < 0.01), an effect that persisted at six months. Women diagnosed with MBC undergoing chemotherapy can safely achieve and maintain nutritional ketosis, while improving body composition and insulin resistance, out to six months.

Left Ventricular Hypertrophy Findings on Electrocardiogram Predict Impaired Left Atrial Functions.

Electrocardiographic left ventricular hypertrophy (ECG LVH) holds significant clinical importance in cardiovascular disease. Pathological processes that lead to left ventricular hypertrophy (LVH) also induce remodeling and impair left atrial (LA) function. Atrial function can be assessed using speckle-tracking echocardiography. This study investigates the potential impact of ECG LVH on LA strain. A total of 62 individuals diagnosed with LVH, based on the echocardiographic left ventricular mass index, were included. ECG LVH was assessed using established protocols: the Sokolow-Lyon voltage criteria (SV1 + RV5/RV6 > 35 mm), Cornell voltage criteria (RaVL + SV3 > 28 mm for men and > 20 mm for women), and the Cornell product criteria [(SV3 + RaVL + (for women 8 mm)] x QRS duration > 2440 mm x ms). Participants were categorized into two groups based on the presence or absence of ECG LVH. The relationship between LA strain measures and ECG characteristics was explored. The study population had a median age of 58.3 ± 10.1 years, with 40.3% being female, 91.9% hypertensive, and 35.5% diabetic. Nineteen patients (30.6%) were identified with ECG LVH based on Sokolow-Lyon voltage, Cornell voltage, or Cornell product criteria. These patients exhibited significantly reduced LA reservoir, conduit, and contraction strains (P < 0.001). Statistically significant correlations were observed between all three phases of LA strain measures and Sokolow-Lyon voltage (reservoir r = -0.389, P < 0.01; conduit r = -0.273, P < 0.05; contraction r = -0.359, P < 0.01), Cornell voltage (reservoir r = -0.49, P < 0.001; conduit r = -0.432, P < 0.001; contraction r = -0.339, P < 0.01), and Cornell product (reservoir r = -0.471, P < 0.001; conduit r = -0.387, P < 0.01; contraction r = -0.362, P < 0.01). ECG LVH is associated with impaired LA strain, validating its use as an effective tool for predicting LA dysfunction.

Prevalence and Clinical Characteristics of Familial Hypercholesterolemia in Patients with Acute Coronary Syndrome according to the Current Japanese Guidelines: Insight from the EXPLORE-J study.

Little data exists for evaluating the prevalence and patient characteristics of familial hypercholesterolemia (FH) according to the latest 2022 guidelines for FH published by the Japan Atherosclerosis Society (JAS), which revised the Achilles tendon thickness (ATT) threshold from 9.0 mm in both sexes to 8.0 mm in men and 7.5 mm in women. This study used a nationwide registry of patients with acute coronary syndrome (ACS) to evaluate the prevalence of FH according to the latest diagnostic criteria for FH and to investigate the application of Achilles tendon imaging in the diagnosis of FH.A previous prospective observational study at 59 Japanese centers involving consecutive patients with ACS who were managed between April 2015 and August 8, 2016 was conducted to explore lipid management and persistent risk in patients hospitalized for ACS (EXPLORE-J). The study population consisted of 1,944 EXPLORE-J enrollees. According to the diagnostic criteria for FH in the 2022 JAS guidelines, the prevalence of probable or definite was among patients with ACS was 6.6% (127/1944). Among patients with premature ACS (male, age ＜55 years; female, age ＜65 years), the prevalence of FH was 10.1% (43/427). The mean ages were of the probable FH and definite FH groups were 59.9 and 61.0 years, respectively, while the mean age of the possible-or-unlikely FH group was 66.4 years (significantly older). Relative to the possible-or-unlikely FH group, the low-density lipoprotein cholesterol (LDL-C) levels were similar in the probable FH group and and significantly higher in the definite FH group. The prevalence of FH was considerably higher than previously reported, especially for patients with premature ACS. The age and LDL-C levels of the patients in the probable FH and definite FH groups were similar.

Ideal insertion point and projection of the infra-acetabular screw in acetabular fracture surgery

BackgroundIn acetabular fracture surgery, an infra-acetabular screw (IAS) is inserted from the anterior to the posterior column through the infra-acetabular corridor to stabilize both columns. Although the IAS is useful for increasing fixation strength, proper placement requires proficiency and often results in extraosseous screw penetration. The complex anatomy of the infra-acetabular corridor and difficult intraoperative detection of the ideal insertion point and angle make proper placement of the IAS challenging. This study aimed to detect the ideal insertion point and angle of the IAS based on anatomical landmarks that can be directly identified intraoperatively. MethodsWe retrospectively reviewed the pelvic CT of 50 adults who underwent serial slice CT imaging. The pelvic inlet plane (PIP), which contains the anterior border of both the sacroiliac joint and posterior superior edge of the pubic symphysis, was used as the reference plane for the pelvic coordinate system to simulate the ideal insertion of IAS. The distance from the posterior superior edge of the pubic symphysis to the ideal insertion point of the IAS (IAS distance) and the angle and length of the IAS that could be inserted from the ideal insertion point were measured. ResultsThe mean IAS distance was 61.0 ± 5.7 mm (57.6 ± 4.3 mm in men and 64.4 ± 4.9 mm in women). The mean angle between ideal IAS and yz-plane on the outlet view (α-angle) was 8.4 ± 6.6 ° (6.4 ± 5.6° in men and 10.5 ± 7.0° in women). The mean angle between ideal IAS and y-axis on the yz-plane (β-angle) was 86.5 ± 10.6 ° (86.0 ± 10.3° in men and 87.0 ± 10.9° in women). The length of IAS was 97.1 ± 4.7 mm in men and 89.2 ± 3.6 mm in women. ConclusionThe IAS ideal insertion point detected as a distance from the pubic symphysis may aid in the proper insertion of the IAS during surgery. The insertion angle was parallel or tilted 10 ° laterally to the longitudinal axis in the pelvic outlet plane and almost perpendicular to the PIP in the sagittal plane when inserted from the ideal insertion point.

NIMG-34. TEMPORAL MUSCLE THICKNESS AS A PROGNOSTIC MARKER IN A REAL-LIFE COHORT OF NEWLY DIAGNOSED MGMT PROMOTER METHYLATED GLIOBLASTOMA PATIENTS: A MULTICENTRIC IMAGING ANALYSIS

Abstract BACKGROUND In cranial MRI assessed temporal muscle thickness (TMT) correlates with lumbar skeletal muscle mass, which serves as surrogate marker of sarcopenia. Prior research has identified TMT as a prognostic marker in glioblastoma. However, incorporation into clinical practice is challenging due to the heterogeneity of previous studies and the absence of established cutoff values. To address this, we conducted a multicenter analysis to validate recently proposed sex-specific cutoff values in a homogeneous real-life cohort of newly diagnosed MGMT promoter-methylated glioblastoma patients uniformly treated with combined CCNU/temozolomide. We implemented a balanced control cohort for comparison. METHODS TMT was measured at baseline using preoperative or early postoperative MRI and in the disease course using the first MRI after completion of radiotherapy. Patients were TMT-based divided into “at risk of sarcopenia” or “normal muscle status”. Kaplan-Meier statistics and multivariable Cox regression analysis were used for correlation with survival. RESULTS In total, n = 126 patients were analyzed (n = 66 received CCNU/temozolomide; n = 60 received temozolomide). Patients with normal muscle mass at baseline (&amp;gt; 6,3 mm for men; &amp;gt; 5,2 mm for women) had significantly prolonged mOS (44.3 versus 16.7 months for CCNU/temozolomide; 29.5 versus 17.4 months for temozolomide) compared to those at risk of sarcopenia. In a multivariable Cox regression analysis, normal muscle mass (HR: 0.39, 95% CI: 0.23-0.66; p = 0.0003) and age at diagnosis of &amp;lt; 50 years (HR: 0.42, 95% CI: 0.22-0.79; p = 0.0067) were significant prognostic markers. Longitudinally, survival was best in patients with lack of TMT decline. CONCLUSIONS This analysis suggests TMT to serve as a prognostic marker in glioblastoma patients treated with CCNU/temozolomide or with temozolomide. However, for TMT assessment to be implemented in a generalizable manner, such as for patient selection for therapeutic measures, further validation in prospective controlled trials is necessary.

A standard canulated screw may not fit up to 1/3 of the patients treated percutaneously for anterior column acetabular fractures—A pilot study

A proper evaluation of the narrowings and length of the anterior acetabular column would offer better predictability and precision for implant insertion in the case of an acetabular fracture. ObjectiveTo determine the diameter and length of the safety corridor of the anterior column of the acetabulum in patients with available pelvic computed tomography (CT), analyze the obtained measurements against those of a standard 6.5-mm implant, and verify possible sex differences regarding these measurements. A secondary aim was to develop a method for measurement of the anterior column of the acetabulum based on CT images. Materials and MethodsIn 200 CT scans of hemipelvises we measured the diameter of two areas of narrowing and the length of the safety corridor of the anterior column. The images were submitted to multiplanar reformatting adjusted to a plane orthogonal to the bone corridor, drawn at the level of the superior pubic ramus. ResultsMeasurement #1 had a mean value of 8.12 (2.27) mm in the overall sample and median values of 9.03 (7.76–10.48) mm in men and 6.77 (5.44–7.19) mm in women. Measurement #2 had a mean value of 7.29 (2.19) mm and median values of 8.23 (7.18–9.82) mm in men and 5.9 (4.65–7.19) mm in women. Measurement #3 had a mean value of 109.53 (13.66) mm in the overall sample and median values of 117.17 (112.9–122.9) mm in men and 100.91 (90.95–111.17) mm in women (p<0.001 all three measurements). Measurement #1 was smaller than 6.5 mm in 22.5% of the patients (of whom 90% were women). Measurement #2 was smaller than 6.5 mm in 35% of the patients (of whom 80% were women). ConclusionsThis study proposed an anatomic evaluation of the anterior column of the acetabulum using conventional CT images The areas of narrowing in the anterior column had an average of 8.12 mm at the level of the pubic tubercle and 7.29 mm at the level of the acetabular fossa. The mean length of the safety corridor was 109.53 mm. In 35% of the cases, a 6.5 mm percutaneous screw would have violated the cortical bone of the safety corridor.

Demographic heterogeneity in valgus angulation of the proximal ulnar canal in relation to the flexion-extension axis.

The long-term outcome of total elbow arthroplasty remains unsatisfactory because of loosening and polyethylene wear, which could be caused by malpositioning of the ulnar component. When introducing an ulnar component, 2 different angles should be considered in the coronal plane: the valgus angulation of the proximal ulna in relation to the flexion-extension axis (FE-axis) and the intramedullary varus angulation in relation to the FE-axis. Currently, available TEA designs may not always be able to reconstruct the FE-axis because of the morphologic variability of the ulna. This study aimed to determine the demographic variability of the ulna and the relation between the 2 angulations in the frontal plane based on 3-dimentional computed tomography (CT) reconstructions of the elbow joint of healthy volunteers. Computed tomography scans of 36 left elbows of healthy volunteers were obtained (20 men and 16 women). The scans were segmented and analyzed using the Mimics Research 20.0 software. A local coordinate system was created based on the FE-axis of the elbow and the ulna's longitudinal axis. The measurements were conducted using the 3-Matic Research 12.0 software. The valgus angulation of the proximal medullary canal was on average 16° in men but 12° in women and ranged between 5° and 21°. The varus angulation of the medullary cavity could be determined at 57 mm in men and 64 mm in women from the FE-axis. This angulation was on average 10° in men and 7° in women. There was no significant correlation between this angle and the length of the ulna or the point of varus angulation. This study found a wide range of valgus angulation of the proximal ulnar canal in relation to the FE-axis. The available elbow implant designs are discordant with the mean valgus angulation of the proximal ulna found in this study, and the valgus laxity of the implants does not cover the variability in the population.

Differences in the course of coxitis in men and women with early axial spondyloarthritis

Introduction. Currently, there is a small number of studies devoted to the differences in the manifestations of axial spondyloarthritis (axSpA) in men and women, and there are no studies assessing the frequency of coxitis in axSpA in patients of different sexes. The purpose of the study is to compare the main manifestations of coxitis in axial spondyloarthritis in men and women. Material and methods. The study was conducted on the Moscow Cohort of Early SpondyloArthritis (CoRSAr), which currently includes 175 patients. Their age at the time of inclusion in the cohort was on average 28.5±5.8 years, the duration of the disease was 24.1±15.4 months. 92.6% of patients were positive for HLA-B27 (human leukocyte antigen B27). All patients were assessed for pain in the hip joints (HIP) using a numerical rating scale (NRS) (0–10), and pelvic radiography, magnetic resonance imaging (MRI) and ultrasound examination of the Hip joint were performed. An increase in the cervical-capsular distance (NCD) of more than 7.0 mm was considered a sign of coxitis according to ultrasound data. When analyzing MRI results, signs of coxitis were considered to be synovitis and/or osteitis of the femoral head or acetabulum. X-ray changes in the hip joint were assessed using the BASRI-hip index (Bath Ankylosing Spondylitis Radiology Hip Index). Results and discussion. Among the 175 patients, there were 97 (55.4%) men and 79 (44.6%) women. At the time of inclusion in the study, women were older than men (p&lt;0.01), while the duration of the disease in men and women was the same and averaged about 2 years. In men, X-ray changes in the hip joint were more common than in women (in 7.2% and 1.3% of cases, respectively; p&lt;0.05). Clinical signs of coxitis were detected in 54 (55.7%) men and 41 (51.9%) women, while the level of pain according to the NRS in women averaged about 2, and in men – about 3 points (p&gt;0.05). According to ultrasound data, coxitis was detected in 15 (18.9%) women and 27 (27.8%) men; NCD averaged 6.2 mm in men and 5.9 mm in women (p&gt;0.05). In men, signs of damage to the hip joint according to MRI were more common than in women (in 27.8% and 15.1% of cases, respectively; p&lt;0.05). The level of C-reactive protein (CRP) in men was also higher than in women (on average 12.8 and 4.3 mg/l, respectively; p&lt;0.05). Conclusion. Women develop axSpA at a later age than men, and the latter are more likely to have HLA-B27, MRI features of coxitis, and higher levels of CRP.