Mm In Women Research Articles

Abstract 9165: Relationship Between the Cholesterol and Triglyceride Content of Lipoprotein Subclasses and Carotid Imtima-Media Thickness: Results from the Kyushu and Okinawa Population Study

Introduction: The association between 20 lipoprotein cholesterol and triglycerides subclasses and carotid intimal medial thickness (cIMT) progression has not been evaluated fully. Objective: Our goal was to assess which lipoprotein subclasses were associated with max cIMT levels. Methods: Levels of cIMT and 20 lipoprotein cholesterol and triglycerides subclasses using gel permeation high-performance liquid chromatography (GP-HPLC) were analyzed in 864 men and women (mean age 57 years, free of chronic liver or kidney diseases and off cholesterol-lowering, hormone replacement, or adrenocorticosteroid medications). Univariate and multivariate regression analyses were performed to examine the relationships between lipoprotein subclasses and max cIMT levels. Results: Max cIMT levels were 0.90 mm in women and 0.97 mm in men. After adjustment for age, gender, systolic blood pressure, smoking habits, diabetes, and hypertension treatment, elevated low-density lipoprotein cholesterol-2 and -3 were associated with higher max cIMT levels in both women and men. Decreased high-density lipoprotein cholesterol-7 were associated with higher max cIMT levels only in women (all P for trend < 0.05). However, no associations were found between any triglyceride subclasses and max cIMT levels. Conclusions: Our data indicate that elevated smaller LDL cholesterol levels separated by GP-HPLC were significantly associated with max cIMT in both men and women. Our results support the concept that small dense LDL cholesterol is the most atherogenic lipoprotein parameter.

Prolactinoma Outcome After Pregnancy and Lactation: A Cohort Study.

Context:Prolactinoma is the most frequent pituitary tumor among women of childbearing age. Fewer studies have addressed the outcome of prolactinomas after gestation.Objective:The aim was to study the spontaneous remission rate and change in tumor size after pregnancy and/or lactation in women with prolactinomas.Patients and Methods:Retrospective study conducted at a tertiary care center of north India. Records of 25 women with 31 pregnancies (20 microprolactinomas and 11 macroprolactinomas), who conceived on dopamine agonist (cabergoline) were studied. Cabergoline was stopped at conception in 24 pregnancies and continued in 7. Serum prolactin was noted 3 months after delivery and/or lactation. Magnetic resonance imaging available at last visit after delivery and/or lactation was also noted. Remission was defined as normal serum prolactin after pregnancy and/or lactation without use of cabergoline.Results:Among patients in whom cabergoline was stopped during pregnancy (n = 24), 41.6% (n = 10) had prolactin in normal range (achieved remission) after pregnancy and/or lactation. In 25% (n = 6) of women, adenoma size decreased by more than 50%, in 33%(n = 8), there was no change in adenoma size, and in 42% (n = 10), decrease in adenoma size was less than 50% after pregnancy and/or lactation. The median duration of cabergoline treatment before pregnancy among patients who achieved remission was 60 months against 24 months in those who did not achieve remission. The median pre-pregnancy adenoma size was 5.5 mm in women with remission against 8 mm in women who did not achieve remission.Conclusion:Pregnancy-induced remission of hyperprolactinemia was seen in 41.6% prolactinomas. Longer duration of dopamine agonist treatment before pregnancy, small pre-pregnancy adenoma size, and lower baseline prolactin were associated with high likelihood of remission, though not statistically significant.

Dynamic Mediolateral Patellar Translation Is a Sex- and Size-Independent Parameter of Adult Proximal Patellar Tracking Using Dynamic 3 Tesla Magnetic Resonance Imaging

To provide normal values for physiological patellofemoral tracking in a representative group of healthy individuals, as well as sex differences, using real-time 3T-magnetic resonance imaging (MRI) and to test for the reliability of the presented technique. One hundred knees of healthy individuals with no history of patellofemoral symptoms were scanned with dynamic MRI sequences, during repetitive cycles of flexion (40°) and full extension. Within a 30-seconds time-frame, three simultaneous, transverse slices were acquired. Dynamic mediolateral patellar translation (dMPT) and dynamic patellar tilt (dPT) were measured on two occasions by two independent examiners. Common radiological parameters were measured using static MRI, and correlations were calculated. 100 knees (53 right, 47 left; age: 26.7 ± 4.4 years; BMI: 22.5 ± 3.1) of 57 individuals (27 females, 30 males) were included. Mean height was 170.1 ± 7.7 cm in women and 181.8 ± 6.4 cm in men. Average patella diameter was 37.9 ± 2.7 (95% CI 37.1-38.7) mm in women and 42.4 ± 3.2 (95% CI 41.5-43.3) mm in men. In females, the patellar diameters and intercondylar distances were significantly smaller than in males (P < .001). Radiological parameters for patellar maltracking were within the normal range. During the range of motion, mean dMPT was 1.7 ± 2.4 (95% CI .9-2.5) mm in females and 1.8 ± 2.7 (95% CI 1.1-2.6) mm in males (P= .766). Mean dPT was 1.3 ± 2.9° (95% CI .4-2.1°) in females and-0.2 ± 3.8° (95% CI-1.2-.9°) in males (P= .036). Neither dMPT nor dPT was correlated with height, BMI, or patellar diameter. Intercondylar distance correlated weakly with dPT (r=-.241; P= .041). Intra- and interrater reliability were excellent for dMPT and dPT. Dynamic mediolateral patellar translation is a size- and sex-independent parameter for proximal patellar tracking. In healthy individuals without patellofemoral abnormalities normal dMPT proximal to the trochlea groove was 1.7 ± 2.5 (1.2-2.2) mm, independent of size or sex. Normal dPT showed a dependency on sex and was 1.3±2.9 (.4-2.1)° in women and-0.2 ± 3.8 (-1.2-0.9)° in men. Level II, diagnostic study.

Ultrasound Assessment of Diaphragm Thickness and Thickening: Reference Values and Limits of Normality When in a Seated Position.

Background: Diagnosing diaphragm dysfunction in the absence of complete paralysis remains difficult. The aim of the present study was to assess the normal values of the thickness and the inspiratory thickening of both hemidiaphragms as measured by ultrasonography in healthy volunteers while in a seated position.Methods: Healthy volunteers with a normal pulmonary function test were recruited. The diaphragmatic thickness was measured on both sides at the zone of apposition of the diaphragm to the rib cage during quiet breathing at end-expiration, end-inspiration, and after maximal inspiration. The thickening ratio, the thickening fraction, and the thickness at end-inspiration divided by the thickness at deep breathing were determined. The mean values and the lower and upper limits of normal were determined for men and women.Results: 200 healthy volunteers (100 men and 100 women) were included in the study. The statistical analysis revealed that women had a thinner hemidiaphragm than men on both sides and at the various breathing times studied. The lower limit of normality of the diaphragm thickness measured at end-expiration was estimated to be 1.3 mm in men and 1.1 mm in women, on both sides. The thickening fraction did not differ significantly between men and women. In men, it ranged from 60 to 260% on the left side and from 57 to 200% on the right side. In women, it ranged from 58 to 264% on the left side and from 60 to 229% on the right side. The lower limits of normality of the thickening fraction were determined to be 40 and 39% in men and 39 and 48% in women for the right and left hemidiaphragms, respectively. The upper limit for normal of the mean of both sides of the ratio thickness at end-inspiration divided by the thickness at deep breathing was determined to be 0.78 in women and 0.79 in men.Conclusion: The normal values of thickness and the indexes of diaphragmatic function should help clinicians with detecting diaphragm atrophy and dysfunction.

Higth-sensitivity T troponin and NT pro B-type natriuretic peptide as predictors of early development of structural heart disease in patients with stage 0 of Chagas disease

Abstract Background Approximately 30% of patients with Chagas disease (ChD) develop structural heart disease at some point in their evolution. There is an asymptomatic period where there is no evidence of cardiac involvement, called stage 0. Prognostic evaluation in this group of patients remains a challenge. On the other hand, the presence of elevated hight-sensitivity T troponin (HS-TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) has been documented in the early stages of the ChD. The role of these biomarkers as predictors of early development of structural heart disease in the follow-up of stage 0 ChD has been poorly studied. Purpose The aim of this study is to evaluate if HS-TnT and NT-proBNP are a predictor of early development of cardiac structural alterations in the follow up of patients with stage 0 ChD. Materials and methods Outpatients with stage 0 of ChD (positive serology, with normal electrocardiogram, 24-hours holter and echocardiogram) were included prospectively. Baseline measurement of HS-TnT and NT-proBNP was performed. The follow-up was carried out with serial echocardiography and 24-hour Holter. The end point of development of structural heart disease was considered, defined as one of the following: left ventricular dilation (diastolic diameter of left ventricle &amp;gt;60 mm in men or &amp;gt;55 mm in women), deterioration of ventricular function (Drop &amp;gt;10 points of Left Ventricular Ejection Fraction (LVEF) or LVEF &amp;lt;50%), Complex ventricular arrhythmia or Atrio-ventricular block ≥ second degree Mobitz II. Univariate and multivariate analysis was performed by cox regression. Results Three hundred two patients were included, with 47±9 years old, 46% woman. With a median of follow-up of 34 (interquartile range 19 – 43) months, the end point of development of structural heart disease was presented in 4.6% (n=14 patients). In multivariate analysis both HS-TnT and NT-ProBNP were independent predictors of development of structural heart disease [HR 1.18 (IC95% 1.05–1.33), p=0.003 and HR 1.01 (CI95% 1.00–1.01), p=0.001; respectively]. The area under the Receiver operating characteristic (ROC) curve was calculated, for HS-TnT it was 0.80 (95% CI 0.65–0.93), with a cut-off point for HS-TnT &amp;gt;14 ng/ml and for NT-proBNP it was 0.88 (95% CI 0.83–0.95) with a cut-off point for NT-proBNP &amp;gt;200 pg/ml. The figure shows the Kaplan-Meier curve for HS-TnT and NT-proBNP. In adjusted analysis, HS-TnT &amp;gt;14 ng/ml had a HR 5.27 (CI95% 1.4–18.9), p=0.01 and NT-proBNP HR 3.07 (CI95% 1.01–10.9), P=0.04. Conclusions In our population of patients with stage 0 chagas disease, HS-TnT and NT-proBNP were independent predictors of early development of structural heart disease, with good predictive capacity. The baseline measurement of these biomarkers can be useful in the evaluation and follow-up of patients with ChD without initial evidence of cardiac involvement. Funding Acknowledgement Type of funding sources: None. Kaplan-Meier curve

Normal values of aortic root diameters in sub saharan africans: the TAHES study

Abstract Introduction Reference values of aortic root diameters (ARD) are proposed to define normal versus diseased aorta. However, reported ranges of normal values are mostly issued from Caucasian cohorts. Data on blacks African subjects are sparse and not issued from community-dwelling cohorts. Purpose Our study aimed to establish reference values for ARD in a Beninese general population cohort. Methods This study is a part of TAHES, a population-based prospective cohort study initiated in 2015 in the district of Tanvè, Republic of Benin. Demographic, blood pressure and blood glucose data were collected using a questionnaire adapted from WHO-STEPS tools. Transthoracic echocardiography examinations were performed by 4 cardiologists, and analyzed off-line by a single observer. ARD were measured using inner-edge to inner-edge diameters during diastole for sinuses of Vasalva (SV), sinotubular junction (STJ) and proximal ascending aorta (AA), and during systole for annulus. Normal limits were defined as the 95th percentiles. Variables are presented as mean ±SD (5th-95th percentiles). Results We included 513 normotensive, non-diabetic and cardiovascular disease-free individuals (206 men and 307 women, age 40±14 years [26–68]). The absolute values of ARD were significantly greater in men: the non-indexed ARD values for the annulus, SV, STJ and AA were respectively 21.3±2 (18.5–25), 28.5±3.4 (23–34), 24.1±3 (19–29) and 27±3 (22.5–32) mm for men and 19.3±1.8 (1.8 (15- 22), 25.8±2.8 (21.6–30), 22±2.7 (18–26) and 24.8±2.8 (21–30) mm for women, respectively (all p&amp;lt;0.0001). No significant differences between sexes were recorded for body surface area (BSA)-indexed ARD for Annulus, STJ and AA. BSA-indexed SV dimension was greater in men (17.3±2.6 mm; 13.5–22) than women (16.8±2.5 mm; 13–21). There was a correlation between SV, STJ, AA indexed-diameters and age in both sexes but not for annulus indexed-diameter (r=0.14, 0.19 and 0.36 for women and 0.34, 0.45 and 0.32 for men, all p&amp;lt;0.05). The upper limits for ARD are summarized in Table 1. In order to compare these values to those in Caucasians, the data of the NORRE study are also displayed. Conclusion Normal values from a general population in West Africa appear could to differ from those established in Caucasian populations. This ethnic-appropriate reference is proposed for appropriate diagnosis in patients in sub-Saharan Africa. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): APREL (CHU Limoges) Table 1

A LATE PRESENTATION OF MOUNIER-KUHN SYNDROME IN A 71-YEAR-OLD MAN

TOPIC: Imaging TYPE: Fellow Case Reports INTRODUCTION: Mounier-Kuhn Syndrome (MKS) is a rare congenital entity characterized by abnormal enlargement of the trachea and main bronchi. MKS was first described at autopsy in 1897 by Czyhlarz. Mounier-Kuhn described the association of endoscopic and radiographic appearance of the enlarged airways in 1932. CASE PRESENTATION: A 71-year-old male, former smoker, with a past medical history of an intellectual disability, severe malnutrition, weight loss, chronic decubitus ulcers, on 2 L. home oxygen therapy and multiple prior episodes of pneumonia, presented to the emergency department by Emergency Medical Service (EMS) after experiencing cardiac arrest at home. Earlier in the day, the patient was reported to be intermittently hypoxic with desaturations to the 70s. After lunch, he suddenly became unresponsive. He had bystander cardiopulmonary resuscitation (CPR) for 10 minutes until EMS arrived. Return of spontaneous circulation (ROSC) was achieved, but he arrested again after intubation, with additional 7 minutes of CPR prior to achieving ROSC. At the hospital, the patient was hypotensive and required intravenous fluids and multiple vasopressor support. A chest x-ray reported a right-sided pneumonia. He was treated with antibiotics. CTA of the chest showed enlargement of the trachea and bilateral bronchi with bronchiectasis, consistent with MKS. Also showed a pneumomediastinum and a small pneumothorax on the right. Pulmonary embolism (PE) was ruled out. Bronchoalveolar lavage showed Methicillin resistance Staphylococcus aureus (MRSA) and antibiotics were de-escalated. He eventually required a tracheostomy and discharged to LTAC. DISCUSSION: MKS is an entity more common in males with 8:1 predominance. The prevalence in the population has not been determined yet but a review found 360 cases published until 2016. The mean age of diagnosis is 53.9 years.The diagnosis of MKS is made when the transverse and sagittal diameters of the trachea exceed 25 mm and 27 mm in men and 21 mm and 23 mm in women, respectively; or when the transverse diameters of the right and left main bronchi exceed 21.1 mm and 18.4 mm in men and 19.8mm and 17.4 mm in women, respectively. There has been no correlation between increasing age and increasing tracheal diameter.Bronchiectasis, tracheal diverticulosis and tracheobronchial dyskinesia have been associated frequently. The most common complains are cough, dyspnea and recurrent respiratory infections.This case was unfortunately missed by many providers and incidentally found in post cardiac arrest admission. CONCLUSIONS: Providers should recognize the enlarge airways on chest imaging and the diagnosis is easily made once obtaining measurements. REFERENCE #1: Krustins E, Kravale Z, Buls A. Mounier-Kuhn syndrome or congenital tracheobronchomegaly: a literature review. Respir Med. 2013;107(12):1822-1828. doi:10.1016/j.rmed.2013.08.042. REFERENCE #2: Menon B, Aggarwal B, Iqbal A. Mounier-Kuhn syndrome: report of 8 cases of tracheobronchomegaly with associated complications. South Med J. 2008;101(1):83-87. doi:10.1097/SMJ.0b013e31815d4259 REFERENCE #3: Krustins E. Mounier-Kuhn syndrome: a systematic analysis of 128 cases published within last 25 years. Clin Respir J. 2016;10(1):3-10. doi:10.1111/crj.12192 DISCLOSURES: no disclosure on file for Frank Biscardi; No relevant relationships by Moises Cossio, source=Web Response No relevant relationships by Fernando Fuentes, source=Web Response

Navigation system for percutaneous tracheotomy

Background Percutaneous dilatational tracheotomy (PDT) is a well-established method. The prerequisite is to identify anatomical landmarks of the neck. We introduce a three-dimensional navigation system – SafeTrach. Aims/objectives We present an alternative technique using internal landmarks that can be used in patients with difficult anatomy. Material and methods The device is a forceps-like instrument with an outer and an inner shank. The later serves as a ventilation lumen and stabilizes the orotracheal tube in the midline of trachea. The outer shank acts as a three-dimensional guide for the puncturing needle. Results Out of 48 patients we have determined the level of puncture in 20 patients by using intraoperative measurements. The distance from the vocal cords to the puncture site was about 50 mm for men and 40 mm for women. In 13 of the patients who had had CT scans, we studied the distance between the vocal cords and the optimal puncture site and found the median distance for men 45 mm and for women 42 mm. Conclusions and significance With the studied navigation system one may use external or internal landmarks to indicate the puncture level in PDT. The device may minimize the risk of injuring the posterior tracheal wall.

Quantifying displacement of urogenital organs after abdominoperineal resection for rectal cancer.

AimThis study aimed to quantify displacement of urogenital organs after abdominoperineal resection (APR), and to explore patient and treatment characteristics associated with displacement.MethodPatients from 16 centres who underwent APR for primary or recurrent rectal cancer (2001–2018) with evaluable preoperative and 6–18 months postoperative radiological imaging were included in the study. Anatomical landmarks on sagittal images were related to a coordinate system based on reference lines between fixed bony structures and absolute displacements were calculated using the Pythagorean theorem. Rotation of landmarks was measured relative to a pubic‐S5 reference line.ResultsThere were 248 patients included of which 171 were men and 77 women. The median displacement of the internal urethral orifice was 25 mm in men (maximum 65), and 17 mm in women (maximum 50). Rotation of the internal urethral orifice was in a caudal direction in 160/170 (94%) of men and 65/73 (89%) of women, with a median of 32 degrees (maximum 85) and 33 degrees (maximum 83), respectively. Displacements of the posterior bladder wall, distal end of prostatic urethra and cervix were significantly correlated with the internal urethral orifice. In linear regression analysis, biological mesh reconstruction of the pelvic floor and visceral interposition were significantly associated with increased displacement of the internal urethral orifice, and female gender and any filling of the presacral space with decreased displacement.ConclusionsSubstantial absolute displacement and rotation of urogenital organs after APR for rectal cancer were observed, but with high variability among both men and women, and being significantly associated with reconstructive interventions.

Sex-specific normal values and determinants of infrarenal abdominal aortic diameter among non-aneurysmal elderly population

To establish age- and sex-specific distribution of the infrarenal abdominal aortic diameters (IAD) among non-aneurysmal elderly population and to investigate the associations between traditional cardiovascular risk factors and IAD in men and women. We included 4032 participants (mean age 67.2 years; 60.4% women) from the population-based Rotterdam Study, free of cardiovascular disease, who underwent IAD ultrasound assessment between 2009–2014. Linear regression analysis was used to identify determinants of IAD. The medians (inter-quartile range) of absolute IAD and body surface area (BSA)-adjusted IAD were 17.0 (15.0–18.0) mm and 9.3 (8.5–10.2) mm for women and 19.0 (18.0–21.0) mm and 9.4 (8.6–10.3) mm for men, respectively. There was a non-linear relationship between age and IAD. IAD increased steeply with advancing age and up to 70 years. After around 75 years of age, the diameter values reached a plateau. Waist circumference and diastolic blood pressure were associated with larger diameters in both sexes. Body mass index [Effect estimate (95% CI): 0.04 (0.00 to 0.08)], systolic blood pressure [− 0.01(− 0.02 to 0.00)], current smoking [0.35 (0.06 to 0.65)], total cholesterol levels [− 0.21 (− 0.31 to − 0.11)], and lipid-lowering medication [− 0.43 (− 0.67 to − 0.19)] were significantly associated with IAD in women. Sex differences in IAD values diminished after taking BSA into account. The increase in diameters was attenuated after 70 years. Differences were observed in the associations of several cardiovascular risk factors with IAD among men and women.

From FIGO-2009 to FIGO-2018 in women with early-stage cervical cancer; Does the revised staging reflect risk groups?

ObjectivesWe aimed to evaluate if the revised staging according to FIGO-2018 in early-stage cervical cancer correctly predicts the risk for nodal metastases. MethodsWe reallocated 245 women with early-stage cervical cancer from FIGO-2009 to FIGO-2018 stages using data from a national, prospective cohort study on sentinel lymph node (SLN) mapping. We used univariate and multivariate binary regression models to investigate the association between FIGO-2018 stages, tumor characteristics, and nodal metastases. ResultsStage migration occurred in 54.7% (134/245) (95% CI 48.2–61.0), due to tumor size or depth of invasion (71.6%, 96/134) and nodal metastases (28.4%, 38/134). Imaging preoperatively upstaged 7.3% (18/245); seven had nodal metastatic disease on final pathology. Upstaging occurred in 49.8% (122/245) (95% CI 43.4–56.2%) and downstaging to FIGO-2018 IA stages in 4.9% (12/245) (95% CI 2.6–8.4). The tumor size ranged from 3.0–19.0 mm in women with FIGO-2018 IA tumor characteristics, and none of the 14 women had nodal metastases. In multivariate analysis, risk factors significantly associated with nodal metastases were FIGO-2018 ≥ IB2 (RR 5.01, 95% CI 2.30–10.93, p < 0.001), proportionate depth of invasion >2/3 (RR 1.88, 95% CI 1.05–3.35, p = 0.033), and lymphovascular space invasion (RR 5.56, 95% CI 2.92–10.62, p < 0.001). ConclusionsThe FIGO-2018 revised staging system causes stage migration for a large proportion of women with early-stage cervical cancer. Women who were downstaged to FIGO-2018 IA stages did not have nodal metastatic disease. The attention on depth of invasion rather than horizontal dimension seems to correctly reflect the risk of nodal metastases.

Özofageal inlet patch: Hastaların demografik ve endoskopik karakteristikleri ve litaratürün gözden geçirilmesi

Background and Aims: An esophageal inlet patch is crucial in swallowing difficulty, laryngopharyngeal reflux symptoms, and rarely in the etiology of proximal esophagus adenocarcinoma. We aimed to evaluate the endoscopic and demographic features of patients with esophageal inlet patch during endoscopic evaluation and compare them with those of the literature. Material and Method: Between January 2017 and January 2021, we evaluated the age, gender ratio, inlet patch size, and number along with the other endoscopic findings in patients with proximal esophageal inlet patch. Results: Overall, 53 patients (women, 36 (68%); mean age, 46.3 ± 15.8 years; range, 19–83 years) were included the study. Only 13 patients (24.5%) had specific symptoms of esophageal inlet patch. The median esophageal inlet patch size was 7.0 mm in women (range, 4–30), while it was 8 mm (range, 5–20) in men. The median inlet patch number was 1 in both sexes (range, 1–3 in women, 1–2 in men). Forceps biopsy was possible in 30 (56.6%) patients. We found no additional esophageal pathology in 45 (84.9%) patients, normal lower esophageal sphincter in 39 (73.5%), incompetent lower esophageal sphincter in 14 (26.4%), hiatal diaphragmatic hernia in 1 (1.8%), and endoscopic antral gastritis in 29 (55.7%) patients. Twelve (54.5%) of 22 endoscopic biopsies were positive for Helicobacter pylori. We detected esophageal inlet patch in the distal esophagus in 2 (3.7%) patients. Conclusion: Esophageal inlet patch was more common in women, unrelated to gastroesophageal reflux disease, and most patients were asymptomatic, with a median size of 8 mm (range, 4–30), with no gender difference. Moreover, inlet patch size was not associated with presence of symptoms. Evidence of malignancy in the biopsied inlet patches was not observed.

Structure of the Upper and Lower Surfaces of Human Corpus Callosum

The corpus callosum in the interval between the cerebral hemispheres is a plate of white matter, uneven in thickness, in which two surfaces are distinguished - the upper and lower ones, bent according to its lateral profile. The objective of the study was to study the individual variability of location of the lateral and medial longitudinal strips on the upper surface of the corpus callosum, as well as structural features of its lower surface. The material was the brain of men and women (10 specimens each) of the second period of adulthood, who died for the causes not related to the pathology of the central nervous system. After two weeks of fixation in a 10% formalin solution, the brain was prepared by separating the cerebral hemispheres and other parts of the brain from the corpus callosum, resulting in exposure of its upper and lower surface, which was photographed using a digital camera. As evidenced by the obtained data, the width of the trunk of the corpus callosum in men varies from 9 to 16 mm, whereas in women the difference between the minimum (11.0 mm) and the maximum (20.0 mm) values is greater than in men, when in fact there is only small difference of the arithmetic mean value. Thus, we offer to consider the lateral longitudinal strips to be the boundaries of the corpus callosum hemispherical part and the distance between them determines the width of this formation, which in average is 13.0 ± 2.5 mm in men and 14.4 ± 2.7 mm in women. In the meantime, the nature of the individual variability of the width of the corpus callosum trunk in women is more diverse than in men.

Quality of life in patients with psoriatic arthritis

Currently, the prevalence of PsA in the population is 0.05-1.6%. In terms of the rate of progression, deterioration of the quality of life and disability, PsA patients are comparable to rheumatoid arthritis and ankylosing spondylitis. Purpose: to study the effect of psoriatic arthritis on the quality of life of patients. Materials and methods. A study was conducted with the participation of 75 patients. For the study, we used standardized questionnaires developed to assess the quality of life of patients with PsA. Research method - questioning patients using standardized questionnaires, analysis of the information received. Results. Psoriatic arthritis has a significant impact on the quality of life of patients, affecting the physical, social and emotional spheres. The most important areas of influence of psoriatic arthritis from the point of view of patients are: pain (78%), skin problems (72%), decreased functionality (60%), discomfort (51%) and fatigue (44%). In patients with PsA, pronounced functional disorders are noted. The HAQ index in men averaged 1.98 0.86 (from 1.12 to 2.84 points), in women - 1.77 0.34 (from 1.44 to 2.11 points) (p 0.0001). The pain syndrome according to the VAS averaged 74.34 9.22 mm in men, and 65.77 8.19 mm in women. Patients noted the greatest disturbances in such activities as walking (44%), standing up (37%), hygiene procedures (21%), using transport (36%), housework (47%). Almost 40% of patients use various devices or the help of others (p 0.0001). Psoriatic arthritis also affects the emotional sphere of life. Subclinical emotional disorders were more often detected in women than in men (symptoms of anxiety - 61.9% and 42.2%, depression - 71.4% and 39.4%, respectively); however, approximately the same number of men had clinically expressed signs of depression ( 12.1%) and women (11.9%). Psoriatic arthritis significantly reduces the quality of life, affecting the most important aspects of it - physical, emotional and social.

Incidence of early diaphragmatic dysfunction after lung transplantation: results of a prospective observational study.

Diaphragmatic dysfunction is common after cardiothoracic surgery, but few studies report its incidence and consequences after lung transplantation. We aimed to estimate the incidence of diaphragmatic dysfunction using ultrasound in lung transplant patients up to 3months postoperatively and evaluated the impact on clinical outcomes. This was a single-center prospective observational cohort study of 27 lung transplant recipients using diaphragmatic ultrasound preoperatively, at 1day, 1week, 1month, and 3months postoperatively. Diaphragmatic dysfunction was defined as excursion<10mm in men and<9mm in women during quiet breathing. Clinical outcomes measured included duration of mechanical ventilation, length of stay (LOS) in Intensive Care (ICU), and hospital LOS. Sixty-two percentage of recipients experienced new, postoperative diaphragmatic dysfunction, but the prevalence fell to 22% at 3months. No differences in clinical outcomes were found between those with diaphragmatic dysfunction compared to those without. Patients who experienced diaphragmatic dysfunction at 1day postoperatively were younger and had a lower BMI than those who did not. Diaphragmatic dysfunction is common after lung transplant, improves significantly within 3months, and did not impact negatively on duration of mechanical ventilation, LOS in ICU or hospital, or discharge destination.

Fat mass assessment using the triceps skinfold thickness enhances the prognostic value of the Global Leadership Initiative on Malnutrition criteria in patients with lung cancer.

The present study evaluated whether fat mass assessment using the triceps skinfold (TSF) thickness provides additional prognostic value to the Global Leadership Initiative on Malnutrition (GLIM) framework in patients with lung cancer (LC). We performed an observational cohort study including 2672 LC patients in China. Comprehensive demographic, disease and nutritional characteristics were collected. Malnutrition was retrospectively defined using the GLIM criteria, and optimal stratification was used to determine the best thresholds for the TSF. The associations of malnutrition and TSF categories with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HR). Malnutrition was identified in 808 (30·2 %) patients, and the best TSF thresholds were 9·5 mm in men and 12 mm in women. Accordingly, 496 (18·6 %) patients were identified as having a low TSF. Patients with concurrent malnutrition and a low TSF had a 54 % (HR = 1·54, 95 % CI = 1·25, 1·88) greater death hazard compared with well-nourished individuals, which was also greater compared with malnourished patients with a normal TSF (HR = 1·23, 95 % CI = 1·06, 1·43) or malnourished patients without TSF assessment (HR = 1·31, 95 % CI = 1·14, 1·50). These associations were concentrated among those patients with adequate muscle mass (as indicated by the calf circumference). Additional fat mass assessment using the TSF enhances the prognostic value of the GLIM criteria. Using the population-derived thresholds for the TSF may provide significant prognostic value when used in combination with the GLIM criteria to guide strategies to optimise the long-term outcomes in patients with LC.

Peri-implant tissue stability in premolar and molar sites: a retrospective clinical and radiographic analysis.

The retrospective study was undertaken to assess the peri-implant tissue stability in premolar and molar sites clinically and radiographically for implants 7 years after loading. 408 implants placed in 275 patients from 2012 to 2020 and following a regular recall protocol were assessed for Modified Plaque Index (MPI), Sulcus Bleeding Index (SBI), pocket probing depth (PPD), and the peri-implant soft tissue dehiscence (PSTD) clinically and mesial bone loss (MBL) and distal bone loss (DBL) radiographically. Significant differences were found in MPI, SBI, and PPD amongst both men and women in the premolar and molar regions. The mean MBL and DBL were substantially greater in women than in men and marginally more in the maxilla than in the mandible. Maximum mean bone loss on either aspect of the premolar and molar implants was 2.80 ± 1.54 mm and 2.97 ± 0.96 mm for women. Implant success of 96.82% at 7 years was achieved and the patient satisfaction levels of 94.55% and 95.50% in the mandibular and maxillary arches, respectively, implied that patients were satisfied with the treatment. Women exhibited greater marginal bone loss on the mesial and distal aspects than men, with premolar implant sites demonstrating greater propensity for marginal bone loss than molar implant sites.

Screening for sarcopenia and obesity by measuring thigh muscle and fat thickness by ultrasound in patients with rheumatoid arthritis

ObjectivesSarcopenia is relatively common in rheumatoid arthritis (RA) patients. Thicknesses of the quadriceps muscle and fat are easily measured by ultrasound (US) and are known to be related to skeletal muscle mass and fat mass, respectively. MethodsEighty-four patients enrolled in the prospective correlation research of sarcopenia, skeletal muscle, and disease activity in rheumatoid arthritis study (UMIN000023744) underwent US examinations of anterior thigh muscle thickness (MT) and fat thickness (FT). Muscle and body fat (BF) mass were also examined by a body composition analyzer. Whether MT and FT were related to sarcopenia and obesity was examined. ResultsMT was significantly lower in RA patients with sarcopenia than in those without (23.8 vs 28.2 mm, P = 0.001). MT was related to sarcopenia (men: r = 0.56, P = 0.02, women: r = 0.32, P = 0.01). The cut-off value of MT for sarcopenia was 24.7 mm in men and 19.7 mm in women on receiver operating characteristic curve analyses. FT was correlated with BF percentage (%BF; men: r = 0.66, P < 0.01, women: r = 0.62, P < 0.001), which was estimated by 2.04xFT+8.53 in men and 1.2xFT+17.42 in women by a simple linear regression model. This means that FT ≥ 8.1 mm in men and FT ≥ 14.6 mm in women indicated obesity. ConclusionsUS examination of the anterior thigh was useful to detect sarcopenia and obesity in RA patients.

Atherosclerotic Burden and Remodeling Patterns of the Popliteal Artery as Detected in the Magnetic Resonance Imaging Osteoarthritis Initiative Data Set.

BackgroundAn artificial intelligence vessel segmentation tool, Fully Automated and Robust Analysis Technique for Popliteal Artery Evaluation (FRAPPE), was used to analyze a large databank of popliteal arteries imaged through the OAI (Osteoarthritis Initiative) to study the impact of atherosclerosis risk factors on vessel dimensions and characterize remodeling patterns.Methods and ResultsMagnetic resonance images from 4668 subjects contributing 9189 popliteal arteries were analyzed using FRAPPE. Age ranged from 45 to 79 years (median, 61), and 58% were women. Mean lumen diameter, mean outer wall diameter, and mean wall thickness (MWT) were measured per artery. Their median values were 5.8 mm (interquartile range, 5.2–6.5 mm), 7.3 mm (interquartile range, 6.7–8.1 mm), and 0.78 mm (interquartile range, 0.73–0.84 mm) respectively. MWT was associated with multiple cardiovascular risk factors, with age (4.2% increase in MWT per 10‐year increase in age; 95% CI, 3.9%–4.5%) and sex (8.6% higher MWT in men than women; 95% CI, 7.7%–9.3%) being predominant. On average, lumen and outer wall diameters increased with increasing MWT until the thickness was 0.92 mm for men and 0.84 mm for women. After this point, lumen diameter decreased steadily, more rapidly in men than women (−7.9% versus −6.1% per 25% increase in MWT; P<0.001), with little change in outer wall diameter.ConclusionsFRAPPE has enabled the analysis of the large OAI knee magnetic resonance imaging data set, successfully showing that popliteal atherosclerosis is predominantly associated with age and sex. The average vessel remodeling pattern consisted of an early phase of compensatory enlargement, followed by a negative remodeling, which is more pronounced in men.

Prevalence of Thoracic Aortic Aneurysms in Patients with Degenerative Abdominal Aortic Aneurysms: Results from the Prospective ACTA Study

There are no recommendations for screening for thoracic aortic aneurysms (TAAs), even in patients with infrarenal abdominal aortic aneurysms (AAAs). The aims of this study were to determine the prevalence of TAAs in patients with AAAs and to analyse the risk factors for this association. This was a multicentre prospective study. The Aortic Concomitant Thoracic and Abdominal Aneurysm (ACTA) study included 331 patients with infrarenal AAAs > 40 mm between September 2012 and May 2016. These patients were prospectively enrolled in three French academic hospitals. Patients were classified as having a normal, aneurysmal, or ectatic (non-normal, non-aneurysmal) thoracic aorta according to their maximum aortic diameter indexed by sex, age, and body surface area. Thoracic aortic ectasia (TAE) was defined as above or equal to the 90th percentile of normal aortic diameters according to gender and body surface area. Descending TAA was defined as ≥ 150% of the mean normal value, and ascending TAA as > 47 mm in men and 42 mm in women; 7.6% (n= 25) had either an ascending (seven cases; 2.2%) or descending aortic TAA (18 cases; 5.4%), and 54.6% (n= 181) had a TAE. Among the 25 patients with TAAs, five required surgery; two patients had TAAs related to penetrating aortic ulcers < 60 mm in diameter, and three had a TAA > 60 mm. In the multinomial regression analysis, atrial fibrillation (AF) (odds ratio [OR] 11.36, 95% confidence interval [CI] 2.18 - 59.13; p= .004) and mild aortic valvulopathy (OR 2.89, 1.04-8.05; p= .042) were independent factors associated with TAAs. Age (OR 1.06, CI 1.02 - 1.09; p= .003) and AF (OR 4.36, 1.21 - 15.61; p= .024) were independently associated with ectasia. This study confirmed that TAAs coexisting with AAAs are not rare, and one fifth of these TAAs are treated surgically. Systematic screening by imaging the whole aorta in patients with AAAs is clinically relevant and should lead to an effective prevention policy.