Neck Mobility Research Articles

FORESTIER DISEASE

Introduction We present the case of M.E., a 73 year old patient, who presented to his local medical services for progressive dysphagia. Follow-up cervical CT scan revealed ossification of the anterior longitudinal ligament, at C3 - C4, C4 - C5 and C5 - C6 levels, consistent with diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier disease. Material and Methods The patient was operated on by a multidisciplinary team (Neurosurgery and O.M.F. surgery). After a left sided vertical cervical incision and dissection of tissue, the spinal cervical levels were identified radiologically, followed by reduction of bony elevations at C3 - C4, C4 - C5 and C5 - C6 using a regular drill tip. Postoperatively the patient’s dysphagia was completely alleviated. Conclusion Although Forestier disease is usually identified incidentally, patients may present with decreased neck mobility, cervical pain and dysphagia. While the disease is similar to ankylosing spondylitis, it does not have a genetic component and it mainly affects the cervical and thoracic spines. Surgery may be necessary if dysphagia progresses.

Correction of Severe Pterygium Colli with a Staged, Double, Posterior and Lateral Approach: A Case Report

AbstractPterygium colli is a rare congenital disorder characterized by excessive skin in the lateral and posterior neck, often associated with genetic syndromes such as Turner's syndrome or Klippel–Feil syndrome. Severe presentations present special challenges for surgeons since its diagnosis is not always evident and its treatment often results in important scaring. Surgical correction of the typical cases mostly involves a lateral approach, but in this “special” case, we used a double, posterior and lateral approach. A 15-month-old girl with prenatal diagnosis of a cystic lesion in the posterior neck presented with massive neck webbing at birth. Genetic studies ruled out chromosomal disorders and RASA 1 mutations. Surgical correction involved a modified posterior approach combined with a lateral approach 1 year later. The cervical tissue redundancy was successfully reduced achieving a good aesthetic outcome with very acceptable scars. At 1 year of follow-up, the patient continues with good neck appearance and mobility. The goal of surgical treatment of pterygium colli is achieving a harmonious neck contour with good function and minimal scarring while minimizing complications and sequelae. No consensus exists on the optimal approach for its correction, emphasizing the need for individualized treatment considering patient-specific characteristics, particularly in the severe cases.

Efficacy and safety of acupuncture treatment for stiff neck: A systematic review and meta-analysis.

Stiff neck is a common acute musculoskeletal condition that significantly affects the quality of life of patients. Acupuncture is recommended as an effective method for alleviating pain and restoring neck mobility in patients with stiff neck, but there is currently a lack of scientific evidence supporting its efficacy and safety. The purpose of this study was to investigate the efficacy and safety of acupuncture in the treatment of stiff neck. This study searched 8 Chinese and English electronic medical databases, including China Biology Medicine disc, VIP database, Wanfang Data, China National Knowledge Infrastructure, Web of Science, PubMed, Embase, and the Cochrane Library, with a search period up to May 13, 2024. The focus was on clinical randomized controlled trials evaluating acupuncture treatment for stiff neck. The primary outcome measures were the total effective rate and visual analog scale scores. The quality of evidence and methodology of the included studies were assessed according to the GRADEpro guidelines. Meta-analysis was conducted to assess the results, with heterogeneity analysis, sensitivity analysis, subgroup analysis, trial sequential analysis, and publication bias analysis performed to verify the robustness of the combined results and explore potential sources of heterogeneity. This study evaluated 10 clinical randomized controlled trials comparing acupuncture therapy with conventional treatment, involving 754 patients. The treatment group received acupuncture alone or in combination with conventional treatment, whereas the control group received only conventional treatment. The analysis results showed that the treatment group was significantly superior to the control group in improving the total effective rate (risk ratio = 1.12, 95% confidence interval [CI] [1.04, 1.21], P = .002), reducing visual analog scale scores (mean difference [MD] = -0.93, 95% CI [-1.29, -0.57], P < .001), reducing neck disability index scores (MD = -6.39, 95% CI [-6.79, -6.00], P < .001), and restoring cervical range of motion (cervical lateral flexion: MD = 4.29, 95% CI [3.15, 5.43], P < .001; cervical rotation: MD = 6.08, 95% CI [4.46, 7.70], P < .001). Acupuncture is an effective and safe method for treating stiff neck. However, to validate this conclusion, more rigorously designed and higher-quality studies are needed in the future.

Impact of proprioceptive cervical dizziness in chronic neck pain syndromes on gait and stance during active head-turn challenges.

An earlier observational study described selected patients with acute neck pain syndrome, who experienced short bursts of cervical vertigo elicited by rapid head movements. The current study on a larger cohort of 20 patients with chronic or frequently recurring neck pain syndrome and age-matched controls focused on two major questions: (1) Can head movements in subjects with exacerbations of neck pain and restrictions of neck mobility also elicit bursts of vertigo? (2) What is the impact on postural balance measured by analysis of body sway and locomotion? A detailed questionnaire was applied, posture and gait were evaluated by use of instrumented posturography-and gait analysis with and without slow or rapid horizontal head rotations in the yaw plane with and without sight/visual input. All patients reported some or frequent episodes of dizziness in the range of seconds only elicited by rapid, not by slow head movements. Postural sway in patients was unremarkable in undisturbed conditions without head movements, but specifically increased by rapid but not slow head turns. The latter is best explained by the lack of continuous control of velocity and amplitude of saccadic head movements. Gait analysis revealed a slowed and cautious gait pattern already at undisturbed condition that was even exaggerated during rapid head turns. These observations demonstrate that chronic or recurrent neck pain is associated with episodic experiences of dizziness and above results in both chronic and episodic alterations of stance and gait that resemble those described for patients with phobic postural vertigo/persistent postural perceptual dizziness, a functional gait disorder.

Clinical value of transperineal ultrasound in evaluating the effects of different delivery methods on the primipara pelvic floor structure and function

To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P < 0.05). Compared to the cesarean delivery group, the vaginal delivery group exhibited larger posterior vesicourethral angles in resting and maximum Valsalva states (P < 0.05). The distances between vesical neck and posterior inferior margin of pubic symphysis were greater in the cesarean delivery group than in the vaginal delivery group at both resting and maximum Valsalva, with that at maximum Valsalva showing significant inter-group difference (P < 0.05). The vaginal delivery group exhibited greater vesical neck mobility and urethral rotation angle at maximum Valsalva compared to the cesarean delivery group (P < 0.05). The incidences of stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse were all higher in the vaginal delivery group than in the cesarean delivery group, with the stress urinary incontinence and bladder prolapse incidences showing significant inter-group differences (P < 0.05). With transperineal ultrasound, various pelvic floor indicators of primiparas can be clearly measured and, through these ultrasound indicators, the effects of different delivery methods on the pelvic floor function can be evaluated, which is conducive to early clinical detection and intervention of postpartum pelvic floor dysfunctions, thus facilitating the early postpartum treatment.

The Therapeutic Effect of Monopolar Radiofrequency Therapy on Urinary Symptoms and Sexual Function.

Objectives: Stress urinary incontinence (SUI) negatively affects the quality of life and sexual function in women. This study aimed to evaluate the efficacy of radiofrequency (RF) therapy in reducing SUI symptoms and its impact on sexual function. Methods: Thirty-four women with SUI were enrolled and underwent a single RF treatment session using the Viveve® System (Viveve Medical Inc., USA) with parameters of 90 J/cm2 and 220 pulses per hour. Assessments at baseline and 6 months post treatment included perineal ultrasound and personal interviews to evaluate lower urinary tract symptoms and sexual function. Urodynamic studies, voiding diaries, and questionnaires such as the Female Sexual Function Index (FSFI), Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) measured outcomes. Results: RF therapy significantly improved sexual function, with higher FSFI scores in all domains except pain at 6 months. SUI symptoms were significantly reduced, as indicated by improved scores on OABSS, UDI-6, IIQ-7, and ICIQ-SF, alongside better voiding diary results. Anatomical changes included reduced bladder neck mobility, decreased vaginal width, and a reduced rotation angle of the proximal urethra. Conclusions: RF therapy is effective and safe for treating mild to moderate SUI and enhances sexual function, potentially due to changes in vaginal topography. These results suggest RF therapy as a viable non-surgical option for managing SUI and improving sexual health.

Evaluation of the Effect of Vaginal Delivery on Stress Urinary Incontinence and Bladder Neck Mobility with Transperineal Ultrasonography

Aim: Stress urinary incontinence is a common and distressing situation in females, impacting emotional and psychological well-being by interrupting sexual, physical, and social forms of life. Perineal trauma, especially at childbirth, is one of the most common contributing factors. The objective of this research is assessing the impact of vaginal delivery, a factor known to elevate the likelihood of postpartum stressxincontinence, on bladder neck mobility. This evaluation will be conducted utilizing transperinealxultrasonography, a noninvasivexand well-toleratedxdiagnostic technique. Materials and Methods: In our study, 116 patients who gave birth in our hospital between January 2020 and May 2022 were evaluated retrospectively. The presence of stress urinary incontinence and transperineal ultrasonography data of all patients were examined from the patient files. To evaluate changes in bladder neck motility, ultrasound measurements made both prenatally and postnatally were evaluated retrospectively. Results: With regard to the demographic values of the patients, a statistically significant difference was seen in terms of the presence of urinary incontinence when multiparous and primiparous patients were compared with patients in the cesarean section group (p:0.01). There was a significant difference in ΔDx, ΔDy, and M values for the cesarean delivery group as compared to both the primiparous and multiparous vaginal delivery groups (p

7443 Severe Hypothyroidism and Adrenal Insufficiency in a 27-Year-Old Male with Klippel-Feil Syndrome: A Case Report

Abstract Disclosure: S. Almardini: None. F. Haddadin: None. L. Aoun: None. F. Saliba: None. J. Zaidan: None. Background: Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by improper segmentation of the cervical vertebrae. The classical clinical triad consists of short neck, low posterior hairline, and limited neck mobility. It is uncommonly associated with endocrine abnormalities. We present a rare case of KFS with severe primary hypothyroidism. Case Presentation: A 27-year-old male with KFS presented for evaluation of profound fatigue and lack of energy. His vital signs revealed a heart rate of 50 and a borderline low blood pressure. On physical exam patient was noted to be lethargic and icteric, thyroid exam was limited due to patient short neck. Labs were consistent with severe hypothyroidism TSH of 825 mIU/L, total T4 &amp;lt;0.4 mcg/dL, low 8 AM cortisol of 4.3 mcg/dL, elevated LDL at 333 mg/dL, elevated liver enzymes AST 491 U/L, ALT 294 U/L, neutropenia with WBC 2.69 x10^3/uL 20% neutrophils and anemia Hb 12 g/dL. TPO and thyroglobulin antibodies were positive at 149.0 and 109.0 IU/mL respectively, 21 hydroxylase antibodies were negative. Thyroid Ultrasound showed small and diffusely heterogenous thyroid. Patient was started on Levothyroxine 125 mcg daily and hydrocortisone with improvement in his symptoms as well as normalization of his lipid panel, liver enzymes and neutropenia. The patient was continued on levothyroxine 125 mcg, hydrocortisone was tapered and repeat cortisol levels were normal. Discussion: This case demonstrates an unusual association between KFS and hypothyroidism secondary to Hashimoto thyroiditis, likely representing an incidental finding rather than a causative relationship. The cervical spinal abnormalities and short neck characteristic of KFS could potentially lead to compression of neurological and vascular structures in the neck. However, this is unlikely to fully explain our patient's hypothyroidism. There are few published case reports of KFS with endocrine disorders in the literature that describe incidental findings like autoimmune thyroiditis and hypoparathyroidism, but there is no known biological mechanism linking KFS and endocrine dysfunction. Moreover, there is no evidence in either our patient's case or in existing literature to suggest a higher occurrence of autoimmune disorders like Hashimoto in such individuals. Conclusion: we present a novel case of KFS found incidentally with primary hypothyroidism. While these endocrine disorders could compound the growth delay and developmental issues typically seen in KFS, they do not appear to be causally related. This case highlights the need to monitor endocrine function in KFS patients and serves as a reminder that common conditions may co-occur simply by chance. Presentation: 6/3/2024

Value of transperineal three-dimensional ultrasonography in diagnosis of pelvic floor dysfunction.

To investigate the correlation between three-dimensional ultrasonography parameters and pelvic floor dysfunction (PFD) and its application value in diagnosis and treatment. 92 patients with PFD and 22 without who underwent three-dimensional ultrasonography were selected. Transperineal three-dimensional ultrasonography was performed by Voluson E8 color Doppler ultrasonography to analyze the anteroposterior diameter (LHAD), transverse diameter (LHLD), pelvic diaphragmatic hiatus area (LHA), and bladder neck mobility (BND) of the patients. Diagnostic sensitivity and specificity of ultrasound parameters in PFD were analyzed using ROC curves. Paired sample t test was used to analyze the improvement of PFMT in patients with PFD. Patients with PFD had significantly higher levels of △LHAD, △LHLD, △LHA and BND than controls (all P < 0.01). Binary logistic regression analysis showed that △LHA or BND levels were independent risk factors for the development of PFD. The ROC results showed that the area under the ROC curve with BND level was the highest (0.917). The diagnostic sensitivity of BND in PFD was 100.0% and the specificity was 70.7%. In Urinary incontinence (UI) patients, there was a significant positive correlation between the occurrence of UI and BND levels (all r > 0, P < 0.05). After PFMT treatment, the levels of △LHAD, △LHLD, △LHA and BND in patients with PFD were significantly decreased (all P < 0.001). The abnormal changes in the level of three-dimensional ultrasound parameters can be used as a sensitive indicator to evaluate PFD and a guiding parameter for PFMT treatment. The feasibility of operation and repetition by three-dimensional pelvic floor ultrasonography could provide a reliable imaging basis for clinical diagnosis and treatment of patients with PFD.

Prevalence and related factors for neck pain in military personnel: a systematic review.

In the military, neck pain is second to low back pain among musculoskeletal disorders. However, the prevalence and related factors of neck pain in military personnel have not been systematically investigated, which may lead to the lack of neck pain prevention and the generation of additional medical expenses, posing challenges to medical care. This review aimed to obtain the prevalence and related factors for neck pain in military personnel in an attempt to provide directions for prevention and intervention. We searched PubMed, Embase, and Cochrane databases in December 2021. Two researchers independently screened studies according to eligibility criteria and assessed study quality. We screened titles and abstracts of 503 articles, and 17 articles met the inclusion criteria. Sixteen articles received moderate to high-quality evaluations. Neck pain is common in the military, with 1-year prevalence as high as 83% and lifetime prevalence as high as 78%. Old age (OR = 5.0), poor neck mobility (OR = 3.61), shoulder pain (OR = 4.9), low back pain (OR = 2.3), high-G pilots (OR = 1.6), longer flight time (OR = 2.53), type of aircraft (OR = 3.93), and use of helmets and night vision systems (OR = 1.9) may be associated with the prevalence of neck pain. Neck pain is highly prevalent in military personnel and exhibits a substantial lifetime prevalence rate. The high prevalence rate of neck pain in the military is related to many individual-related factors and work-related factors. The in-depth assessment and prevention of specific factors is an important direction of future research.

Can Primigravid Stress Urinary Incontinence be Predicted by Translabial Urethral Motion Profile Ultrasonography?

Aims: To determine SUI prevalence and its association with urethral and bladder neck mobility among late third-trimester primigravid women. Introduction: Stress urinary incontinence (SUI) is a relatively common urogynecological disorder in pregnant women that significantly disrupts their quality of life. Although its prevalence is increasing along with gestational age, there have been reports of underreporting due to various reasons. Therefore, a diagnostic modality is needed to determine the presence of SUI in such a population. Methods: A total of 209 late third-trimester primigravid women included in the study between November 2016 and July 2019 were examined by translabial ultrasound. Bladder neck descent (BND), retrovesical angle (RVA), urethral rotation (RoU) and funneling were observed in each patient. SUI was diagnosed using a cough stress test and Questionnaire for Urinary Incontinence Diagnosis (QUID). Thirty-five subjects from each group were randomly selected for further analysis. Results: Among 209 late third-trimester primigravid women, SUI was observed in 57 patients (prevalence 27.3%). The RVA and funneling of the SUI group were significantly higher than the control group (P &lt; 0.05). The BND and RoU were similar between groups. Identified risk factors of SUI were body mass index &gt;23 kg/m2 and the presence of funneling in the translabial ultrasound. Conclusions: The prevalence of SUI among late third-trimester primigravid was 27.3%. Positive funneling and higher BMI were shown to be the independent risk factors for SUI.

Anesthetic management of a high-risk patient with complex medical conditions: A case report of multimodal analgesia and regional nerve blocks in urgent transfemoral amputation

This case article presents the anesthetic management of a patient with complex medical conditions and surgical requirements. The patient had secondary hyperparathyroidism due to chronic renal failure, resulting in hypocalcemia. The patient required a transfemoral amputation due to progressive bacterial infection and global foot gangrene. The urgency of the operation prevented preoperative preparation and necessitated careful consideration of the patient's cardiovascular and respiratory challenges. Due to the patient's facial deformity and limited neck mobility, general anesthesia was not feasible. Instead, a multimodal analgesia approach was adopted, utilizing regional nerve blocks targeting various nerves involved in lower limb innervation. This approach, combined with sedation, provided effective surgical anesthesia.

Hluboké krční záněty u dětí – přístup k diagnostice a léčbě

Summary Introduction: In the treatment of deep throat infections, it is necessary to make a correct decision about surgical treatment. The aim was to observe trends and characteristics of patients requiring surgical treatment and to identify factors that predict the type of treatment. Materials and methods: This is a retrospective study including pediatric patients hospitalized in the Children‘s Hospital of The University Hospital Brno with deep throat infections between 2010–2019. Studied parameters: age, sex, duration of problems before hospitalization, presence of dysphagia, odynophagia, impaired neck mobility, bulging of the pharyngeal wall, ankylostomia, respiratory problems, dysphonia, drooling, cervical lymphadenitis, sore throat, length of hospitalization, conservative or surgical approach, and well-being day. Laboratory investigations included CRP, neutrophil granulocyte count, and microbiological findings. Imaging examinations monitored the presence of phlegm or abscess, side, position relative to the great vessels and oppression of the great vessels, and size of abscess. Results: This study presents the clinical characteristics of 78 deep throat infections. Observed trends: patients with abscesses were younger, had higher CRP, and were hospitalized longer. Larger abscess statistically resulted in surgical treatment. Patients with phlegm had a shorter time to achieve comprehensive improvement. The incidence of an abscess is not related to gender. Boys had statistically significantly higher CRP and neutrophil granulocyte counts. The most common microbiological finding was Streptococcus pyogenes. Conclusion: Patients with abscesses were younger, had longer hospital stays, and had higher CRP. Key words children – deep neck infection – abscess

Influence of pregnancy and mode of delivery on pelvic floor function: a review of literature.

Pelvic floor disorders (PFDs), such as pelvic organ prolapse (POP) and urinary incontinence (UI), severely affect women's quality of life. Among these, stress urinary incontinence (SUI) is the most common, impacting a significant proportion of women. In the US, the lifetime risk of undergoing surgery for UI or POP stands at 20%. Pregnancy-related factors, notably delivery method and UI occurrence during pregnancy, have a potent correlation with PFD onset. The pathophysiology of PFDs during pregnancy is complex, with factors like increased intra-abdominal pressure, changes in bladder neck mobility, and shifts in pelvic floor muscle strength and collagen metabolism playing pivotal roles. PFD risk factors span across pregnancy, labor, and the postnatal phase and include UI or fecal incontinence (FI) during pregnancy, advanced maternal age, elevated BMI, multiple births, instrumental and spontaneous vaginal deliveries, and newborns weighing over 4000 grams. Conversely, Cesarean deliveries are linked with a reduced long-term risk of UI and POP compared to vaginal births. Current prognostic models can predict the likelihood of PFD development based on variables such as delivery method, number of births, and familial history. Preventive measures encompass lifestyle changes like caffeine reduction and weight management, alongside pelvic floor muscle training (PFMT) during pregnancy. Thus, expectant mothers are advised to participate in physical activities, prominently including PFMT.

Comparison of Paraglossal Technique of Miller Blade Insertion with McCoy and Macintosh Adult Laryngoscopes on the Cormack–Lehane Grade in Patients with Simulated Restricted Neck Mobility—A Randomized Control Trial

Abstract Background The paucity in round-the-clock availability of advanced tools like flexible bronchoscopes and video laryngoscopes makes it preferable to have alternative easily available gadgets for securing the airway in patients with cervical spine injuries where head and neck movements must be strictly avoided. This study compared the paraglossal technique of Miller blade insertion with the McCoy and Macintosh laryngoscope blades on the Cormack and Lehane grading (CLG) in patients with simulated restricted neck mobility. Methods We randomized 90 patients undergoing general anesthesia to be intubated either using Miller blade (Group-Mill), McCoy blade (Group-McCoy), or Macintosh blade (Group-Mac) following neck restriction using a soft cervical collar. CLG grade, the number of intubation attempts, use of bougie, intubation time, and hemodynamic parameters were noted. Nonparametric data were compared using the chi-squared test and parametric data using one-way analysis of variance. Results Group-MILL had significantly higher patients with Grade-1 CLG compared to Group-Mac (p = 0.02). The number of attempts, use of bougie, and intubation time were, however, comparable among the three groups. The hemodynamic parameters at intubation were not significantly different among the groups. Conclusion In adult patients with simulated restricted neck, the Miller laryngoscope blade, despite providing a better laryngeal view, showed no benefit in decreasing the intubation time when compared to the McCoy or Macintosh blades.

Cervical Health Parameters in Car Drivers: Assessing the Influence of Driving on Neck Pain, Mobility, Proprioception and Craniovertebral Angle - A Cross-Sectional Study.

Prolonged sitting during driving is linked to neck pain, uncomfortable body positions, and repetitive motions. Recognizing these challenges, this study aimed to investigate Cervical Health Parameters in Car Drivers. The sample consisted of 160 car drivers between 25 and 45 years. This subject was then divided into two groups based on neck pain. Participants met the required criteria, such as being between 25-45 years of age, maintaining a BMI of 18-24, and driving for at least 2 hours each day for at least 3-5 years. To evaluate the results, we employed a clinometer and compass app on a smartphone to measure the Cervical Range of Motion (CROM). We used Surgimap software to estimate the Craniovertebral Angle (CVA), and a (Cervical range of motion) CROM device was used for proprioception assessment. The result shows the participants in neck pain group displayed lower Cervical Range of Motion (CROM) values than without neck Pain Group. Similarly, the Craniovertebral Angle (CVA) was smaller in the neck Pain Group (mean difference of -6.3°), indicating a more forward head posture. Neck pain resulted in a mean difference of -4.5° in proprioception accuracy. This indicates that neck pain affects CROM, CVA, and proprioception in car drivers. Car driving significantly impacts cervical parameters in individuals with neck pain, reducing cervical range of motion, altered craniovertebral angle, and diminished proprioceptive accuracy. These findings emphasize the need for ergonomic interventions and proprioceptive training tailored for drivers. Future research should broaden demographic parameters and consider potential confounders to provide a holistic understanding of the relationship between car driving and neck health.

Opioid-free General Anesthesia and Awake Fiberoptic Intubation with Dexmedetomidine in a Class IV Obese Patient with Cervical Spondylosis

Abstract Patients with Class IV obesity (C4O) (body mass index [BMI] &gt;50 kg/m2) are at a particularly high risk of anesthesia-related complications during the postoperative period, e.g., critical respiratory events (CREs) including respiratory arrest and oversedation, leading to problems with maintaining open airway, hypoxia, and hypercapnia. We present the case of a 67-year-old C4O (BMI 57.2 kg/m2) female patient with cervical spondylosis, scheduled for laparoscopic sleeve gastrectomy. Preanesthesia evaluation revealed hypertension, type 2 diabetes mellitus (DM), nonalcoholic steatohepatitis, and obstructive sleep apnea as comorbidities. Awake fiberoptic intubation was planned because of a high potential for difficult intubation (neck circumference of 45 cm, cervical spondylosis, reduced neck mobility, and type 2 DM), using topical anesthesia and dexmedetomidine (Dex) infusion. General anesthesia was given with desflurane and muscle relaxant. “Opioid-free anesthesia,” wherein use of systemic, neuraxial, or intracavitary opioids is completely eliminated, was maintained with Dex infusion for sedation and analgesia. Reversal of anesthesia was done in Fowler’s position (FP), and after extubation, nasopharyngeal airway connected to high-flow oxygen (10 L/min) via tubing was used, which facilitated spontaneous breathing, maintaining oxygen saturation and uneventful recovery. Postoperatively, intravenous paracetamol alone was adequate for effective pain relief. The patient remained hemodynamically stable throughout the perioperative period. This case underscores the benefits of “opioid-free anesthesia” using intraoperative Dex infusion and efficacious use of nasopharyngeal airway in FP postoperatively, avoiding requirement of ventilator, in supermorbidly obese patients, reducing CREs and optimizing postoperative outcomes.

Determinants of difficult laryngoscopy based on upper airway indicators: a prospective observational study

BackgroundThe main cause of anesthesia-related deaths is the failure to manage difficult airways. Difficult laryngoscopic exposure is a major cause of unsuccessful management of difficult airways. Inadequate preoperative airway assessment hinders the clinical management of difficult airways cases, emphasizing the critical need for accurate identification of difficult airways. Currently, no definitive and reliable indicators are available to predict a difficult airway. Our study aims to predict laryngoscope exposure risk factors by combining ultrasonically measured upper airway anatomic parameters with physical examination indicators.MethodsPatients aged 18 to 75 years, classified as American Standards Association (ASA) I-III, and scheduled for elective general anesthesia with endotracheal intubation were included. All patients received the upper airway and ultrasonographic measurements. After anesthesia induction, laryngoscope exposure was analyzed using the Cormack-Lehane grading system, with Grades III and IV as indicative of difficult laryngoscopy. Univariate and multivariate logistic regression analyses were performed to identify reliable indicators for predicting difficult laryngoscopy. Receiver Operating Characteristic (ROC) curve analysis was utilized to assess the predictive performance of each indicator.ResultsA total of 1120 patients finished the study, with 710 cases found in Grade I laryngoscopic exposure group, 360 cases in Grade II group, and 50 cases in Grade III group. There was no case observed in Grade IV group, thereby resulting in an incidence of difficult laryngoscopy of 4.46%. Univariate logistic regression analysis revealed that several parameters including age, Body Mass Index (BMI), neck circumference, neck mobility, snoring intensity, as well as ultrasound measurements of the pre-epiglottic space and thyromental distance were identified as significant risk factors for difficult laryngoscopy (P < 0.05). Among these, BMI, and neck circumference exhibited notable predictive value, with Area Under The Curve (AUC) values of 0.746 (95%CI 0.649–0.842) and 0.732 (95%CI 0.638–0.827), respectively. Neck mobility was also identified as an independent risk factor for predicting difficult laryngoscopy (P = 0.009) in multivariate logistic regression analysis, with an AUC of 0.672 (0.562–0.782) in the ROC curve.ConclusionsOur findings revealed a direct correlation between difficult laryngoscopy and age, BMI, neck circumference, neck mobility, snoring intensity, as well as ultrasound measurements of the pre-epiglottic space and thyromental distance. Furthermore, neck mobility was identified as an independent predictive factor.Trial registrationThe trial was registered prior to patient enrollment at clinicaltrials.gov (register no. ChiCTR2100053826, Date of registration: November 30, 2021).

Abstract 6383: Targeting radiation-induced fibrosis: Exploring promising therapeutic avenues and innovative assessment methods

Abstract Introduction: Radiation therapy is a vital cancer treatment for nearly 50% of patients, yet it poses a significant challenge in the form of radiation-induced fibrosis (RF). RF affects about 60% of those undergoing radiation, leading to painful scarring from excessive collagen accumulation. In head and neck cancer patients, as an example, RF reduces tissue flexibility, causing limited neck mobility and impaired swallowing. Furthermore, approximately 30% of patients also face disease recurrence post-radiation, with RF increasing surgical complications. Our laboratory previously identified the role of reduced fatty acid oxidation in RF (Zhao et al; Nat Metab;1(1):147 2019), offering a promising avenue for future drug development. We described the potential therapeutic benefit of caffeic acid phenethyl ester (CAPE) in countering pro-fibrotic metabolic changes. Our current objective is to develop more effective lead compounds to mitigate RF. Methods: Collagen expression, utilized as a surrogate marker for fibrosis, was quantified using ELISA, Western blot analysis, and RT-qPCR. Metabolic changes were assessed by examining the expression levels of PPARG and CD36. CAPE-like analogs were derived from an in-house collection, a commercially available library, and structure-activity relationship (SAR) analyses. In vivo, RF was induced in the hindlimbs of mice through exposure to 40 Gy, followed by weekly X-ray evaluations of hindlimb angles for 16 weeks. During X-ray assessments, both hindlimbs were subjected to a 5 g weight to enable measurement of the joint angle between the femur and tibia (wherein higher acute angles were a measure of worsening fibrosis). Skin samples from irradiated and unirradiated limbs were collected for the evaluation of collagen deposition, utilizing Picro Sirius staining followed by polarized microscopy. Results: Amongst 200 newly synthesized analogs, approximately one-third successfully reduced collagen secretion in human primary dermal fibroblasts. The most promising compounds exhibited a half-maximum inhibition concentration (IC50) for collagen secretion from 1 to 5µM. They also decreased intracellular collagen production and gene expression, associated with upregulation of PPARG and CD36 transcripts. The joint angle measurements in vivo revealed three distinct phases in the development of dermal fibrosis: 1) inflammatory; 2) recovery; and 3) fibrotic phases. Conclusions: We have successfully synthesized novel and potent analogs of CAPE which were able to reduce secretion of collagen. Furthermore, a novel method for the in vivo assessment of fibrosis was also developed. This innovative approach will facilitate the detailed assessments of future compounds capable of reducing collagen deposition in vivo, thereby providing an innovative avenue to mitigate one of the most pressing late normal tissue toxicities of radiation therapy. Citation Format: Pierre-Antoine Bissey, Leonardo Massignan, Ross Mancini, Wei Shi, Justin Williams, Mark Reed, Kenneth W. Yip, Fei-Fei Liu. Targeting radiation-induced fibrosis: Exploring promising therapeutic avenues and innovative assessment methods [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6383.

Comparison of urethral parameters in females presenting cystoceles with and without stress urinary incontinence based on dynamic magnetic resonance imaging: are they different?

To compare urethral parameters between cystocele patients with and without stress urinary incontinence (SUI) and explore factors influencing SUI in cystocele patients via dynamic MRI. The two-dimensional parameters evaluated included the paravaginal defects, levator ani muscle defects, urethral length, urethral funnel shape, bladder neck funnel width, bladder neck funnel depth, urethral angle, posterior vesicourethral angle, and anterior bladder protrusion. The three-dimensional parameters included the proximal urethra rotation angle, the distal urethra rotation angle, bladder neck mobility, urethral midpoint mobility, and externalurethralmeatus mobility. The independent samples t test was used for continuous variables, and the chi-square test was used for categorical variables. Binary logistic regression was used to identify factors independently associated with SUI in cystocele patients. The baseline parameters were similar between the 2 groups. Cystocele patients with SUI had a significantly higher point Aa (1.63 ± 1.06cm vs. 0.81 ± 1.51cm, p = 0.008); more anterior bladder protrusion (33.3% vs. 11.4%, p = 0.017); greater bladder neck mobility (36.38 ± 11.46mm vs. 28.81 ± 11.72mm, p = 0.005); mid-urethral mobility (22.94 ± 6.50mm vs. 19.23 ± 6.65mm, p = 0.014); and external urethral meatus mobility (22.42 ± 8.16mm vs. 18.03 ± 8.51mm, p = 0.022) than did cystocele patients without SUI. The other urethral parameters were similar in the groups (p > 0.05). Binary logistic regression showed that bladder neck mobility was independently associated with SUI in females with cystoceles (odds ratio, 1.06; 95% CI 1.015-1.107; p = 0.009). Cystocele patients with SUI have a higher point Aa, more anterior bladder protrusion, and greater urethral mobility than those without SUI. Bladder neck mobility is independently associated with SUI in females with cystoceles. NCT03146195.