Body Mass Index In Patients Research Articles

ПРОГНОЗНАЯ ОЦЕНКА КОЛЛАПСА СУСТАВНОЙ ПОВЕРХНОСТИ ПРИ СУБХОНДРАЛЬНОМ ПЕРЕЛОМЕ НЕДОСТАТОЧНОСТИ КОСТНОЙ ТКАНИ КОЛЕННОГО СУСТАВА (SIFK)

Background. Subchondral insufficiency fracture of the knee (SIFK) is a frequent cause of knee joint pain in patients over 55 years of age. Diagnosis of this pathology at an early stage has certain difficulties, as it requires magnetic resonance imaging (MRI). Aim of the study. To determine the relationship between the size of the lesion in subchondral insufficiency fracture of the knee joint, the patient's body mass index and the risk of articular surface collapse. Material and Methods. In 35 female patients with subchondral insufficiency fracture the size of the lesion in frontal and sagittal planes, as well as its volume according to MRI were determined. The obtained results made it possible to assess the risk of articular surface collapse. Results. The study revealed a relationship between the size of the lesion and the risk of articular surface collapse in subchondral insufficiency fracture of the knee. An anteroposterior size of the lesion of more than 14.1 mm, a transverse size of more than 10.2 mm, and a craniocaudal size of more than 1.22 mm are risk factors for subsequent articular surface collapse and progression of osteoarthritis of the knee joint. The analysis of the correlation between body mass index (BMI) and the development of articular surface collapse found no specific BMI value associated with articular surface collapse. Conclusions. A risk factor for articular surface collapse in patients with subchondral bone insufficiency fracture of the knee joint was determined, which allows predicting the outcomes of the disease treatment. Body mass index and the development of articular surface collapse do not correlate with each other.

Association of Body Mass Index with Pain Perception, Anxiety, Depression, and Disability in Fibromyalgia Patients

Background: A disorder of uncertain origin, Fibromyalgia (FM) is accompanied by pervasive pain, tiredness, disturbed sleep, and cognitive deficit. It has been related to depression, manic-depressive illness, and chronic fatigue. FM is negatively affected by obesity on both clinical and biological parameters. Methods: A total of n=150 FM patients (132 Female and 18 Male) were included in the study. Initially, informed consent and demographic data were gathered from the participants. Afterwards, each patient's Body Mass Index (BMI) was calculated and classified into average weight, overweight, and obese categories. The Numeric Pain Rating Scale (NPRS) was used to quantify the intensity of pain, the Hamilton Anxiety Scale (HAM-A) was used to determine the participants’ anxiety levels, the Hamilton Rating Scale for Depression (HAM-D) was used to examine their depression levels, and Health Assessment Questionnaire Disability Index (HAQ-DI) was used to measure their functional status. All these questionnaires were self-administered by the participants. Results: In the NPRS, HAM-A, HAM-D, and HAQ-DI categories, no significant differences were found (p>0.05). However, between the BMI level and anxiety, a weak positive correlation was detected (r=0.195, p=0.017). BMI levels were not statistically significantly correlated with pain, depression, or disability (r=0.011, p=0.0897; r=0.048, p=0.562; r=0.072, p=0.383). Conclusion: The results of the study revealed that there is no significant association of pain perception, anxiety, depression and disability with increasing BMI among FM patients except for a weak positive correlation with anxiety. Keywords: Body Mass Index, Fibromyalgia, Pain, Obesity.

Impact of parental body mass index at diagnosis on obesity in survivors of pediatric craniopharyngioma.

It is well known that both genetic background and lifestyle influence the development of 'general' obesity. However, the role of parental body mass index (BMI) on the development of obesity in long-term survivors of childhood-onset craniopharyngioma (CP) is not well understood. This study analyzed the correlation of patients' BMI at diagnosis and last visit and parental BMI at CP diagnosis and further explored potential risk factors for obesity in CP patients. This is a registry-based retrospective cohort study. In total,291 CP patients and their parents recruited in the German KRANIOPHARYNGEOM studies were included. Correlations between patient's BMI SDS at CP diagnosis and last visit and parental BMI at CP diagnosis were analyzed. The associations between hypothalamic damage, maternal/paternal BMI and CP patients' obesity at last visit were analyzed by multivariable logistic regression. At follow-up, 52% of CP patients developed obesity (BMI > 3SDS). Patient's BMI SDS at last visit was moderately correlated with BMI-SDS at CP diagnosis (r = 0.48, 95% CI: 0.38-0.58, P < 0.001), and also with maternal BMI at diagnosis (r = 0.28, 95% CI: 0.17-0.38, P < 0.001) and paternal BMI at diagnosis (r = 0.3, 95% CI: 0.19-0.41, P < 0.001). However, the contributing role of parental BMI to the pathogenesis of obesity was small compared to the impact of hypothalamic damage. We conclude that besides hypothalamic damage, parental disposition for obesity is associated with the development of obesity in patients after CP. Our results indicate that also the family situation could have an influence on the development of obesity after CP and might be a therapeutic target. Survivors of childhood-onset craniopharyngioma are at risk of developing morbid obesity. So far, patients with posterior hypothalamic involvement and lesion were identified as a high risk group. With this study, the influence of parental body mass index on the risk of obesity was investigated. Patient's body-mass-index at last visit was correlated with maternal and paternal body mass index at diagnosis. With increasing maternal or paternal body mass index, the likelihood of obesity in individuals with CP increased. Nevertheless, the parents' weight had only a small effect on the development of patients' obesity compared to hypothalamic damage.

Combined Robotic and Vaginal Surgery for Pelvic Exenteration Due to Vaginal Sarcoma Relapse in an Obese Woman

Pelvic exenteration (PE) is an aggressive surgical procedure that implies a large hard-to-fill pelvic defect. Different reconstruction techniques were proposed to improve abdominal organ support and reduce complications (infections, pelvic organs herniation, vaginal stump dehiscence, bowel prolapse and obstruction) [1], with conflicting results [2]. Because of young age and survival greater than 50% at 5 years in patients with no residual tumor after surgery [3], a new approach with better clinical results to pelvic reconstruction is needed. The aim of this surgical film is to present an unusual presentation of vaginal sarcoma, successfully managed with a minimally invasive approach, and to illustrate our contextual multilayer technique of pelvic reconstruction using a combination of pedicled omental flap (POF) and human acellular dermal matrix (HADM). Tertiary level academic hospital. A 42-year-old obese patient with recurrent and symptomatic myxoid leiomyosarcoma, previously underwent vaginal-assisted laparoscopic surgery at a primary care center for the removal of a vaginal swelling. The multidisciplinary board determined anterior PE as the optimal therapeutic approach. Given the patient's body mass index (33 kg/m2), young age, and the favorable outcomes of robotic surgery in obese patients compared with other approaches [3,4], we proposed a combined robotic and vaginal surgery for both exenteration and reconstructive procedures [5]. During surgery, we initially explored the abdominal cavity to exclude macroscopic metastasis, followed by anterior PE. Urinary diversion was achieved with a Bricker ileal conduit by means of an ileoileal laterolateral anastomosis and an uretero-ileo-cutaneostomy. The pelvic dead space was partially filled with a POF on the left gastroepiploic artery. Subsequently, the pelvic defect was covered by a 15 × 10 mm HADM inlay inserted circumferentially at the pelvic brim, fixed with a barbed thread suture on residual pelvic structures. The final pathology confirmed the recurrence of myxoid leiomyosarcoma and indicated tumor-free resection margins. The intraoperative and postoperative periods were uneventful. The patient was discharged 14 days after surgery and underwent adjuvant doxorubicin- and dacarbazine-based chemotherapy, which was initiated 45 days after the surgery. Currently the patient is asymptomatic and disease free at the sixth month of follow-up. Robotic PE proves to be a feasible technique in obese patients, reducing postoperative hospital stay and complications. The contextual pelvic floor reconstruction with a POF and HADM supports abdominal viscera, diminishing interorgan adhesions and bowel prolapse. VIDEO ABSTRACT.

The impact of prepregnancy body mass index on pregnancy and neonatal outcomes.

The obesity epidemic in the United States is continuing to worsen. Obesity is a known risk factor for pregnancy morbidity. However, many studies use the patient's body mass index (BMI) at the time of delivery, do not stratify by class of obesity, or utilize billing codes as the basis of their study, which are noted to be inaccurate. This study aims to investigate the prepregnancy BMI class specific risks for pregnancy and neonatal complications based on a prepregnancy BMI class. We conducted a retrospective cohort study of40,256 pregnant women with 55,202 singleton births between October 16, 2007 and December 3, 2023. We assessed the risk of pregnancy and neonatal morbidity based on the maternal prepregnancy BMI category. The primary outcome was composite maternal morbidity, including hypertensive disorders of pregnancy (i.e.,gestational hypertension [GHTN] and preeclampsia), and gestational diabetes mellitus (GDM), adjusted for pregestational diabetes mellitus and chronic hypertension (cHTN). Secondary maternal outcomes included preterm premature rupture of membranes (PPROM), preterm delivery (PTD<37 and <32weeks), induction of labor (IOL), cesarean delivery (CD), and postpartum hemorrhage (PPH). Neonatal outcomes included a composite adverse outcome (including stillbirth, intraventricular hemorrhage (IVH), hypoglycemia, respiratory distress syndrome [RDS], APGAR [Appearance, Pulse, Grimace, Activity, and Respiration] <7 at 5 min, and neonatal intensive care unit [NICU] admission), birthweight, fetal growth restriction (FGR), and macrosomia. Composite maternal morbidity (odds ratio [OR] 4.40,confidence interval [CI] 3.70-5.22 for class III obesity [BMI≥40.0 kg/m2] compared with normal BMI), hypertensive disorders of pregnancy (HDP), GDM, PTD, IOL, CD, PPH, neonatal composite morbidity, hypoglycemia, RDS, APGAR<7 at 5 min, NICU admission, and macrosomia showed a significant increasing test of trend among BMI classes. Increased BMI was protective for FGR. Our data provides BMI-class specific odds ratios (ORs) for adverse pregnancy outcomes. Increased BMI class significantly increases the risk of HDP, GDM, IOL, CD, composite adverse neonatal outcomes, and macrosomia, and decreases the risk of FGR. Attaining a healthier BMI category prior to conception may lower pregnancy morbidity.

Obesity and overweight are associated with worse survival in early-onset colorectal cancer

BackgroundObesity and its associated lifestyle are known risk factors for early-onset colorectal cancer and are associated with poor postoperative and survival outcomes in older patients. We aimed to investigate the impact of obesity on the outcomes of early-onset colorectal cancers. MethodsRetrospective review of all patients undergoing primary resection of colon or rectal adenocarcinoma at our institution between 2015–2022. Patients who had palliative resections, resections performed at another institution, appendiceal tumors, and were underweight were excluded. The primary endpoint was survival according to the patient's body mass index: normal weight (18–24.9 kg/m2), overweight (25–29.9 kg/m2), and obesity (≥30 kg/m2). Patient and tumor characteristics and survival were compared between the three groups. ResultsA total of 279 patients aged <50 years with colorectal cancer were treated at our hospital; 120 were excluded from the analysis for the following reasons: main treatment or primary resection performed at another hospital (n = 97), no resection/palliative resection (n = 23), or body mass index <18 kg/m2 (n = 2). Of these, 157 patients were included in the analysis; 61 (38.9%) were overweight and 45 (28.7%) had obesity. Except for a higher frequency of hypertension in the overweight (P = .062) and obese (P = .001) groups, no differences in patient or tumor characteristics were observed. Mean overall survival was 89 months with normal weight, 92 months with overweight, and 65 months with obesity (P = .032). Mean cancer-specific survival was 95 months with normal weight, 94 months with overweight, and 68 months with obesity (P = .018). No statistically significant difference in disease-free survival (75 vs 70 vs 59 months, P = .844) was seen. ConclusionIndividuals with early-onset colorectal cancer who are overweight or obese present with similar tumor characteristics and postoperative morbidity to patients with normal weight. However, obesity may have a detrimental impact on their survival. Addressing obesity as a modifiable risk factor might improve early-onset colorectal cancer prognosis.

Effect of Diet Counseling on Nutritional Status of Chronic Respiratory Diseases Patients Enrolled in the Pulmonary Rehabilitation Program in a Teaching Hospital: A Pre-Post Intervention Study.

We conducted the study to assess the effect of patient-tailored diet counseling on the nutritional status of chronic respiratory disease (CRD) patients under the pulmonary rehabilitation program from June 2021-May 2022. These patients completed 2 months of patient-tailored diet counseling sessions under the pulmonary rehabilitation program, which consisted of 4-5 interactive diet counseling sessions fortnightly. The pre- and postassessment was done using standardized outcomes: Malnutrition Universal Screening Tool (MUST), body mass index (BMI), and ideal body weight. The study enrolled 110 CRD patients. There was a statistically significant improvement in pre- and postassessment in MUST score, appetite, and unintentional weight loss (P < 0.001). Most of the patient's BMI normalized. In prenutritional assessment, most of the patients were malnourished and in postassessment, the number of malnourished and anemic patients was reduced. This study concludes that nutritional counseling effectively improves nutritional status and anemia.

Effects of Tongue Strength Training on Patients with Mild to Moderate Sleep-disordered Breathing: A Randomized Controlled Trial.

: Several studies have reported that oropharyngeal myofunctional therapy (OMT) reduces the severity of obstructive sleep apnea (OSA). However, because OMT protocols are often complicated, they take time and effort to implement. The aim of this study was to determine the therapeutic effect of 8 weeks of simple tongue strength training with a training device. : Twenty patients with mild to moderate sleep-disordered breathing were randomized to the control group (n=10) or intervention group (n=10). The patients in the intervention group completed 8 weeks of daily tongue strength training using a training device. After 8 weeks, we evaluated each patient for sleep-disordered breathing by portable monitoring. We also evaluated each patient's body mass index (BMI), neck circumference, Epworth Sleepiness Scale (ESS) score, and tongue pressure. No significant difference was found in the change in apnea hypopnea index (AHI) from baseline to 8 weeks between the control and intervention groups (P=0.44). However, the changes in neck circumference (P=0.02) and maximum tongue pressure (P=0.03) from baseline to 8 weeks were significantly different between the two groups. No significant difference was found for changes in BMI and ESS scores from baseline to 8 weeks between the two groups. : Tongue strength training in patients with sleep-disordered breathing did not significantly improve AHI as measured by portable monitoring, although significant changes were observed for increased tongue pressure and reduced neck circumference.

Mobility and self-care outcomes in patients with a bariatric comorbidity during inpatient rehabilitation.

First, we describe the characteristics and functional outcomes of obese and bariatric patients in an inpatient rehabilitation facility (IRF). Second, we assessed differences in functional outcomes for bariatric, obese, and standard weight body mass index (BMI) groups. Third, we explored whether these characteristics differ between time periods and diagnostic groups. A retrospective study comparing electronic medical record data collected in 2016 and 2018, using a repeated cross-sectional cohort design. IRF. Individuals ≥18 years of age diagnosed with brain injury, medical complexity, general neurology, orthopedic, spinal cord injury (SCI), and stroke. Participants grouped as standard (BMI <30 kg/m2), obese (BMI 30-39 kg/m2), and bariatric (BMI ≥40 kg/m2) weights. (N = 2015 in 2016, N = 2768 in 2018.) INTERVENTIONS: Patients received standard inpatient rehabilitation. In 2018, clinicians had access to new weight-appropriate equipment. Discharge destination; length of stay (LOS) by BMI group and medical diagnoses; item-specific functional independence measure (FIM) change scores. Sixty-four percent to 67% of all BMI groups achieved a home discharge. The bariatric BMI group had a longer LOS (21 days) than the standard or obese groups. There was a significant interaction in a linear regression analysis between diagnosis and LOS, where LOS was longer in medically complex patients with bariatric BMI (19.3 days compared to 16.1 days) but shorter in bariatric patients with SCI (20.6 days) compared to standard weight patients (26.2 days). In 2018, the bariatric BMI group had greater average FIM change scores for bathing, lower body dressing, toilet transfers, and bed transfers. Patient BMI is associated with LOS in the IRF, although affected by diagnosis. Patients with higher BMIs can make changes in specific individual motor FIM items. For patients with bariatric BMIs, FIM change scores were higher in 2018, possibly due to the use of equipment and facilities designed for higher weight capacities.

Challenges of Retrograde Ureteroscopic Procedures in Overweight Patients.

Obesity and urolithiasis are both prevalent conditions that have an impact on the healthcare system. The ureteric diameter and accessibility play a crucial role in the management of urolithiasis in both overweight and normal weight patients. Studies have shown that obesity can lead to changes in ureter diameter where excessive body fat can exert pressure on the kidneys, causing them to enlarge in size and this enlargement can result in a compression of the adjacent structures, including the ureter. The aim of this study is to assess the incidence of intraoperative challenges faced during retrograde ureteroscopic procedures in overweight patients with ureteric and renal calculi. We retrospectively reviewed patients who underwent retrograde ureteroscopic surgery (RURS) for urolithiasis from 1st January 2021 until 30th August 2023. The outcome and any complications were documented and compared with the patient's Body Mass Index (BMI). All patients who undergo RURS in our facility have to have a Non-Contrast CT scan prior to surgery. Procedural success was determined by the ability to obtain access to the stone site intraoperatively and stone-free status in kidney, ureter, and bladder (KUB) X-ray post-operatively. Post-operative complications were recorded up to two weeks post-operatively and classified according to the Calvein Dindo Classification. Our total sample size was 146 patients out of which 75 were overweight and 71 were normal weight patients. In 34 (45%) of overweight patients' access to the ureter was restricted due to a narrow ureteric orifice with ureteroscopy not successful; on the contrary 13 (18%) of normal weight patients faced this same issue. This was statistically significant with a p-value of .004. The stone clearance rates were 91% and 95% in overweight and normal weight patients respectively, which is higher in normal weight patients however this difference was not found to be a statistically significant finding (p-value .028). Overweight patients had 12% Grade I and 8% Grade II complications whereas normal weight patients had 11% Grade I complications and 1.4% Grade II with no higher-grade complications. Retrograde ureteroscopic procedures are a safe treatment modality for patients with urolithiasis in both overweight and normal weight populations. They are shown to have similar success rates between both populations once ureteric access is obtained. However, access failure rates are shown to be slightly higher in overweight patients. Hence, further preoperative patient counselling and technical considerations should be undertaken.

Study on the diagnostic value of different posterior cruciate ligament index measurement methods for anterior cruciate ligament injury

To compare the posterior cruciate ligament(PCL) index with six different measurement methods, and analyze and verify its clinical diagnostic value in anterior cruciate ligament (ACL) injury. The Magnetic resonance imaging (MRI) data of 225 knee joints in our hospital from May 2018 to March 2022 were retrospectively analyzed, aged from 18 to 60 years old, with a median of 32 years old. On the sagittal MRI images of 114 patients with ACL injury and 111 patients with intact ACL, Measure the straight-line distance (A) between the femoral attachment point and the tibial attachment point of the PCL on the MRI sagittal image and the maximum vertical distance (B) between the straight line and the arcuate mark point of the PCL on the sagittal image, calculate the PCL index and evaluate the diagnostic value of the PCL index for ACL injury. The PCL index of the ACL normal group and the ACL injury group were statistically described. There was no significant difference in PCL index 1, 2, 3 and 6 between the two groups(P>0.05). The difference of PCL index 4 and 5 between the two groups was statistically significant (P<0.001). This study only found that the PCL index 2, 6 in the ACL normal group had a negative correlation with the patient's age (correlation coefficient=-0.213, -0.819;P<0.05), and the PCL index 5 in the ACL injury group was significantly correlated with the patient's body mass index(BMI)had a negative correlation (correlation coefficient=-0.277, P<0.05). The change of PCL index is helpful for the diagnosis of ACL injury, PCL index 4 and 5 can be used as effective reference indexes for diagnosing ACL injury in clinic.

Investigation on laparoscopic sleeve gastrectomy for the management of type II diabetes mellitus

In order to treat obesity and other disorders associated with it, laparoscopic sleeve gastrectomy (LSG) is increasingly being applied. This study examines a grading system's effectiveness in categorizing and forecasting TII-DM remission and the results of LSG aftereffects of TII-DM remission. The study included 160 TII-DM patients (80 men and 80 women) with a Body Mass Index (BMI) that is morbidly obese who had LSG between 2020 and 2023. The patient's BMI, Level of C-peptide, age, and TII-DM duration (years) comprise the ABCD score. Using this score, the absence of TII-DM following LSG was assessed Ninety treated patients had complete follow-up information at 12 months following surgery. Both the mean HbA_1c and weight loss were lowered. Significantly more patients saw progress in their blood sugar control, including nine patients who improved, 18 who experienced partial remission, and 50 who underwent complete remission. The ABCD score was greater in those with TII-DM resolution following surgery than in those without. The success rate for TII-DM remission was better for patients with higher ABCD scores (100% at score 5, which increased from 0% at point 0) LSG is a safe and efficient technique for remission of TII-DM and weight loss. The ABCD score, a straightforward multifaceted grading system, can forecast how well TII-DM will respond to LSG therapy. Surgery ObesRelat Dis: American Society for Diabetic and Weight Loss Reserved rights.

The cardiovascular polypill as baseline treatment improves lipid profile and blood pressure regardless of body mass index in patients with cardiovascular disease. The Bacus study.

Pharmacological treatment with lipid-lowering and antihypertensive drugs has been proposed as a strategy to improve excess cardiovascular (CV) risk among obese individuals. The present study aimed to assess whether the CV polypill (Sincronium®) could be an effective strategy to help improve CV risk factor control in obese/overweight individuals requiring secondary prevention. This was an observational, retrospective study reviewing the hospital medical records of 479 patients with established CV disease who initiated treatment with the CV polypill between 2013 and 2019 at a general hospital in Mexico. Patients were grouped as normal weight, overweight or obese according to their initial body mass index (BMI). We collected blood pressure (BP), lipid profile, and vascular age at the last visit recorded during the period following treatment. At the end of the study, all assessed lipid parameters improved compared to baseline regardless of the initial BMI category (all p<0.001). There was an increase from baseline regarding the proportion of patients with at target low-density lipoprotein cholesterol after treatment (2.3% vs. 30.1%; p<0.001), more than 80% of patients achieved triglyceride levels <200 mg/dL (p<0.001), and more than 80% achieved target BP levels in all BMI subgroups (p<0.001). The subanalyses in the elderly population yielded similar results, with a significant overall improvement in lipid and BP control after initiating the CV polypill strategy. The use of the CV polypill as baseline therapy for secondary prevention seems to be a reasonable strategy that enhances CV risk factor control regardless of the patient's BMI.

Endovenous Thermal Ablation for Treatment of Symptomatic Saphenous Veins-Does the Body Weight Matter?

This study aimed to examine whether body weight may affect the effectiveness and safety of endovenous thermal ablation (ETA) for the treatment of symptomatic varicose veins. This retrospective single-center cohort study analyzed the outcomes and patient demographic data with a focus on the body weight of all patients who had ETA of symptomatic varicose veins between September 2017 and October 2020. A total of 1178 treated truncal veins from 636 patients were analyzed. The mean ± standard deviation body mass index (BMI) was 25.5 ± 4.9. In 2.3% of cases, the patients were underweight (BMI < 18.5), 31.0% were overweight (BMI > 25), and 16.6% were obese (BMI > 30). Complete truncal occlusion was observed 1 year post intervention in 97.6-100% and patients were satisfied or very satisfied in 96.2-100% across BMI groups. Pain was low but significantly higher in the patients with obesity 6 weeks post intervention (visual analog scale 0.84 ± 1.49) and a higher infection rate was observed in the patients with obesity (n = 4/132; 3.0%). No significant association was observed between BMI and bleeding or thromboembolic events. Patients with obesity experienced prolonged pain and more infections after ETA, but ETA for varicose vein treatment remains effective and safe, independent of the patient's BMI.

Effective prolonged suppression of HIV-1 viral load using tenofovir alafenamide, emtricitabine and efavirenz in an adult with BMI >59 kg/m2.

Limited information is available regarding the efficacy of antiretrovirals in people with HIV-1 and high or very high Body Mass Index (BMI). This is especially the case for the alafenamide salt of tenofovir as clinical trials have only enrolled patients with BMI ≤30 kg/m2. Lower concentrations of some antiretrovirals are expected in patients with BMI >30 kg/m2 due to potential changes in clearance and distribution of medication. This report describes an individual taking tenofovir alafenamide, emtricitabine and efavirenz in whom HIV-1 viral load was consistently undetectable (<50 copies/ml) over a 2.5 year period. During this period the patient's BMI ranged between 59.8 and 68.1kg/m2. Further data is required to support the efficacy of antiretrovirals in individuals with high and very high BMI.

Mean Heart Dose Prediction Using Parameters of Single-Slice Computed Tomography and Body Mass Index: Machine Learning Approach for Radiotherapy of Left-Sided Breast Cancer of Asian Patients.

Deep inspiration breath-hold (DIBH) is an excellent technique to reduce the incidental radiation received by the heart during radiotherapy in patients with breast cancer. However, DIBH is costly and time-consuming for patients and radiotherapy staff. In Asian countries, the use of DIBH is restricted due to the limited number of patients with a high mean heart dose (MHD) and the shortage of radiotherapy personnel and equipment compared to that in the USA. This study aimed to develop, evaluate, and compare the performance of ten machine learning algorithms for predicting MHD using a patient's body mass index and single-slice CT parameters to identify patients who may not require DIBH. Machine learning models were built and tested using a dataset containing 207 patients with left-sided breast cancer who were treated with field-in-field radiotherapy with free breathing. The average MHD was 251 cGy. Stratified repeated four-fold cross-validation was used to build models using 165 training data. The models were compared internally using their average performance metrics: F2 score, AUC, recall, accuracy, Cohen's kappa, and Matthews correlation coefficient. The final performance evaluation for each model was further externally analyzed using 42 unseen test data. The performance of each model was evaluated as a binary classifier by setting the cut-off value of MHD ≥ 300 cGy. The deep neural network (DNN) achieved the highest F2 score (78.9%). Most models successfully classified all patients with high MHD as true positive. This study indicates that the ten models, especially the DNN, might have the potential to identify patients who may not require DIBH.

Decreasing Patient Radiation Exposure from Computed Tomography for Hip Preservation Surgery

AbstractThis article describes how we were able to decrease patient radiation exposure from hip computed tomography (CT) for hip preservation evaluation without a degradation of image quality. This is a retrospective review of a quality improvement project. The study included patients who underwent hip CT at a single center as part of a clinical evaluation for young adult hip pain. Four distinct protocols were used during the study period. All protocols included at CT scan of the hip with slices through the distal femur to evaluate femoral version. Patient variables collected included age, gender, and body mass index (BMI). The dose–length product was collected and the effective dose in millisieverts (mSv) was calculated. Differences in dose between protocols were compared using analysis of variance with appropriate post hoc tests and multivariate general linear regression. A total of 613 patients underwent hip CT during the study period with 304 patients in protocol 1, 83 in protocol 2, 136 in protocol 3, and 91 in protocol 4. When controlling for age, gender, and BMI there was a significant decrease in effective dose of radiation from protocol 1 (3.63 mSv) to protocol 2 (3.06 mSv) (p = 0.002) and protocol 2 (3.06 mSv) to protocol 3 (2.16 mSv) (p &lt; 0.001). There was no difference between protocol 3 (2.16 mSv) and protocol 4 (2.10 mSv) (p = 0.269) but protocol 4 was easier to administer. In regression modeling, BMI (p &lt; 0.001) and protocol used (p &lt; 0.001) were independent predictors of effective radiation dose (model R 2 = 0.585). Through a longitudinal clinical quality improvement project, we were able to decrease the effective radiation exposure to patients undergoing hip CT for hip preservation evaluation by close to 50%. Only CT protocol used and patient's BMI were predictors of ionizing radiation exposure. Level of Evidence Level 3, retrospective comparative study.

Adenosine vs. regadenoson for stress induction in dynamic CT perfusion scan of the myocardium: A single‑center retrospective comparison.

Cardiac computed tomography (CT) angiography offers several approaches to determine the hemodynamic severity of coronary artery obstruction. Dynamic myocardial perfusion is based on serial CT imaging of contrast flow into the myocardium and calculation of absolute myocardial perfusion rates. East-Slovak Institute of Cardiovascular Diseases has been the first center in Slovakia intensively using this modern technique to increase the quality level of non-invasive diagnosis of symptomatic patients with a low to moderate pre-test probability of ischemic heart disease. The present study included 46 patients with a mean age of 64 years (33 men and 13 women). Prior to the CT study, myocardial stress was pharmacologically (adenosine, n=15 and regadenoson, n=31) induced by vasodilatation of the coronary arteries. Hemodynamic parameters (myocardial blood flow) were evaluated in all patients following successful CT perfusion without complications, allergic reaction or other severe side effects. The present study revealed that regadenoson increased the heart rate following infusion with a higher magnitude compared with adenosine. Moreover, the effect of regadenoson was independent of patient's body mass index and was associated with a lower incidence of mild adverse effects. The present study provided further clinical evidence for a more wider use of regadenoson over adenosine.

Evaluation of BMI-based tube voltage selection in CT colonography: A prospective comparison of low kV versus routine 120kV protocol.

To explore the value of individualized kVp selection based on the patient's body mass index (BMI, kg/m2 ) in CT colonography (CTC). Seventy-eight patients underwent two CTC scans: conventional 120kVp in supine position (Group A) with 30% Adaptive statistical iteration algorithm (ASIR-V) and BMI-based lower kV p in prone position (Group B): tube voltage was suggested by an experienced investigator according to the patient's body mass index (BMI; calculated as weight divided by height squared; kg/m (2)).70kV for BMI<23kg/m2 (Group B1, n=27), 80kV for 23≤BMI≤25kg/m2 (Group B2, n=21) and 100kV for BMI>25kg/m2 (Group B3, n=30). Group A, corresponding to the BMI value in Group B, was divided into A1, A2, and A3 subgroups for analysis. Groups B used ASIR-V of different weights (30%-90% ASIR-V). The Hounsfield Unit (HU) and SD values of the muscles and the intestinal cavity air were measured, and the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) of images were calculated. Imaging quality was evaluated by two reviewers and statistically compared. The 120kV scans were preferred more than 50% of the time. All images had excellent quality with good consistency between reviewers (Kappa>0.75, p<0.05). The radiation dose was reduced in groups B1, B2 and B3 by 63.62%, 44.63%, and 32.14%, respectively, compared with group A (p<0.05). The SNR and CNR values between group A1/A2/A3 and B1/B2/B3+60%ASIR-V were not statistically significant (p<0.05). There was no statistically significant difference between the subjective scores of group B combined with 60%ASIR-V and group A (p>0.05). BMI-based individualized kV CTC imaging significantly reduces overall radiation dose while providing an equal image quality with the conventional 120kV.

The Quality of Preoperative Glycemic Control Predicts Insulin Sensitivity During Major Upper Abdominal Surgery: A Case-Control Study.

To examine the association of the quality of preoperative glycemic control and insulin sensitivity during major upper abdominal surgery. In cardiac surgery, glycated hemoglobin A1c (HbA1c), an indicator of glycemic control during the preceding 3 months, correlated with intraoperative insulin sensitivity. Furthermore, insulin resistance showed a significant association with adverse clinical outcomes. This study is a post hoc exploratory analysis of a randomized controlled trial in patients undergoing elective hepatectomy and receiving the hyperinsulinemic-normoglycemic clamp (HNC) as a potential intervention to reduce surgical site infections (ClinicalTrials.gov NCT01528189). Immediately before skin incision, the HNC was initiated by infusing insulin at the rate of 2 mU/kg/min. Dextrose was administered at rates titrated to maintain normoglycemia (4.0-6.0 mmol/L). The average of 3 consecutive dextrose infusion rates during steady state was used as a measure of insulin sensitivity. Primary outcome was the relationship between preoperative HbA1c and insulin sensitivity during surgery. Secondary outcomes were the associations of insulin sensitivity with the patient's body mass index (BMI) and postoperative morbidity. Thirty-four patients were studied. HbA1c (Y = -0.52X + 4.8, P < 0.001, R2 = 0.29), BMI (Y = -0.12X + 5.0, P < 0.001, R2 = 0.43) showed negative correlations with insulin sensitivity. The odds ratio of postoperative complications within 30 days of surgery for every increase in insulin sensitivity by 1 mg/kg/min was 0.22 (95% confidential interval, 0.06-0.59; P = 0.009). We demonstrate significant associations of the quality of preoperative glycemic control and body mass index with insulin sensitivity during hepatectomy. The degree of insulin resistance correlated with postoperative morbidity.