Preperitoneal Fat Research Articles

A rare presentation of linea alba hernia involving fibrolipoma of the hepatic round ligament: a case report and literature review

BackgroundLinea alba hernias are relatively rare types of hernias. They manifest as small protrusions situated in the linea alba between the umbilicus and xiphoid cartilage. Usually, hernia contents comprise the pre-peritoneal fat, omentum, and gastrointestinal tract. However, very few cases of linea alba hernias involving the hepatic round ligament have been reported, to date.Case presentationAn 80-year-old woman presented with upper abdominal pain and a 1-week history of a mass in the upper midline. Abdominal computed tomography revealed adipose tissue protruding from the abdominal wall contiguous with the hepatic round ligament, suggesting a linea alba hernia. During surgery, the hernial sac content was found to be a mass, which was resected. A linea alba hernia defect measuring 20 mm was repaired using a mesh. Histopathological findings revealed that the mass included mature adipocyte proliferation with broad fibrous septa, which was diagnosed as fibrolipoma of the hepatic round ligament.ConclusionsWe report the first case of a linea alba hernia involving fibrolipoma of the hepatic round ligament worldwide and describe the clinical features, diagnosis, and surgical procedure with a literature review.

Logistics of safe and stress-free epicardial access in the electrophysiology lab: creative percutaneous subxiphoid pericardiostomy

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Professor Nanthakumar is a recipient of the mid-career investigator award from the Heart & Stroke Foundation of Ontario. Introduction Dry epicardial access (EA) into the virtual pericardial space carries a 6-25% risk of collateral damage to important adjacent structures including the right ventricle and the coronary and internal thoracic arteries.1 This renders conventional dry EA a potentially daunting and stressful undertaking. Separation of the parietal and visceral pericardial layers by CO2 insufflation has been described and may mitigate some risk , however even in experienced tertiary centres, injury to superior epigastric arteries, liver, stomach, and transverse colon, has been reported. Furthermore, insufflating the pericardial space may cause unwanted haemodynamic changes . There is thus the need for an approach that separates the pericardial layers and avoids injury to right ventricle and coronary arteries while also avoiding abdominal and thoracic structures by direct visualisation. Purpose We describe the logistics of a creative technique that combines percutaneous EA with a minimally-invasive subxiphoid pericardiostomy that can be done with a surgeon in the electrophysiology (EP) lab for the initial 20 minutes of the procedure. Methods We performed the procedure with a surgeon in 4 patients in a single tertiary centre. The procedure was done in the EP lab under general anaesthesia with standard surgical asepsis and IV cefazolin administered pre-operatively. The subxiphoid area is infiltrated with local anaesthesia. Following a limited 5cm midline incision, the linea alba is dissected exposing the preperitoneal fat but the peritoneal space is not entered. The lower sternum is retracted anteriorly to expose the diaphragm and cardiophrenic fat pad. The diaphragm is progressively sutured to the skin to bring the pericardium into view. A 0-silk suture is then used to tent the pericardium at which point an incision is made in the pericardium to create the window. The steerable sheath and pericardial drain are inserted in the standard over-the-wire percutaneous technique through separate adjacent punctures with direct pathway visualisation through the window. Following this, the surgical incision is closed, allowing the surgeon to leave, and mapping to ensue. Results The time from skin incision to pericardial drain insertion was 18±5 minutes. None of our patients had acute or delayed bleeding or adjacent organ injury peri-procedurally. The pericardial drain was removed within 12-24 hours. One patient had mild pericarditis that resolved after a short course of non-steroidal anti-inflammatory agents. The subxiphoid wound healed well in all patients. Conclusions Percutaneous EA with easy entry into the pericardial space under direct visualisation and realtime monitoring via a pericardiostomy can be readily attained with surgical collaboration. We propose this as an alternative approach to EA, particularly in situations in which the percutaneous access will be challenging (e.g. obesity, or in presence of adhesions).

V-023 ETEP REPAIR OF AN M2-3 W2 INCISIONAL HERNIA WITH AN ASSOCIATED SPIEGEL HERNIA. A CASE REPORT

Abstract Aim To describe a case of an extended-view totally extraperitoneal approach for both an M2-3 W2 incisional hernia with an associated right Spiegel hernia. Material & Methods A 68a female with a previous medical history of a midline laparotomy after diffuse peritonitis presented with a midline bulge in the upper third of the previous surgical wound. Preoperative CT scan showed a midline hernia of 4cm and found a right-sided Spiegel hernia of 3cm. Endoscopic treatment of both defects was offered and accepted. Results Patient was placed in supine position. Retromuscular space was created using blunt dissection with a balloon, which helped with direct visualization. Two 5mm trocars were placed in the left pararectal region. Dissection was performed and crossover from left to right was achieved following standard eTEP procedure. Reduction of preperitoneal fat was performed, and midline defects identified. Dissection was continued to the Retzius space and Cooper's ligaments. Identification and reduction of the Spiegel hernia followed. After completing the dissection of the retro rectus and preperitoneal space, primary closure was performed. A lightweight polypropylene mesh was deployed. No complications ocurred and discharge was on the 2nd day. Conclusions Treatment of incisional hernias is in evolution, as minimally invasive techniques have developed greatly since their description and now have a more widespread use among surgeons. eTEP is a novel approach that can be used for the treatment of midline incisional and some primary hernias, as shown in the case, with satisfactory short-term results and similar long-term outcomes to other techniques.

Influence of diabetes mellitus on changes in preperitoneal fat measured by nutritional ultrasound, in a cohort of patients who required intensive care unit (ICU) admittance due to severe covid-19 pneumonia, during a 6-month follow-up program

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Sonographic Measurement of Mesenteric Fat Thickness Is a Better Predictor of Aortic Stiffness Compared With Conventional Obesity Indexes.

Increased aortic stiffness is closely associated with central obesity whereas mesenteric fat is the key adipose tissue in central obesity. We investigated the associations of mesenteric fat thickness with aortic stiffness, with comparison to conventional obesity measures. We used ultrasound to measure mesenteric, pre-peritoneal and subcutaneous fat thickness, carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (c-f PWV), an index of central aortic stiffness. Anthropometric indexes, blood pressure, fasting plasma glucose and lipid profile were measured. One hundred forty-seven healthy volunteers (age [mean ± standard deviation]: 43.2 ± 13.3 y; 41.5% men) were assessed. On univariate analysis, mesenteric, preperitoneal and subcutaneous fat thickness, body mass index (BMI), waist circumference (WC), waist/hip ratio (WHR) and waist/height ratio (WHtR) were associated with c-f PWV with or without adjustment for age. The mesenteric fat thickness had the highest correlation coefficient (r=0.48, p < 0.001) with c-f PWV among all the investigated obesity indexes. Using multiple linear regression analysis, only mesenteric fat thickness remained to be an independent determinant of c-f PWV after adjustments for other abdominal fat thickness, anthropometric and metabolic indexes and CIMT. In conclusion, mesenteric fat thickness is an independent risk factor for aortic stiffness and has a stronger association with aortic stiffness compared with conventional obesity indexes.

Хроническая сердечная недостаточность с сохраненной фракцией выброса на фоне предиабета и абдоминального ожирения: компартменты жировых депо и кардиометаболические маркеры

Aim: to assess the fat depot compartments and some cardiometabolic risk markers in patients with chronic heart failure with preserved ejection fraction (CHFpEF), prediabetes and abdominal obesity. Patients and Methods: this randomized open single-center study was carried out in the Research Institute for Therapy and Preventive Medicine — Branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the RAS and included 64 subjects (32 of them were males) with CHFpEF, prediabetes and abdominal obesity. The standard general clinical examination and laboratory tests, measurements of NT-proBNP and high-sensitivity C-reactive protein (CRP) in blood plasma, as well as ultrasonography for imaging epicardial and preperitoneal fat depots (lipometry) were used to evaluate patients. Results: median age of the studied male patients was 58.00 [54.25; 60.00] years, female patients — 58.00 [56.00; 59.00] years. Males had a higher body weight as compared to females (р=0.036). The level of NT-proBNP in women was lower than in men (p=0.036), just as the glomerular filtration rate (р=0.034). The thickness of the epicardial and preperitoneal fat layers were similar in men and women, while the subcutaneous fat layer was thicker in women (р=0.001). Male patients with grade 3 obesity had the lowest NT-proBNP concentration in blood plasma. In women with grade 2 and 3 obesity the concentration of high-sensitivity C-reactive protein (CRP) in blood plasma was higher than in women with overweight and grade 1 obesity (р=0.047). A moderate linear relationship between NT-proBNP and high-sensitivity CRP levels was found in female patients (r=0.375, p=0.034). Conclusion: body weight measurements, glomerular filtration rates and NT-proBNP concentrations in blood plasma were higher in the studied sample of men as compared to those in women. Male patients with grade 3 obesity had the minimal NT-proBNP level (just slightly above the diagnostic limit). The highest high-sensitivity CRP measurements were reported in women with grade 2 and 3 obesity which underscores their proinflammatory status. No significant differences in the visceral epicardial and preperitoneal fat compartments were found between male and female patients. KEYWORDS: chronic heart failure with preserved ejection fraction, prediabetes, obesity, NT-proBNP, C-reactive protein, epicardial fat, premesenteric fat, subcutaneous fat, males, females. FOR CITATION: Tsygankova O.V., Evdokimova N.E., Latyntseva L.D. Chronic heart failure with preserved ejection fraction amid prediabetes and abdominal obesity: fat depot compartments and cardiometabolic risk markers. Russian Medical Inquiry. 2023;7(1):22–29 (in Russ.). DOI: 10.32364/2587-6821-2023-7-1-22-29.

LBODP053 Significance Of Insulin Resistance And Development Of Type 2 Diabetes Mellitus

Abstract A study was conducted via Clinical and laboratory parameters affecting the formation of insulin resistance(IR) and development of Type 2 Diabetes Mellitus. Data was collected in 140 patients below the age of 50, noted as overweight or obese. The results of the analysis demonstrated a significant direct correlation of the size of pre-peritoneal fat with fasting glycemia (rS=0.35, p&amp;lt;0. 05) and insulin level (rS=0.33, p&amp;lt;0. 05). The calculated risk of developing insulin resistance increased with increasing thickness of pre-peritoneal fat (b=1.46) (exp(b)=4.29 (1.54÷1.90), p=0. 005). Thus, with a size of pre-peritoneal fat of more than 1.5 cm, the relative risk (RR) of IR formation was 5.60 (2.48÷37.11). It should be noted that the linear size of subcutaneous fat did not significantly affect the development of IR. It was also noted that the risk of developing IR (exp (b) = 0.43 (0.91÷2.55), p = 0. 08)) had a steady upward trend with an increase in triglyceride levels, and amounted to 2.86 (1, 03÷7.91). At triglyceride levels above 1.75 mmol/l, the risk of developing IR was significant. When assessing the risk of developing type 2 diabetes mellitus, a steady upward trend was obtained with an increase in the thickness of pre-peritoneal fat (b=0.35; exp(b)=1.15 (0.82÷3.89; p&amp;lt;0.10) and the level of triglycerides (b=0.56; exp(b)=1.75(0.85 ÷3.83); p&amp;lt;0.10). In addition, the risk of developing type 2 diabetes significantly increased with age (b=0.11; exp(b)=1.12 (1. 01÷1.23), p&amp;lt;0. 03) and amounted to 1.52 (1 . 09÷15.39) for individuals over 37.74 years. Thus, individuals over 37.74 years with linear size of pre-peritoneal fat more than 1.5 cm and level of triglycerides above 1.75 mmol/l, has a significant risk for the developing insulin resistance, type 2 diabetes mellitus and can be recommended for targeted screening. Presentation: No date and time listed

OC-073 PATHWAYS OF THE PREPERITONEAL PLANE: FROM THE “FATTY TRIANGLE” IN RIVES TO THE “FATTY TRIDENT” IN EXTENDED RETROMUSCULAR ABDOMINAL WALL RECONSTRUCTION

Abstract Aim Retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence on retromuscular preperitoneal dissections. Material &amp; Methods Thirty frozen cadaver torsos were dissected by posterior component separation (PCS). The shape of the preperitoneal fat was identified, and the dimensions and distances were calculated. Results Results showed that preperitoneal fat resembles a trident, along the midline under the linea alba, and expands in the epigastrium into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach Retzius´s space. Bogros space communicated the root of the trident laterally with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum uncovered by the preperitoneal trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair. Conclusion The concept of preperitoneal fatty trident may be of practical assistance in performing hernia procedures, from the simple ventral hernia repair to more complex preperitoneal ventral repair or PCS techniques. The consistency of this layer allows us to follow three specific pathways to the plane between the peritoneum and muscles to extend the preperitoneal dissection.

P-100 ANATOMICAL STUDY ON THE PREPERITONEAL FAT DISTRIBUTION IN EXTENDED RETROMUSCULAR PREPERITONEAL DISSECTION: FROM THE FATTY TRIANGLE TO THE FATTY TRIDENT

Abstract Aim Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model. Material and methods Thirty frozen cadaver torsos were dissected by posterior component separation. The shape of the preperitoneal fat was identified, and the dimensions and more significant distances were calculated. Results The results showed that the preperitoneal fat resembles a trident, exists along the midline under the linea alba, and expands in the epigastric area into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. The mean rhomboid area was 35 cm2. Caudally, the midline preperitoneal fat widened under the arcuate line to reach the Retzius space. Laterally, the Bogros space communicated the root of the trident with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The mean width of the midline prong at the umbilicus was 2.8 cm. It was easier to tear the peritoneum outside the area reinforced by the fatty trident. Conclusions The concept of preperitoneal fatty trident may be of practical assistance to perform various hernia procedures, from the simple ventral hernia repair to the more complex preperitoneal ventral repair or posterior component separation techniques. The consistency of this layer allows us to follow our plane between the peritoneum and muscle layers to extend the preperitoneal dissection.

V-030 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR OF A RIGHT SPIGELIAN HERNIA USING BIOSYNTHETIC (N-BUTYL CYANOACRYLATE) GLUE FOR MESH FIXATION AND PERITONEAL FLAP CLOSURE

Abstract Spigelian hernia consists one of the most uncommon anterolateral abdominal wall hernias (&amp;lt;1%). The defect occurs at the spigelian fascia which is located lateral to rectus abdominis muscle along the linea semilunaris and is comprised of the transversus abdominis and internal oblique aponeuroses. Most commonly the defect is located at or below the level of arcuate line. Its diagnosis may be challenging because the aponeurosis of external oblique remains intact, leading to an intraparietal hernia, with no obvious bulge on inspection or even palpation of the abdominal wall in many cases. Computed tomography (CT) is the most reliable imaging method to diagnose a spigelian hernia. Due to the high risk of strangulation, surgery should be advised to all patients with spigelian hernia. Surgery can be performed either by open or by minimally invasive techniques. In this video we present the case of a 54-year-old female patient suffering from a symptomatic right spigelian hernia. The diagnosis was suspected during clinical examination and was confirmed with CT. The patient underwent a laparoscopic transabdominal preperitoneal repair. During the procedure, a peritoneal flap was created; the content of the hernia sac, composed from preperitoneal fat, was completely reduced; the defect was closed with 2/0 PDS sutures; a PVDF mesh, measuring 14 cm by 12 cm, was placed in the preperitoneal area and fixed with N-butyl cyanoacrylate glue; the peritoneal flap was closed also with glue. The patient had an unremarkable postoperative period and was discharged on the first postoperative day in good clinical condition.

Cardiometabolic predictive value of anthropometric parameters, vascular ultrasound indexes, and fat depots in patients at high cardiovascular risk: an 8-year prospective cohort study.

Adiposity has a few phenotypes associated with various levels of risk for diabetes mellitus (DM), but their exact predictive value is not well understood. We aimed to assess the predictive value of anthropometric parameters, vascular ultrasound indexes, and fat depots for long‑term cardiometabolic risk. A total of 150 patients with chronic coronary syndrome (CCS) scheduled for elective coronary angiography were enrolled and a comprehensive clinical and ultrasound assessment of adiposity was performed (2012-2013). Of them, 143 individuals were followed for 8 years for insulin resistance (IR) and / or DM development. At baseline, DM and prediabetes were found in 22% and 8% of the patients, respectively. It was established that 11.7% of the participants died during the follow‑up. The rate of DM increased to 46% with a decrease in the prediabetes rate (3.5%). Significant correlations with the Homeostatic Model Assessment of Insulin Resistance and glycated hemoglobin were observed for major anthropometric and ultrasound variables. In the multivariable analysis, independent predictors of IR were preperitoneal fat thickness (PreFT) (per 10mm increase: odds ratio [OR], 1.63; 95% CI, 1.22-2.33; P = 0.003) and body surface area (per 0.1m2 increase: OR, 1.59; 95% CI, 1.11-2.39; P = 0.02). DM was independently predicted by the high‑density lipoprotein cholesterol concentration (OR, 0.93; 95% CI, 0.87-0.97; P = 0.005) and body fat mass (OR, 1.09; 95% CI, 1.03-1.17; P = 0.003). A complex assessment of the adipose tissue in patients with CCS is a valuable method for improving metabolic risk stratification. Some anthropometric and ultrasound parameters, such as PreFT or body surface area, were associated with IR and DM development.

Adipose and serum zinc alpha-2-glycoprotein (ZAG) expressions predict longitudinal change of adiposity, wasting and predict survival in dialysis patients

There were limited data on adipose and serum zinc alpha-2-glycoprotein (ZAG) expression and its association with body composition in patients with advanced chronic kidney disease (CKD). This study aimed to quantify adipose and serum ZAG expression and evaluate their association with body composition and its longitudinal change, together with mortality in incident dialysis patients. We performed a single-center prospective cohort study. Patients who were planned for peritoneal dialysis were recruited. ZAG levels were measured from serum sample, subcutaneous and pre-peritoneal fat tissue obtained during peritoneal dialysis catheter insertion. Body composition and functional state were evaluated by bioimpedance spectroscopy and Clinical Frailty Scale respectively at baseline and were repeated 1 year later. Primary outcome was 2-year survival. Secondary outcomes were longitudinal changes of body composition. At baseline, the average adipose and serum ZAG expression was 13.4 ± 130.0-fold and 74.7 ± 20.9 µg/ml respectively. Both adipose and serum ZAG expressions independently predicted adipose tissue mass (ATM) (p = 0.001, p = 0.008, respectively). At 1 year, ATM increased by 3.3 ± 7.4 kg (p < 0.001) while lean tissue mass (LTM) remained similar (p = 0.5). Adipose but not serum ZAG level predicted change in ATM (p = 0.007) and LTM (p = 0.01). Serum ZAG level predicted overall survival (p = 0.005) and risk of infection-related death (p = 0.045) after adjusting for confounders. In conclusion, adipose and serum ZAG levels negatively correlated with adiposity and predicted its longitudinal change of fat and lean tissue mass, whilst serum ZAG predicted survival independent of body mass in advanced CKD patient.

The relationship between the body mass index and the subcutaneous adipose tissue

Objectives: The aim of the study was to investigate the relationship between the body mass index and ultrasound-measured subcutaneous adipose tissue (SCAT) thickness, in order to propose an alternative non-invasive and inexpensive method to measure the subcutaneous fat. We also evaluated the liver size and the existence of hepatosteatosis, and investigated whether there was a relationship between liver measurements and body mass index (BMI), and the SCAT measurements. Methods: Height, weight, arm SCAT, umbilical SCAT, thigh SCAT, umbilical preperitoneal fat (PPF) and craniocaudal liver size of 72 volunteers were measured and liver parenchymal echogenicity was evaluated with ultrasound. Correlations between BMI and the SCAT, the PPF, and liver measurements were evaluated statistically. Results: BMI was mostly well correlated with umbilical SCAT (r=0.650, p&lt;0.001). The arm SCAT (r=0.549, p&lt;0.001) and the thigh SCAT (r=0.470, p£0.001) followed it. The umbilical PPF was only correlated with the umbilical SCAT. There was no relationship between arm, or thigh SCAT values and existence of hepatosteatosis, but existence of hepatosteatosis was related with umbilical SCAT (p=0.008), and umbilical PPF (p=0.009) values. Conclusion: As an alternative method to skinfold measurement, SCAT measurement with ultrasound can be used to evaluate body fat status.

Pathways of the preperitoneal plane: from the "fatty triangle" in Rives to the "fatty trident" in extended retromuscular abdominal wall reconstruction. A tribute toProf. Schumpelick.

Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence in retromuscular preperitoneal dissections. Thirty frozen cadaver torsos were dissected by posterior component separation. The shape of the preperitoneal fat was identified, and the dimensions and more significant distances were calculated. The results showed that the preperitoneal fat resembles a trident, exists along the midline under the linea alba, and expands in the epigastric area into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach the Retzius space. Laterally, the Bogros space communicated the root of the trident with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum not covered by the preperitoneal fatty trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair. The concept of preperitoneal fatty trident may be of practical assistance to perform various hernia procedures, from the simple ventral hernia repair to the more complex preperitoneal ventral repair or posterior component separation techniques. The consistency of this layer allows us to follow three specific pathways to find our plane between the peritoneum and muscle layers to extend the preperitoneal dissection.

Evaluation of ultrasound measurements of abdominal fat for the prediction of gestational diabetes in the first and second trimesters of pregnancy

Objective To evaluate whether ultrasound abdominal fat measurements in the first and second trimesters can predict adverse gestational outcomes, particularly gestational diabetes mellitus (GDM), and identify early patients at higher risk for complications. Methods A prospective cohort study of 126 pregnant women at 11–14 and 20–24 weeks of gestation with normal fasting glucose levels during early pregnancy. From 126 participants with complete data, 13.5% were diagnosed with GDM, based on the cutoffs established for the peripherical blood glucose. Subcutaneous, visceral, and maximum preperitoneal abdominal fat were measured using ultrasound techniques. GDM status was determined by oral glucose tolerance test (OGTT) with 75 g glucose overload, and the following values were considered abnormal: fasting glucose ≥92 mg/dl and/or 1 h after overload ≥180 mg/dl and/or 2 h after overload ≥153 mg/dl. The receiver operator characteristic (ROC) curve was used to determine the optimal threshold to predict GDM. Results Maximum preperitoneal fat measurement was predictive of GDM, and subcutaneous and visceral abdominal fat measurements did not show significant differences in the prediction of GDM. According to the ROC curve, a threshold of 45.25 mm of preperitoneal fat was identified as the optimal cutoff point, with 87% sensitivity and 41% specificity to predict GDM. The raw and adjusted odds ratios for age and pre-pregnancy body mass index were 0.730 (95% confidence interval [CI], 0.561–0.900) and 0.777 (95% CI, 0.623–0.931), respectively. Conclusion The use of a 45.25 mm threshold for maximum preperitoneal fat, measured by ultrasound to predict the risk of GDM, appears to be a feasible, inexpensive, and practical alternative to incorporate into clinical practice during the first trimester of pregnancy.

Ultrasound-Based Assessment of Preperitoneal Fat as a Surrogate Marker of Cardiovascular Risk: Comparative Study Between People Living with HIV and Controls.

Optimal management of cardiovascular disease should start with the identification of subjects at subclinical stages. However, available tools are not always accurate or affordable. We assess the usefulness of ultrasound-guided measurement of abdominal fat layers as a surrogate marker of cardiovascular risk. We performed a cross-sectional, case-control, exploratory, pilot study in 10 people living with HIV (PLWH) and 10 HIV-uninfected subjects (control group) matched for age, sex, and body mass index. All participants were men 45-60 years of age, with no active disease or previous abdominal surgery; the PLWH group had been virologically suppressed for ≥2 years under stable antiretroviral therapy. The thickness of abdominal superficial and deep subcutaneous fat, preperitoneal fat, omental (periaortic) fat, and retroperitoneal (perirenal) fat was compared between both groups. Correlations between fat layers and traditional markers of cardiovascular risk were assessed. The thickness of most layers was always higher among PLWH. The differences were statistically significant for the preperitoneal fat layer (p = .04). The presence of atherosclerotic plaque was correlated with the preperitoneal fat layer in the PLWH group (odds ratio = 1.49, p = .02), and metabolic syndrome was correlated with superficial subcutaneous fat, although this was low (odds ratio = 0.54, p = .02). In the control group, several associations were found between carotid intima media thickness and abdominal fat layers. All abdominal fat layers were thicker in the PLWH group, especially preperitoneal fat, and several associations were found between specific fat layers and traditional cardiovascular risk markers. Our results suggest that the thickness of abdominal fat layers, assessed by ultrasound, could be a marker of cardiovascular risk. However, further studies with larger populations are required to confirm these findings.

Perinatal morbidity prediction utilizing ultrasonographic central adiposity measures compared to BMI in patients with BMI≥40

We observed that a 3-variable model of late 3rd trimester ultrasonographic (US) measures of central adiposity is superior to BMI alone in predicting cesarean delivery (CD) in patients with BMI≥40 kg/m2. As these patients are more likely to experience maternal and neonatal morbidity, we evaluated the predictive ability of these measurements as well as a new primary model for adverse perinatal outcomes and compared these to BMI alone. Planned secondary analysis of a single center prospective cohort study of patients with BMI≥40 at >36 weeks’ GA and viable singletons. Patients underwent a single study visit >36 weeks’ (blinded to clinicians) at which BMI and 19 US/anthropometric central adiposity measures were obtained by trained personnel. Exclusions were contraindications to vaginal birth or prior CD. For this analysis, the primary outcome was composite perinatal morbidity (maternal puerperal infection, umbilical cord arterial pH< 7.1, NICU admission and other neonatal morbidities, Table). Receiver operator characteristics (ROC) curves with area under the curve (AUC) assessed the original 3-variable model’s predictive ability for the composite; AUCs for BMI, the 3-variable model from the primary analysis, and a new best-fit forward selection (α =0.05) model for the composite were compared. From 2017-2020, 149 women (mean BMI 45.4±5.2) were enrolled. The rate of perinatal morbidity was 18%. Multivariable logistic regression retained only one measurement, minimum pre-peritoneal subxiphoid fat depth, that was significantly associated with the perinatal composite (Model 1), but was poorly predictive (AUC 0.64 95%CI 0.52-0.76). BMI had no predictive ability (AUC 0.49 [0.37-0.61]), while our original 3-variable model (Model 2) had poor prediction, similar to Model 1 (Table). In patients with BMI≥40, maternal US fat depth measurements are no more predictive of adverse perinatal outcome than BMI alone, itself a poor predictor. As perinatal outcome may reflect other maternal and labor characteristics, incorporating these into models may improve prediction.

P126 LAPAROSCOPIC TREATMENT OF HYDROCELE IN FEMORAL CANAL: A CASE REPORT

Abstract Aim The hydrocele of the femoral canal (Femorocele) is one of the rarest entities of femoral hernia (1). All of the reported cases were an intraoperative diagnosis and were treated with an open approach. We are reporting, the probably first femorocele diagnosed and treated laparoscopically. Material and Methods A 57-years-old female patient was presented in our outpatient clinic with pain and an unclear lump in the groin area for 6 months. The sonographic examination revealed a cystic structure in the groin area resampling Nuck’s cyst. An elective laparoscopic exploration and transabdominal preperitoneal (TAPP) repair was planned. Results A laparoscopic exploration was carried out. Intraoperatively, the cystic structure was not found in the Nuck’s Canal, but in the femoral canal as a content of a femoral hernia with some pre-peritoneal fat. By the extraction of the cyst, a gush of clear fluid was noted. After the usual preparation of the preperitoneal area, a mesh was placed in TAPP technique. Conclusions This rare variety of femoral hernias, femorocele, is commonly misdiagnosed as a strangulated hernia or Nuck’s cyst (as in this case) among other differential diagnoses (2). All published femorocele cases were treated with an open approach. As demonstrated here, such unclear cases can be laparoscopically explored and treated accordingly.

Adipose expression of miR-130b and miR-17-5p with wasting, cardiovascular event and mortality in advanced chronic kidney disease patients.

There are limited data on the association of adipose microRNA expression with body composition and adverse clinical outcomes in patients with advanced chronic kidney disease (CKD). We aimed to evaluate the association of adipose miR-130b and miR-17-5p expressions with body composition, functional state, cardiovascular outcome and mortality in incident dialysis patients. We performed a single-center prospective cohort study. Patients who were planned for peritoneal dialysis were recruited. miR-130b and miR-17-5p expressions were measured from subcutaneous and pre-peritoneal fat tissue obtained during peritoneal dialysis catheter insertion. Body composition and physical function were assessed by bioimpedance spectroscopy and Clinical Frailty Scale. Primary outcome was 2-year survival. Secondary outcomes were 2-year technique survival and major adverse cardiovascular event (MACE) rate. Adipose expression of miR-130b and miR-17-5p correlated with parameters of muscle mass including intracellular water (miR-130b: r=0.191, P=0.02; miR-17-5p: r=0.211, P=0.013) and lean tissue mass (miR-17-5p: r=0.176, P=0.04; miR-17-5p: r=0.176, P=0.004). miR-130b expression predicted frailty significantly (P=0.017). Adipose miR-17-5p expression predicted 2-year all-cause survival (P=0.020) and technique survival (P=0.036), while miR-130b expression predicted incidence of MACE (P=0.015). Adipose miR-130b and miR-17-5p expressions correlated with body composition parameters, frailty, and predicted cardiovascular events and mortality in advanced CKD patients.

The relationship between visceral adiposity and cardiometabolic risk in Chinese women with polycystic ovary syndrome

ObjectiveTo compare the extent to which visceral adiposity, as measured by mesenteric fat thickness, contribute to cardiometabolic risk, especially insulin resistance, in women with PCOS and healthy control. MethodsThis is a cross-sectional study with a total of 190 women with PCOS fulfilling the Rotterdam diagnostic criteria. Women without PCOS were recruited from a previous study, which comprised 416 healthy women controls with normal glucose tolerance. All subjects underwent OGTT, biochemical assessment, and sonographic assessment with measurements of mesenteric, preperitoneal and subcutaneous fat thickness. ResultsMesenteric fat thickness was strongly correlated to cardiometabolic traits including blood pressure, fasting and 2-h glucose, triglycerides, HOMA-IR; and was negatively correlated to HDL-C in both cohorts (all p < 0.01). In PCOS, positive correlation was observed between mesenteric fat thickness and free androgen index (p < 0.01). Compared with controls, the regression line between mesenteric fat and HOMA-IR is much steeper in PCOS (p < 0.01). ConclusionWomen with PCOS remain more insulin resistant compared to controls at any given degree of visceral adiposity.