Preoperative assessment of idiopathic scoliosis in adolescent and young adult with three-dimensional T2-weighted spin-echo MRI

PurposeTo compare tridimensional (3D) T2-weighted spin-echo MRI and CT for minimal pedicle width measurements in the preoperative assessment of adolescent idiopathic scoliosis (AIS) in adolescent and young patients.Materials and methodsA total of 22 adolescents/young patients suffering from AIS were retrospectively included. There were 18 females and 4 males with a mean age of 15.3 ± 2.3 (SD) years (range: 11–21 years). Preoperative lumbar spine MRI and CT examinations of the 22 patients were reviewed by two independent readers who measured the minimal width of 259 pedicles. Inter-reader agreement for CT and MRI was assessed using intra-class correlation coefficient (ICC). Intra-reader agreement and relative differences in measurements between MRI and CT were also assessed for each reader.ResultsInter-reader agreement was excellent (ICC ≥ 0.8) for both CT and MRI. Relative differences in measurements between CT and MRI was 10.3% for reader 1 and 9.4% for reader 2.Conclusion3D T2-weighted spin-echo MRI underestimates minimal pedicle width by only 9.4 - 10.3% compared to CT. 3D T2-weighted MRI appears as a valuable alternative to CT for preoperative measurements of vertebral pedicles in AIS.     

The degree and distribution of cortical bone mineralization in the human femoral shaft change with age and sex in a microradiographic study

BackgroundThe incidence of osteoporotic hip fractures increases with age, more sharply in women than in men, as a result of qualitative and quantitative bone alterations. Mineralization (a qualitative parameter) showed no differences with age or sex in cancellous bone in earlier studies. Few studies assessed such differences in cortical bone, a major contributor to femoral bone strength. The aim of this in vitro cross-sectional study of a large group of human femoral midshafts was to look for age- and sex-related differences in the degree and distribution of cortical mineralization that might be implicated in bone fragility.MethodsCortical bone specimens from 193 femurs were studied using quantitative microradiography, with an aluminum step-wedge reference. The femurs were from 99 females and 94 males in a Caucasian anthropological collection covering a broad age spectrum. We determined the mean degree of mineralization of osteons (On.DMB-Al), interstitial tissue (Int.DMB-Al), and total bone (Tt.DMB-Al), and representative parameters of density histograms. Results were expressed as relative values. Age- and sex-related differences in DMB-Al values were evaluated using non-parametric tests.ResultsDegree of tissue mineralization (Tt.DMB-Al) decreased significantly with age in females (r = ? 0.257; P = 0.010) but did not change in males. Tt.DMB-Al was higher in females than males until 50 years of age (P = 0.001) but was lower in elderly females than elderly males (P = 0.016). DMB-Al distribution varied significantly with sex and age. The first DMB-Al quartiles in osteons and interstitial tissue were not different between males and females, but the third quartile and interquartile range differed significantly (P = 0.032 and P = 0.000, respectively). The mineralization difference between the two tissues indicated greater bone heterogeneity in females than males (P = 0.000).ConclusionsIn this in vitro cross-sectional study of anterior midfemoral cortical specimens, the degree and distribution of mineralization varied with age and sex. In females, mineralization started at a higher level than in males but was lower in the sixth decade, falling below the level in males. Mineralization was far more stable throughout life in males. In elderly females, the lower degree and greater heterogeneity of mineralization may have consequences on bone strength and the risk of fracture.     

Reliability of Achilles Tendon Resting Angle and Calf Circumference measurement techniques

BackgroundThe resting angle of the ankle joint may be altered following apparently successful management of Achilles tendon rupture. The reliability of the Achilles Tendon Resting Angle and Calf Circumference measurements was determined.MethodsThree test–retest measurements for reliability assessment were performed on 16 healthy subjects: 10 males and 6 females.ResultsThe mean left Achilles Tendon Resting Angle was mean 50.1° (range [26–61]), ICC 0.92 (CI [0.83–0.97]), SEM 2.4°. The mean right Achilles tendon resting angle was mean 49.9° (range [26–60]), ICC 0.91 (CI [0.80–0.96]), SEM 2.6°. The mean left calf circumference was mean 38.5 cm (range [33.3–44.2]), ICC 0.97 (CI [0.94–0.98]), SEM 0.6 cm, and the mean right calf circumference was mean 38.4 cm (range [33.3–43.6]), ICC 0.97 (CI [0.94–0.99]), SEM 0.5 cm.ConclusionsThe Achilles Tendon Resting Angle and Calf Circumference at 15 cm from the antero-medial joint line had excellent test–retest reliability. These are simple, quick and inexpensive measurements, which have the potential to correlate with tendon elongation and functional outcome. The Achilles tendon resting angle may be used as a guide to tendon length during intra-operative repair and rehabilitation     

The effect of vitamin C intake on the risk of hyperuricemia and serum uric acid level in Korean Multi-Rural Communities Cohort

ObjectiveThe aim of this study was to determine the association between vitamin C intake and risk of hyperuricemia or serum uric acid levels in male and female subjects in the Korean Multi-Rural Communities Prospective Cohort.MethodsThis cross-sectional analysis was conducted in 9400 subjects enrolled in the Korean Multi-Rural Communities Cohort Study. The risk of hyperuricemia was assessed in five quintiles (Q1 to Q5) according to dietary and total vitamin C intake using multivariate-adjusted logistic regression models. Relationships between serum uric acid levels and vitamin C intake were evaluated using linear regression analysis after adjustment for covariates. Information about dietary components was collected using validated food frequency questionnaires.ResultsDietary vitamin C intake, but not total vitamin C intake, was significantly different between hyperuricemic and non-hyperuricemic subjects in males (P = 0.01) and females (P = 0.02). The risk of hyperuricemia decreased with increased dietary vitamin C intake in male and female subjects after multivariate adjustment (P for trend = 0.002 in males and P for trend = 0.02 in females). An effect of total vitamin C intake on hyperuricemia risk was identified in females (P for trend = 0.04), but not males (P for trend = 0.06). Serum uric acid level was linearly associated with total vitamin C intake in females (β = −0.0001, P = 0.01), but not with dietary vitamin C intake in either gender.ConclusionThis study showed that vitamin C intake might be in part responsible for hyperuricemia or serum uric acid level in the Korean Multi-Rural Communities Cohort.     

Computed tomographic-based morphometric study of thoracic spine and its relevance to anaesthetic and spinal surgical procedures

BackgroundTo collect a baseline computer software aided normative morphometric data of thoracic spine in the Indian population and analyze it to give pre-procedural guidelines to clinicians for safe surgical and anaesthetic procedures in the thoracic spine.MethodsCT scans of thoracic spine of patients free from spinal disorders were reviewed in a total of 600 vertebrae in 50 patients. Parameters recorded with the help of computer software were pedicle width, length and height, transverse pedicle angles, chord length, canal dimensions, body width and height, spinous process angle and transverse process length.ResultsPedicle width decreased from T1 (9.27 ± 1.01) to T4 (4.5 ± 0.93) and increased to T12 (8.31 ± 1.83). At T4 76% and at T5 62% of the pedicles were smaller than 5 mm and would not accept 4 mm screw with 1.0-mm clearance. However, at T1 2%, at T11 7% and at T12 8% would not accept a 4 mm screw. Chord length gradually increased in upper thoracic vertebrae and was relatively constant in middle and decreased in lower thoracic vertebrae. Shortest estimated chord length was at T1 (30.30 ± 2.11). On an average, from T1 to T6 and at T11 and T12, a screw length of 25–30 mm could be accommodated and from T7 to T10, 30–35 mm screw length could be accommodated. Transverse pedicle angle decreased from T1 (35.4 ± 2.21) to T12 (−9.8 ± 2.39). Canal dimensions were narrowest at T4/T5 (20.02 ± 1.23) in anteroposterior and 21.12 ± 1.23 in interpedicular diameters. Spinous process angle increased from T1 (30.11 ± 6.74) to T6 (57.89 ± 9.31) and decreased to 16.21 ± 7.38 at T12. Transverse process length increased from T1 to T7 (23.54 + 2.12 to 31.21 + 1.91) and then decreased to 12.11 + 2.3 at T12. Vertebral body dimensions showed increasing trends from T1 to T12.ConclusionsA thorough knowledge of anatomical and radiological characteristics of the spine and their variations is essential for the clinicians. Data collected in the present study provides baseline normative values in Indian population and will help in guiding safe and effective completion of both surgical and anaesthetic procedures in the thoracic spine. Computer software aided morphometric data can help in selecting appropriate size and optimal placement of the implant with minimal procedural difficulties and complications during spine surgery.     

Bone Mineral Density in Premenopausal Arab Women With Type 2 Diabetes Mellitus

IntroductionThis study compares an ethnically uniform group of premenopausal type 2 diabetic (T2DM) Arab women with a matched control group of nondiabetic subjects, in terms of their bone mineral density (BMD) and anthropometric measurements.MethodsThe study included 252 premenopausal Arab women. Their age ranged from 26 to 50 yr with a mean ± SD of 43.65 ± 8.97 yr. One hundred and twenty-two women were T2DM patients and 130 women were nondiabetic controls. The controls matched the subjects in gender, age, and body mass index (BMI). BMD was measured at total lumbar spine (L1–L4) and total left hip, using dual-energy X-ray absorptiometry (DXA; HOLOGIC, QRS SERIES, Europe, Belgium). Difference in BMD and its relationship to the anthropometric measurements in T2DM and control groups were assessed.ResultsSignificant difference was found between T2DM patients and nondiabetic patients in their mean hip BMD (0.92 ± 0.16 vs. 0.87 ± 0.14, p < 0.05) and spine BMD (0.93 ± 0.15 vs. 0.88 ± 0.14, p < 0.01). No significant difference was found in age, height, weight, and BMI (p > 0.05). The increase in hip BMD in T2DM patients normalized and the increase in spine BMD persisted after controlling for the confounding effect of age and anthropometric measurements.ConclusionPremenopausal Arab women with T2DM have higher BMD at the spine than women without T2DM. The underlying mechanism causing this increase does not seem to be related to ethnicity, gender, hormonal status, or anthropometric measurements.     

T2-weighted Dixon MRI of the spine: A feasibility study of quantitative vertebral bone marrow analysis

PurposeTo compare the measurements of fat fraction (FF) and in-phase vs. opposed-phase ratio between two-dimensional T2-weighted (T2W) spin-echo (SE) Dixon and three-dimensional (3D) T1-weighted (T1W) volume interpolated breath-hold examination (VIBE) Dixon sequences in malignant vertebral lesions and normal vertebral bone marrow.Materials and methodsThirty patients with focal vertebral malignancies (20 men, mean age, 67.3 ± 9.4 [SD] years; age range: 41–84 years) and 30 patients without malignant spinal disease (11 men, mean age, 70.1 ± 12.9 [SD]; age range: 53–93 years) were retrospectively included. Each patient underwent spine MRI at 1.5 Tesla including T2W SE and T1W VIBE 2-point Dixon sequences. Two readers independently performed 3D-volume of interest (VOI) and region of interest (ROI)-based FF and IO-ratio measurements of malignant lesions and normal vertebrae. Student t-test, Pearson correlation (r) test and two-way mixed model intraclass correlation coefficients (ICC) were used to compare measurements.ResultsT2W SE and T1W VIBE mean FF and IO-ratio were significantly smaller in malignancy compared to normal marrow, but there were significant differences of paired measurement mean values between T2W SE and T1W VIBE Dixon parameters in malignant lesions T2W SE VOI FF = 9%, T2W SE ROI FF = 7%, T2W SE IO-ratio = 4% vs. T1W VIBE VOI FF = 11%, T1W VIBE ROI FF = 9%, T1W VIBE IO-ratio = ?2%, and in normal vertebrae T2W SE VOI FF = 74%, T2W SE ROI FF = 77%, T2W SE IO-ratio = 51% vs. T1W VIBE VOI FF = 67%, T1W VIBE ROI FF = 73%, T1W VIBE IO-ratio = 58% (each P comparing the paired T2W TSE and T1W VIBE parameter, respectively < 0.001). There was excellent positive correlation between T2 W SE and T1 W VIBE-FF (r ≥ 0.99) and VOI and ROI FF measurements for each sequence (r ≥ 0.99). Inter-reader agreement was excellent for all measurements (ICC ≥ 0.94 for all).ConclusionCalculation of T2W SE Dixon derived FF is feasible and gave valid results that help discriminate between malignant vertebral lesions and normal vertebral bone marrow.     

Measures of body habitus are associated with lung function in adults with cystic fibrosis: A population-based study

BackgroundBody habitus differences may explain some of the variation in lung function between individuals with cystic fibrosis (CF). We tested the hypothesis that measures of lean muscle mass and obesity are independently associated with lung function in CF.MethodsCross-sectional study design using UK CF registry data from 2096 clinically stable adults.ResultsSerum creatinine and BMI were positively and independently associated with FEV₁ and FVC. One standard deviation increment in serum creatinine was associated with an FEV₁ increase of 171 ml (95% confidence intervals CI: + 116 to + 227 ml) in males and 90 ml (95% CI: + 46 to + 133 ml) in females. Compared to the reference group of 20–24.9 kg/m², those with a BMI < 20 kg/m² had lower FEV₁ with values of ? 642 ml (95%CI: ? 784 to ? 500 ml) for males and ? 468 ml (95%CI: ? 564 to ? 372 ml) for females.ConclusionsProspective studies and controlled trials are required to ascertain if these associations have therapeutic potential in modifying disease progression.     

iDXA,Prodigy, and DPXL Dual-Energy X-ray Absorptiometry Whole-Body Scans: A Cross-Calibration Study

PurposeTotal body fat, lean, and bone mineral content (BMC) in addition to regional fat and lean mass values for arms, legs, and trunk were compared across a pencil-beam (Lunar DPXL) and 2 fan-beam (GE Lunar Prodigy and GE Lunar iDXA) dual-energy X-ray absorptiometry (DXA) systems.MethodsSubjects were a multiethnic sample of 99 healthy adult males (47%) and females (mean ± SD: age, 46.3 ± 16.9 yr; weight, 73.4 ± 16.6 kg; height, 167.6 ± 9.7 cm; body mass index, 26.0 ± 5.2 kg/m²) who had whole-body scans performed within a 3-h period on the 3 systems. Repeated measures ANOVA was used to test the null hypothesis that the mean values for the 3 systems were equal. Translation equations between the methods were derived using regression techniques.ResultsBone mineral content (BMC): For both genders, total BMC by iDXA was lower (p ≤ 0.004) than the other systems. Lean: for males, iDXA was lower (p ≤ 0.03) than the other systems for total, trunk, and arms. For females, DPXL estimated higher (p < 0.001) lean mass compared with the other systems for total, trunk, and arms, but iDXA estimated greater legs lean mass. For both genders, all DPXL mean values were greater than Prodigy mean values (p < 0.001).Fat: in females, all the 3 systems were different from each other for total, trunk, and legs (p ≤ 0.04). For arms, DPXL and iDXA were higher than Prodigy (p < 0.0004). For males, DPXL was less (p < 0.001) for total body, trunk, and legs compared with the other 2 systems and greater than Prodigy only for arms (p < 0.0007). These data were used to derive translation equations between systems. For several measurements, the differences between systems were related to gender.ConclusionFor estimation of BMC and body composition, there was high agreement between all DXA systems (R² = 0.85–0.99). Even so, cross-calibration equations should be used to examine data across systems to avoid erroneous conclusions.     

The effect of thoracic spine high-velocity low-amplitude thrust manipulation on myoelectric activity of the lower trapezius and posterior deltoid muscles during treadmill walking

ObjectivesTo investigate the effect of thoracic spine thrust manipulation on the EMG activity of posterior deltoid and lower trapezius during treadmill walking.MethodsVolunteers (n = 40; 19 males and 21 females) were randomly assigned to a ‘sham ultrasound’ control group (n = 20) or a thoracic spine high-velocity thrust (HVLAT) manipulation group (n = 20). Surface EMG recordings were collected from the right posterior deltoid and lower trapezius muscles whilst participants walked on a treadmill for 2 min, at 2.8 mph, both prior to and immediately post-intervention. EMG recordings were analysed by evaluating the difference of integral values for pre and post data using repeated measures ANOVA.ResultsBoth control (sham ultrasound) and experimental groups (HVLAT) exhibited small non-significant reductions in post-intervention EMG activity of lower trapezius (p = 0.201) and a significant reduction in posterior deltoid (p = 0.003) during treadmill walking. No significant difference was found in the integrated EMG (IEMG) power between control and experimental group in either the ‘before’ or ‘after’ measurements for both target muscles.ConclusionsManipulation of the thoracic spine does not significantly alter the myoelectric activity of lower trapezius and posterior deltoid muscles during treadmill walking.     

Previsão do comprimento de inserção de cateter em veia subclávia direita à beira do leito

Background and objectiveThe present study aimed to evaluate whether right subclavian vein (SCV) catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I‐IC), via the top of the SCV arch, or via the clavicle (denoted as I‐T‐IC and I‐C‐IC, respectively).MethodIn total, 70 SCV catheterizations were studied. The I‐IC, I‐T‐IC, and I‐C‐IC distances in each case were measured after ultrasound‐guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X‐ray.ResultsL differed from the I‐T‐IC, I‐C‐IC, and I‐IC distances by 0.14 ± 0.53, 2.19 ± 1.17, and −0.45 ± 0.68 cm, respectively. The mean I‐T‐IC distance was the most similar to the mean L (intraclass correlation coefficient = 0.89). The mean I‐IC was significantly shorter than L, while the mean I‐C‐IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm) = −0.037 + 0.036 × Height (cm) + 0.903 × I‐T‐IC (cm) (adjusted r² = 0.64).ConclusionThe I‐T‐IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.     

Life satisfaction of adolescents and adults with cystic fibrosis: Impact of partnership and gender

BackgroundThis is the first study to assess the impact of gender and partnership on life satisfaction in adolescents and adults with CF, using a model combining subjective importance and satisfaction ratings.MethodsLife satisfaction of 243 CF patients (16–58 years, M = 29.6, SD = 7.4, 46.9% male) was assessed with the Questions on Life Satisfaction (FLZ^M). The effects of gender and partnership on life satisfaction were calculated.ResultsSignificantly less males than females reported living with a partner (χ² = 16.5, p < 001). Gender only had a significant effect on health-related life satisfaction, with females reporting worse life satisfaction. Partnership had small to large effects on general, health-related and CF-specific life satisfaction (η² = .049–.144). Participants with partners always reported higher life satisfaction than those without partner. However, no significant interaction effect of partnership and gender could be shown.ConclusionsHaving a partner is associated with higher life satisfaction, regardless of the patient's gender and might have beneficial effects on medical outcomes.     

Is the same brace fit for all? The length of abduction bar in Steenbeek foot abduction brace for Indian children—A pilot study

PurposeWe measured the foot size and shoulder width in North Indian children with idiopathic clubfoot and calculated the corresponding metal rod length for abduction brace. The differences in the foot length in unaffected, unilateral and bilateral clubfeet were also measured.Patient and methodsTwo sets of measurements were taken on each child: feet size and shoulder width. Using statistical analysis, the following were compared: Differences in the manual prescribed and our calculated SFAB bar length, foot size in unilateral clubfoot and unaffected foot and both feet in bilateral clubfoot.ResultsThere were 156 patients with 76 unilateral (37 left + 39 right) and 80 bilateral feet. The mean prescribed bar length for foot sizes 8–14 in the Steenbeek manual is 30.18 cm. The mean predicted bar length worked out to be 22.33 cm in our series (p < 0.001). In unilateral clubfoot, the mean foot length (11.9 cm) when matched with unaffected foot (12.6 cm) was comparable (p = 0.08). Bilateral clubfeet lengths (12.29 cm versus 12.3 cm) were also comparable (p = 0.978).ConclusionsThere was significant difference between the prescribed and the predicted bar length in foot sizes 8–14 with a smaller bar length measurement of Indian children. The Ponseti treated unilateral club foot length matched the unaffected foot. The foot lengths in bilateral feet disease were also similar.     

Correlação entre saturação venosa central de oxigênio perioperatória e mortalidade em cirurgia cardíaca: estudo prospectivo observacional

BackgroundCardiac surgery can produce persistent deficit in the ratio of Oxygen Delivery (DO₂) to Oxygen Consumption (VO₂). Central venous oxygen Saturation (ScvO₂) is an accessible and indirect measure of DO₂/VO₂ ratio.ObjectiveTo monitor perioperative ScvO₂ and assess its correlation with mortality during cardiac surgery.MethodsThis prospective observational study evaluated 273 patients undergoing cardiac surgery. Blood gas samples were collected to measure ScvO₂ at three time points: T0 (after anesthetic induction), T1 (end of surgery), and T2 (24 hours after surgery). The patients were divided into two groups (survivors and nonsurvivors). The following outcomes were analyzed: intrahospital mortality, length of Intensive Care Unit (ICU) and hospital stay (LOS), and variation in ScvO₂.ResultsOf the 273 patients, 251 (92%) survived and 22 (8%) did not. There was a significant perioperative reduction of ScvO₂ in both survivors (T0 = 78% ± 8.1%, T1 = 75.4% ± 7.5%, and T2 = 68.5% ± 9%; p < 0.001) and nonsurvivors (T0 = 74.4% ± 8.7%, T1 = 75.4% ± 7.7%, and T2 = 66.7% ± 13.1%; p < 0.001). At T0, the percentage of patients with ScvO₂ < 70% was greater in the nonsurvivor group (31.8% vs. 13.1%; p = 0.046) and the multiple logistic regression showed that ScvO₂ is an independent risk factor associated with death, OR = 2.94 (95% CI 1.10 − 7.89) (p = 0.032). The length of ICU and LOS were 3.6 ± 3.1 and 7.4 ± 6.0 days respectively and was not significantly associated with ScvO₂.ConclusionsEarly intraoperative ScvO₂ < 70% indicated a higher risk of death. A perioperative reduction of ScvO₂ was observed in patients undergoing cardiac surgery, with high intraoperative and lower postoperative levels.     

Nefrectomía laparoscópica derecha de donante vivo: evaluación del resultado y asociación del IMC con la longitud de la vena renal derecha

AimsThe aim of this study was to describe outcomes of laparoscopic living donor right nephrectomy (LLDRN) and study factors affecting the length of right renal vein from the donors.Material and methodsThis study was conducted in 60 donors (48 males and 12 females) from January 2016 to December 2017. We performed a retrospective review of consecutive patients who underwent transperitoneal right laparoscopic living donor nephrectomy at our unit.ResultsLLDRN was successfully performed in all subjects by the same surgeons. Among 60 cases, 47 donors had single renal artery and vein, 2 cases had one artery and 2 veins, and 5 donors had 2 arteries and one vein, and the rest had 2-3 arteries with 1-3 veins. Operative time was 142.60 ± 33.73 min. Warm ischemic time was 2.64 ± 0.76 min. The mean hospital stay was 6.69 ± 0.63 days. The median length of right renal vein was 1.92 ± 0.41 cm. All transplanted kidneys showed immediate function. No graft losses were recorded. Almost no gender differences were found in study variables except BMI and warm ischemic time, that was higher BMI but shorter warm ischemic time in female versus male donors. Further analysis showed a negative correlation between BMI and right renal vein (r = −0.282, P < 0.05), but a positive correlation between operative time and estimate blood loss (r = 0.37, P < 0.01).ConclusionsLLDRN is a feasible safe procedure, less traumatic approach, and provides good outcomes kidney for recipients. Notably, in the study group the higher BMI was associated with resulting more difficult LLDRN and kidney transplantation.     

Demographic and socioeconomic disparities of benign and malignant spinal meningiomas in the United States

IntroductionSpinal meningiomas constitute the majority of primary spinal neoplasms, yet their pathogenesis remains elusive. By investigating the distribution of these tumors across sociodemographic variables can provide direction in etiology elucidation and healthcare disparity identification.MethodsTo investigate benign and malignant spinal meningioma incidences (per 100,000) with respect to sex, age, income, residence, and race/ethnicity, we queried the largest American administrative dataset (1997–2016), the National (Nationwide) Inpatient Sample (NIS), which surveys 20% of United States (US) discharges.ResultsAnnual national incidence was 0.62 for benign tumors and 0.056 for malignant. For benign meningiomas, females had an incidence of 0.81, larger (P = 0.000004) than males at 0.40; yet for malignant meningiomas, males had a larger (P = 0.006) incidence at 0.062 than females at 0.053. Amongst age groups, peak incidence was largest for those 65–84 years old (2.03) in the benign group, but 45–64 years old (0.083) for the malignant group. For benign and malignant meningiomas respectively, individuals with middle/high income had an incidence of 0.67 and 0.060, larger (P = 0.000008; P = 0.04) than the 0.48 and 0.046 of low income patients. Incidences were statistically similar (P = 0.2) across patient residence communities. Examining race/ethnicity (P = 0.000003) for benign meningiomas, incidences for Whites, Asian/Pacific Islanders, Hispanics, and Blacks were as follows, respectively: 0.83, 0.42, 0.28, 0.15.ConclusionsAcross sociodemographic strata, healthcare inequalities were identified with regards to spinal meningiomas. For benign spinal meningiomas, incidence was greatest for patients who were female, 65–84 years old, middle/high income, living in rural communities, White, and Asian/Pacific Islander. Meanwhile, for malignant spinal meningiomas incidence was greatest for males, those 45–65 years old, and middle/high income.     

Defining the pubic symphysis angle with respect to the coronal plane — Clinical and biomechanical considerations

BackgroundFixation strength of constructs placed across the pubic symphysis after injury is dependent on screw length, maximisation of which requires knowledge of the bony anatomy. The aim of this study was to describe the ideal angle of drilling to achieve maximal safe screw placement within the pubic body. Furthermore, the influences of age and gender on the skeletal topography were investigated.MethodsThree hundred CT scans of patients without pelvic injury were analysed to record the angle of the pubic body (APB) with respect to the coronal plane, and the depth of the pubic body (DPB) in the sagittal plane.ResultsMean APB and DPB were 54.69° and 55.35 mm, respectively. Females had a significantly higher mean APB than males (57.29° vs. 52.41°; p < 0.001), whereas males had a significant larger mean DPB (59.13 mm vs. 51.03 mm; p < 0.001). Age had no effect on the mean APB. Mean width of the pubic body at the base was 9.38 mm.ConclusionThe anatomy of this region is reliable in terms of angles and sizes; a drill angle of 55° with respect to the operating table will allow maximal screw length, which should be in the region of 55 mm. The mean width of the pubic body should allow for placement of a 3.5 or 4.5 mm diameter screw.     

Aortic Length Changes During Abdominal Aortic Aneurysm Formation,Expansion and Stabilisation in a Rat Model

BackgroundDeterminants of extracellular matrix (ECM) destruction/reconstruction balance influencing abdominal aortic aneurysm (AAA) diameter may impact length.ObjectiveDocument aortic lengthening, its correlation to diameter, and determine how treatments that impact diameter also affect length.MethodsThree hundred and fifty-five diameter and length measurements were performed in 308 rats during AAA formation, expansion and stabilisation in guinea pig aortas xenografted in rats. Impact of modulation of ECM destructive/reconstructive balance by endovascular Vascular Smooth Muscle Cell (VSMCs) seeding, TIMP-1, PAI-1 and TGF-beta1 overexpression on length has been assessed.ResultsLength increased in correlation with diameter during formation (correlation coefficient (cc): 0.584, P < 0.0001) and expansion (cc: 0.352, P = 0.0055) of AAAs. Overexpression of TIMP-1 and PAI-1 decreased lengthening (P = 0.02 and 0.014, respectively) demonstrating that elongation is driven by matrix metalloproteinases and their activation by the plasmin pathway. Overexpression of TGF-beta1 controlled length in formed AAAs (17.3 ± 9.6 vs. 5.9 ± 7.4 mm, P = 0.022), but not VSMC seeding, although both therapies efficiently prevented further diameter increase. Length and diameter correlation was lost after biotherapies.ConclusionLength increases in correlation with diameter during AAA formation and expansion, as a consequence of ECM injury driven by MMPs activated by the plasmin pathway. Correlation between length and diameter increases is not universally preserved.     

¿Puede la cirugía mínimamente invasiva resultar en sitios inusuales de metástasis?

ObjectiveTo compare sites of metastasis for the laparoscopic (LRC) and open (ORC) approaches in a cohort of patients at a district general hospital. Morbidity and mortality for the two approaches are assessed using secondary outcomes of length of stay and complication rate. Metastasis rate and site are compared.MethodsA retrospective case note review was carried out for all patients who underwent cystectomy for bladder malignancy at Pinderfields General Hospital, Wakefield between 2010 and 2016 (n = 219). There were 150 males and 69 females in 107 minimally invasive cases and 87 open (missing data on 25 cases). Data were analysed using Microsoft Excel XLSTAT.ResultsRecurrence rate was 25.1% and did not differ significantly with approach (p = 0.89). Sites of recurrence did not differ with operative approach, the most frequent being pelvis, chest and bone. Unusual sites of recurrence included abdominal wall and sigmoid colon which both occurred in LRC. Length of stay was greater for the open approach (median LRC = 10, ORC = 13, p < 0.01). Five-year survival was 74.9%. Survival distribution did not significantly differ with operative approach (p = 0.43), and there was no significant association between operative approach and patient death within the follow-up period (p = 0.09). Stricture rate was 4.1% and was not significantly different between the two groups (p = 0.29). Median time to stricture was 130 days. Clavien-Dindo scores for complications did not differ with approach (p = 0.93), and there was no significant association between operative approach and whether complications developed (p = 0.19).ConclusionsThe adverse oncological outcomes in minimally invasive approaches suggested by some studies are not confirmed here. Those in the LRC group were discharged sooner, though this did not translate into differences in morbidity or survival. Analysis of the association between individual complications and length of stay may clarify this further. Shorter hospital stay is also likely to have significant financial implications.Despite no significant difference in outcomes, the findings demonstrate potential benefits of LRC. Extensions of this study could include: cost-benefit analysis, examination of individual complications’ effect on length of stay; and analysis of approach-specific factors contributing to perioperative deaths.