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Diagnostics (Basel, Switzerland) Jun 2023Three subtypes of achalasia have been defined using esophageal manometry. Several studies have reported that symptoms are experienced differently among men and women,...
Three subtypes of achalasia have been defined using esophageal manometry. Several studies have reported that symptoms are experienced differently among men and women, regardless of subtype. All subtypes could have some impact on the appearance of respiratory symptoms and lung complications due to compression of the trachea or aspiration of undigested food. The aim of this research was to analyze the differences in respiratory symptoms and radiographic presentation of lung pathology depending on the diameter and achalasia types. One or more respiratory symptoms were reported in 48% of 114 patients, and all of them had two or more gastrointestinal symptoms. The symptom score (SS) is statistically significant for the prediction of subtype 1 (area under the curve = 0.318; < 0.001, cut-off score of 6.5 had 95.2% sensitivity) and subtype 2 (area under the curve = 0.626; = 0.020, cut-off score of 7.5 had 93.1% sensitivity). The most common type was subtype 2 (50.8%), and although only 14 patients had subtype 3, they had the largest esophageal diameter (mean 5.8 cm). The difference in esophageal diameter was significant between subtype 1 and 3 ( = 0.011), subtype 2 and subtype 3 ( = 0.011). Nine patients (6%) had mega-esophagus (four patients in type 1, three in type 2 and two in type 3). More than half of all patients (51.7%) had at least one parenchymal lung change on CT scan. Recurrent micro-aspirations led to changes in the structure of the airways and lung parenchyma such as ground glass (GGO) and nodular changes (12%) and fibrosis (14.5%), and they had higher esophageal diameters ( < 0.001). Patients with chronic lung CT changes had significantly higher esophageal diameter than with acute changes ( < 0.001). Awareness of the association of achalasia and lung disorders is important in early diagnosis and treatment. More than half (57.5%) of patients with achalasia had some clinical and/or structural pulmonary abnormalities. All three subtypes had similar respiratory symptoms, meaning they cannot be used to predict the subtype of achalasia; on the contrary, SS can predict the first two subtypes. A higher diameter of the esophagus is associated with chronic structural lung changes. Although unexpected, the pathological radiological findings and diameter were significantly different in subtype 3 patients, but those parameters cannot lead us to a specified subtype.
PubMed: 37443591
DOI: 10.3390/diagnostics13132198 -
Kidney Research and Clinical Practice Dec 2023The fluid status and rate of blood flow through the arteriovenous fistula (AVF) are two important factors affecting hemodynamic in hemodialysis patients; however, their...
BACKGROUND
The fluid status and rate of blood flow through the arteriovenous fistula (AVF) are two important factors affecting hemodynamic in hemodialysis patients; however, their effects on pulmonary hypertension have rarely been studied. Hence, we aimed to evaluate the effects of these factors in hemodialysis patients with pulmonary hypertension.
METHODS
This single-center cross-sectional survey included 219 maintenance hemodialysis patients (139 [63.5%] male). The prevalence of pulmonary hypertension was 13.6% (30 of 219). Pulmonary artery pressure was measured by echocardiography, fluid status was measured objectively using bioimpedance spectroscopy, and blood flow rate in the AVF (Qa) was determined using Doppler ultrasound.
RESULTS
The overall mean overhydration before hemodialysis was 1.5 L (range, 0.6-2.8 L). The mean overhydration in patients with and without pulmonary hypertension was 3.6 L (range, 2.3-4.6 L) and 1.4 L (range, 0.6-2.4 L), respectively (p < 0.001). The overall mean Qa was 780 mL/min (range, 570-1,015.5 mL/min). The mean Qa of patients with and without pulmonary hypertension was 672 mL/min (range, 505.7-982.2 mL/min) and 790 mL/min (range, 591-1,026 mL/min), respectively (p = 0.27). Overhydration (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.08-1.97; p = 0.01), N-terminal prohormone of brain natriuretic peptide (NT-proBNP; OR, 1.36; 95% CI, 1.09-1.71; p = 0.007), and left atrial diameter (OR, 1.14; 95% CI, 1.01-1.28; p = 0.03) were risk factors.
CONCLUSION
Pulmonary hypertension is strongly associated with overhydration, NT-proBNP, and left atrial diameter in hemodialysis patients.
PubMed: 38062624
DOI: 10.23876/j.krcp.23.021 -
Cureus Dec 2023Background The imaging of the lumbar canal is an important aspect of low back pain (LBP) management. Magnetic resonance imaging (MRI) has gained widespread acceptance...
Background The imaging of the lumbar canal is an important aspect of low back pain (LBP) management. Magnetic resonance imaging (MRI) has gained widespread acceptance for the evaluation of spine anatomy. Objective The objective of the study is to compare the MRI findings of the anteroposterior diameter, transverse diameter, and thecal sac area of the lumbar vertebral canal in symptomatic low back pain patients to that of patients without low back pain. Methods The cross-sectional study included 200 subjects of which 100 subjects (49 males and 51 females) were symptomatic cases of low back pain and 100 subjects (53 males and 47 females) had no symptoms of low back pain and were enrolled as controls. The MRI scans were studied for the anteroposterior diameter, transverse diameter, and thecal sac area of the lumbar vertebral canal. Results In our study, the anteroposterior diameter of the lumbar vertebral canal among cases was found to have a mean of 14.42, 14.09, 13.44, 13.63, and 13.79 with a standard deviation (SD) of 1.25, 1.32, 1.75, 1.75, and 2.65 at L1, L2, L3, L4, and L5 levels, respectively. The anteroposterior diameter of the lumbar vertebral canal among controls was found to have a mean of 15.26, 15.16, 14.71, 14.68, and 15.28 with an SD of 1.60, 1.67, 1.30, 1.36, and 1.97 at L1, L2, L3, L4, and L5 levels, respectively. The difference in anteroposterior diameters of the lumbar vertebral canal was found to be statistically significant at each level, between cases and controls. The transverse diameter of the vertebral canal was found to be smaller in cases as compared to controls with a statistically significant difference at each of the levels studied. The thecal sac area of the vertebral canal was found to be less in subjects with low back pain at each of the vertebral levels studied. Conclusion The study results provide insight into the lumbar vertebral parameters in the study population and give comparative data among the symptomatic low back pain patients and control subjects without low back pain. The MRI reflected decreased anteroposterior diameter, transverse diameter, and thecal sac area of the lumbar vertebral canal among symptomatic low back pain patients.
PubMed: 38292988
DOI: 10.7759/cureus.51407 -
Journal of Neurosciences in Rural... 2023S100B is a biochemical marker of head injury and optic nerve sheath diameter (ONSD) is a non-invasive bedside technique to detect intracranial pressure. We aim to...
UNLABELLED
S100B is a biochemical marker of head injury and optic nerve sheath diameter (ONSD) is a non-invasive bedside technique to detect intracranial pressure. We aim to demonstrate whether ONSD correlates with S100B protein in head injury patients with contusions and also whether the grade of contusion correlates with S100B protein. This is a prospective study done on head injury patients aged between 18 and 75 years having isolated contusions admitted within 24 h of injury. Patients were assessed neurologically with Glasgow Coma Scale (GCS) and cranial computed tomography study on admission. Ocular sonography was done for ONSD recording, and S100B protein venous samples were collected at 24 h, 48 h, and at discharge. The outcome was evaluated with Glasgow Outcome Scale (GOS) at discharge and 3 months. Out of 42 patients, the mean age was 46.2 years and 27 were males. There were 12 patients with mild, 25 with moderate, and 5 patients with severe head injury. The mean GCS at 24 h was 12.35, the mean ONSD at 24 h was 3.9 mm, and the mean S100B at 24 h was 0.214 µg/L. There was a statistically significant correlation noted between mean S100B and contusion grade. A moderate positive correlation was noted between ONSD and S100B at 48 h in mild and moderate head injury groups. Favorable outcome (GOS 4,5) at 3 months can be predicted by GCS, contusion grade, and S100B values. Better GCS (14 and 15), focal contusion grade, and S100B values (<0.5 µg/L) predict good outcome. Although ONSD and S100B give important information in different scenarios, S100B gives better predictive information in patients with traumatic cerebral contusions.
KEY MESSAGE
S100 B and ONSD are simple biochemical and radiological investigations that can be done in every neurosurgical setup and can be useful in the management of head injury patients.
PubMed: 38059225
DOI: 10.25259/JNRP_45_2023 -
World Journal of Gastrointestinal... Dec 2023Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD), and the choice of pancreaticojejunostomy (PJ) is...
BACKGROUND
Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD), and the choice of pancreaticojejunostomy (PJ) is considered a key factor affecting the occurrence of POPF. Numerous anastomotic methods and their modifications have been proposed, and there is no method that can completely avoid the occurrence of POPF. Based on our team's experience in pancreatic surgery and a review of relevant literature, we describe a novel invagination procedure for PJ using double purse string sutures, which has resulted in favourable outcomes.
AIM
To describe the precise procedural steps, technical details and clinical efficacy of the novel invagination procedure for PJ.
METHODS
This study adopted a single-arm retrospective cohort study methodology, involving a total of 65 consecutive patients who underwent PD with the novel invagination procedure for PJ, including the placement of a pancreatic stent, closure of the residual pancreatic end, and two layers of purse-string suturing. Baseline data included age, sex, body mass index (BMI), pancreatic texture, pancreatic duct diameter, operation time, and blood loss. Clinical outcomes included the operation time, blood loss, and incidence of POPF, postoperative haemorrhage, delayed gastric emptying, postoperative pulmonary infection, postoperative abdominal infection, and postoperative pulmonary infection.
RESULTS
The mean age of the patients was 59.12 (± 8.08) years. Forty males and 25 females were included, and the mean BMI was 21.61 kg/m (± 2.74). A total of 41.53% of patients had a pancreatic duct diameter of 3 mm or less. The mean operation time was 263.83 min (± 59.46), and the mean blood loss volume was 318.4 mL (± 163.50). Following the surgical intervention, only three patients showed grade B POPF (4.62%), while no patients showed grade C POPF. Five patients (5/65, 7.69%) were diagnosed with postoperative haemorrhage. Six patients (6/65, 9.23%) experienced delayed gastric emptying. Four patients (4/65, 6.15%) developed postoperative pulmonary infection, while an equivalent number (4/65, 6.15%) exhibited postoperative abdominal infection. Additionally, two patients (2/65, 3.08%) experienced postoperative pulmonary infection.
CONCLUSION
The novel invagination technique for PJ is straightforward, yields significant outcomes, and has proven to be safe and feasible for clinical application.
PubMed: 38222010
DOI: 10.4240/wjgs.v15.i12.2792 -
Gynecological Endocrinology : the... Dec 2023To determine the incidence and severity of ovarian hyperstimulation syndrome (OHSS) in high responders (25-35 follicles with a diameter of ≥12 mm on day of...
Incidence and severity of ovarian hyperstimulation syndrome (OHSS) in high responders after gonadotropin-releasing hormone (GnRH) agonist trigger in "freeze-all" approach.
OBJECTIVE
To determine the incidence and severity of ovarian hyperstimulation syndrome (OHSS) in high responders (25-35 follicles with a diameter of ≥12 mm on day of triggering) who received a gonadotropin-releasing hormone (GnRH) agonist to trigger final follicular maturation.
METHODS
We used individual data from women who participated in four different clinical trials and were high responders to ovarian stimulation in a GnRH antagonist protocol in this retrospective combined analysis. All women were evaluated for signs and symptoms of OHSS using identical criteria based on Golan's system (1989).
RESULTS
High responders ( = 77) were of different ethnicities. There were no differences in baseline characteristics between women with or without signs and symptoms of OHSS. Mean ± standard deviation baseline data were: age, 32.3 ± 3.5 years; anti-Müllerian hormone, 42.4 ± 20.7 pmol/L; antral follicle count, 21.5 ± 9.2. Before triggering, duration of stimulation was 9.5 ± 1.6 days and the mean number of follicles with a diameter of ≥12 mm and ≥17 mm was 26.5 ± 4.4 and 8.8 ± 4.7, respectively. Mean serum estradiol (17,159 pmol/l) and progesterone (5.1 nmol/l) levels were high at 36 h after triggering. Overall, 17/77 high responders (22%) developed signs and symptoms of mild OHSS which lasted 6-21 days. The most frequently prescribed medication was cabergoline to prevent worsening of OHSS. No severe OHSS occurred and no OHSS cases were reported as serious adverse events.
CONCLUSIONS
High responders receiving GnRH agonist for triggering should be informed that they may experience signs and symptoms of mild OHSS.
Topics: Female; Humans; Adult; Pregnancy; Ovarian Hyperstimulation Syndrome; Incidence; Retrospective Studies; Chorionic Gonadotropin; Ovulation Induction; Gonadotropin-Releasing Hormone; Fertilization in Vitro; Pregnancy Rate
PubMed: 37156263
DOI: 10.1080/09513590.2023.2205952 -
Heliyon Dec 2023Cirrhosis is a chronic liver disease that is frequently complicated by increased portal venous pressure and the formation of EV. The most common clinical manifestation...
UNLABELLED
Cirrhosis is a chronic liver disease that is frequently complicated by increased portal venous pressure and the formation of EV. The most common clinical manifestation of portal hypertension is esophageal varices, and ruptured varices are the most fatal complication of portal hypertension. The diagnosis and follow-up of esophageal varices is done by Esophagogastroduodenoscopy, but in most developing countries, the follow-up of cirrhotic patients by gastrointestinal endoscopy remains a challenge.
OBJECTIVE
Assessment of diagnostic accuracy of noninvasive tests as predictors of esophageal varices among cirrhotic patients at University of Gondar comprehensive Hospital.
METHOD
Institution based cross-sectional study was conducted among cirrhotic patients from March 2022-October 2022. All study participants underwent screening for Esophageal Varices, Spleen Diameter, Platelet count and Platelet count/spleen diameter ratio. Data were analyzed using SPSS version 26. ROC curves were plotted for Spleen Diameter, Platelet count and Platelet count/spleen diameter ratio with specific cutoffs determined. Diagnostic performance was assessed using ROC curve. The diagnostic thresholds were specified with their sensitivity, specificity, positive predictive value, negative predictive value positive and negative likelihood ratios.
RESULT
A total of 206 patients were included The mean age was 41.84 year and SD of (41.84 ± 12.398). About 79.4 % percent were males. Endoscopy confirmed esophageal varices were present in 176(85.4 %) cases. Sixty-seven percent of cases had decompensated cirrhosis (Child-Pugh class B&C). The platelet count to spleen diameter ratio less than 818 had a PPV of 94.7 % (AUROC = 0.835), while spleen diameter greater than 145 mm had 93.7 % PPV (AUROC = 0.783). At a platelet count cutoff <121,000/mm3, the PPV was 95.1 % (AUROC = 0.818).
CONCLUSION
In this study, platelet count, spleen diameter, and PC/SD all performed well for EV diagnostics, with PC/SD outperforming the others. This finding supports the use of these noninvasive indicators for the diagnosis and implementation of prophylactic treatment foe esophageal varices in health institutions where gastrointestinal endoscopy is unavailable.
PubMed: 38149190
DOI: 10.1016/j.heliyon.2023.e23229 -
Archives of Oral Biology Apr 2024This study examines whether larger enamel prism diameters accommodate a greater enamel volume from the enamel-dentine junction (EDJ) to the outer-enamel surface (OES) in...
OBJECTIVE
This study examines whether larger enamel prism diameters accommodate a greater enamel volume from the enamel-dentine junction (EDJ) to the outer-enamel surface (OES) in primate molars, and how prism size relates to enamel thickness and crown location.
DESIGN
We assessed variation in enamel prism diameter in relation to crown location and enamel thickness in catarrhine lower molars (n = 14 species) and one platyrrhine. Prism diameter and enamel thickness were recorded in four locations (lingual lateral; lingual cuspal; buccal cuspal; buccal lateral), using a buccal-lingual section through the centre of the mesial cusps. Ten prism diameter readings were collected at inner (near the EDJ), outer (near the OES) and middle (between the two locations) enamel for each location.
RESULTS
Mean prism diameter values for each species were similar (range: 4.06 µm to 5.81 µm). Prism diameter enlarged from inner to outer enamel, suggesting larger prisms help accommodate the increase in enamel volume from the EDJ to the OES. Average prism diameter does not associate with enamel thickness. Instead, cuspal positions had significantly smaller prism diameter at the EDJ than lateral positions, and larger prism sizes at the OES, leading to an overall similar prism diameter mean for all positions (Lingual lateral: 5.11 µm; Lingual cuspal: 5.04 µm; Buccal cuspal: 4.78 µm; Buccal lateral: 4.99 µm).
CONCLUSIONS
Our study revealed consistent average enamel prism diameters in various crown locations of lower primate molars, potentially contributing to the mechanical integrity and functional optimization of enamel in primates.
Topics: Animals; Hominidae; Dentin; Dental Enamel; Primates; Molar
PubMed: 38266424
DOI: 10.1016/j.archoralbio.2024.105895 -
Monaldi Archives For Chest Disease =... Sep 2023The clinical relevance of aortic root diameter (ARD) and main pulmonary artery diameter (MPAd) or pericardial fat volume (PFV) in the assessment of coronary artery...
The clinical relevance of aortic root diameter (ARD) and main pulmonary artery diameter (MPAd) or pericardial fat volume (PFV) in the assessment of coronary artery disease (CAD) is largely unknown. We aimed to assess the relationship of pericardial fat volume (PFV), ARD, MPAd, and MPAd/ARD ratio with occlusive CAD (stenosis>50%).This cross-sectional study included patients who had chest pain suggestive of CAD and underwent a 64-multislice multi-detector CT angiography exam to exclude occlusive CAD presence. A total of 145 patients were enrolled in this study. The mean age was 54±10 years, 51% were males. The mean PFV, ARD, MPAd, and MPAd/ARD ratio in all patients were 155 cm3, 29.9 mm, 23.4 mm and 0.8, respectively. On univariate analysis, PFV (OR (CI)=1.1 (1.01-1.3), P<0.01), ARD (OR (CI)=1.2 (1.1-1.4), P<0.01), and MPAd/ARD ratio (OR (CI)= 0.2 (0.1-0.5), p=0.02) showed significant association with occlusive CAD presence. After adjusting for cardiac risk factors, only PFV (OR (CI)=1.1 (1.02-1.3), p<0.01), but not ARD (OR (CI)=0.9(0.3-2), p=0.85) or MPAd/ARD ratio (OR (CI)=0.1(0.1-2), p=0.69), was independently associated with occlusive CAD. In conclusion, increased PFV, but not ARD or MPAd/ARD ratio, showed a significant and independent association with occlusive CAD presence in patients with chest pain suggestive of CAD.
PubMed: 37702440
DOI: 10.4081/monaldi.2023.2655 -
Computers in Biology and Medicine Sep 2023Accurate planning of transcatheter aortic valve implantation (TAVI) is important to minimize complications, and it requires anatomic evaluation of the aortic root (AR),...
Accurate planning of transcatheter aortic valve implantation (TAVI) is important to minimize complications, and it requires anatomic evaluation of the aortic root (AR), commonly performed through 3D computed tomography (CT) image analysis. Currently, there is no standard automated solution for this process. Two convolutional neural networks with 3D U-Net architectures (model 1 and model 2) were trained on 310 CT scans for AR analysis. Model 1 performs AR segmentation and model 2 identifies the aortic annulus and sinotubular junction (STJ) contours. After training, the two models were integrated into a fully automated pipeline for geometric analysis of the AR. Results were validated against manual measurements of 178 TAVI candidates. The trained CNNs segmented the AR, annulus, and STJ effectively, resulting in mean Dice scores of 0.93 for the AR, and mean surface distances of 0.73 mm and 0.99 mm for the annulus and STJ, respectively. Automatic measurements were in good agreement with manual annotations, yielding annulus diameters that differed by 0.52 [-2.96, 4.00] mm (bias and 95% limits of agreement for manual minus algorithm). Evaluating the area-derived diameter, bias, and limits of agreement were 0.07 [-0.25, 0.39] mm. STJ and sinuses diameters computed by the automatic method yielded differences of 0.16 [-2.03, 2.34] and 0.1 [-2.93, 3.13] mm, respectively. The proposed tool is a fully automatic solution to quantify morphological biomarkers for pre-TAVI planning. The method was validated against manual annotation from clinical experts and showed to be quick and effective in assessing AR anatomy, with potential for time and cost savings.
Topics: Humans; Transcatheter Aortic Valve Replacement; Aortic Valve; Aortic Valve Stenosis; Aorta, Thoracic; Deep Learning; Tomography, X-Ray Computed
PubMed: 37329622
DOI: 10.1016/j.compbiomed.2023.107147