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Cureus Apr 2024Identification is an important aspect of forensic medicine. Identification plays an imperative role, especially in highly decomposed bodies, mutilated bodies, and...
INTRODUCTION
Identification is an important aspect of forensic medicine. Identification plays an imperative role, especially in highly decomposed bodies, mutilated bodies, and undisclosed and fragmentary human remains. The estimation of sex is an essential parameter of human identification. In forensic anthropometry, sex determination is related to morphometric characteristics of skeletal bones, such as the skull and mandible, clavicle, sternum, scapula, humerus, pelvic bone, sternum, and femur. Since teeth are decay-resistant, conscientious analysis of teeth can accredit reliable sex estimation of an individual, especially when other determinants are fragmented or destroyed.
AIM
The aim of the study was to explore the association between sex and buccolingual crown dimensions of teeth.
MATERIALS AND METHODS
The study sample consists of 100 volunteer subjects (50 male subjects and 50 female subjects) aged between 20 and 35 years. Alginate was used to take impressions of the teeth and the cast was prepared using pouring by dental stone. Measurements of buccolingual parameters of all the teeth (except the third molars) of both jaws were done on dental casts by using a digital caliper.
RESULTS
Collected data were analyzed using SPSS software (IBM Corp., Armonk, NY) and were outlined as mean and standard deviation (SD). The male and female groups were compared using an independent Student's t-test or unpaired test. The results of this study revealed that 16 out of 28 odontometric parameters (except third molar) of the two groups (male and female) were higher in the male group as compared to the female group (p < 0.05).
CONCLUSION
Buccolingual odontometric parameters can be used for sex estimation in the North Indian population.
PubMed: 38765404
DOI: 10.7759/cureus.58495 -
Journal of Bodywork and Movement... Apr 2024Patients submitted to heart surgery are restricted to the bed of the Intensive Care Units (ICUs), due to this period of immobility the individual is likely to present...
INTRODUCTION
Patients submitted to heart surgery are restricted to the bed of the Intensive Care Units (ICUs), due to this period of immobility the individual is likely to present clinical and functional alterations. These complications can be avoided by early mobilization; however, in some hospitals, this is not feasible due to the use of subxiphoid drain in the immediate postoperative period.
OBJECTIVE
To verify the safety and feasibility of mobilizing patients after cardiac surgery using subxiphoid drain.
METHODS
This was a prospective cohort study. On the first day the patient was positioned in sedestration in bed, then transferred from sitting to orthostasis, gait training and sedestration in an armchair. On the second postoperative day the same activities were performed, but with walking through the ICU with a progressive increase in distance. At all these moments, the patient was using the subxiphoid and intercostal drain. The patients were seen three times a day, but physical rehabilitation was performed twice. The adverse events considered were drain obstruction, accidental removal or displacement, total atrioventricular block, postoperative low output syndrome, cardiorespiratory arrest, pneumomediastinum, infection, and pericardial or myocardial damage.
RESULTS
176 patients were evaluated. Only 2 (0.4 %) of the patients had complications during or after mobilization, 1 (0.2 %) due to drain obstruction and 1 (0.2 %) due to accidental removal or displacement.
CONCLUSION
Based on the data observed in the results, we found that the application of early mobilization in patients using subxiphoid drain after cardiac surgery is a safe and feasible conduct.
Topics: Humans; Early Ambulation; Male; Prospective Studies; Female; Middle Aged; Cardiac Surgical Procedures; Aged; Drainage; Feasibility Studies; Postoperative Complications; Adult; Xiphoid Bone
PubMed: 38763556
DOI: 10.1016/j.jbmt.2024.01.007 -
The Annals of Thoracic Surgery May 2024Limited data exist regarding outcomes of delayed sternal closure (DSC) in adults with congenital heart disease (ACHD).
BACKGROUND
Limited data exist regarding outcomes of delayed sternal closure (DSC) in adults with congenital heart disease (ACHD).
METHODS
We reviewed 159 ACHD patients undergoing cardiac operation from 1993 to 2023 who required DSC (open sternum at the end of operation, n = 112) or sternum emergently reopened (n = 47). Regression models were performed to determine factors associated with outcomes.
RESULTS
Of 112 patients undergoing DSC, 87 patients (77.6%) underwent DSC ≤4 days and 25 patients (22.3%) >4 days. The most common operations were valve (n = 35 [31.2%]), aortic (n = 33 [29.4%]), and right ventricular outflow tract procedures (n = 23 [20.5%]). Median time to chest closure was 2 days (interquartile range, 1-5 days). Apart from sex, baseline characteristics were similar between DSC groups. A stepwise increase in early mortality was observed from DSC ≤4 days to DSC >4 days (6.8% vs 32%), as well as the incidence of early complications, except sternal infection. Risk factors associated with early mortality were age (P = .02), DSC >4 days (P < .001), hemodynamic indication (P = .03), and single ventricle (P = .02). On multivariable analysis, lower ejection fraction (P = .04), hemodynamic indication (P = .02), single ventricle (P = .004), and diabetes mellitus (P = .03) were predictors of prolonged time to chest closure. Among hospital survivors, late survival was similar between patients undergoing DSC ≤4 days vs >4 days (P = .48).
CONCLUSIONS
A brief duration of DSC in ACHD patients is associated with low morbidity and mortality. Higher early mortality and complications were observed among patients who did not achieve chest closure within 4 days.
PubMed: 38763220
DOI: 10.1016/j.athoracsur.2024.04.031 -
Medical Science Monitor : International... May 2024BACKGROUND Computer-aided design (CAD) has been used in the Nuss procedure to determine the bar length and shape. Despite computer aid, the shape and design remain quite...
BACKGROUND Computer-aided design (CAD) has been used in the Nuss procedure to determine the bar length and shape. Despite computer aid, the shape and design remain quite intuitive. We tested a new algorithm to determine the optimal bar shape. MATERIAL AND METHODS The normal sterno-vertebral distance was defined on computed tomography (CT) scans of patients without pectus excavatum (PEx) at the same level where the deepest depression was found on CT scans of 97 patients with PEx. Four points were marked on the CT scan of 60 patients with PEx at the deepest deformity: P1: edge of the vertebra; P2: edge of the deformity; P3: the expected contact point of the bar and the rib; and P4: the expected end of the bar. The algorithm generated 3 circles upon these points, and the fusion of the arcs drew the line of the ideal bar. Corrected and normal sterno-vertebral distance values were compared with the Mann-Whitney U test. Ten bars were bent manually guided by a 1: 1 printout of the designed bar and were implanted in 10 adolescents. RESULTS The shortest sterno-vertebral distance was 3 cm below the intermammillary line in PEx patients. The normal mean sterno-vertebral distance at this level was 10.16±1.35 cm in non-PEx patients. The mean virtually corrected sterno-vertebral distance was 10.28±1.27 cm. No significant difference was found (P=0.44). The bars were seamless and were successfully implanted. No bar needed adjustment, the operation time was shorter, and the patient satisfaction score was 9.4/10. CONCLUSIONS With our new algorithm, an optimal Nuss bar can be designed.
Topics: Humans; Funnel Chest; Adolescent; Male; Algorithms; Female; Computer-Aided Design; Tomography, X-Ray Computed; Child; Sternum
PubMed: 38760925
DOI: 10.12659/MSM.943705 -
Frontiers in Endocrinology 2024There is a controversy in studies of circulating inflammatory proteins (CIPs) in association with osteoporosis (OP) and fractures, and it is unclear if these two...
OBJECTIVE
There is a controversy in studies of circulating inflammatory proteins (CIPs) in association with osteoporosis (OP) and fractures, and it is unclear if these two conditions are causally related. This study used MR analyses to investigate the causal associations between 91 CIPs and OP and 9 types of fractures.
METHODS
Genetic variants data for CIPs, OP, and fractures were obtained from the publicly available genome-wide association studies (GWAS) database. We used inverse variance weighted (IVW) as the primary analysis, pleiotropy, and heterogeneity tests to analyze the validity and robustness of causality and reverse MR analysis to test for reverse causality.
RESULTS
The IVW results with Bonferroni correction indicated that CXCL11 (OR = 1.2049; 95% CI: 1.0308-1.4083; = 0.0192) can increase the risk of OP; IL-4 (OR = 1.2877; 95% CI: 1.1003-1.5070; = 0.0016), IL-7 (OR = 1.2572; 95% CI: 1.0401-1.5196; = 0.0180), IL-15RA (OR = 1.1346; 95% CI: 1.0163-1.2668; = 0.0246), IL-17C (OR = 1.1353; 95% CI: 1.0272-1.2547; = 0.0129), CXCL10 (OR = 1.2479; 95% CI: 1.0832-1.4377; = 0.0022), eotaxin/CCL11 (OR = 1.1552; 95% CI: 1.0525-1.2678; = 0.0024), and FGF23 (OR = 1.9437; 95% CI: 1.1875-3.1816; = 0.0082) can increase the risk of fractures; whereas IL-10RB (OR = 0.9006; 95% CI: 0.8335-0.9730; = 0.0080), CCL4 (OR = 0.9101; 95% CI: 0.8385-0.9878; = 0.0242), MCP-3/CCL7 (OR = 0.8579; 95% CI: 0.7506-0.9806; = 0.0246), IFN-γ [shoulder and upper arm (OR = 0.7832; 95% CI: 0.6605-0.9287; = 0.0049); rib(s), sternum and thoracic spine (OR = 0.7228; 95% CI: 0.5681-0.9197; = 0.0083)], β-NGF (OR = 0.8384; 95% CI: 0.7473-0.9407; = 0.0027), and SIRT2 (OR = 0.5167; 95% CI: 0.3296-0.8100; = 0.0040) can decrease fractures risk.
CONCLUSION
Mendelian randomization (MR) analyses indicated the causal associations between multiple genetically predicted CIPs and the risk of OP and fractures.
Topics: Humans; Mendelian Randomization Analysis; Osteoporosis; Genome-Wide Association Study; Fractures, Bone; Polymorphism, Single Nucleotide; Fibroblast Growth Factor-23; Genetic Predisposition to Disease; Female; Osteoporotic Fractures
PubMed: 38757000
DOI: 10.3389/fendo.2024.1386556 -
CJEM Jun 2024
Topics: Humans; Wounds, Nonpenetrating; Sternum; Chest Pain; Fractures, Bone; Male; Tomography, X-Ray Computed; Child
PubMed: 38753293
DOI: 10.1007/s43678-024-00693-5 -
Translational Breast Cancer Research :... 2024Poland syndrome is an occasional congenital malformation characterized by unilateral chest wall dysplasia and ipsilateral upper limb abnormalities. An association...
BACKGROUND
Poland syndrome is an occasional congenital malformation characterized by unilateral chest wall dysplasia and ipsilateral upper limb abnormalities. An association between Poland syndrome and breast cancer has been reported, but no clear etiological link between Poland syndrome and breast tumors has been established. We report a case of Poland syndrome combined with breast cancer and analyzed the clinical features of breast cancer in this case and its influence on the choice of treatment for breast cancer.
CASE DESCRIPTION
In February 2022, we admitted a 47-year-old woman with Poland syndrome involving the right limb combined with right-sided breast cancer. After admission, the patient was given eight cycles of neoadjuvant therapy and underwent a modified radical mastectomy on September 7, 2022. Absence of right pectoralis major muscle and pectoralis minor muscle, thoracic deformity, and an adhesive band along the side of the sternum to the right axilla were observed during the operation. After surgery, the incision achieved grade-A healing, and the targeted therapy was continued for 1 year. The patient was followed up for 8 months after surgery, and the limb function of the affected side recovered well, and no obvious subcutaneous effusion, flap necrosis, upper limb edema, and other complications were observed.
CONCLUSIONS
The anatomic variation of patients with Poland syndrome has some influence on the selection of surgical methods for breast cancer, but whether it would affect the prognosis of patients is unknown. To clarify the relationship between Poland syndrome and breast cancer, we need more cases to conduct etiological studies in the future.
PubMed: 38751683
DOI: 10.21037/tbcr-23-46 -
International Heart Journal May 2024Cardiopulmonary resuscitation (CPR) is essential for the survival of cardiac arrest patients, but it can cause severe traumatic complications. In the catheterization...
Cardiopulmonary resuscitation (CPR) is essential for the survival of cardiac arrest patients, but it can cause severe traumatic complications. In the catheterization laboratory, various physical constraints complicate the appropriate performance of CPR. However, we are not aware of reports of CPR complications in this setting. Here, we report a case of coronary artery perforation (CAP) caused by manual CPR in the catheterization laboratory. The patient, a 68-year-old woman, initially underwent successful percutaneous coronary intervention (PCI) for unstable angina. Back in the ward, the patient experienced acute stent thrombosis, which resulted in cardiac arrest, and another PCI was performed under ongoing manual CPR. Although revascularization was successful, sudden CAP occurred, leading to cardiac tamponade. Despite extensive treatment efforts, the patient died 18 hours later.Initially, the compression site of CPR was on the midline of the sternum; however, the compression site shifted to the left, to just above the left anterior descending artery, by the time that CAP was detected via angiography. This corresponded to the area where rib fractures were observed upon computed tomography, suggesting the possibility of traumatic CAP due to manual CPR. The physical constraints in the catheterization laboratory can lead to an inappropriate CPR technique and severe traumatic complications.
Topics: Humans; Aged; Female; Cardiopulmonary Resuscitation; Coronary Vessels; Percutaneous Coronary Intervention; Fatal Outcome; Heart Arrest; Coronary Angiography; Cardiac Catheterization; Angina, Unstable; Cardiac Tamponade
PubMed: 38749750
DOI: 10.1536/ihj.23-549 -
Physiological Measurement May 2024Intra-esophageal pressure (Pes) measurement is the recommended gold standard to quantify respiratory effort during sleep, but used to limited extent in clinical practice...
Intra-esophageal pressure (Pes) measurement is the recommended gold standard to quantify respiratory effort during sleep, but used to limited extent in clinical practice due to multiple practical drawbacks. Respiratory inductance plethysmography belts (RIP) in conjunction with oronasal airflow are the accepted substitute in polysomnographic systems (PSG) thanks to a better usability, although they are partial views on tidal volume and flow rather than true respiratory effort and are often used without calibration. In their place, the pressure variations measured non-invasively at the suprasternal notch (SSP) may provide a better measure of effort. However, this type of sensor has been validated only for respiratory events in the context of obstructive sleep apnea syndrome (OSA). We aim to provide an extensive verification of the suprasternal pressure signal against RIP belts and Pes, covering both normal breathing and respiratory events.We simultaneously acquired suprasternal (207) and esophageal pressure (20) signals along with RIP belts during a clinical PSG of 207 participants. In each signal, we detected breaths with a custom algorithm, and evaluated the SSP in terms of detection quality, breathing rate estimation, and similarity of breathing patterns against RIP and Pes. Additionally, we examined how the SSP signal may diverge from RIP and Pes in presence of respiratory events scored by a sleep technician.The SSP signal proved to be a reliable substitute for both esophageal pressure (Pes) and respiratory inductance plethysmography (RIP) in terms of breath detection, with sensitivity and positive predictive value exceeding 75%, and low error in breathing rate estimation. The SSP was also consistent with Pes (correlation of 0.72, similarity 80.8%) in patterns of increasing pressure amplitude that are common in OSA.This work provides a quantitative analysis of suprasternal pressure sensors for respiratory effort measurements.
Topics: Humans; Pressure; Male; Sleep; Female; Adult; Plethysmography; Signal Processing, Computer-Assisted; Respiration; Sternum; Middle Aged; Polysomnography; Young Adult
PubMed: 38749433
DOI: 10.1088/1361-6579/ad4c35 -
Journal of Cardiothoracic Surgery May 2024Deep sternal wound infection (DSWI) after midline sternotomy of cardiac surgery is a challenging complication that affects the outcome of surgery. This study aims to...
Antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management for sternal infection after midline sternotomy.
INTRODUCTION
Deep sternal wound infection (DSWI) after midline sternotomy of cardiac surgery is a challenging complication that affects the outcome of surgery. This study aims to assess the clinical effectiveness of the antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management in the treatment of DSWI.
METHODS
We retrospectively analyzed 5 patients with DSWI who underwent antibiotic-loaded bone cement combined with bilateral pectoralis major muscle flaps for chest wall reconstruction after sternotomy for cardiac surgery in a tertiary hospital in China from January 2020 to December 2021. The clinical and follow-up data were retrospectively analyzed.
RESULTS
All patients had no perioperative mortalities, no postoperative complications, 100% wound healing, and an average hospital stay length of 24 days. The follow-up periods were from 6 to 35 months (mean 19.6 months). None of the cases showed wound problems after initial reconstruction using antibiotic-loaded bone cement combined with bilateral pectoralis major muscle flaps.
CONCLUSIONS
We report our successful treatment of DSWI, using antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management. The clinical and follow-up results are favorable.
Topics: Humans; Male; Sternotomy; Anti-Bacterial Agents; Retrospective Studies; Bone Cements; Pectoralis Muscles; Middle Aged; Surgical Wound Infection; Female; Surgical Flaps; Aged; Cardiac Surgical Procedures; Sternum; Plastic Surgery Procedures
PubMed: 38745239
DOI: 10.1186/s13019-024-02749-0