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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 -
Portuguese Journal of Cardiac Thoracic... May 2024Minimally invasive repair of pectus carinatum (MIRPC) has been performed using the Abramson technique in which the bar that compresses the sternum is fixed with steel...
Minimally invasive repair of pectus carinatum (MIRPC) has been performed using the Abramson technique in which the bar that compresses the sternum is fixed with steel wires on the ribs. A 14-year-old patient underwent to a MIRPC using a sandwich technique in which two metallic bars fixed with bridges were implanted below the sternum under thoracoscopic vision, and another bar in a subcutaneous tunnel was implanted above. This technique has the potential to avoid specific problems related to the original technique like loosening of support for correction (broken wire), avoidance of induction of pectus excavatum or subcutaneous tissue adhesion.
Topics: Humans; Pectus Carinatum; Adolescent; Male; Minimally Invasive Surgical Procedures; Thoracoscopy; Sternum; Bone Wires; Treatment Outcome
PubMed: 38743519
DOI: 10.48729/pjctvs.404 -
The Journal of Craniofacial Surgery Jun 2024Rib graft is a common source of cartilage in rhinoplasty. Donor site choices for this resource were identified according to the authors who presented the introduction of...
Rib graft is a common source of cartilage in rhinoplasty. Donor site choices for this resource were identified according to the authors who presented the introduction of this technique. However, the scientific basis of this valuable method lacks information, including the anatomical properties of costal cartilage. In this study, cartilage radioanatomy is examined and tested for if any estimators are present. A total of 148 thoracal CT scans of patients who applied to our facility were analyzed. Patients were divided per their sex and age of 35, and rib cartilage dimensions, including axial length between the sternal and costal ends of the cartilage (TotL), posteroanterior diameters at the sternal end (StDia), costal end (CosDia), the thickest part (MaxDia) as diametrical parameters and vertical height at the thickest part (h) were recorded. Length of the sternum (St), the axial length of the clavicle (ClavL), the distance of the sixth rib from the anterior axillary border (AntAx), and thorax circumferences at the level of both pectoralis major muscle origin (ThC) and nipples (BrC) were recorded. Statistical analyses were done for correlations. St, ClavL, ThC, and BrC were found to have the most correlated measurements in groups with the age of 35 and less of both genders, and the relations were lost in older groups. Thorax shape may change after the age of 35 years, but in younger patients, St in females and ClavL in males can be used as estimators of cartilage amount.
Topics: Humans; Costal Cartilage; Male; Female; Adult; Tomography, X-Ray Computed; Tissue and Organ Harvesting; Algorithms; Rhinoplasty; Ribs; Sternum; Clavicle; Middle Aged
PubMed: 38738902
DOI: 10.1097/SCS.0000000000010101 -
Journal of Thoracic Disease Apr 2024Although transfemoral transcatheter aortic valve implantation (TF-TAVI) offers superior early outcome over open surgical aortic valve replacement (SAVR) in the elderly,...
BACKGROUND
Although transfemoral transcatheter aortic valve implantation (TF-TAVI) offers superior early outcome over open surgical aortic valve replacement (SAVR) in the elderly, a comparison of TF-TAVI with surgery performed through partial upper mini sternotomy (PUMS) hasn't yet been validated. The aim of the present study is to evaluate the clinical outcome and quality of life of patients subjected to TF-TAVI and open surgical aortic valve replacement through partial upper mini sternotomy (PUMS-SAVR).
METHODS
Baseline, procedural and post-treatment data of 197 consecutive patients: 137 TF-TAVI and 60 PUMS-SAVR treated at Philipps University of Marburg, were retrospectively collected. The propensity score method was used to create two groups in a 1:1 fashion. Questionnaire assessment (SF36_LQ) of quality of life of the matched patients was carried out at the ambulant routine control presentation. A competing risk regression model is used to evaluate the impact of the clinical outcome on health-related quality of life (HrQoL).
RESULTS
After propensity matching, TF-TAVI remained associated with lower procedural time (136±50 298±36 min, P<0.01), intensive care unit stay (2.68±2.70 4.29±2.43 days, P<0.01), transfusion of packed red cell units (0.46±2.05 1.60±2.00 U, P=0.02) and higher heart block (42.86% 0%, P<0.01) and permanent pacemaker implantation rates (14.29% 0%, P=0.05) compared to PUMS-SAVR. TF-TAVI is associated with less complains, superior HrQoL (excellent 40% and very good 60% very good 100% in PUMS). Partial sternotomy is the main predictor of the inferior HrQoL, with the regression coefficient of -1.11 (95% confidential interval, -1.503 to -0.726; R=0.324, P<0.0001). Transfusion (P=0.26), paravalvular leakage (0.618), pacemaker implantation (P=0.19) and delirium (P=0.92) did not influence HrQoL after the minimal-invasive treatment of aortic valve stenosis in elderly patients.
CONCLUSIONS
Although PUMS-SAVR offers better technical outcomes with less permanent pacemaker implantation and less paravalvular leakage than TF-TAVI, it is still associated with more need for transfusion, longer ventilation-and intensive care unit-times, and prolonged hospital stay. In the elderly, PUMS-SAVR achieves inferior quality of life compared to TF-TAVI. Partial sternotomy reveals as the strongest risk factor of perceived health-level post-treatment. It remains to be revealed whether fast-track open heart surgery that maintains a fully intact sternum and allows immediate postoperative extubation-as performed through video-assisted mini-thoracotomy or thoracoscopic robotic procedures with percutaneous cannulation - should be favored against PUMS-SAVR.
PubMed: 38738226
DOI: 10.21037/jtd-23-1509 -
Gait & Posture Jul 2024Challenges to postural stability emerge in the transition from locomotion to a standing posture as during gait termination, often accompanied by another task (e.g.,...
BACKGROUND
Challenges to postural stability emerge in the transition from locomotion to a standing posture as during gait termination, often accompanied by another task (e.g., opening a door), which may complicate control. However, less is known about postural control during terminating gait while engaged in a secondary manual task.
RESEARCH QUESTION
What are the changes in postural control when terminating gait with and without a prehension task?
METHODS
In a cross-sectional design, 15 healthy young adults (M=8, F=7; 27±2 years; 69±13 kg; 171±8 cm) underwent both a single task gait termination (GTO) and dual task (gait termination plus reaching; GTR). Postural Time-to-Contact (TtC) was measured using Center of Pressure (CoP) and the sternum position in anterior-posterior (AP) and medial-lateral (ML) directions over two different phases: preparatory phase and stabilization phase. Five successful trials were recorded to obtain a mean TtC. For statistical analysis of TtC, a two-tailed paired t-test was used (p =.05) as normality was satisfied.
RESULTS
For the preparatory phase, there were no differences for the CoP, but TtC of the sternum position in AP was shorter in GTR than GTO (p =.001). Meanwhile, for the stabilization phase, TtCs of both the CoP and sternum position were longer in GTR in both AP and ML directions (p's <.001).
SIGNIFICANCE
We suggest that for the preparatory phase, the shorter TtC of the sternum position with intact TtC of the CoP in GTR indicates that healthy young individuals are flexible, in that they smoothly integrate CoP control with the upper body demands required to also perform the prehension task. Meanwhile, for the stabilization phase, the longer TtC in dual termination and prehension task indicates that the perturbation imposed by the prehension movement did not result in reduced stabilization when returning to an upright posture.
Topics: Humans; Postural Balance; Male; Female; Adult; Gait; Cross-Sectional Studies; Biomechanical Phenomena; Young Adult; Standing Position
PubMed: 38735092
DOI: 10.1016/j.gaitpost.2024.04.020