The effect of minimally invasive pectus excavatum repair on thoracic scoliosis

Abstract OBJECTIVES The Nuss technique comprises the placement of an intrathoracic bar behind the sternum. However, besides improving the body posture through the correction of the pectus excavatum (PE), this procedure may cause or worsen thoracic scoliosis as a result of the considerable stress loaded on the chest wall and the thorax. Our goal was to investigate the impact of the Nuss procedure on the thoracic spinal curvature in patients with PE. METHODS A total of 100 patients with PE who underwent the Nuss procedure were included in the study and evaluated retrospectively. The Haller index (HI), asymmetry index and sternal torsion angle were calculated from thoracic computed tomography images before the operation. To evaluate the scoliosis in the T2–T8 thoracic vertebrae, Cobb angles were calculated on a plain chest X-ray before the Nuss operation and after the removal of the bar. Cobb angles were classified as normal (5°), scoliotic posture (5°–10°) and scoliosis (>10°). All angles before and after the Nuss operation were compared. The patients were followed up for a mean of 41 months. Substernal bars were removed after a mean of 33 months. RESULTS The mean age of the patients was 19.6 ± 6.7 years. The Cobb angle was statistically significantly increased in all patients (P = 0.01), male patients (P = 0.01) and children (P = 0.046) but not in adults (P = 0.11) and female patients (P = 0.54). The Cobb angle was increased in patients with severe (HI ≥ 3.5) but not in patients with moderate (3.2 < HI < 3.5) or mild (2.0 < HI < 3.2) PE deformity. CONCLUSIONS The present study shows that the Cobb angle indicates that the severity of thoracic scoliosis increases following the Nuss procedure, particularly in male patients, in patients with mild and moderate sternal torsion angle and in those with a high preoperative HI. This alteration might be due to correctional forces and torque applied by the bar. Patients undergoing the Nuss procedure for the correction of PE should be followed up strictly for timely diagnosis and management of the scoliosis.

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Effects of Pectus Excavatum on the Spine of Pectus Excavatum Patients with Scoliosis

Journal of Healthcare Engineering ◽

10.1155/2017/5048625 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6

Author(s):

WeiHong Zhong ◽

JinDuo Ye ◽

JingJing Feng ◽

LiYang Geng ◽

GuangPu Lu ◽

...

Keyword(s):

Torsion Angle ◽

Pectus Excavatum ◽

Statistical Significance ◽

Vertical Position ◽

Haller Index ◽

Correction Surgery ◽

Offset Coefficient ◽

The Right ◽

Biomechanical Factors ◽

The Impact

Background. There is high risk in the correction surgery of pectus excavatum with scoliosis because of the lack of the correction mechanism of pectus excavatum with scoliosis. This study performed a comprehensive analysis about the impact that pectus excavatum had on scoliosis and elaborated its biomechanical mechanism in pectus excavatum patients with scoliosis. Methods. 37 pectus excavatum patients were selected. According to age, Haller index of pectus excavatum, offset coefficient, vertical position, sternal torsion angle, and asymmetric index, 37 patients were, respectively, divided into 2 compared groups. The result was statistically calculated. Results. The scoliosis incidence and severity did not correlate with Haller index, offset coefficient, vertical position, sternal torsion angle, and asymmetric index of pectus excavatum, and there was no statistical significance between the two compared groups. Conclusions. The incidence and severity of scoliosis in PE patients with scoliosis have nothing to do with the geometric parameters of pectus excavatum but correlate with age. The scoliosis will aggravate with the increase of age. The heart may provide an asymmetric horizontal force to push the spines to the right. The mechanism of how the biomechanical factors exert influences on spines needs to be further investigated to keep the spine stable.

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A Retrospective Study on the Impact of Bar Flipping on the Recurrence of Pectus Excavatum after the Nuss Procedure

10.21203/rs.3.rs-172038/v1 ◽

2021 ◽

Author(s):

Yu-Jiun Fan ◽

Po-Cheng Lo ◽

Yuan-Yu Hsu ◽

I-Shiang Tzeng ◽

Bo-Chun Wei ◽

...

Keyword(s):

Retrospective Study ◽

Pectus Excavatum ◽

Slope Angle ◽

Chest Radiographs ◽

The Other ◽

Nuss Procedure ◽

Patient Groups ◽

Lateral Chest ◽

The Impact ◽

Improvement Index

Abstract BackgroundThe Nuss procedure is widely used to correct pectus excavatum. Bar displacement is a common complication associated with this procedure. How the flipping of the bar affects pectus excavatum recurrence has not been reported. In our study, we discuss this and also offer an easier method to determine bar flipping.MethodsThis retrospective study analyzed pectus excavatum patients who underwent primary Nuss repair from August 2014 to December 2018. The preoperative and postoperative Haller indices were measured on chest radiographs (cxrHI). The slope angle of bar flipping (α) was measured on lateral chest radiographs. The improvement index after surgical repair was calculated by: ([preoperative cxrHI-postoperative cxrHI]/preoperative cxrHI×100). The impact of α on the improvement index was analyzed using one-way analysis of variance and receiver operating characteristic tests.ResultsIn this study, 359 adult and adolescent patients with an average age of 23.9±7.7 years were included. We formed four subgroups based on the α value: α ≤ 10° (n=131), α = 11-20° (n=154), α = 21-30° (n=51), and α > 30° (n=23). The mean improvement indices in these groups were 27%, 28%, 26%, and 13%, respectively. Patients with α > 30° were associated with a significantly poorer improvement index than those from the other subgroups (p<0.001).ConclusionsThe α value is an alternative measurement method for presenting the radiological outcomes after the Nuss procedure. An α > 30° indicates a possible recurrence of pectus excavatum after the Nuss repair. Surgical revision may be considered in patients with an α > 30°, while monitoring should be considered in the other patient groups.

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Proper positioning of mice for Cobb angle radiographic measurements

10.21203/rs.3.rs-89191/v1 ◽

2020 ◽

Author(s):

Zhe Yi Chen ◽

Keith Dip Kei Luk ◽

You Qiang Song ◽

Bo Gao ◽

Jason Pui Yin Cheung

Keyword(s):

Cobb Angle ◽

The Body ◽

Interorbital Space ◽

Mouse Imaging ◽

Radiographic Measurements ◽

Curve Magnitude ◽

Relative Standard ◽

Set Up ◽

Whole Spine ◽

The Impact

Abstract BackgroundThere is no recommended standard for positioning of a mouse for radiographic assessment of the spine. This is necessary to have reproducible radiographic data and avoid false positive results. The objective of this study was to investigate the impact of various postures on Cobb angle measurements and to set up a positioning standard for imaging mouse spines. MethodsThis study was conducted in three parts. Firstly, we identified the problem of lack of posture standardization for radiographs. We collected 77 C57BL/6J mice for spine radiographs and found a scoliosis prevalence of 28.6% with large variations in curve magnitude. Secondly, 24 C57BL/6J mice underwent 4 consecutive weekly radiographs and observed high variations (relative standard deviation: 125.3%) between radiographs. Thirdly, we collected another 82 C57BL/6J mice and designed 14 different postures that could take place during imaging. These postures were related to curling of the limbs, and head, pelvic and tail tilting. ResultsThe results showed that head and pelvic tilting significantly affects the curve magnitude with effect size (Glass’s delta) over 1.50. Avoiding these incorrect positions during radiographs is warranted. The standard recommended posture for mouse imaging entails positioning the snout, interorbital space, neck and whole spine in one line, and with the limbs placed symmetrical to the trunk, whilst avoiding stretching the body of the mouse. ConclusionsOur work exemplified the importance of standard protocol during imaging when using animal model in the scoliosis study. We recommend utilizing this standard in studying various disorders of the spine.

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A retrospective study on the impact of bar flipping on the recurrence of pectus excavatum after the Nuss procedure

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01621-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yu-Jiun Fan ◽

Po-Cheng Lo ◽

Yuan-Yu Hsu ◽

I-Shiang Tzeng ◽

Bo-Chun Wei ◽

...

Keyword(s):

Retrospective Study ◽

Pectus Excavatum ◽

Slope Angle ◽

Chest Radiographs ◽

The Other ◽

Nuss Procedure ◽

Patient Groups ◽

Lateral Chest ◽

The Impact ◽

Improvement Index

Abstract Background The Nuss procedure is widely used to correct pectus excavatum. Bar displacement is a common complication associated with this procedure. How the flipping of the bar affects pectus excavatum recurrence has not been reported. In our study, we discuss this and also offer an easier method to determine bar flipping. Methods This retrospective study analyzed pectus excavatum patients who underwent primary Nuss repair from August 2014 to December 2018. The preoperative and postoperative Haller indices were measured on chest radiographs (cxrHI). The slope angle of bar flipping (α) was measured on lateral chest radiographs. The improvement index after surgical repair was calculated by: ([preoperative cxrHI-postoperative cxrHI]/preoperative cxrHI × 100). The impact of α on the improvement index was analyzed using one-way analysis of variance and receiver operating characteristic tests. Results In this study, 359 adult and adolescent patients with an average age of 23.9 ± 7.7 years were included. We formed four subgroups based on the α value: α ≤ 10° (n = 131), α = 11–20° (n = 154), α = 21–30° (n = 51), and α > 30° (n = 23). The mean improvement indices in these groups were 27%, 28%, 26%, and 13%, respectively. Patients with α > 30° were associated with a significantly poorer improvement index than those from the other subgroups (p < 0.001). Conclusions The α value is an alternative measurement method for presenting the radiological outcomes after the Nuss procedure. An α > 30° indicates a possible recurrence of pectus excavatum after the Nuss repair. Surgical revision may be considered in patients with an α > 30°, while monitoring should be considered in the other patient groups.

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Proper positioning of mice for Cobb angle radiographic measurements

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03949-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhe Yi Chen ◽

Keith Dip Kei Luk ◽

You Qiang Song ◽

Bo Gao ◽

Jason Pui Yin Cheung

Keyword(s):

Cobb Angle ◽

The Body ◽

Interorbital Space ◽

Mouse Imaging ◽

Radiographic Measurements ◽

Curve Magnitude ◽

Relative Standard ◽

Set Up ◽

Whole Spine ◽

The Impact

Abstract Background There is no recommended standard for positioning of a mouse for radiographic assessment of the spine. This is necessary to have reproducible radiographic data and avoid false positive results. The objective of this study was to investigate the impact of various postures on Cobb angle measurements and to set up a positioning standard for imaging mouse spines. Methods This study was conducted in three parts. Firstly, we identified the problem of lack of posture standardization for radiographs. We collected 77 C57BL/6 J mice for spine radiographs and found a scoliosis prevalence of 28.6% with large variations in curve magnitude. Secondly, 24 C57BL/6 J mice underwent 4 consecutive weekly radiographs and observed high variations (relative standard deviation: 125.3%) between radiographs. Thirdly, we collected another 82 C57BL/6 J mice and designed 14 different postures that could take place during imaging. These postures were related to curling of the limbs, and head, pelvic and tail tilting. Results The results showed that head and pelvic tilting significantly affects the curve magnitude with effect size (Glass’s delta) over 1.50. Avoiding these incorrect positions during radiographs is warranted. The standard recommended posture for mouse imaging entails positioning the snout, interorbital space, neck and whole spine in one line, and with the limbs placed symmetrical to the trunk, whilst avoiding stretching the body of the mouse. Conclusions Our work exemplified the importance of standard protocol during imaging when using an animal model in the scoliosis study. We recommend utilizing this standard in studying various disorders of the spine to avoid technical causes for the appearance of a curve.

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Effects of Nuss procedure on thoracic scoliosis in patients with pectus excavatum

Journal of Thoracic Disease ◽

10.21037/jtd.2017.08.128 ◽

2017 ◽

Vol 9 (10) ◽

pp. 3810-3816 ◽

Cited By ~ 6

Author(s):

Hyung Joo Park ◽

Jae Jun Kim ◽

Jae Kil Park ◽

Seok Whan Moon

Keyword(s):

Pectus Excavatum ◽

Nuss Procedure ◽

Thoracic Scoliosis

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The Impact of Phenylketonuria on Body Composition in Adults

Annals of Nutrition and Metabolism ◽

10.1159/000520047 ◽

2021 ◽

pp. 1-8

Author(s):

András Gellért Barta ◽

Dóra Becsei ◽

Erika Kiss ◽

Csaba Sumánszki ◽

Erika Simonová ◽

...

Keyword(s):

Body Composition ◽

Patient Group ◽

The Body ◽

Adult Patients ◽

Fat Percentage ◽

Therapy Adherence ◽

Female Patients ◽

Multifrequency Bioimpedance ◽

Male Patients ◽

The Impact

Introduction: Patients with phenylketonuria (PKU) must follow a lifelong phenylalanine (Phe)-restricted diet with additional amino acid supplementations, and this may put them at risk for nutritional disturbances. However, the body composition and nutritional status of adult patients with PKU has only been partially explored. The current study aims to assess the body composition of adult patients with PKU using multifrequency bioimpedance analysis (MF-BIA) and to reveal potential correlations between therapy adherence and body composition. Additionally, we compared body composition of patients with healthy controls. Methods: Fifty adult patients with early-treated PKU (27 female and 23 male) and 40 healthy, age- and gender-matched controls were included in this single-center, cross-sectional study. MF-BIA was performed on all subjects. Additionally, we determined serum nutritional markers for all patients. In the PKU patient group, correlation analyses were performed between body composition parameters and therapy adherence. We compared body composition of patients with PKU and controls using BIA. Results: The proportion of overweight was 56% among all patients with PKU. Female patients with PKU had significantly higher body fat percentage compared with controls. In parallel with higher fat content, we observed lower muscle mass, protein, and mineral content among female patients with PKU compared to controls. Such findings were not observed in male patients. Female patients with PKU had decreased therapy adherence and had significantly lower prealbumin levels compared with males. There was no significant correlation observed between body composition parameters and therapy adherence over the last 10 years in the PKU patient group. Conclusion: Although female patients had less optimal therapy adherence over the last 10 years compared with male patients, our results suggest that this does not influence body composition fundamentally. Our results suggest that obesity is an important comorbidity in young adult patients with PKU, especially in females. We advocate that nutritional assessments and weight management should be additional objectives of PKU management to provide optimal care.

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Significant impact of three-dimensional volumetry of perinephric fat on the console time during robot-assisted partial nephrectomy

BMC Urology ◽

10.1186/s12894-019-0567-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Daisuke Motoyama ◽

Yuto Matsushita ◽

Hiromitsu Watanabe ◽

Keita Tamura ◽

Toshiki Ito ◽

...

Keyword(s):

Partial Nephrectomy ◽

Three Dimensional ◽

The Body ◽

Renal Tumors ◽

Perioperative Outcomes ◽

Robot Assisted ◽

Computed Tomography Images ◽

Significant Difference ◽

The Impact ◽

Perinephric Fat

Abstract Background To assess the impact of volumetry of perinephric fat (PNF) on the perioperative outcomes of robot-assisted partial nephrectomy (RAPN). Methods Between 2016 and 2019, a single surgeon performed RAPN for 128 patients with clinical T1a-b renal tumors at our institution, and the 70 most recent patients were included in this study to minimize the effects of surgical experience. PNF was defined as a fatty area around the kidney within the anatomical structures, including the lateroconal fascia, fusion fascia, psoas muscle, lumbar quadrate muscle and diaphragm, and its volume was calculated based on reconstructed three-dimensional computed tomography images using the SYNAPSE VINCENT system. Results In this series, the trifecta and MIC (margin, ischemia and complications) score system outcomes were achieved in 69 (98.6%) and 64 patients (91.4%), respectively. The median PNF volume in the 70 patients was 166.05 cm3, which was significantly correlated with both the body mass index (BMI) and Mayo adhesive probability (MAP) score (correlation coefficient = 0.68 and 0.74, respectively). There was no significant difference in the R.E.N.A.L. nephrometry score, PNF volume or console time during RAPN among 5 groups consisting of 14 consecutive patients. Of several factors examined, the console time was significantly affected by the sex, MAP score and PNF volume, and only the PNF volume was independently associated with the console time. Conclusion Even if performed by an experienced robotic surgeon beyond the initial learning curve, the PNF volume may influence the console time during RAPN.

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The Impact of Shariah Governance and Corporate Governance on the Risk Management Practices: Evidence from Local and Foreign Islamic Banks in Malaysia

The Journal of Muamalat and Islamic Finance Research ◽

10.33102/jmifr.v15i2.174 ◽

2018 ◽

Vol 15 (2) ◽

pp. 1-20

Author(s):

Sabri Embi ◽

Zurina Shafii

Keyword(s):

Risk Management ◽

Corporate Governance ◽

Management Practices ◽

Principal Component ◽

T Test ◽

The Body ◽

Primary Data ◽

Islamic Banks ◽

Shariah Governance ◽

The Impact

The purpose of this study is to examine the impact of Shariah governance and corporate governance (CG) on the risk management practices (RMPs) of local Islamic banks and foreign Islamic banks operating in Malaysia. The Shariah governance comprises the Shariah review (SR) and Shariah audit (SA) variables. The study also evaluates the level of RMPs, CG, SR, and SA between these two type of banks. With the aid of SPSS version 20, the items for RMPs, CG, SR, and SA were subjected to principal component analysis (PCA). From the PCA, one component or factor was extracted each for the CG, SR, and RMPs while another two factors were extracted for the SA. Primary data was collected using a self-administered survey questionnaire. The questionnaire covers four aspects ; CG, SR, SA, and RMPs. The data received from the 300 usable questionnaires were subjected to correlation and regression analyses as well as an independent t-test. The result of correlation analysis shows that all the four variables have large positive correlations with each other indicating a strong and significant relationship between them. From the regression analysis undertaken, CG, SR, and SA together explained 52.3 percent of the RMPs and CG emerged as the most influential variable that impacts the RMPs. The independent t-test carried out shows that there were significant differences in the CG and SA between the local and foreign Islamic banks. However, there were no significant differences between the two types of the bank in relation to SR and RMPs. The study has contributed to the body of knowledge and is beneficial to academicians, industry players, regulators, and other stakeholders.

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Influence of DAFS-25+polizon composition on blood and functional state of liver of steers at fattening

Veterinaria Kubani ◽

10.33861/2071-8020-2020-1-15-18 ◽

2020 ◽

pp. 15-18

Author(s):

Inna R. Kilmetova ◽

◽

Igor A. Rodin ◽

Nazira I. Khayrullina ◽

Nikolay G. Fenchenko ◽

...

Keyword(s):

Functional State ◽

White Blood Cells ◽

Live Weight ◽

The Body ◽

Farm Animals ◽

Control Group ◽

Standard Diet ◽

The Impact ◽

Experimental Group ◽

Stimulation Of

Summary. The disbalanced feeding and the uneven distribution of micro- and macroelements in the environment leads to a trace element, in particular hypomelanosis. To accelerate the growth and preservation of young farm animals include in the diet of various biological additives and drugs, which include selenium. For stimulation of weight gain in the livestock industry, as well as for the prevention and treatment of pathological processes in addition to micro - and macrouse amino acids, primarily methionine. The aim of this work was to study the influence of composition of DAFS-25+Polizon on morpho-biochemical parameters of blood and functional state of the liver in fattening bulls of black-motley breed in the conditions of the Republic of Bashkortostan. Experiments using were conducted on bull-calves of black-motley breed of the properties in the properties age from 6 to 15 months. The first experimental group during the experiment was additionally given the composition of DAFS-25+Polizon at a dose of 2 mg/kg, the animals of the control group received a standard diet. To assess the impact of the composition DAFS-25+Polizon on metabolism cattle studied morphological and biochemical indicators of blood and conducted histological examination of the liver. It is established that the use of the composition of DAFS-25+Polizon at a dose of 2 mg/kg increases the number of erythrocytes and hemoglobin in the experimental group and reduces the amount of white blood cells. The serum content of total protein, phosphorus and calcium increases in the group of experimental animals. Microscopic examination of the liver revealed no changes in the structure of the organ and hepatocytes in the experimental group, whereas in the control group hemodynamic disorders and dystrophic changes in liver cells were observed. Thus, the use of the composition DAFS-25+Polizon at a dose of 2 mg/kg of live weight in fattening bulls black-and-white breed contributes to the increase of redox processes in the body, stimulation of metabolism, prevent the development of liver disorders of cellular mechanisms of metabolism, optimizes the structure of the liver, which generally provides higher productivity.

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