scholarly journals CORRELATION BETWEEN OBESITY, SAGITTAL BALANCE AND CLINICAL OUTCOME IN SPINAL FUSION

2015 ◽  
Vol 14 (3) ◽  
pp. 186-189 ◽  
Author(s):  
Marcel Machado da Motta ◽  
Raphael Rezende Pratali ◽  
Marcela Almeida Campos Coutinho ◽  
Carla Balkanyi Hoffman ◽  
Carlos Eduardo Gonçales Barsotti ◽  
...  
Keyword(s):  
Waist Circumference ◽  
Clinical Outcome ◽  
Spinal Fusion ◽  
Sagittal Balance ◽  
Statistical Significance ◽  
Abdominal Circumference ◽  
Postoperative Results ◽  
Radiographic Parameters ◽  
Spinopelvic Balance ◽  
Spinal Arthrodesis

Objective:To correlate obesity with radiographic parameters of spinal and spinopelvic balance in patients undergoing spinal arthrodesis, and to correlate obesity with clinical outcome of these patients.Methods:Observational retrospective study including patients who underwent spinal arthrodesis, with minimum follow-up period of three months. We measured waist circumference, as well as height and weight to calculate body mass index (BMI) and obtained radiographs of the total column. The clinical parameters studied were pain by visual analog scale (VAS) and the Oswestry questionnaire (ODI). Obesity correlated with radiographic parameters of the sagittal and spinopelvic balance and postoperative clinical parameters.Results:32 patients were analyzed. The higher the BMI, the greater the value of VAS found, but without statistical significance (p=0.83). There was also no correlation between BMI and the ODI questionnaire. Analyzing the abdominal circumference, there was no correlation between the VAS and ODI. There was no correlation between BMI or waist circumference and the radiographic parameters of global spinopelvic sagittal alignment. Regarding the postoperative results, there was no correlation between the mean BMI and waist circumference and the postoperative results for ODI and VAS (p=0.75 and p=0.7, respectively).Conclusions:The clinical outcomes of patients who undergone spinal fusion were not affected by the BMI and waist circumference. Also, there was no correlation between radiographic parameters of spinal and spinopelvic sagittal balance with obesity in patients previously treated with arthrodesis of the spine.

scholarly journals INFLUENCE OF THE SAGITTAL BALANCE ON THE CLINICAL OUTCOME IN SPINAL FUSION

2016 ◽  
Vol 15 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Marcela Almeida Campos Coutinho ◽  
Raphael de Rezende Pratali ◽  
Marcel Machado da Motta ◽  
Carla Balkanyi Hoffman ◽  
Carlos Eduardo Gonçales Barsotti ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Spinal Fusion ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Functional Parameters ◽  
Radiographic Parameters ◽  
Study Results ◽  
Fusion Methods ◽  
Spinopelvic Balance ◽  
Satisfaction With Treatment

ABSTRACT Objective: Evaluates which radiographic parameters of the sagittal and spinopelvic balance influence the clinical and functional outcomes of a sample of patients undergoing spinal fusion. Methods: We studied 32 patients who underwent spinal fusion. Radiographs of the total spine were obtained from all patients. The clinical and functional parameters studied were analysis of pain by visual analogic scale (VAS) and Oswestry and SRS-30 questionnaires. We analyzed the correlation between the clinical and functional parameters and radiographic parameters of the sagittal and spinopelvic balance. Results: There was no significant correlation between parameters pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL) and difference between PI and LL (PI-LL) and clinical parameters (p > 0.05 and r <0.2). Significant correlation were identified only between Sagittal Vertical Axis (SVA) and Satisfaction with Treatment domain of SRS-30 (r = 0.402 e p = 0.023) and between thoracic kyphosis (TK) and the total SRS-30 (r = 0.419 and p = 0.017). Conclusions: According to the study results, it was not possible to precisely characterize the role of the parameters of the sagittal and spinopelvic balance in the post-operative analysis of the clinical outcome of spinal fusion. There was a significant correlation only between SVA and the Satisfaction with Treatment domain of SRS-30 and between TK and total SRS-30.

scholarly journals Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome

2021 ◽  
Author(s):  
Gopal Krishna ◽  
Varun Aggarwal ◽  
Ishwar Singh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Clinical Outcome ◽  
Road Traffic ◽  
Statistical Significance ◽  
Platelet Counts ◽  
Coagulation Abnormalities ◽  
The Mean ◽  
D Dimer

Abstract Introduction Traumatic brain injury (TBI) affects the coagulation pathway in a distinct way than does extracranial trauma. The extent of coagulation abnormalities varies from bleeding diathesis to disseminated thrombosis. Design Prospective study. Methods The study included 50 patients of isolated TBI with cohorts of moderate (MHI) and severe head injury (SHI). Coagulopathy was graded according to the values of parameters in single laboratory. The incidence of coagulopathy according to the severity of TBI and correlation with disseminated intravascular coagulation (DIC) score, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen was observed. The comparison was also made between expired and discharged patients within each group. It also compared coagulation derailments with clinical presentation (Glasgow Coma Scale [GCS]) and outcome (Glasgow Outcome Scale [GOS]). Results Road traffic accident was the primary (72%) mode of injury. Fifty-two percent had MHI and rest had SHI. Eighty-four percent of cases were managed conservatively. The mean GCS was 12.23 and 5.75 in MHI and SHI, respectively. Sixty-two percent of MHI and 96% of the patients with SHI had coagulation abnormalities. On statistical analysis, DIC score (p < 0.001) strongly correlated with the severity of head injury and GOS. PT and APTT were also significantly associated with the severity of TBI. In patients with moderate TBI, D-dimer and platelet counts showed association with clinical outcome. Fibrinogen levels did not show any statistical significance. The mean platelet counts remained normal in both the groups of TBI. The mean GOS was 1.54 and 4.62 in SHI and MHI, respectively. Conclusion Coagulopathy is common in isolated TBI. The basic laboratory parameters are reliable predictors of coagulation abnormalities in TBI. Coagulopathy is directly associated with the severity of TBI, GCS, and poor outcome.

scholarly journals LINC-25. BRAF ABERRATIONS IN PEDIATRIC PILOCYTIC ASTROCYTOMAS (PCAs): PREVALENCE AND IMPACT ON CLINICAL OUTCOME

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii383-iii383
Author(s):  
Subramaniam Ramanathan ◽  
Maya Prasad ◽  
Tushar Vora ◽  
Mamta Gurav ◽  
Ayushi Sahay ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Statistical Significance ◽  
Tumor Resection ◽  
Brafv600e Mutation ◽  
Therapeutic Implications ◽  
Pilocytic Astrocytomas ◽  
Ffpe Tissues ◽  
Braf Fusion ◽  
Poor Outcomes ◽  
The Impact

Abstract BACKGROUND Increasing knowledge on pilocytic astrocytoma (PCA) biology now points towards an aberration in BRAF/MAPK/ERK pathway which has both diagnostic and therapeutic implications. This study was done to note the impact of BRAF aberrations on clinical outcome in childhood PCA. METHODS FFPE tissues of all childhood PCA diagnosed during 2011–2017 were evaluated for BRAFV600E mutation by Sanger sequencing and KIAA1549 fusion transcripts (16–9;15–9;16-11) by reverse transcriptase polymerase chain reaction. Children undergoing gross tumor resection received no adjuvant treatment. Unresectable tumors (only biopsy) and NF-1 associated PCAs, were treated if clinically indicated. Only patients with documented therapy details/followup were included for analysis. STUDY RESULTS Ninety-eight patients (median age-7.7yrs; boy:girl ratio-1.4) were included. Major sites were: Cerebellum-37(38%), 3rd Ventricle-26(27%), Cerebrum-15(15%). While BRAFV600E mutation was noted in 7/89(8%) specimens, BRAF-fusions were found in 34/85(40%). Following surgery/biopsy, 23(24%) and 21(22%) received adjuvant chemotherapy and radiotherapy respectively. The 1-year/3-year/5-year-EFS of the overall cohort was 90.7%/81.3%/67.4% respectively. Cerebellar tumors did better vis-à-vis other sites(5yr-EFS:74.3% v/s 66.4%;p=0.403). The 5yr-EFS of BRAF-fusion positive tumors (34), tumors without any BRAF aberration (40) and BRAFV600E mutant tumors (7) was 84.8%/ 69.6%/ 42.9% (p=0.215). CONCLUSIONS BRAF-fusion and BRAFV600E mutation were associated with good and poor outcomes respectively. Lack of statistical significance could be attributed to use of radiation as planned therapy in patients from earlier years. Data on BRAF aberrations in PCAs aids decision making regarding adjuvant therapy and choosing appropriate salvage-therapy especially in relapsed/refractory PCAs.

scholarly journals Assessment of Normal Sagittal Alignment of the Spine and Pelvis in Children and Adolescents

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Hasan Ghandhari ◽  
Hamid Hesarikia ◽  
Ebrahim Ameri ◽  
Abolfazl Noori
Keyword(s):  
Children And Adolescents ◽  
Sagittal Balance ◽  
Sagittal Alignment ◽  
Demographic Data ◽  
Lateral View ◽  
Old People ◽  
Spinopelvic Parameters ◽  
Spinopelvic Balance ◽  
History Of ◽  
Data History

Aim. We aimed to determine spinopelvic balance in 8–19-year-old-people in order to assess pelvic and spinal parameters in sagittal view.Methods. Ninety-eight healthy students aged 8–19 years, who lived in the central parts of Tehran, were assessed. Demographic data, history of present and past diseases, height (cm), and weight (kg) were collected. Each subject was examined by an orthopedic surgeon and spinal radiographs in lateral view were obtained. Eight spinopelvic parameters were measured by 2 orthopedic spine surgeons.Results. Ninety-eight subjects, among which 48 were girls (49%) and 50 boys (51%), with a mean age of13.6±2.9years (range: 8–19) were evaluated. Mean height and weight of children were153.6±15.6cm and49.9±13.1kgs, respectively. Mean TK, LL, TT, LT, and PI of subjects were 37.1 ± 9.9°, 39.6 ± 12.4°, 7.08 ± 4.9°, 12.0 ± 5.9°, and 45.37 ± 10.7°, respectively.Conclusion. Preoperation planning for spinal fusion surgeries via applying PI seems reasonable. Predicating “abnormal” to lordosis and kyphosis values alone without considering overall sagittal balance is incorrect. Mean of SS and TK in our population is slightly less than that in Caucasians.

The effects of dexamethasone on bone fusion in an experimental model of posterolateral lumbar spinal arthrodesis

2001 ◽  
Vol 94 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Paul D. Sawin ◽  
Curtis A. Dickman ◽  
Neil R. Crawford ◽  
M. Stephen Melton ◽  
William D. Bichard ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Bone Graft ◽  
Spinal Fusion ◽  
Experimental Model ◽  
Content Type ◽  
Bone Fusion ◽  
Group 12 ◽  
Spinal Arthrodesis ◽  
Lumbar Spinal ◽  
Fine Print

Object. The use of corticosteroid agents during the healing phase after spinal arthrodesis remains controversial. Although anecdotal opinion suggests that corticosteroids may inhibit bone fusion, such an effect has not been substantiated in clinical trials or laboratory investigations. This study was undertaken to delineate the effect of exogenous corticosteroid administration on bone graft incorporation in an experimental model of posterolateral lumbar fusion. Methods. An established, well-validated model of lumbar intertransverse process spinal fusion in the rabbit was used. Twenty-four adult New Zealand white rabbits underwent L5–6 bilateral posterolateral spinal fusion in which autogenous iliac crest bone graft was used. After surgery, the animals were randomized into two treatment groups: a control group (12 rabbits) that received intramuscular injections of normal saline twice daily and a dexamethasone group (12 rabbits) that received intramuscular dexamethasone (0.05 mg/kg) twice daily. After 42 days, the animals were killed and the integrity of the spinal fusions was assessed by radiography, manual palpation, and biomechanical testing. In seven (58%) of the 12 control rabbits, solid posterolateral fusion was achieved. In no dexamethasone-treated rabbits was successful fusion achieved (p = 0.003). Tensile strength and stiffness of excised spinal segments were significantly lower in dexamethasone-treated animals than in control animals (tensile strength 91.4 ± 30.6 N and 145.3 ± 48.2, respectively, p = 0.004; stiffness 31.4 ± 11.6 and 45.0 ± 15.2 N/mm, respectively, p = 0.02). Conclusions. The corticosteroid agent dexamethasone inhibited bone graft incorporation in a rabbit model of single-level posterolateral lumbar spinal fusion, inducing a significantly higher rate of nonunion, compared with that in saline-treated control animals.

P–515 Clinical outcome of mosaic-blastocyst transfer versus euploid-blastocyst transfer in single frozen blastocyst transfer cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
W Y Yap ◽  
M W Lim ◽  
C S S Lee
Keyword(s):  
Retrospective Study ◽  
Clinical Outcome ◽  
Statistical Significance ◽  
Implantation Rate ◽  
Clinical Pregnancy ◽  
Blastocyst Transfer ◽  
Miscarriage Rate ◽  
Similar Clinical Outcome ◽  
Group A ◽  
Transfer Group

Abstract Study question What is the clinical outcome of transferring a mosaic blastocyst versus a euploid blastocyst in single frozen blastocyst transfer (sFBT) cycles? Summary answer Single mosaic blastocyst transfer has similar clinical outcome to single euploid blastocyst transfer. What is known already Embryonic mosaicism occurs when there are two or more distinct cell lines found in preimplantation embryos derived from IVF. Data from recent studies show that mosaic blastocysts have the potential to implant and can result in healthy live births. As a result, patients now have the option of transferring mosaic blastocyst when they do not have any euploid blastocyst available for transfer. However, the clinical outcome of transferring mosaic blastocyst has not been definitively reported. Thus, a retrospective study was conducted to compare the clinical outcome of mosaic sFBT and euploid sFBT. Study design, size, duration A total of 602 patients underwent frozen blastocyst transfer in Alpha IVF from January to October 2019 and had their blastocysts screened for aneuploidy. These patients were divided into 2 groups: 26 patients with mosaic blastocysts transferred (Group A, age ranged 19–44), and 576 patients with euploid blastocysts transferred (Group B, age ranged 21–44). The mean age of patients from Group A and B were 34.0 and 32.8 respectively (p &gt; 0.05). Participants/materials, setting, methods All samples had their DNA libraries constructed for sequencing using Next Generation Sequencing according to manufacturer’s specification (IonTorrent, USA). All blastocysts were frozen for subsequent sFBT cycle (Cryotech, Japan). All thawed blastocysts for sFBT survived with morphologically intact inner cell mass and trophectoderm cells. The importance of antenatal confirmation of the fetal chromosome status was emphasized in patients from Group A. The clinical outcomes of both groups were analysed and compared. Main results and the role of chance No significant differences were seen in the clinical pregnancy and implantation rate of Group A and B (65.4% vs 63.0%; p &gt; 0.05). The miscarriage rate of Group A and B were 23.5% and 14.0% respectively. Albeit the higher miscarriage rate in Group A, there was no statistical significance between these two groups (p &gt; 0.05). Group A was further divided into two subgroups, Subgroup A1: low risk mosaic blastocyst transfer; Subgroup A2: high risk mosaic blastocyst transfer. In the comparison of Group A subgroups, the clinical pregnancy and implantation of Group A1 is higher than Group A2 (76.9% vs 44.4%). In addition, the miscarriage rate of Group A1 and A2 were 23.1% and 0.0% respectively. Interestingly, there was no statistical significance in clinical pregnancy rate, implantation rate and miscarriage rate between these two subgroups. Limitations, reasons for caution This is a retrospective study and the sample size was comparatively smaller in the mosaic blastocyst transfer group than the euploid blastocyst transfer group. Further studies with a larger sample size should be carried out to ascertain the clinical outcome. Wider implications of the findings: Single mosaic blastocyst transfer has similar clinical outcome to single euploid blastocyst transfer. Thus, mosaic blastocyst can be considered for transfer when no euploid blastocyst are available. Nevertheless, stringent antenatal surveillance for chromosomal abnormalities to confirm the chromosomal status of the fetus must be followed. Trial registration number Not applicable

Abstract P269: Fasting HDL-C Partially Explains the Association of Postprandial Triglycerides and Coronary Artery Disease Detected by Computed Tomography Angiography

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Henrique L Staniak ◽  
Wilson Filho ◽  
Marcio Miname ◽  
Isabela Benseñor ◽  
Paulo Lotufo ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Statistical Significance ◽  
Postprandial Lipemia ◽  
Tolerance Test ◽  
Abdominal Circumference ◽  
Postprandial Metabolism ◽  
Postprandial Triglycerides ◽  
Artery Disease ◽  
Over Time

Background: Postprandial triglycerides (TG) are associated with severe coronary artery disease (CAD), though the underlying mechanisms remain unclear. In this study, we have investigated the effect of clinical and laboratory parameters on the association between postprandial TG and CAD detected by coronary computed tomographic angiography (CTA). Methods: We enrolled 130 patients without previous diagnosis of CAD, (85 with CAD detected by CTA and 45 without); who underwent an oral fat tolerance test. We studied the postprandial lipemia measuring TG from time 0h, 2h, 4h and 6h to analyze the TG change over time. We used a longitudinal multivariable linear mixed effects model with the log of the TG (lnTG) as the primary outcome due to non normal distribution of TG. To evaluate the effect of the other parameters on the longitudinal changes in the TG, each variable has been individually included in the model to evaluate for changes in the lnTG over time. Results: Patients with CAD were older (56.5 ± 6.8 vs 50.4 ± 7.1 years, p<0.001), predominantly male (68.2% vs. 37.8%, p< 0.001) and had lower fasting HDL-C (49 ± 14 vs. 54 ± 12 mg/dL, p=0.015). The majority of individuals with CAD had non-obstructive atherosclerosis (65.6%). The patients with CAD had similar fasting lnTG (2.08 ± 0.20 vs. 2.02 ± 0.18, p=0.069)and increase in lnTG from 0 to 4 hours (p=0.54), but a significantly slower clearance of postprandial lnTG change from 4h to 6h (p=0.040) compared to patients without CAD. Interestingly, although age, gender, fasting glucose, and abdominal circumference did not influence those findings, after the inclusion of fasting HDL-C in the model, the change in the lnTG clearance after 4 hours did not reach statistical significance (Table 1). Conclusion: Patients with CAD had an impaired postprandial metabolism, due to a delayed TG clearance. This association was partially explained by the lower fasting HDL-C. Thus, the contribution of postprandial TG metabolism to the development of CAD, may be partially, related to the low fasting HDL-C concentrations.

scholarly journals Short Term Radiographic and Patient Outcomes of a Novel Biplanar Plating System for Hallux Valgus Correction

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0029
Author(s):  
Kshitij Manchanda ◽  
Stephen Blake Wallace ◽  
Junho Ahn ◽  
George T. Liu ◽  
Michael D. Van Pelt ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Complication Rates ◽  
Time Of Surgery ◽  
Radiographic Parameters ◽  
Valgus Angle ◽  
Patient Reported ◽  
Outcome Scores

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux valgus is a complex deformity of the great toe and is a major cause of pain for patients. Despite the variety of techniques, traditional osteotomies often do not address rotational deformities. A novel biplanar plating system was used to perform correction of metatarsal rotation at our institution starting in 2017. The purpose of this study was to determine the correction of rotational deformity and of radiographic parameters, maintenance of this correction (versus recurrence of hallux valgus), complication rates and patient-reported objective survey scores. We sought to determine prognostic factors for successful correction, including age, gender, and time of surgery. Methods: By retrospective chart review, we identified all patients treated by the novel biplanar plating at our institution. We recorded patient demographics, pre-operative range of motion and maltracking, surgical details, operative complications, and any subsequent surgery. Imaging was reviewed at pre-operative and post-operative visits to approximate the hallux valgus angle (HVA), intermetatarsal angle (IMA), and tibial sesamoid position (TSP). Outcome scores (AOFAS, FAAM, SF12 PCS and MCS) pre- operatively and post-operatively at 3 months, 6 months and 12 months were also recorded. The changes in these radiographic parameters and scores were then computed and analyzed to determine if there was an improvement with surgery. Results: Fifty-seven procedures (in 55 patients) were performed and evaluated. There were 8 complications and average follow- up time was 27.1 weeks (+13.8 weeks). Older age was significantly associated with more complications (p = 0.018). Gender and time of surgery did not show any significant association with complications. Radiographic parameters including HVA, IMA, and TSP were analyzed. At 3 and 6 months post-operatively, these parameters were significantly reduced from pre-operative values. At 12 months, there was a trend towards significant reduction (p values of 0.06, 0.06, and 0.053 respectively); however, there were fewer patients who maintained follow-up during this period. The Outcome scores showed improvement post-operatively, but only the AOFAS score showed statistical significance at 3 and 6 months. Conclusion: Although statistical analysis was limited due to our population size and the retrospective nature of the study, there was an overall improvement in both radiographic parameters and clinical outcome scores. Older patients are also at higher risk of complications. Malrotation correction with this biplanar plating system is a novel technique and does require meticulous training. With continued expansion of our patient database and further longitudinal analysis, we hope to determine not only if correction is maintained over time, but also if the steepness of the learning curve affects the number of complications earlier versus later in each individual surgeon’s experience.

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