Precision and reliability of tape measurements in the assessment of head and neck lymphedema.

OBJECTIVES: Tape measurement is a commonly used method in the clinical assessment of lymphedema. However, few studies have assessed the precision and reliability of tape measurement in assessing head and neck lymphedema. This study aimed to evaluate the reliability and precision of using tape measurement, performed by different evaluators, for the assessment of head and neck lymphedema. METHODS: This study was conducted at a tertiary care cancer hospital. Between January and December 2019, 50 patients with head and neck cancers and 50 normal subjects were enrolled. Each subject was examined using tape measurements for 7 point-to-point distances of facial landmarks, 3 circumferences of the neck (upper, middle, and lower), and 2 circumferences of the face (vertical and oblique) by 3 random examiners. Test precision and reliability were assessed with the within-subject standard deviation (Sw) and intra-class correlation coefficient (ICC), respectively. RESULTS: Overall, the standard deviation of the tape measurements varied in the range of 4.6 mm to 18.3 mm. The measurement of distance between the tragus and mouth angle (Sw: 4.6 mm) yielded the highest precision, but the reliability (ICC: 0.66) was moderate. The reliabilities of neck circumference measurements (ICC: 0.90-0.95) were good to excellent, but the precisions (Sw: 8.3-12.3 mm) were lower than those of point-to-point facial measurements (Sw: 4.6-8.8 mm). CONCLUSIONS: The different methods of tape measurements varied in precision and reliability. Thus, clinicians should not rely on a single measurement when evaluating head and neck lymphedema.

Evaluating the responsiveness of the fullerton advanced balance scale in patients with lymphedema secondary to breast cancer surgery.

Lymphedema following surgical treatment for breast cancer can impair balance and predispose patients to falling. Fullerton Advanced Balance (FAB) Scale is a reliable and valid tool which can identify persons with different balance levels, but its responsiveness has not been investigated in patients with lymphedema secondary to breast surgery. Thirty women with stage 2 lymphedema secondary to breast cancer treatment received complex decongestive therapy (CDT) for 2 weeks as a routine treatment method. They were evaluated with FAB Scale and Timed Up and Go Test (TUGT), volumetric measurements and circumferential measurements of the upper limbs before and after CDT. A moderate change was found in FAB score after CDT (Cohen's effect size = 0.65). For FAB, the computed standard error of the mean was 0.85 and minimal detectable change was 2.33. Significant improvement in FAB score and TUGT results, and significant reductions in circumferential and volumetric measurements were seen after 2 weeks of CDT. The FAB score change showed a moderate correlation with circumference change and volumetric change (r = -0.41) but a very weak correlation with TUGT change (r = -0.1). The FAB Scale showed acceptable responsiveness in detecting treatment effects in patients with unilateral secondary lymphedema after breast cancer treatment.

Defining Weight Loss After Bariatric Surgery: a Call for Standardization.

BACKGROUND: Some weight regain is expected after bariatric surgery; however, this concept is not well defined. A favorable weight loss response has commonly been defined as 50% excess weight loss (EWL). The medical literature uses %total weight loss (%TWL), which has recently been adopted in some surgical literature. OBJECTIVE: To demonstrate variability in bariatric surgery outcomes based on the definition applied and propose a standardized definition. METHODS: A retrospective review of patients who underwent bariatric surgery from 2001 to 2016 with ≥ 1 year follow-up was completed. Several previously proposed definitions of weight regain were analyzed. RESULTS: One thousand five hundred seventy-four patients met inclusion criteria. Preoperative mean body mass index (BMI) was 47.6 ± 6.4 kg/m2. Increased preoperative BMI was associated with increased mean %TWL at 2 years postoperative (29.3 ± 9.1% for BMI < 40, vs. 37.5 ± 9.5% for BMI > 60; P < 0.001). Based on %EWL, 93% of patients experienced ≥ 50% EWL by 1-2 years, and 61.8% maintained ≥ 50% EWL through the 10-year follow-up period. Similarly, 97% experienced ≥ 20% TWL by 1-2 years and 70.3% maintained ≥ 20% TWL through the 10-year follow-up period. Over 50% of patients maintained their weight based on several proposed definitions through 5 years follow-up. CONCLUSIONS: A high percentage (> 90%) of patients achieve ≥ 20% TWL and ≥ 50% EWL. Increased preoperative BMI was associated with increased %TWL and decreased %EWL at 2 years postoperative. The incidence of weight regain varies depending on the definition. We propose a standardized definition for identifying good responders following bariatric surgery to be ≥ 20% TWL, as this measure is least influenced by preoperative BMI.

BK 2108 - The Calculation of the Normalized Relative Lumbar Disc Height. / BK 2108 ­ Die Berechnung der normierten relativen lumbalen Bandscheibenhöhe.

The assessment of the medical conditions (liability-compliant causality) of the BK 2108 is a frequent assessment, which poses a challenge to the medical expert in orthopaedics and trauma surgery. In assessing the load-consistent damage pattern, defined changes in the intervertebral discs as well as the adjacent vertebral bodies must be comprehended in a standardised manner. Of several technical measuring methods, three practicable methods are discussed and their application explained. Thus, methods are provided which allow the medical expert to calculate the normalised relative disc height. In this way, the specifications of the consensus recommendations can be met in order to define the damage profile.

Validity of multi-frequency bioelectric impedance methods to measure body composition in obese patients: a systematic review.

OBJECTIVE: Excessive lean tissue loss following bariatric surgery may pose serious metabolic consequences. Accurate methods to assess body composition following bariatric surgery are required. This review aimed to investigate if multi-frequency bioelectric impedance (MF-BI) is a valid tool to determine body composition in obese patients. METHODS: MEDLINE, EMBASE, CINAHL and CENTRAL databases were searched until March 2017. Included studies were published in English with obese (body mass index (BMI) ≥ 30 kg/m2) adults measuring body composition with MF-BI methods in comparison with reference methods. Exclusions were pregnancy, animal studies, non-English language studies, single frequency BI. A total of 6395 studies were retrieved. RESULTS: Sixteen studies were eligible for inclusion. Sample sizes ranged from 15 to 157, with BMI 26-48 kg/m2. MF-BI underestimated fat mass (FM) in 11 studies and overestimated fat-free mass (FFM) in nine studies in comparison with reference methods. Correlations of absolute values from MF-BI and reference methods for FM and FFM were high, however, agreement was lower at an individual level. When adjustments for BMI were made to machine algorithms, measurement accuracy improved. Significant heterogeneity was evident among included studies. CONCLUSIONS: This review found that MF-BI is reliable for use at a group level. Obese-specific adjustment of algorithms for MF-BI machines increases the accuracy of absolute measures of body composition in obese individuals, improving their utility in the clinical setting. Multiple variables contributed a lack of consistency among studies included, highlighting the need for more robust studies that control confounding variables to establish clear validity assessment.

Adductor Pollicis Muscle Thickness for nutritional assessment: a systematic review / Espesura del Músculo Aductor del Pulgar para evaluación nutricional: una revisión sistemática / Espessura do Músculo Adutor do Polegar para avaliação nutricional: uma revisão sistemática

ABSTRACT Objective: The aim of this study is to systematically review the scientific findings about the efficacy of the measure of the Adductor Pollicis Muscle Thickness for nutritional assessment of individuals in various clinical conditions. Method: Systematic review study performed according to the methodology Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: 13 original articles published between 2004 and 2016 were included. The measure was associated/correlated to parameters of nutritional status (such as weight, body mass index and Global Subjective Assessment) and muscle mass markers (such as circumference brachial muscle circumference, brachial muscle area, calf circumference, and muscle mass). All these correlations were weak or moderate. Conclusion: The measurement can be used in different populations, being able to estimate nutritional status and muscle mass. However, it is suggested that it be used in a complementary way to the nutritional evaluation, not constituting a single diagnostic/monitoring parameter.

RESUMEN Objetivo: Revisar de forma sistemática las constataciones científicas acerca de la eficacia de la medida de la Espesura del Músculo Aductor del Pulgar para evaluación nutricional de los individuos bajo diversas condiciones clínicas. Método: Estudio de revisión sistemática, realizado conforme la metodología Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: Se incluyeron 13 artículos originales publicados entre 2004 y 2016. La medida se presentó asociada/correlacionada a los parámetros de evaluación del estado nutricional (peso, índice de masa corporal y Evaluación Subjetiva Global) y a los marcadores de masa muscular (como circunferencia braquial, circunferencia muscular braquial, área muscular braquial, circunferencia de la pantorrilla y masa muscular). Todas estas correlaciones fueron débiles o moderadas. Conclusión: La medida puede ser utilizada en diferentes poblaciones, siendo capaz de estimar el estado nutricional y la masa muscular. Sin embargo, se sugiere que se emplee de forma complementaria la evaluación nutricional, no constituyendo un parámetro único de diagnóstico/monitoreo.

RESUMO Objetivo: Revisar de forma sistemática as constatações científicas acerca da eficácia da medida da Espessura do Músculo Adutor do Polegar para avaliação nutricional de indivíduos em diversas condições clínicas. Método: Estudo de revisão sistemática, realizado conforme a metodologia PreferredReportingItems for SystematicReviewsand Meta-Analyses (PRISMA). Resultados: Foram incluídos 13 artigos originais publicados entre 2004 e 2016. A medida apresentou-se associada/correlacionada aos parâmetros de avaliação do estado nutricional (como peso, índice de massa corporal e Avaliação Subjetiva Global) e aos marcadores da massa muscular (como circunferência braquial, circunferência muscular braquial, área muscular braquial, circunferência da panturrilha e massa muscular). Todas essas correlações foram fracas ou moderadas. Conclusão: A medida pode ser utilizada em diferentes populações, sendo capaz de estimar o estado nutricional e a massa muscular. No entanto, sugere-se que seja empregada de modo complementar à avaliação nutricional, não constituindo um parâmetro único de diagnóstico/monitoramento.

Prevalence of Different Types of Apical Root Canal Morphology and their Treatment Recommendations in an Institute.

INTRODUCTION: Canals can be of different shapes in cross section including round canals, oval canals, long oval canals or ribbon shaped canals. Recesses of nonround canals may not be included in the round preparation created by rotary instruments and thus they remain unprepared. The aim of this study included determination of shape and taper of the apical root canal based on diameter at different levels. Measurement of the diameter of the root canal at one, two and three mm cross sections from the apex of the tooth were done such that apical instrumentation in root canal treatment could be modified based on the results obtained. METHODS: This was a cross sectional study which used convenient sampling technique to determine the sample size. Seventy extracted teeth were sectioned horizontally at one, two and three millimeter from the apex using the diamond disc which was observed under trinocular research microscope for the determination of diameter of root canal under 10x magnification. Digital images of the sections were taken by a camera attached to the research microscope and analysis done using DigiPro 4.0 software. RESULTS: The most common canal configuration was oval. The taper of the canals was 25% in mesial root and 20% in distal in bucco-lingual orientation and 14% in mesial root and 15% in distal in mesio-distal orientation. CONCLUSIONS: The most prevalent canal configuration in this study was non round, however, most of the rotary instruments tend to prepare root canals into round shape making their use questionable. The taper of the root canals was found to be higher in our study than what most of the shaping instruments have to offer. So it would be advisable to consider this fact while selecting instruments and preparing these non-round canals as far as the Nepalese subpopulation is considered.

[Pelvimetrics measures as predictives factors of positives surgical margins after robot-assisted laparoscopic prostatectomy]. / Mesures pelvimétriques prédictives de marges chirurgicales au décours d'une prostatectomie totale robot-assitée pour cancer prostatique.

INTRODUCTION: Anthropometric data report that pelvic bone of African subjects are narrower and the pelvic cavity is deeper. The aim of the study was to evaluate the influence of pelvic dimensions (PD) on Positive surgical margins (PSM) rate in Afro-Caribbean population after robot-assisted laparoscopic prostatectomy (RALP). PATIENTS AND METHODS: Preoperative pelvic MRI of all patients who have had RALP at the University Hospital Center of Guadeloupe between January 2013 and December 2015 was retrospectively analyzed. PD, including the Height of the upper edge of the prostate (HP), the Apical Depth (AD) and Ischial Spines Distance (ISD), and indexes (prostate volumetric index [ISD/VP], apical depth index [ISD/AD] and prostate depth index [ISD/(AD/HP)]) were compared according to the presence or absence of PSM with uni and multivariate analysis. RESULTS: One hundred and seventy-eight patients were included in the study, of whom 60 (33.7%) presented PSM. In univariate analysis, significant differences between the presence or absence of PSM were observed on the AD (30.3±8.7mm versus 24.8±8.0mm, P<0.001), the HP (9.5±8.5mm versus 16.8±11.9mm, P<0.001) and the ISD (89.6±8.8mm versus 96.1±8.4mm) as well as the indexes of apical depth and prostatic depth. In multivariate logistic regression, the ISD (P<0.001) and HP (P=0.02) were associated with increased likelihood of PSM, but not AD or indexes. CONCLUSION: This study suggests that interspinous distance is the best predictor of PSM during RALP in Afro-Caribbean patients. This measure may be useful to define the therapeutic pattern of patients with prostate cancer. A prospective study with a larger population, comparing RALP in Afro-Caribbean and in caucasians patients, would be needed.

Measuring Cutaneous Lesions: Trends in Clinical Practice.

BACKGROUND: Knowing the size of a cutaneous lesion can be important for tracking its progression over time, selecting the proper treatment modality, surgical planning, determining prognosis, and accurate billing. However, providers vary in their consistency, accuracy, and methods of measuring cutaneous lesions. OBJECTIVE: To investigate the clinical practices of US dermatologists and dermatologic surgeons regarding how they determine the size of cutaneous lesions. MATERIALS AND METHODS: A survey was electronically distributed to members of the American Society for Dermatologic Surgery. RESULTS: Four hundred twenty-six dermatologists completed the online survey. When a lesion is suspected to be malignant, 85% of respondents obtained exact measurements most, if not all, of the time; however, only 8% did for benign lesions. Most providers determined lesion sizes themselves rather than delegating to staff. When performing visual estimation, approximately three-quarters believed that they were accurate to within 1 to 2 mm. The top reasons for obtaining exact measurements were for tracking atypical pigmented lesions, determining treatment pathways, and accurate billing. CONCLUSION: The majority of respondents believed that lesion size affected management decisions; however, the need for exact measurement remains controversial, particularly for benign lesions. Future studies may investigate whether taking exact versus estimated measurements has an effect on outcomes.

Glycemic control after metabolic surgery: a Granger causality and graph analysis.

The purpose of this study was to examine the contribution of nonesterified fatty acids (NEFA) and incretin to insulin resistance and diabetes amelioration after malabsorptive metabolic surgery that induces steatorrhea. In fact, NEFA infusion reduces glucose-stimulated insulin secretion, and high-fat diets predict diabetes development. Six healthy controls, 11 obese subjects, and 10 type 2 diabetic (T2D) subjects were studied before and 1 mo after biliopancreatic diversion (BPD). Twenty-four-hour plasma glucose, NEFA, insulin, C-peptide, glucagon-like peptide-1 (GLP-1), and gastric inhibitory polypeptide (GIP) time courses were obtained and analyzed by Granger causality and graph analyses. Insulin sensitivity and secretion were computed by the oral glucose minimal model. Before metabolic surgery, NEFA levels had the strongest influence on the other variables in both obese and T2D subjects. After surgery, GLP-1 and C-peptide levels controlled the system in obese and T2D subjects. Twenty-four-hour GIP levels were markedly reduced after BPD. Finally, not only did GLP-1 levels play a central role, but also insulin and C-peptide levels had a comparable relevance in the network of healthy controls. After BPD, insulin sensitivity was completely normalized in both obese and T2D individuals. Increased 24-h GLP-1 circulating levels positively influenced glucose homeostasis in both obese and T2D subjects who underwent a malabsorptive bariatric operation. In the latter, the reduction of plasma GIP levels also contributed to the improvement of glucose metabolism. It is possible that the combination of a pharmaceutical treatment reducing GIP and increasing GLP-1 plasma levels will contribute to better glycemic control in T2D. The application of Granger causality and graph analyses sheds new light on the pathophysiology of metabolic surgery.

[Localization of gestational age reference table and its application in prenatal screening].

Objective: To establish a fetal biparietal diameter (BPD)-gestational age formula based on the data of pregnant women from Xiaoshan District of Hangzhou, and to evaluate its application in prenatal screening. Methods: Data of 3500 pregnant women with gestational age between 15 weeks and 19 weeks+6 receiving prenatal screening in Xiaoshan Hospital during May 2014 and May 2015 were collected. BPDs were used to establish a localized BPD-gestational age formula. The localized formula was used to evaluate the prenatal screening risks in 1759 pregnant women with irregular menstrual cycles or uncertain last menstrual period (LMP) in Xiaoshan District, and the results were compared with those calculated using formula in LifeCycle 4.0. Results: With localized formula, the total positive rate of Down syndrome, trisomy 18 syndrome and deformity of neural tube was decreased from 6.96% to 5.85% ( P<0.05), in which the positive rate of Down syndrome decreased ( P<0.05), that of deformity of neural tube increased ( P<0.05), and that of trisomy 18 syndrome remained the same ( P>0.05). The median MoMs of free-hCG ß and α-fetoprotein calculated using localized formula were significantly different from those calculated using the formula in LifeCycle 4.0 (all P<0.05), and the former ones were more closer to 1. For women of fetus diagnosed with the above diseases, the positive rate calculated using localized formula was almost the same as that calculated using the formula in LifeCycle 4.0. Conclusion: BPD-gestational age formula should be localized based on the statistical analysis of the local population, which will help to reduce the false positive rate, and make the results more accurate and reliable in prenatal screening.

Abdominal Aortic Aneurysm Diameters: A Study on the Discrepancy between Inner to Inner and Outer to Outer Measurements.

INTRODUCTION: The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) uses the maximal anterior to posterior (AP) inner-to-inner (ITI) wall diameter in sizing aortic dimensions when screening with ultrasound. It is recognised that ITI measurements are smaller than outer-to-outer (OTO) measurements, and the primary aim was to calculate the absolute difference in AP ITI and OTO measurements across varying aortic diameters. The secondary aim was to estimate the potential number of patients lost from the screening programme. METHODS: Since April 2012, patients outside the screening programme that undergo ultrasound of abdominal aortas have their ITI and OTO measurements recorded. These measurements were compared retrospectively and analysed for variability at threshold sizes of AAAs. RESULTS: From May 2012 to October 2013, 452 abdominal aortic ultransound scans recorded both ITI and OTO measurements. The majority (81%) were performed on men with the mean age of 78 years. The mean difference between ITI and OTO measurements was 4.21 mm (p < .001). There was no difference between the genders. Thresholds were created for analysis between different ITI and OTO aortic diameters; these were <3 cm, 3.1-4 cm, 4.1-5 cm, and >5 cm. There was no significant difference between the means at each threshold size for ITI diameter (p = .758). In the first 2 years from April 2012, 15,447 men underwent screening.Of these, 177 (1.14%) had sub-threshold ITI aortic diameters between 2.6 cm and 2.9 cm. This would upscale to 5,316 men nationally. CONCLUSION: We have demonstrated a consistent and significant 4mm difference between ITI and OTO diameters in live scanning. Lowering the threshold for entry into a surveillance AAAs to an ITI diameter of 26mm rather than the current 30 mm is advocated. An alternative cost-effective way is to rescreen this small sub-group at 5 or 7 years.

Variability of Origin of Splanchnic and Renal Vessels From the Thoracoabdominal Aorta.

OBJECTIVE: To analyze the variability of origin of the celiac trunk (CT), the superior mesenteric artery (SMA), the right renal artery (RRA), and the left renal artery (LRA) in terms of mutual distances, angle from the sagittal aortic axis (clock position), and ostial diameters on computed tomography angiographies (CTAs) in three groups of patients. METHODS: One hundred and fifty CTAs of 50 patients with a non-dilated thoracoabdominal aorta (group A), 50 with thoracoabdominal aneurysm (B), and 50 with infrarenal aneurysm (C) were reviewed. The measurements performed on CTAs, as well as the patients' age, sex, and body surface area, were analyzed. p values <.05 were considered statistically significant. RESULTS: The clock position of the CT and the SMA, the diameters of all vessels, and the distance of the CTeSMA followed a Gaussian distribution. In contrast, the clock position of the renal vessels did not follow a normal distribution, and nor did the distances of the SMA-RRA, SMA-LRA, RRA-LRA or the distances between the renal arteries and the aortic bifurcation. The same values did not differ significantly among the three groups, with the exception of the distances between the renal arteries and the aortic bifurcation, significantly greater in group C. The clock position of the LRA and the distances of the SMA-LRA, SMA-RRA, RRA-LRA and between both renal arteries and the aortic bifurcation showed a significant correlation with the increase of aortic diameter. CONCLUSION: The anatomic variability of the origin of both the CT and the SMA in terms of clock position and mutual distances followed a Gaussian distribution, regardless of group. The same applies to the ostial diameters of renal and visceral vessels. In contrast, the origin of the renal vessels had a statistically significant heterogeneity that seemed to be correlated with the increase of aortic diameter in the mesenteric and renal aortic region.

Validity of soft-tissue thickness of calf measured using MRI for assessing unilateral lower extremity lymphoedema secondary to cervical and endometrial cancer treatments.

AIM: To determine whether soft-tissue thickness of the calf measured using MRI could be valid for assessing unilateral lower extremity lymphoedema (LEL) secondary to cervical and endometrial cancer treatments. MATERIALS AND METHODS: Seventy women with unilateral LEL and 25 without LEL after cervical or endometrial cancer treatments underwent MRI examinations of their calves. Total thickness of soft-tissue (TT), muscle thickness (MT), and subcutaneous tissue thickness (STT) of the calf, and the difference between the affected and contralateral unaffected calf regarding TT (DTT), MT (DMT), and STT (DSTT) were obtained using fat-suppressed T2-weighted imaging in the middle of the calves. The volume of the calf and difference in volume (DV) between calves were obtained by the method of water displacement. Statistical analysis was performed to determine the validity of MRI measurements by volume measurements in staging LEL. RESULTS: There was a close correlation between volume and TT for the affected (r = 0.927) or unaffected calves (r = 0.896). STT of the affected calf, and DTT or DSTT of the calves were closely correlated with volume of the affected calf or DV of the calves (all p < 0.05). Multivariate analysis showed significant differences in TT, STT, volume of the affected calf, DTT, DSTT, and DV between stages except in volume of the affected calf or in DV between stage 0 and 1. For staging LEL, DSTT showed the best discrimination ability among all the parameters. CONCLUSIONS: Soft-tissue thickness of the calf measured at MRI could be valid for quantitatively staging unilateral LEL, and DSTT of the calves could be the best classifying factor.

[Screening and diagnosis of small for gestational age fetuses]. / Modalités de dépistage et de diagnostic du fœtus petit pour l'âge gestationnel.

OBJECTIVE: Define the mode of screening and diagnosis of fetal small for gestational age (SGA). METHODS: Bibliographic research by consulting Pubmed database and guidelines of the international professional societies. Keywords used: Intra uterine growth retardation or restriction, small for gestational age, curve, chart, fetal biometry, screening, velocity, fundal height measurement. RESULTS: The performance of ultrasound to detect SGA is low. The mode of screening and diagnosis of SGA must be well defined to be consensual. The fundal height measurement keeps its place in the screening from 22SA (grade C). The criteria for measuring ultrasound parameters defined by the comité technique d'échographie are recommended (professional agreement). They allow the calculation of the estimated fetal weight (EFW). That must be transferred to the reference curve adopted (professional agreement). The introduction of audit on techniques for measuring ultrasound parameters should be encouraged (grade B). CONCLUSION: Fetal biometry must be interpreted according to the clinical context and ultrasound including Doppler (grade C). To improve the performance of ultrasound, there is no need to another ultrasound examination in late pregnancy (grade A) except after a clinical suspicion (grade C). The minimum interval between two biometric tests is 3 weeks (grade B). This interval may be lower if the EFW is important in the decision of any fetal extraction (professional consensus).

Reporting weight change: standardized reporting accounting for baseline weight.

BACKGROUND: Although it is recognized that a standardized approach to reporting weight change is essential to meaningful comparisons among cohorts and across studies, consensus is lacking. This study aimed to propose a method of reporting weight change that would allow meaningful comparisons among studies of patients who underwent bariatric surgery and to demonstrate its utility using an example from the Longitudinal Assessment of Bariatric Surgery (LABS). METHODS: Relationships among several measures of weight change are described. Results from an observational, longitudinal cohort study of adults undergoing bariatric surgery and from simulation studies are used to illustrate the proposed method. RESULTS: Baseline weight is a critical parameter when assessing weight change. Men undergoing a bariatric procedure other than gastric bypass or adjustable band tended to have greater weight loss 12 months after surgery than men undergoing gastric bypass when not accounting for baseline weight, but the opposite was found when results were adjusted for baseline weight. Simulation results show that with relatively modest sample sizes, the adjusted weight loss was significantly different between the 2 groups of men. CONCLUSION: A consistent metric for reporting weight loss after bariatric surgery is essential to interpret outcomes across studies and among subgroups. The baseline weight adjusted percent of weight loss (A%WL) uses a standard population (e.g., the LABS cohort) to account for differences between cohorts with respect to baseline weight, and its use can change the interpretation of results compared with an unadjusted measure.

Anthropometric indices of central obesity how discriminators of metabolic syndrome in Brazilian women with polycystic ovary syndrome.

BACKGROUND: Central obesity is highly prevalent in women with polycystic ovary syndrome (PCOS) and is strongly associated with metabolic syndrome (MetS). OBJECTIVES: To define cut-off points of waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and conicity index (C-Index) to discriminate metabolic syndrome (MetS) in Brazilian women with PCOS. METHODS: In a cross-sectional study, anthropometric, biochemical and clinical parameters were measured in 113 Brazilian PCOS women (27.2 ± 4.5 years). Receiver operating characteristic (ROC) analysis was used to find out the cut-off points of anthropometric indices to predict MetS according with National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria. RESULTS: Considering the ROC curve analysis the WC and WHtR had a similar performance in predicting MetS and these parameters were better than WHR and C-Index. The optimal cut-off values of the anthropometric indices for discriminate MetS were: WC = 95 cm; WHtR = 0.59; WHR = 0.88; and C-Index = 1.25. By using these cut-off points the sensitivity and specificity rates of WC and WHtR were higher than those observed for WHR and C-Index. CONCLUSION: Our results indicated that WC and WHtR are more accurate than WHR and C-Index to predict MetS in Brazilian PCOS women.

Development and validation of a new method for the radiologic measurement of the tibial slope.

PURPOSE: The posterior tibial slope has a huge influence on the kinematics of the knee. In several orthopedic interventions such as high tibial osteotomy and unicondylar or bicondylar knee replacement changing, the tibial slope can result in altered knee mechanics. Therefore, an exact preoperative measurement of the posterior tibial slope is mandatory. Several methods are used on conventional radiographs and CT scans, but until now there is no standard validated method. The aim of this study was to compare several methods and imaging techniques to measure the posterior tibial slope and to establish a standard and reliable measurement method by radiography. METHODS: Fourteen knees (seven cadavers) were scanned by a 64-slice CT, a 3T-MRI, and true lateral radiographs were performed. The anatomical references (TPAA = tibial proximal anatomical axis; ATC = anterior tibial cortex; PTC = posterior tibial cortex) and the new computed reference (MPA = mean of PTA and ATC) were compared by short as well as long radiographs, CT scan and MRI. The influence of a malrotation in radiographs of the knees was also analyzed. RESULTS: CT scan and MRI are suitable for the measurement of the medial and lateral posterior tibial slopes, the results of the radiographs varied depending on the method used. The new method (MPA) showed the best correlation to the CT scan (r = 0.997), even on short radiographs (10 cm distal the joint line). CONCLUSION: The measurement of the posterior tibial slope on a short lateral radiograph using the MPA is a reliable method and should be established as a standard. LEVEL OF EVIDENCE: Diagnostic study, Level II.

Race- and sex-specific associations of obesity measures with ischemic stroke incidence in the Atherosclerosis Risk in Communities (ARIC) study.

BACKGROUND AND PURPOSE: Studies have suggested differences in the association between obesity and ischemic stroke in black versus white populations. In this study, we explored ischemic stroke risk in relation to a variety of obesity measures by sex and race. METHODS: Using data from the Atherosclerosis Risk in Communities Study, we obtained information on body mass index, waist circumference, and waist-to-hip ratio from 13 549 black and white participants who were aged 45 to 65 years between 1987 and 1989. All were free of cardiovascular disease and cancer at baseline. Incident strokes over a median follow-up of 16.9 years were ascertained from hospital records. RESULTS: Although crude incidence rates of ischemic stroke varied more than 3-fold by race and sex, the relationship between higher measures of obesity and ischemic stroke risk was positive and linear across all groups. The crude incidence of ischemic stroke was 1.2 per 1000 person-years for white women with the lowest body mass index, ranging up to 8.0 per 1000 person-years for black men with the highest body mass index. Hazard ratios for the highest versus lowest quintile of body mass index, waist circumference, and waist-to-hip ratio ranged from 1.43 to 3.19, indicating increased stroke risk associated with obesity, however it was measured, even after adjustment for potential confounders. Additional adjustment for factors that may mediate the relationship, such as diabetes and hypertension, significantly attenuated the associations, suggesting that these factors may explain much of the stroke risk associated with obesity. CONCLUSIONS: Degree of obesity, defined by body mass index, waist circumference, or waist-to-hip ratio, was a significant risk factor for ischemic stroke regardless of sex or race.

Proposta de pontos de corte para indicação da obesidade abdominal entre adolescentes / Proposal of cut points for the indication of abdominal obesity among adolescents / Propuesta de puntos de corte para indicación de la obesidad abdominal entre adolescentes

Fundamento: A ausência de valores críticos para a identificação de risco cardiovascular entre adolescentes brasileiros representa uma importante limitação. Objetivos: Elaborar valores críticos para circunferência de cintura e analisar sua eficiência na indicação de valores elevados de pressão arterial. Métodos: Estudo transversal que avaliou 1.145 adolescentes de 11 a 17 anos (536 do sexo masculino e 609 do feminino), dos quais foram coletados valores de peso corporal, estatura, resistência, reatância, dobra cutânea tricepital, circunferência de cintura e pressão arterial (n= 334). A obesidade abdominal foi indicada por meio de valores de circunferência de cintura. Resultados: Os adolescentes obesos apresentaram valores mais altos de circunferência de cintura e, independentemente de gênero e grupo etário, houve relação significativa entre os valores de circunferência de cintura e todos os indicadores de adiposidade adotados no estudo. Os valores críticos propostos apresentaram maior sensibilidade na indicação de valores elevados de pressão arterial. Conclusões: Os valores críticos propostos para circunferência de cintura foram mais sensíveis na indicação de valores elevados de pressão arterial. Entretanto, ainda são necessários estudos para averiguar a eficiência dos mesmos na indicação de outros parâmetros clínicos e laboratoriais.

Background: The absence of critical values for the cardiovascular risk identification among Brazilian adolescents represents an important limitation. Objectives: To prepare critical values for the waist circumference and to analyze its efficiency in indicating increased values of the arterial pressure. Methods: Transversal study that evaluated 1,145 adolescents, from 11 to 17 years old (536 of the male sex and 609 of the female), their body weight values, stature, resistance, reactance, tricipital cutaneous fold, waist circumference and arterial pressure (n = 334) were collected. The abdominal obesity was indicated by waist circumference values. Results: The obese adolescents presented higher waist circumference values and, independently of the gender and age group, there was a significant relation between the waist circumference values and all the adiposity indicators adopted in the study. The proposed critical values presented higher sensibility in indicating increased values of the arterial pressure. Conclusions: The critical values proposed for the waist circumference were more sensitive in the indication of increased values of the blood pressure. However, other studies to investigate their efficacy in the indication of other clinical and laboratorial parameters are still needed.

Fundamento: La ausencia de valores críticos para la identificación de riesgo cardiovascular entre adolescentes brasileños representa una importante limitación. Objetivos: Elaborar valores críticos para el perímetro de cintura y analizar su eficiencia en la indicación de valores elevados de presión arterial. Métodos: Estudio transversal que evaluó a 1145 adolescentes de 11 a 17 años (536 de sexo masculino y 609 de femenino), de quienes se recolectaron valores de peso corporal, estatura, resistencia, reactancia, pliegue cutáneo tricipital, circunferencia de cintura y presión arterial (n= 334). La obesidad abdominal fue indicada mediante los valores de perímetro de cintura. Resultados: Los adolescentes obesos presentaron valores más altos de circunferencia de cintura e, independientemente de género y grupo etario, se observó una relación significativa entre los valores de circunferencia de cintura y todos los indicadores de adiposidad adoptados en el estudio. Los valores críticos propuestos presentaron mayor sensibilidad en la indicación de valores elevados de presión arterial. Conclusiones: Los valores críticos propuestos para la circunferencia de cintura fueron más sensibles en la indicación de valores elevados de presión arterial. No obstante, se requieren aún estudios que permitan averiguar la eficiencia de los mismos en la indicación de otros parámetros clínicos y de laboratorio.