Abstract The diameter (mPAD) of the main pulmonary artery (pulmonary artery trunk) is a crucial indicator for cardiovascular health and prognoses in various conditions. Its enlargement is associated ...with increased mortality and severity in COVID‐19‐related pneumonia. However, its relevance to non‐COVID pneumonia remains uncertain. The aim of this study was to establish an association between mPAD and the severity of non‐COVID pneumonia. Eligible participants with qualified Chest Computed Tomography scans from November 2019 to February 2023 were recruited to a cross‐sectional retrospective study. They were stratified into pneumonia and non‐pneumonia cohorts. Exclusion criteria included pulmonary hypertension, polytrauma, lung neoplasia, or a history of pulmonary stenosis repair. The mPAD was measured in both groups, and medical records were reviewed to identify comorbidities. Pulmonary CT data were classified by pattern and severity, and the mPAD was measured perpendicularly to the long axis of the artery at the point of bifurcation on an axial slice. Analysis of 380 CT scans (52.6% men, 47.4% women; mean age 52.88 ± 17.58) revealed a significant difference in mPAD between pneumonia and non‐pneumonia cases (mean difference: 1.19 mm, 95% CI 0.46, 1.92, p = 0.001). Age correlated positively with mPAD ( r = 0.231, 95% CI 0.028, 0.069, p < 0.0001), and this correlation persisted after adjusting for confounders ( r = 0.220, 95% CI 0.019, 0.073, p = 0.001). Ordinal logistic regression indicated 1.28 times higher odds of severe pneumonia with a larger diameter. The study highlights associations between mPAD, pneumonia, and severity, suggesting clinical relevance. Furthermore, the mPAD should be carefully considered in defining severity criteria for adverse outcomes in pneumonia patients. Further research is needed to refine clinical criteria on the basis of these findings.
Acquisition of Basic Surgical Skills (BSS) are essential for medical students. The objective was to determine it's fidelity impact.
Using four suturing models (SM) (pigskin, sponge, commercial pad, ...and orange), SM-quality and student-SM interaction were evaluated. After a 1-h class, participants were divided into groups and randomly assigned exercises in SM in 15-min intervals. The experiment included completing three individual simple stitches and a 3-stitch continuous suture in each SM.
Eighty-two medical students participated. Suturing quality was better in pigskin and sponge, which were also the preferred models (p < 0.001). Significant differences in quality between the insertion and exit point, and firmness of knots (p < 0.05) in both simple and continuous sutures, as well as between length and distance in continuous ones (p < 0.001) were identified.
Acquisition and quality of BSS are influenced by the intrinsic characteristics of SM. An adequate degree of resistance, consistency, and elasticity are necessary.
Transpedicular spinal fusion is the most commonly used fixation technique for the surgical treatment of vertebral disorders. However, the instrumentation of the thoracic spine using this technique ...continues to be controversial. The objective of the present study was to determine the morphometric characteristics of the thoracic pedicle and to establish how these characteristics vary with gender and age. Two hundred thoracic spines (4800 thoracic pedicles) from individuals of known gender and age were analyzed (in accordance with the order of vertebrae). The spines were divided into six groups according to age and gender. The horizontal and vertical diameters of the thoracic pedicle were determined for each piece. The mean and standard deviation of each variable were determined, and differences between age groups for each gender were evaluated using parametric correlation tests. The pedicle diameters of men and women differed significantly for most groups (P < 0.05). The horizontal diameters decreased from T1 to T5 and increased up to T12. The vertical diameter followed a cephalocaudal pattern of development from T1-T12. The pedicle diameters decreased with increasing age in women, while the opposite trend was observed in men. In men, the dimensions of the thoracic spine pedicle increase with increasing age; in women, they decrease. These differences should be taken into account when selecting the appropriate pedicle screw.
To determine viable anatomical landmarks allowing for accurate femoral and tibial tunnel placement in anatomical position during posterior cruciate ligament (PCL) reconstruction. Ten knees were ...dissected to analyze femoral and tibial PCL insertion measurements and the features specific to the PCL and its fascicles. The clock hands system was used to measure femoral insertions. The meniscus and anterior cruciate ligament (ACL) were used as landmarks to measure tibial insertions. The PCL and its corresponding fascicle characteristics were determined by its femoral insertion, central portion and tibial insertion. The mean lengths between the central point of the PCL footprint and the articular cartilage border at 12:00 h were 17.23 mm (±3.94) and 17.73 mm (±4.11) for the right and left knees, respectively. The anterior-posterior mean lengths for the PCL were 11.94 mm (±5.08) between the posterior PCL border and the anterior PCL border. The mean lengths were 33.52 mm (±3.49) from the medial border of the lateral meniscus to the lateral PCL border and 32.24 mm (±2.28) from the medial border of the medial meniscus to the medial PCL border. From the anteroposterior viewpoint, the anterolateral fascicle is greater than the posteromedial one in its femoral and tibial insertions and in its central portion. A quantitative data collection summary was conducted with different PCL variables, along with its fascicles and their various femoral and tibial bony landmarks. Various measurements were obtained, indicating the high functionality shared by the PCL fascicles. Lengths reported for insertions are practical landmarks for the locations of femoral and tibial tunnels during posterior cruciate ligament plasty. We must take into account native PCL form to avoid oversizing the graft during reconstruction and to avoid a possible clamping of the graft with the surrounding structures.
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Introduction
The rectovaginal septum (RVS) is a layer of dense fibro‐connective tissue, smooth muscle, and elastic and collagen fibers containing a neurovascular bundle of the inferior ...hypogastric plexus, providing support, innervation, and irrigation. It allows for mobility between the rectum and vagina and helps in limiting the spread of infections or tumors, as well as a guide for several types of surgeries. Any damage may predispose to rectocele, enterocele, fistula, constipation, incontinence, or sexual dysfunction.
Currently, there is no consensus regarding the morphology (thickness or length). The objective of this study was to determine morphometric characteristics and variations in correlation to the number of pregnancies, method of delivery, parity and estrogenic exposure.
Materials and methods
An observational, cross‐sectional, retrospective, descriptive and comparative study was performed. Pelvic RMIs of Hispanic women from the northeast of México were obtained, with an age of 15 years and older. Those with gynecological pathology were excluded. Age, obstetrics and gynecology history was registered and the population was categorized by the number of pregnancies (nulligravida, 1–3 pregnancies, or ≥ 4 pregnancies), type of delivery (vaginal, cesarean section, or mixed), parity (primiparous or multiparous) and estrogen exposure (premenopause and postmenopause).
Results
A total of 102 RMIs were included, the mean age was 41.03 ± 15.23 years (range 15 to 77). A quarter (24.5%) of the patients were nulligravida, the rest (75.5%) being primi‐ or multigravida. Of those with previous pregnancies, vaginal delivery was the most common type (49.35%); 16.88% had a cesarean section, and 31.17% had a history of both types of delivery. Within the women who had a vaginal delivery, 19.6% were primipara and 41.2% were multipara; only 25.5% were postmenopause.
The mean RVS length was 73.16 mm, with a thickness of 2.76, 2.24, and 2.53 mm for the upper, middle and lower thirds. In women with vaginal delivery, multiparous had a statistically significant longer RVS than primiparous (p 0.011), as well as a tendency of higher thickness, although the latter without statistical significance. Pre‐menopause women had statistically significant longer RVS (p 0.031) with a tendency to lose thickness towards post‐menopause.
Conclusion
The morphology of RVS can be modified by different factors such as age, number of pregnancies, number of births and estrogenic exposure.
The use of hyaluronidase in hyaluronic acid vascular occlusion has been evaluated; however, the models used do not accurately assimilate the facial morphologic characteristics or study the effects on ...adjacent tissues. The purpose of this study was to determine an effective concentration of subcutaneous hyaluronidase to dissolve a hyaluronic acid embolism and its effect on surrounding tissue.
Fifteen rabbits were divided into six groups. An inguinal incision was performed on the femoral artery to create a hyaluronic acid embolism in the control and treatment groups (low-, medium-, and high-hyaluronidase groups). Hyaluronidase was injected subcutaneously. Photographic follow-up, histologic analysis, and quantification of hyaluronic acid were performed. Kruskal-Wallis test and post hoc with Bonferroni correction (p < 0.05) was used to compare the presence of hyaluronic acid in the arterial lumen between groups.
Despite the persistence of intravascular hyaluronic acid, macroscopic and microscopic differences were found between the embolism control group and embolism hyaluronidase high-dose group. Histologic analysis demonstrated thrombosis throughout groups. Skeletal muscle was least affected in the embolism hyaluronidase 500 IU group with less lysis and inflammatory infiltrate.
A 500 IU hyaluronidase dose partially prevents the damage caused by the embolism, and does not affect the surrounding tissue. The use of thrombolytic therapy combined with higher doses of hyaluronidase subcutaneously in this model is proposed.
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