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34% in 2013, 4.85% in 2019, Pearson correlation coefficient= 0.6092, P= .146). The proportion of Medicare patients with BMI >30 kg/m
increased over the study period (35.84% in 2013, 55.77% in 2019, Pearson correlation coefficient= 0.8505, P= .015). When looking at patients with BMI >40 kg/m
and >50 kg/m
, there was no significant change.
Despite concern that reimbursement payments could alter access to care for patients with certain risk factors, this study did not find a noticeable difference in the representation of patients with obesity and smoking status undergoing TKA following the installation of BPCI.
III, retrospective observational analysis.
III, retrospective observational analysis.
Although the effect of tourniquet use during total knee arthroplasty (TKA) on functional outcomes is controversial, there are little data examining cement penetration and implant stability. This study examines the effect of tourniquet use on cement penetration and radiolucent line (RLL) progression.
Patients undergoing primary total knee arthroplasty with a single surgeon, implant, and cement with minimum 5-year follow-up were retrospectively reviewed. Tourniquet use was defined as 30minutes minimum, while no tourniquet was 0minutes. Patients were 11 matched (n= 61 per group) by age (±5), gender, body mass index (±5), and follow-up (±2 years). Cement penetration and RLL were measured on the tibia at 6 weeks, and RLL at 1, 2, and 5 years postoperatively using the Knee Society Radiographic Evaluation System.
Cement penetration was significantly increased in the tourniquet group in anterior-posterior zones 1 (2.16 vs 1.03 mm, P < .0005), 2 (2.23 vs 1.51 mm, P < .0005), and 5 (8.56 vs 6.3 mm, P= .009), and lateral zones 1 (2.89 vs 2.17 mm, P < .0005), 2 (2.86 vs 2.12 mm, P < .0005), 3P (3.99 vs 3.5 mm, P= .039), and 5 (8.18 vs 5.93 mm, P= .006). Cumulative cement penetration averaged 34.48 vs 43.33 mm in the tourniquet group (P < .005). Progression of RLL >2 mm was observed in 27.8% (17/61) vs 11.4% (7/61) of patients in the tourniquet group (P < .005). There were 2 failures for aseptic tibial loosening in the no tourniquet group.
Tourniquet use improves cement penetration and reduces RLL progression. Dryer surfaces during cementation may improve penetration, resulting in superior initial fixation strength and potentially reducing the long-term risk of aseptic loosening.
Tourniquet use improves cement penetration and reduces RLL progression. Dryer surfaces during cementation may improve penetration, resulting in superior initial fixation strength and potentially reducing the long-term risk of aseptic loosening.
Wendler glottoplasty is a voice feminization surgical procedure designed to increase the fundamental frequency (F0) in male-to-female transsexual patients with gender dysphoria. On average, Wendler glottoplasty has the most significant effect on F0 among voice feminization surgical procedures.
We present the case of a young female patient with a testosterone-producing adrenocortical adenoma who underwent irreversible vocal changes secondary to virilization, which impacted her self-esteem and quality of life (QOL). Voice feminization surgery using Wendler glottoplasty was performed with significant improvement in F0 and QOL.
Sex hormones have a profound impact on the voice. Increased testosterone and dihydrotestosterone are known to cause hypertrophy of the laryngeal muscles and ligaments, which leads to a drop in F0. However, women who present androphonia rarely require surgical management and improve with vocal therapy alone. Few cases of voice feminization procedures for the treatment of androphonia have been described in the literature. Our patient presented with severe masculinization of her voice with a F0 lower than the average adolescent male, which led to the requirement of surgical management.
Patients with severe androphonia that significantly affect their QOL and show no improvement after the management of the underlying pathology and intense vocal therapy are candidates for voice feminization surgeries. These procedures offer positive results both in terms of F0 and in improving patient's self-esteem and QOL.
Patients with severe androphonia that significantly affect their QOL and show no improvement after the management of the underlying pathology and intense vocal therapy are candidates for voice feminization surgeries. These procedures offer positive results both in terms of F0 and in improving patient's self-esteem and QOL.
To explore the characteristics of functional dysphonia (FD) using multimodal methods.
A total of 47 FD patients and a group of 22 normal controls were enrolled. Subjective auditory-perceptual assessment of the voice, Voice Handicap Index (VHI) 30, acoustic analysis, psychological scales assessment, surface electromyography (sEMG), nasal airflow and thoracoabdominal studies were performed.
FD was mostly triggered by mood changes. Patient self-evaluation was more serious than auditory-perceptual evaluation and objective acoustic analysis. There was no obvious organic disorder observed under laryngoscope in patients with FD, but there were cases of glottic insufficiency and supraglottic compensation. With regards to sEMG, nasal airflow, chest, and abdomen examination results (1) sEMG in the normal control group was symmetrical and stable on both sides during rest and phonation, and nasal airflow as well as the chest and abdomen were symmetrical and regular; (2) sEMG in the FD group showed increased recruite were seen in some patients; the breathing pattern was mainly chest breathing, and the times of breaths during the short text task significantly increased. With identification of the characteristics of FD, the therapy could be focused them.
FD occurs mainly in middle-aged women, and there are many triggers. The Hamilton Anxiety/Depression Rating Scale scores were higher, and subjective symptoms were more serious than objective evaluation. find more No obvious organic changes were seen under laryngoscope, and features such as supraglottic compensation and glottic insufficiency were observed; muscle tension was significantly higher than that of the normal control group, and prephonation recruitment and postphonatory persistence were seen in some patients; the breathing pattern was mainly chest breathing, and the times of breaths during the short text task significantly increased. With identification of the characteristics of FD, the therapy could be focused them.
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