Search Results (233)

Objectives: Emerging evidence suggests that bilirubin, beyond being a metabolic byproduct, may exert protective effects against metabolic and cardiovascular diseases due to its antioxidant properties. However, its relationship with hyperlipidemia remains unclear. This study investigated the relationship between hyperbilirubinemia and hyperlipidemia in a large, community-based cohort. Methods: Data from 8464 participants in the Jidong Community Cohort were analyzed using a cross-sectional design. Hyperbilirubinemia was defined as serum total bilirubin (STB) ≥ 17.1 μmol/L, whereas hyperlipidemia was determined based on a prior diagnosis or elevated lipid profile. Results: Of all participants, 31.6% had hyperbilirubinemia and 51.8% had hyperlipidemia. Multivariable logistic regression revealed a significant inverse association between hyperbilirubinemia and hyperlipidemia [odds ratio (OR) = 0.764, 95% confidence interval (CI) = 0.686–0.851]. This association was significant in participants aged <65 years (OR = 0.762, p < 0.0001) but not in those aged ≥65 years. Stratified analysis by smoking status further revealed a 29% reduced risk of hyperlipidemia among never-smokers (OR = 0.708, p < 0.001), but not among current (OR = 0.831, p = 0.087) or former smokers (OR = 0.685, p = 0.175). Hyperbilirubinemia was also negatively associated with TC (p < 0.0001), TGs (p < 0.0001), LDL-C (p = 0.0061), very LDL-C (VLDL-C; p = 0.0043), and apolipoprotein B (ApoB; p < 0.0001) levels, as well as the ApoB/apolipoprotein A1 (ApoA1) ratio (p = 0.0003). Restricted cubic spline analysis revealed an inverse relationship of high STB levels with the TC, TG, LDL-C, VLDL-C, and ApoB levels, as well as the ApoB/ApoA1 ratio. Moreover, elevated STB levels were inversely linked to obesity (OR = 0.747, p < 0.0001), arterial stenosis (OR = 0.806, p = 0.0462), and metabolic syndrome (OR = 0.784, p = 0.0008). Conclusions: hyperbilirubinemia may be an independent factor protective against hyperlipidemia and related lipid abnormalities; these results provide insights for the prevention and management of lipid-related diseases. Full article

Background/Objectives: Severe aortic stenosis (AS) poses major anesthetic challenges because cardiac output is highly dependent on preload and heart rate, and abrupt afterload reduction or tachycardia may precipitate ischemia and cardiovascular collapse. Coexisting myelodysplastic syndrome (MDS) with severe thrombocytopenia further increases the perioperative bleeding risk, which we considered particularly important in the anesthetic planning for this patient. We report a case of laparoscopic anterior resection in a patient with severe AS and thrombocytopenia, highlighting a transfusion strategy adjusted according to the patient’s response and remimazolam-based anesthesia. To the best of our knowledge, there have been no previous reports describing remimazolam-based total intravenous anesthesia achieving stable hemodynamics without vasopressor support in a patient with severe AS and MDS–related thrombocytopenia. Method: A 78-year-old man with previously diagnosed MDS and chronic pancytopenia, whose baseline platelet counts (PLTs) ranged from 20,000 to 40,000/μL, was found to have severe AS (aortic valve area, 0.73 cm²; mean pressure gradient, 42 mmHg) during preoperative evaluation for laparoscopic anterior resection. After platelet transfusions titrated to his response, the patient’s PLT increased to 93,000/μL before surgery. Anesthesia was induced and maintained with remimazolam and remifentanil, which were chosen to prevent afterload reduction associated with propofol. Results: Hemodynamics, including arterial pressure, cardiac index, systemic vascular resistance index, and cerebral oxygen saturation, remained stable without vasopressor support. Transient systolic hypertension during surgical stimulation was controlled using remifentanil titration and esmolol. Recovery and the postoperative course were uneventful, and the patient was discharged in a stable condition. Conclusions: Remimazolam-based total intravenous anesthesia can provide hemodynamic stability without vasopressors in high-risk patients with severe AS, and a transfusion strategy adjusted step by step according to the patient’s response can be effective for optimizing PLTs while minimizing the transfusion-related risks of MDS-associated thrombocytopenia. Full article

Degenerative lumbosacral spinal stenosis (DLSS) is a progressive condition characterized by narrowing of the spinal canal and subsequent neural compression, often leading to chronic pain and disability. Neurotrophins, particularly neurotrophin-3 (NT-3) and neurotrophin-4 (NT-4), play essential roles in maintaining neuronal integrity and modulating nociceptive signaling; however, their involvement in DLSS and potential modulation by systemic and behavioral factors remain poorly understood. This study evaluated NT-3 and NT-4 expression in ligamentum flavum (LF) tissue from 96 patients undergoing surgical decompression for DLSS and compared the results to 85 postmortem control samples. Quantitative analyses were performed using RT-qPCR, ELISA, and immunohistochemistry. NT-3 transcript levels were markedly elevated in stenotic LF samples (fold change: 9.12 ± 0.56; p < 0.05), while NT-4 mRNA expression was significantly reduced (fold change: 0.33 ± 0.07; p < 0.05). At the protein level, both NT-3 (134 ± 5.78 pg/mL) and NT-4 (316.77 ± 8.19 pg/mL) concentrations were significantly increased compared to controls (p < 0.05). Although neurotrophin levels did not correlate directly with pain intensity or morphological severity, elevated NT-3 and NT-4 protein levels were significantly associated with obesity, diabetes, alcohol consumption, and tobacco use (p < 0.05). These findings demonstrate that NT-3 and NT-4 are differentially expressed in the ligamentum flavum of patients with DLSS and are influenced by systemic metabolic disturbances and lifestyle factors, suggesting their potential as biomarkers or therapeutic targets in degenerative spinal disease. Full article

Background/Objectives: Spinal fusion with static fixation—surgically joining two or more vertebrae to eliminate motion—is commonly employed to treat degenerative spinal disease. However, the rigidity imposed by static constructs and the increased load on the adjacent segments frequently result in complications such as disc or facet degeneration, spinal stenosis (SS), and segmental instability. This study investigates the effectiveness of pedicle-based dynamic stabilization using the Dynesys system, particularly in a dynamic-transitional optima (DTO) hybrid configuration, in mitigating adjacent segment disease (ASD) and improving clinical outcomes. In this work, we analyzed the mechanical performance and intermediate-term clinical effects of the DTO hybrid lumbar device, focusing on how the load-sharing properties of the Dynesys cord–spacer stabilizers may contribute to junctional complications in individuals with diverse grades of intervertebral disc degeneration. Study Design/Setting: We designed a combined biomechanical finite element (FE) and experimental analysis to predict the clinical outcomes. Patient Sample: Among 115 patients with lumbar SS enrolled for analysis, 31 patients (mean age: 68.5 ± 7.5 years), with or without grade I spondylolisthesis (18/13), underwent a two-level DTO hybrid procedure—L4–L5 static fixation and L3–L4 dynamic stabilization—with minimal decompression to preserve the posterior tension band. Post-surgical follow-ups were conducted for over 48 months (range: 49–82). Outcome Measures: Radiological assessments were performed by two neurosurgeons, one orthopedic surgeon, and one neuroradiologist. The posterior disc height, listhesis distance, and dynamic angular changes were measured pre- and postoperatively to evaluate ASD progression. Methods: Dynamic instrumentation was assigned to the L3–L4 motion segment with lesser disc deterioration, in contrast to the L4–L5 segment, where static fixation was applied due to its greater degree of degeneration. FE analysis was performed under displacement-controlled conditions. Intersegmental motion analysis was conducted under load-controlled conditions in a synthetic model. Results: The DTO hybrid devices reduced stress and motion at the transition segment. However, compensatory biomechanical effects were more pronounced at the adjacent cephalad than the caudal segments. In the biomechanical trade-off zone—where balance between motion preservation and stabilization is critical—the flexible Dynesys cord significantly mitigated stiffness-related issues during flexion. At the L3–L4 transition level, the cord–spacer configuration enhanced dynamic function, increasing motion by 2.7% (rotation) and 12.7% (flexion), reducing disc stress by 4.1% (flexion) and 12.9% (extension), and decreasing the facet contact forces by 4.9% (rotation) and 15.6% (extension). The optimal cord stiffness (50–200 N/mm) aligned with the demands of mild disc degeneration, whereas stiffer cords were more effective for segments with higher degeneration. The pedicle screw motion in dynamic Dynesys systems—primarily caused by axial translation rather than vertical displacement—contributed to screw–vertebra interface stress, influenced by the underlying disc or bone degeneration. Conclusions: Modulating the cord pretension in DTO instrumentation effectively lessened the interface stress occurring at the screw–vertebra junction and adjacent facet joints, contributing to a reduced incidence of pedicle screw loosening, ASD, and revision rates. The modified DTO system, incorporating minimal decompression and preserving the posterior complex at the dynamic level, may be biomechanically favourable and clinically effective for managing transitional degeneration over the mid-term. Full article

Objectives: To evaluate the loss of quality of life (QoL) in patients with chronic obstructive sialadenitis (COS) using the Chronic Obstructive Sialadenitis Questionnaire (COSQ). Methods: The COSQ was administered to patients diagnosed with COS, with the diagnosis confirmed by sialendoscopy. Epidemiological data, obstructive causes and potentially obstructive entities were collected. QoL was assessed using the COSQ. Results: A total of 344 glands in 278 patients with COS were analyzed. Most patients were women (71.94%), and the main obstructive cause was stenosis (47.96%), followed by lithiasis, lack of papilla distensibility (LPD), and mucus plug. Stenosis was significantly more frequent in the parotid gland and in women, whereas lithiasis predominated in the submandibular gland and in men. The mean COSQ score was 30.55 and it was significantly higher in women (p < 0.005), parotid gland (p < 0.005), and in long-standing cases (p < 0.05). Stenosis and LPD were the obstructive causes with the greatest impact on QoL (p < 0.005), while lithiasis had the least impact. Potentially Obstructive Entities (POEs), such as eosinophilic sialodochitis, Sjögren’s syndrome, or radioiodine-induced sialadenitis, were associated with a notable loss of QoL. Likewise, patients without associated POEs presented significantly lower COSQ values (p < 0.05). Conclusions: COS significantly affects QoL, particularly in women and in cases of parotid gland, stenosis, and LPD. Lithiasis has the least impact on QoL. It is important to standardize a thorough evaluation of COS using validated tools such as the COSQ, which are fundamental for understanding the disease and predicting the outcomes of therapeutic interventions. Full article

Background: Plaque protrusion after stent implantation is frequently observed in acute coronary syndrome (ACS) patients, yet studies on its long-term progression and clinical significance are limited. Methods: Seventy-eight ACS patients underwent optical coherence tomography (OCT)-guided PCI and follow-up OCT at 1 year. A total of 101 protruding lesions were classified into atherogenic neointima (AN) and non-AN groups based on OCT findings. Qualitative and quantitative assessments of protruding plaque, including irregularity and plaque intensity, were conducted. Results: AN developed in 17% of irregular protrusion (IP) lesions, whereas no smooth protrusion progressed to AN. Lesions in the AN group showed greater increases in protruding plaque volume (2.80 ± 0.46 mm² vs. 0.67 ± 0.16 mm², p < 0.001) and diameter stenosis (16.5% vs. 10.1%, p = 0.02). Follow-up LDL levels were higher in the AN group compared with the non-AN group (76.9 vs. 61.2 mg/dL, p = 0.02), despite similar baseline levels. Conclusions: Low-intensity IP after stent implantation in ACS patients carries a high risk of progression to AN, particularly under poor LDL control. Aggressive lipid-lowering therapy may mitigate this risk. Full article

The involvement of the serotoninergic system in the pathogenesis of calcific aortic stenosis introduced a novel dimension to our understanding of this complex cardiovascular condition. This study aimed to assess serotonin (5-HT) and its main metabolite, 5-Hydroxyindoleacetic acid (5-HIAA) in patients with severe aortic valve stenosis (AS). The study employed a case–control design, including 76 patients who underwent transthoracic echocardiography, computed tomography (CT), and peripheral blood sampling. Serum concentrations of 5-HT and 5-HIAA were quantified using enzyme-linked immunosorbent assay (ELISA). The severe aortic valve stenosis group exhibited significantly elevated levels of 5-HT and 5-HIAA compared to the control group (5-HT 1066.5 ng/mL (IQR = 961.9–1112 ng/mL) vs. 977.4 ng/mL (IQR = 394.3–1097.9 ng/mL); p = 0.034 and 5-HIAA 57 ± 12.7 ng/mL vs. 47.5 ± 15.3 ng/mL; p = 0.004, respectively). Receiver operating characteristic (ROC) analysis revealed that 5-HT predicted severe AS with a sensitivity of 73.7% and specificity of 50% at a cut-off level > 973.5 ng/mL, whereas 5-HIAA exhibited a sensitivity of 86.8% and specificity of 47.4% when a cut-off level > 45.49 ng/mL was used. This study showed a significant elevation in the 5-HT and 5-HIAA among patients with severe AS, further supporting the potential involvement of the peripheral serotonergic system in the pathophysiology of this condition. Full article

Background/Objectives: Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis, especially in older adults and high-risk patients. However, many TAVI candidates have osteopenia or osteoporosis, indicated by low bone mineral density (BMD), which is linked to frailty and adverse outcomes. Although prior research suggests an association with poor clinical outcomes, data remain limited. We investigated the impact of osteopenia on TAVI outcomes, hypothesizing that a lower BMD is associated with poor perioperative outcomes and decreased long-term survival. Methods: In this single-center retrospective study, we analyzed data from 411 patients who underwent TAVI at Yamaguchi University Hospital from 2014 to 2024. Clinical and survival data were collected, and Cox regression analysis was used to identify independent predictors of mortality. Preoperative BMD was measured using computed tomography, defining osteopenia as <135 Hounsfield units at L1. Patients were categorized as having mild, moderate, or severe osteopenia. Results: Early clinical outcomes and procedural success were similar; however, patients with osteopenia had longer intensive care unit stays (p = 0.04) and higher late cardiac mortality (p < 0.001). Six-year survival was 36.2% and 88.1% in patients with and without osteopenia, respectively (p < 0.0001). Cox regression analysis revealed osteopenia as a mortality risk factor (hazard ratio: 6.75, 95% confidence interval: 2.96–15.38, p < 0.0001). Severe osteopenia was associated with the poorest outcomes. Conclusions: Osteopenia is an independent predictor of poor long-term survival after TAVI. These findings underscore the importance of comprehensive risk assessment, suggesting that targeted interventions may improve outcomes. Full article

Aortic stenosis (AS) is a common degenerative valvular disease in elderly patients, causing obstruction of left ventricular outflow and presenting with symptoms such as angina, syncope, and heart failure. Although surgical aortic valve replacement (SAVR) remains the gold standard, its high perioperative risk in frail patients has led to the adoption of transcatheter aortic valve implantation (TAVI) as a less invasive and effective alternative. The transfemoral (TF) access route is generally preferred, but severe peripheral arterial disease may limit its feasibility. We report the case of a 71-year-old woman with critical AS complicated by multiple comorbidities, including extensive vascular calcifications, a porcelain aorta, and significant subrenal abdominal aortic stenosis. Multimodal imaging, including computed tomography, was essential for procedural planning, revealing complex iliofemoral anatomy unsuitable for conventional device passage without intervention. Intravascular lithotripsy (IVL) was used to disrupt calcific plaques and facilitate safe vascular access. The TAVI procedure was successfully performed under local anesthesia via TF access using a 65 cm GORE® DRYSEAL Flex Introducer Sheath (W. L. Gore & Associates, Flagstaff, AZ, USA) (18-Fr). After balloon valvuloplasty performed over a SAFARI2™ Pre-Shaped TAVI Guidewire, Extra Small (Boston Scientific, Marlborough, MA, USA) Curve in the left ventricle, a self-expanding Medtronic Evolut™ FX 26 (Medtronic, Minneapolis, MN, USA)mm transcatheter valve was implanted. Postoperative imaging confirmed optimal valve function and vascular integrity without complications. This case highlights the role of IVL as an innovative adjunctive technique enabling TF-TAVI in patients with challenging vascular anatomy, thereby expanding treatment options for high-risk individuals with severe AS. Full article

Myocardial hypoxia is a major cause of cardiac dysfunction, triggering cellular injury and apoptosis. This study aims to investigate the effects of subacute hypoxia on cardiac remodeling and mitochondrial oxygen consumption. This study is based on a rabbit experimental model. Hypoxia was induced using a rabbit tracheal stenosis model. Endotracheal intubation with a 1.5 cm segmented tube wrapped with an absorbable hemostat was used to generate tracheal stenosis in six rabbits. Sham controls (n = 3) underwent tracheotomy, with the tracheal exposure site being sutured immediately. After 1 week, the tube was removed. Echocardiography and mitochondrial function from both groups were morphologically and functionally analyzed at 2 weeks after endoscopic confirmation of tracheal stenosis. Compared to sham group, tracheal stenosis group showed significantly reduced interventricular septal wall thickness (2.3 ± 0.1 mm vs. 2.7 ± 0.2 mm, p = 0.08) and enlarged left ventricular end-diastolic volume (5.86 ± 0.58 mL vs. 5.39 ± 0.18 mL, p = 0.46) with reduced left ventricular ejection fraction (54.5 ± 5.3% vs. 66.9 ± 4.0%, p = 0.005). The tracheal stenosis group showed significantly reduced mitochondrial oxygen consumption at state 3 with reduced respiratory control ratio. Caspase activities (caspase-9 and caspase-3) were increased in the tracheal stenosis group than in the sham group. Subacute hypoxia induced by the tracheal stenosis model causes cardiac remodeling and mitochondrial dysfunction through apoptotic pathways. This study suggests that management of hypoxia could prevent cellular apoptosis and cardiac dysfunction. Full article

This study describes the design and validation of an experimental setup for testing photoplethysmographic (PPG) devices intended for the non-invasive monitoring of vascular accesses in hemodialysis patients. Continuous assessment of arteriovenous fistulas is essential to detect pathological conditions such as stenosis, which can compromise patient safety and dialysis efficacy. While PPG-based sensors are capable of detecting such anomalies, their clinical applicability must be supported by controlled in vitro validation. The developed system replicates the anatomical, mechanical, optical, and hemodynamic features of vascular accesses. A 3D fistula model was designed and fabricated via 3D printing and silicone casting. The hydraulic circuit used red India ink and a PWM-controlled pump to simulate physiological blood flow, including stenotic conditions. Quantitative validation confirmed anatomical accuracy within 0.1 mm tolerance. The phantom exhibited an average Shore A hardness of 20.3 ± 1.1, a Young’s modulus of 10.4 ± 0.9 MPa, and a compression modulus of 105 MPa—values consistent with soft tissue behavior. Burst pressure exceeded 2000 mmHg, meeting ISO 7198:2016 standards. Flow rates (400–700 mL/min) showed <1% error. Compliance was 2.4 ± 0.2, and simulated blood viscosity was 3.9 ± 0.3 mPa·s. Systolic and diastolic pressures fell within physiological ranges. Photoplethysmographic signals acquired using a MAX30102 sensor (Analog devices Inc., Wilmington, MA, USA) reproduced key components of in vivo waveforms, confirming the system’s suitability for device testing. Full article

We report the case of a 44-year-old man with end-stage kidney disease (ESKD) who has been on chronic hemodialysis via a radio-cephalic arteriovenous fistula (RC-AVF) for one year. The patient arrived at the emergency department due to an inability to continue dialysis through the AVF. Clinical and ultrasound exams reveal an aneurysm in the cephalic vein, measuring 2.3 cm (cm) in diameter and 5 cm long, located in the middle third of the forearm, with intraluminal thrombosis. A surgical procedure is planned to exclude the aneurysmal segment and reconnect the vein, using a graft made from a bovine pericardium patch. Immediately after surgery, a thrill is detectable, and ultrasound shows a flow rate of 651 mL/min. On the second day, dialysis is performed through the distal cephalic vein segment under ultrasound guidance, avoiding the median forearm zone. At one month, the fistula remains functional, with no signs of thrombosis or stenosis. The bovine pericardium tubular graft has shown complete integration. This case supports the feasibility, safety, and potential advantages of using a tubularized bovine pericardial graft as an alternative conduit for RC-AVF reconstruction in select patients. However, further studies on larger cohorts and with extended follow-up are necessary to validate its reproducibility and long-term patency. Full article

Background: IgG4-related disease (IgG4-RD) is a chronic immune-mediated fibroinflammatory disorder characterized by lymphoplasmacytic infiltrates enriched in IgG4-positive plasma cells, storiform fibrosis, and frequently elevated serum IgG4 levels. Classic forms, such as pancreaticobiliary or retroperitoneal involvement, are often recognized early, whereas atypical manifestations mimic malignancy or inflammatory conditions, leading to delayed or inappropriate treatment. Case Series: A 30-year-old man presented with hyperemesis, proptosis, and gait instability. He was found to have colonic stenosis, stomach thickening, pachymeningitis, and polyserositis. Gastroenteric histology and serology confirmed IgG4-RD. Steroids were ineffective, but rituximab produced sustained clinical and radiologic improvement. A 35-year-old woman developed jaundice and cholestasis with a perihilar mass highly suggestive of cholangiocarcinoma. Histopathology revealed IgG4-RD, and rituximab therapy led to marked clinical and serological improvement. A 64-year-old woman with a submandibular mass underwent sialoadenectomy, with histology confirming IgG4-RD; she remained asymptomatic without systemic treatment. Literature Review: A literature review highlighted the diagnostic challenges of atypical IgG4-RD. Gastrointestinal involvement is rare and often misclassified as inflammatory bowel disease. Isolated biliary disease frequently mimics cholangiocarcinoma, while salivary gland involvement may be misdiagnosed as neoplasia. Serum IgG4 levels >135 mg/dL and IgG4/IgG ratio >0.21 may support clinical suspicion, but histopathology remains indispensable for definitive diagnosis and for excluding malignancy. Steroid responsiveness is a hallmark, though relapses after tapering are common, often necessitating B-cell-directed therapy. Conclusions: IgG4-RD should be considered in patients with unexplained, relapsing, or steroid-responsive conditions. Early recognition, multidisciplinary collaboration, and integration of histopathology with clinical features are essential to avoid misdiagnosis and optimize management. Full article

Background and Clinical Significance: Posteriorly migrated lumbar disc herniation [PMLDH] is a rare entity that may present with atypical clinical and radiological features, often mimicking other spinal pathologies. Migration of sequestered fragments through the interlaminar space is exceptionally uncommon, and diagnostic challenges are further amplified in the presence of spinal instability. While MRI and CT are generally sufficient for diagnosis, undetected lesions on preoperative imaging may complicate clinical management. Case Presentation: A 59-year-old male presented with acute low back pain and left-sided radiculopathy. Examination revealed mild motor weakness in ankle dorsiflexion. MRI showed L4–L5 segmental instability with central canal stenosis but no migrated disc fragment. Owing to neurological deficit, decompressive laminectomy with posterior instrumentation was performed. Intraoperatively, a posteriorly migrated sequestered fragment compressing the thecal sac was excised and confirmed as degenerative disc material. Postoperatively, the patient’s neurological deficit and radicular pain resolved, with no new complaints at 3-month follow-up. Conclusions: This case highlights an unusual presentation of PMLDH in a patient with lumbar stenosis and spinal instability, undetected on preoperative imaging. Recognition of the biomechanical predisposition at the L3–4 and L4–5 levels is important in understanding such rare migrations. Although literature emphasizes early surgical intervention for PMLDH, our patient required urgent surgery due to neurological deficits rather than a definitive preoperative diagnosis. Further studies are warranted to clarify the relationship between instability and posterior migration. Full article

Background/Objectives: A thorough understanding of spinal anatomy is essential for diagnostic assessment and surgical intervention. Interspinous distance (ISD), neuroforaminal dimensions (NFDs), and disc space height (DSH) have each been studied separately; however, their interrelationship remains unstudied. Given the use of interspinous implants as a minimally invasive treatment for lumbar stenosis and degenerative disc disease, defining these relationships is of growing clinical significance. This study investigates the correlation between ISD and both NFDs and DSH in a normative population and whether ISD varies with demographic factors. Methods: A retrospective chart review was performed on 852 patients who underwent CT imaging of the lumbar spine. ISD was measured from L1 to L5 as the shortest distance between the most caudal tip of the superior spinous process and the inferior spinous process. DSH was measured at the anterior, middle, and posterior margins. NFDs were assessed in axial and sagittal views, including axial width, craniocaudal height, and foraminal area. Statistical analysis assessed correlations between ISD, NFDs, DSH, and demographic variables. Results: No strong correlation was observed between ISD and either NFDs or DSH. Slightly greater correlation was present at L1–L3, weakening at L4–L5, where interspinous implants are most commonly placed. Demographic analysis revealed no consistent relationship between ISD and ethnicity, sex, or BMI. While it may be expected that larger ISD correlates with greater NFDs or DSH, our findings do not support this assumption. Conclusions: ISD does not strongly correlate with NFDs or DSH, and demographic factors do not significantly influence ISD in a healthy population. Full article