Effects of smoking cessation and weight gain on cardiovascular disease risk factors in Asian male population

ObjectiveSmoking cessation leads to both beneficial and harmful changes in cardiovascular disease (CVD) risk factors. The basis of the harmful changes, however, is unknown. Our objective was to determine whether they are associated with the weight gain that accompanies smoking cessation.MethodsStudy subjects were male cigarette smokers aged at least 30 years who visited the Health Promotion Center of Seoul National University Hospital between 1995 and 2007 repeatedly with a 1- to 3-year interval between first and second visit. Self-reporting questionnaires gathered clinical and socio-economic characteristics on the initial visit, and CVD risk factors (blood pressure, fasting blood glucose, and serum lipid profile) were measured on both the visits.ResultsWe compared the CVD risk factors between smoking quitters and smoking continuers. The quitters were more likely than the continuers to have harmful health changes such as increase in body weight (P < 0.01), in systolic blood pressure, and in serum levels of total cholesterol, LDL-cholesterol, and non-HDL cholesterol (P < 0.05). When stratified by body weight change, quitters who had gained more than the median (1.3 kg) were more likely than those who had not to have increase in blood pressure (P < 0.01) and in serum levels of total cholesterol, triglycerides, non-HDL cholesterol, and fasting glucose (P < 0.05).ConclusionsHarmful changes in CVD risk factors associated with smoking cessation were mainly secondary to weight gain. To reduce the risk of cardiovascular disease in quitters, therefore, more attention should be focused on preventing weight gain.     

“Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery

Introduction

Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instruments. A surgical robot with wristed instruments could overcome this limitation, but the arms often collide when working coaxially. This study tests a new technique of “chopstick” surgery to enable use of the robotic arms through a single incision without collision.

Methods

Experiments were conducted utilizing the da Vinci S^® robot (Intuitive Surgical, Inc., Sunnyvale, CA) in a Fundamentals of Laparoscopic Surgery (FLS) box trainer with three laparoscopic ports (1 × 12 mm, 2 × 5 mm) introduced through a single “incision.” Pilot work determined the optimal setup for SILS to be a triangular port arrangement with 2-cm trocar distance and remote center at the abdominal wall. Using this setup, five experienced robotic surgeons performed three FLS tasks utilizing either a standard robotic arm setup or the chopstick technique. The chopstick arrangement crosses the instruments at the abdominal wall so that the right instrument is on the left side of the target and the left instrument on the right. This results in separation of the robotic arms outside the box. To correct for the change in handedness, the robotic console is instructed to drive the “left” instrument with the right-hand effector and the “right” instrument with the left. Performances were compared while measuring time, errors, number of clutching maneuvers, and degree of instrument collision (Likert scale 1–4).

Results

Compared with the standard setup, the chopstick configuration increased surgeon dexterity and global performance through significantly improved performance times, eliminating instrument collision, and decreasing number of camera manipulations, clutching maneuvers, and errors during all tasks.

Conclusion

Chopstick surgery significantly enhances the functionality of the surgical robot when working through a small single incision. This technique will enable surgeons to utilize the robot for SILS and possibly for intraluminal or transluminal surgery.     

Cross-cultural differences in infant and toddler sleep

BackgroundTo characterize cross-cultural sleep patterns and sleep problems in a large sample of children ages birth to 36 months in multiple predominantly-Asian (P-A) and predominantly-Caucasian (P-C) countries.MethodsParents of 29,287 infants and toddlers (predominantly-Asian countries/regions: China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam; predominantly-Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.ResultsOverall, children from P-A countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to both bed-share and room-share than children from P-C countries, p < .001. Bedtimes ranged from 19:27 (New Zealand) to 22:17 (Hong Kong) and total sleep time from 11.6 (Japan) to 13.3 (New Zealand) hours, p < .0001. There were limited differences in daytime sleep. Bed-sharing with parents ranged from 5.8% in New Zealand to 83.2% in Vietnam. There was also a wide range in the percentage of parents who perceived that their child had a sleep problem (11% in Thailand to 76% in China).ConclusionsOverall, children from predominantly-Asian countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to room-share than children from predominantly-Caucasian countries/regions. These results indicate substantial differences in sleep patterns in young children across culturally diverse countries/regions. Further studies are needed to understand the basis for and impact of these interesting differences.     

Outcome After Curative Resection of Large (≥10 cm) Gastric Gastrointestinal Stromal Tumors: How Frequent is Adjacent Organ Involvement and is Concomitant Distal Pancreatectomy Necessary?

Introduction

Complete tumor resection with clear margins including adjacent organs is the treatment of choice for gastrointestinal stromal tumors (GISTs). However, true tumor invasion of adjacent organs has been reported to be rare. Concomitant distal pancreatectomy (DP) for suspected tumor infiltration is not infrequently performed during resection of large gastric GISTs. This study aims to determine the true frequency of adjacent organ involvement by large gastric GISTs with particular attention to the pancreas and compares the outcome after curative resection with and without a concomitant DP in order to determine if DP is truly necessary.

Methods

A retrospective review of 37 patients who underwent curative resection of large (≥10 cm) gastric GISTs was conducted.

Results

Wedge resections were performed in 22, partial gastectomies in nine, and total gastrectomies in six patients. The median operative time was 180 min (range, 60–330 min), and the patients had a median postoperative stay of 8 days (range, 4–29 days). Overall, there were eight (22%) morbidities including two (5%) mortalities. Nineteen (51%) had concomitant adjacent organ resection, and these included 15 (41%) DPs with splenectomies. Direct organ invasion was demonstrated in 5/19 patients (26%) and 7/30 organs (23%) resected. Only 1/15 (6.7%) DP specimens demonstrated tumor infiltration. Comparison between the patients with and without a concomitant DP demonstrated that performance of a DP was associated with a longer operation time [225 min (range, 105–305 min) vs 158 min (60–330 min), P?=?.002)], increased postoperative stay [9 days (range, 7–29 days) vs 7.5 days (4–19 days), P?=?.042], and increased postoperative morbidity [6 (40%) vs 2 (9%), P?=?.025]. The DP cohort also had a statistically significant poorer 5-year recurrence free survival (22% vs 60%, P?=?.017).

Conclusion

Although adjacent organ involvement is not uncommon with large gastric GISTs, concomitant DP is usually unnecessary as direct pancreatic invasion is rare. Furthermore, concomitant DP with splenectomy is associated with an increase in postoperative morbidity.     

盐酸小檗碱固体脂质纳米粒包封率的聚结离心法测定

目的:建立测定盐酸小檗碱固体脂质纳米粒(SLN)包封率的聚结离心法.方法:0.5 mL盐酸小檗碱SLN中加入0.05 mL饱和氯化钠水溶液,充分振摇聚结后离心,取上清液,高效液相色谱法测定盐酸小檗碱SLN及上清液中盐酸小檗碱的含量,计算包封率.结果:该方法可将制剂中包裹药物的SLN充分沉淀.平均加样回收率为100.2%(n=3),测得的盐酸小檗碱SLN的平均包封率为93.4%(n=3).结论:使用聚结离心法可准确、快速地测定盐酸小檗碱SLN的包封率.     

The Airway Scope, a new video laryngoscope: its use in three patients with cervical spine problems

Editor—The Airway Scope AWS-S100 (Pentax, Tokyo, Japan)is a new video laryngoscope that enables laryngoscopy withoutalignment of the oral, pharyngeal, and laryngeal axes.¹ Thehandle has a 6 cm LCD monitor screen, and a flexible image tubewith a camera and LED light source mounted at the tip. The disposablepolycarbonate blade, the Pblade, has a channel that completelyencloses and     

Interactions among age, adiposity, bodyweight, lifestyle factors and sex steroid hormones in healthy Singaporean Chinese men

Aim： To examine the inter-relationships among age, lifestyle factors, anthropometric parameters, percent body fat and steroid hormone parameters in 531 healthy Singaporean Chinese men aged between 29 and 72 years old. Methods： Various lifestyle parameters were quantified through a survey, and testosterone （T）, estradiol （E2）, dehydroepiandrosterone sulphate （DHEAS） and sex hormone binding globulin （SHBG） were measured using established methods. Anthropometric parameters were collected and computed, and percent body fat （Siri） was measured using the DEXA scanner. Results： SHBG, DHEAS, bioavailable-T （Bio-T）, E2, Siri, Ht, W/H, W/Ht and work stress were independently correlated with age. Using multivariate analyses and adjusting for age and other related factors, exercise, smoking and alcohol consumption have positive impacts on androgen levels and body composition. However, black and green tea consumption was associated with negative effects on body composition and with higher levels of E2 and Free Estradiol Index （FEI）. Men with shorter sleep duration had significantly lower T levels as compared to those with 6 h or more of nightly sleep. Higher T levels were associated with lower levels of adiposity and other indices of adiposity, whereas higher E2 levels were related to higher levels of adiposity. Men with higher DHEAS were significantly taller and heavier than those with low DHEAS levels. Conclusion： The study showed the close interactions among the gonadal/adrenal and metabolic compartments, with age being a key determinant in their interactions. Lifestyle factors such as exercise, smoking, sleeping and alcohol and tea consumption might play significantly roles in determining the status of health in men.