Is obesity a marker of robustness in vulnerable hospitalized aged populations? Prospective,multicenter cohort study of 1 306 acutely ill patients

Background

The “obesity paradox” is poorly understood in vulnerable older hospitalized populations.

Objectives

To prospectively analyze the impact of body mass index (BMI) and comorbidities on early (6-week), one- and two-year mortality.

Design

Prospective multicenter study with a two-year follow-up of old patients participating in the SAFES cohort study.

Settings

Nine university hospitals in France.

Participants

Patients aged 75 or older hospitalized in medical divisions through the emergency department.

Measurement

Inpatients’ characteristics were obtained through a comprehensive geriatric assessment of inpatients, conducted in the first week of hospitalization. All-cause mortalities at 6-week, one- and two-year were determined using bivariable and multivariable Cox proportional hazard model.

Results

The SAFES cohort included 1,306 patients, aged 85±6 years, with a majority of women (65%). One- and two-year mortality were inversely associated with BMI ≥30 kg/m2 while early mortality was not, and positively associated with age, burden of comorbidities, walking disorders, level of dependency and presence of a dementia syndrome. Survival rates between patients in low (< 18.0 kg/m2) and intermediate (18–24.9 and 25–29.9 kg/m2) BMI categories were not significant.

Conclusion

While our findings seem to confirm the reality of the “obesity paradox” in vulnerable older hospitalized population, the exact understanding of underlying mechanisms and even the truthfulness of this paradoxical relationship are still fraught with considerable methodological, epidemiological and metabolic challenges.     

Noninvasive assessment of elevated pulmonary vascular resistance in children with pulmonary hypertension secondary to congenital heart disease: A comparative study between five different Doppler indices

Background

Pulmonary vascular resistance (PVR) is an important hemodynamic parameter in patients with congenital heart disease (CHD). Noninvasive estimation of PVR represents an attractive alternative to invasive measurements.

Methods

The study included 175 patients with pulmonary hypertension (PH) secondary to CHD. All patients underwent full echocardiographic study and invasive hemodynamic measurements. The study population was then subdivided into four subgroups. Each of the following Doppler indices was measured in one of these four subgroups: peak tricuspid regurgitant velocity (TRV), the ratio of the TRV to the velocity time integral of the right ventricular outflow tract (TRV/TVI_RVOT), peak velocity of tricuspid annular systolic motion (TSm), heart rate corrected acceleration time and infliction time of the proximal left pulmonary artery (ATc, InTc). The data obtained was correlated with invasive PVR measurement. An ROC curve analysis was done to generate cutoff points with the highest balanced sensitivity and specificity to predict PVR > 6WU/m². The receiver operating characteristics (ROC) curves were compared with each other to determine the most reliable cutoff point in predicting elevated PVR > 6WU/m².

Results

There was a significant correlation between both the TRV and TSm and invasive measurement of PVR (r = −0.511, 0.387 and P value = 0.0002, 0.006 respectively). The TSm and TRV cutoff values were the most reliable to predict elevated PVR > 6 WU/m². A TSm cutoff value of ⩽16.16 cm/s provided the best balanced sensitivity (85.7%) and specificity (66.7%) to determine PVR_CATH > 6 WU/m². A cutoff value less than 7.62 cm/s had 100% specificity to predict PVR_CATH > 6 WU/m². A TRV cutoff value of >3.96 m/s provided the best balanced sensitivity (66.7%) and specificity (100%) to determine PVR_CATH > 6 WU/m². Both TRV and TSm had the highest area under the ROC curve among the 5 DOPPLER indices studied.

Conclusion

Prediction of elevated PVR in children with PH secondary to CHD could be achieved noninvasively using a number of Doppler indices. Among the five Doppler indices examined in the current study, the peak TRV and the TSm of the lateral tricuspid annulus had the highest balanced sensitivity and specificity to predict PVRI > 6 WU/m².Abbreviations: AcT, acceleration time; AcTc, acceleration time corrected to heart rate; BSA, body surface area; CHD, congenital heart disease; DTI, Doppler tissue imaging; InT, inflection time; InTc, inflection time corrected to heart rate; MPAP, mean pulmonary artery pressure; PA, pulmonary artery; PCWP, pulmonary capillary wedge pressure; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; Qp, pulmonary blood flow; ROC, receiver operating characteristics curves; RVSP, right ventricular systolic pressure; TRV, peak tricuspid regurgitant velocity; TSm, peak velocity of tricuspid annular systolic motion; TVI_RVOT, right ventricular outflow tract time–velocity integral     

用多指标百分位数法确定医学参考值

目的　建立确定医学参考值的多指标百分位数法 (精确法 )。方法　通过数学证明与医学实践检验。结果　建立了多指标百分位数法 (精确法 ) ,用此法对医学资料建立的医学参考值可用于医学实践。结论　多指标百分位数法(精确法 )是确定多指标医学参考值范围的优良方法     

How clinicians can minimize transfusion-related adverse events?

Objectives

Transfusion-related adverse events (TRAE) can contribute to patient morbidity and mortality. In this brief narrative review, the strategies that clinicians can apply at the bedside to avoid TRAE are discussed.

老年性听力损失的研究进展

老年性听力损失（AHL）是随着年龄增长,听觉器官逐渐衰老退化,进而出现的缓慢进行性的感音神经性听力减退,它严重影响了老年人的生活质量和身心健康。现在全球的AHL患病率都很高,AHL已经成为各国急需解决的健康问题。本文扶研究现状、病因、诊断、预防及治疗等方面对AHL做一综述。     

石河子市老年人听力损失相关因素分析

目的：探讨影响石河子市老年人听力损失（AHL）的相关因素.方法：随机抽取石河子市30个社区的60岁以上老年人800例,通过问卷调查老年人一般情况,采用丹麦Madsen orbiter 922型纯音测听仪测定两耳0.5、1.0、2.0和4KHZ听阈.采用SPSS17.0统计软件包进行t检验、方差分析和多因素分析.结果：（1）单因素分析显示,年龄、性别、高血压及糖尿病与平均听阈有关;年龄、性别、吸烟及饮酒与高频听阈有关.（2）ordinal回归分析显示年龄与低中频听力损失及高频听力损失有关.（3）非条件logistic回归分析显示高龄、糖尿病是低中频听力损失的危险因素;女性是高频听阈的保护因素.结论：年龄、性别、糖尿病与AHL相关,高龄、男性、糖尿病是AHL的危险因素.     

医学院校循证医学应用性教学课程建设的探讨

为提高循证医学的教学质量和医学生的循证医学实践能力和水平,我们建议利用最新的循证医学信息、技术,结合互联网资源,在医学本科生的教学内容中组建一套模拟实践应用的交互式的教学模式——循证医学应用性教学。阐述了循证医学应用性教学课程建设的设想和建议。