Determinants for gallstone formation – a new data cohort study and a systematic review with meta-analysis*

Objective: Only few determinants of gallstone formation have been identified in cohort studies. The aim was to identify further determinants for gallstones in a Danish cohort and to perform a meta-analysis of results from existing cohorts.

Material and methods: Data from a cohort study was used. Gallstone incidence was assessed through repeated ultrasound examinations. Body mass index (BMI), blood pressure, self-rated health, lifestyle variables, blood lipids, and use of female sex hormones were measured at the baseline examination. Statistical analyses included logistic regression. Based on a prospective protocol, a systematic review of the literature was performed identifying all articles dealing with determinants of incident gallstones. Meta-analyses of comparable determinants were performed through fixed effect models.

Results: Participants with no gallstones at baseline and with at least one re-examination were followed-up completely (mean 11.6 years, N?=?2848). The overall cumulative incidence of gallstones was 0.60% per year. Independent positive determinants for incident gallstones were age, female sex, non-high density lipoprotein (non-HDL) cholesterol, and gallbladder polyps. In addition, BMI was positively associated in men. The systematic review additionally identified associations for comorbidities, parity, and dietary factors. Meta-analysis confirmed the significant associations for incident gallstones and age, female sex, BMI, and non-HDL cholesterol. No significant associations were found for blood pressure, smoking, alcohol consumption, HDL cholesterol, or triglycerides in meta-analyses.

Conclusions: Age, female sex, BMI, non-HDL cholesterol, and polyps are independent determinants for gallstone formation. Incident gallstones and the metabolic syndrome share common risk factors. More studies are needed for further exploration.     

Outcome of a 10-year follow-up of laser in situ laser keratomileusis for myopia and myopic astigmatism

PurposeTo evaluate the results of laser in situ laser keratomileusis (LASIK) for myopia/myopic astigmatism over a 10-year period.MethodsWe examined LASIK patients who received regular postoperative assessments over 10 years. We evaluated uncorrected visual acuity (UCVA), manifest refraction, best-corrected visual acuity, intraocular pressure, retreatment rate, safety, efficacy, and complications.ResultsWe studied 5423 eyes between December 1997 and February 2002. The study criteria were met by 346 eyes. A UCVA of 20/40 was achieved in 86.1% of the patients, with 52.0% achieving 20/20 at 10 years. Refraction within 1.00 σ of target was achieved in 76.3% of the patients, and 95.7% were within 2.00 σ at 10 years. Retreatment was required in 124 eyes (35.8%). The preoperative logMAR UCVA of 1.24 improved to −0.08 at 1 month, and slightly decreased to 0.06 at 10 years. The safety and efficacy indices were 1.0 and 0.89 at 1 month, and 0.99 and 0.71 at 10 years.ConclusionWe analyzed 6.3% of patients who regularly returned for postoperative examinations. Despite the relatively low 10-year-visit rate and the inclusion of single- and multiple-treatment cases, our results may represent the real-world picture of LASIK; furthermore, our study shows that LASIK is an effective and safe procedure.     

Retention and HIV seroconversion among drug users on methadone maintenance treatment in Yunnan,China

Setting: Thirteen methadone maintenance treatment (MMT) clinics across Yunnan, the province with the highest human immunodeficiency virus (HIV) burden in China.Objectives: To determine, among HIV-negative participants on MMT, the proportion lost to follow-up (defined as those who missed the 6-monthly follow-up examination), factors associated with loss to follow-up (LFU), HIV seroconversion rate and factors associated with seroconversion.Design: Prospective cohort study from October 2008 to April 2011. All participants were administered a pre-tested structured questionnaire to capture associated factors and offered HIV testing every 6 months. χ² test and log-binomial regression were used for data analysis.Results: Of 1146 participants, 541 (47%) were lost to follow-up in 2.5 years. Factors associated with higher LFU proportion include <6 months of previous MMT, inconvenient location of the MMT clinic and average methadone dose ⩽60 mg/day, with adjusted relative risks (RRs) of respectively 1.4 (95%CI 1.2–1.5), 1.2 (95%CI 1.0–1.4) and 1.1 (95%CI 1.0–1.3). The overall HIV seroconversion rate was 6.6 (95%CI 3.7–11.0) per 1000 person-years. Not living with a partner contributed to higher HIV rates, with an adjusted RR of 3.6 (95%CI 1.0–12.8).Conclusion: The retention rate of MMT participants in Yunnan was not satisfactory. Decentralising service delivery in the community and making directly observed treatment more convenient has the potential to improve retention.     

Electromagnetic Navigated Versus Conventional Total Knee Arthroplasty—A Five-Year Follow-Up of a Single-Blind Randomized Control Trial

BackgroundThe objective of this study is to provide the 5-year follow-up results of a randomized study comparing conventional versus electromagnetic computer navigated total knee arthroplasty.MethodsAnalysis of 127 patients (66 navigated and 61 conventional surgeries) was performed from a prospective, single-blinded, randomized controlled trial. Patient-reported outcome measures were collected at 5 years after surgery and compared with previously published 1-year clinical outcomes. Five-year surgical revision rates were collated and compared between intervention groups.ResultsOverall, there have been continued improvements in the clinical scores of patients in both groups when compared with clinical data at 1 year; however, at 5 years, there is no statistical difference in any of the patient-reported outcome measures between conventional and navigated surgery. Interestingly, improved implant survivorship was observed in the navigated (0% revision rate) compared with the conventional group (4.9% all-cause revision rate).ConclusionElectromagnetic computer navigated technology produces similar clinical outcomes compared with traditional surgery. Further work is required to monitor implant survivorship, and clinical outcomes with long-term follow-up, to determine the cost effectiveness of this technology.     

个案循环跟进护理在慢性心力衰竭患者体质量监测中的应用

目的 探讨个案循环跟进护理在慢性心力衰竭患者体质量监测中的应用效果。方法 选取2018年1—12月心血管内科收治的100例慢性心力衰竭患者为研究对象,采用随机数字表法将其分为观察组和对照组,各50例,对照组按慢性心力衰竭患者常规出院随访管理,观察组在对照组基础上实施个案循环跟进护理,对患者进行体质量监测,随访6个月后比较2组患者基本生活活动能力、心功能指标、体质量监测依从性、再住院率。结果 观察组患者生活自理能力、体质量监测依从性显著高于对照组(t=3.844,P=0.036;Z=-4.926,P＜0.001),心功能指标明显好于对照组(P＜0.05),再住院率显著低于对照组(χ²=4.332,P=0.037)。结论 个案循环跟进护理能明显提高慢性心力衰竭患者体质量监测依从性,缓解心力衰竭症状、改善心功能水平,提高患者生活活动能力,减少再住院率。