Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma

BACKGROUND The impact of body mass index(BMI)on survival in patients with esophageal squamous cell carcinoma(ESCC)undergoing surgery remains unclear.Therefore,a definition of clinically significant BMI in patients with ESCC is needed.AIM To explore the impact of preoperative weight loss(PWL)-adjusted BMI on overall survival(OS)in patients undergoing surgery for ESCC.METHODS This retrospective study consisted of 1545 patients who underwent curative resection for ESCC at West China Hospital of Sichuan University between August 2005 and December 2011.The relationship between PWL-adjusted BMI and OS was examined,and a multivariate analysis was performed and adjusted for age,sex,TNM stage and adjuvant therapy.RESULTS Trends of poor survival were observed for patients with increasing PWL and decreasing BMI.Patients with BMI≥20.0 kg/m2 and PWL<8.8%were classified into Group 1 with the longest median OS(45.3 mo).Patients with BMI<20.0 kg/m2 and PWL<8.8%were classified into Group 2 with a median OS of 29.5 mo.Patients with BMI≥20.0 kg/m2 and PWL≥8.8%(HR=1.9,95%CI:1.5-2.5),were combined into Group 3 with a median OS of 20.1 mo.Patients in the three groups were associated with significantly different OS(P<0.05).In multivariate analysis,PWL-adjusted BMI,TNM stage and adjuvant therapy were identified as independent prognostic factors.CONCLUSION PWL-adjusted BMI has an independent prognostic impact on OS in patients with ESCC undergoing surgery.BMI might be an indicator for patients with PWL<8.8%rather than≥8.8%.     

中国九市四至七岁儿童乳恒牙替换及其与体格生长的相关性分析

目的探讨中国9个城市(简称九市)4~7岁儿童乳恒牙替换及其与体格生长的关系,分析恒牙发育长期变化趋势。方法采用分层整群抽样的方法,以4~7岁儿童为调查对象,于2015年6—10月在北京、哈尔滨、西安(北片),上海、南京、武汉(中片),广州、福州、昆明(南片)九市进行横断面调查,共37973名儿童,其中男19035名,女18938名。6岁以下每6个月为1组,6~<7岁1岁为1组。现场检查乳牙脱落、恒牙萌出情况,测量身高、体重等,并依据2009年中国儿童生长标准计算体格指标Z分值。采用Probit概率单位回归方法计算换牙年龄。不同性别、地区、年龄分组组间比较采用χ2检验或t检验。并利用1995年中国九市儿童体格发育调查中乳恒牙替换相关数据,分析恒牙发育的长期变化趋势。结果九市37973名儿童随着年龄增长换牙率逐渐增加,从4.0~<4.5岁的0.6%(42/7568)增长至5.5~<6.0岁的30.3%(2295/7583),6.0~<7.0岁达到74.5%(5680/7627)。除4.0~4.5岁组外,无论城郊男童换牙率均低于女童(P均<0.05);城区换牙率(男5.5~<6.0岁、女4.5~<5.0岁组之后)略高于郊区,如6.0~<7.0岁组男童城郊分别为74.2%(1427/1924)、69.2%(1305/1885)(χ2=11.446,P<0.01)。九市儿童换牙年龄为6.00(95%CI:5.98~6.01)岁。换牙年龄的第3~97百分位变化范围为4.88~7.11岁。女童中位换牙年龄(5.94岁)早于男童(6.06岁);城区(5.94岁)早于郊区(6.05岁);北片(5.97岁)、中片地区(5.97岁)略早于南片地区(6.05岁)。已换牙儿童体重、身高、体质指数Z分值均高于未换牙儿童(0.35±1.17比0.03±1.13、0.32±1.00比0.03±1.02、0.23±1.16比0.04±1.13,t=20.81、21.67、12.09,P均<0.05)。与1995年相比,2015年5.0岁以后儿童换牙率明显提高,如城区男童6.0~<7.0岁组1995年为63.8%(1146/1796),2015年提高至74.2%(1427/1924)(χ2=46.748,P<0.01);中位换牙年龄2015年较1995年提前0.24岁。结论九市4~7岁儿童换牙年龄女童早于男童,城区早于郊区,北、中片早于南片地区。换牙早晚与体格生长水平有关。近20年换牙年龄存在小幅提前趋势。     

The Effectiveness of Nutrition Specialists on Pediatric Weight Management Outcomes in Multicomponent Pediatric Weight Management Interventions: A Systematic Review and Exploratory Meta-Analysis

Background

Nutrition specialists are considered key members of multicomponent pediatric weight management intervention teams, but to date, their contribution has not been quantified.

Quantile regression and empirical likelihood for the analysis of longitudinal data with monotone missing responses due to dropout,with applications to quality of life measurements from clinical trials

The analysis of quality of life (QoL) data can be challenging due to the skewness of responses and the presence of missing data. In this paper, we propose a new weighted quantile regression method for estimating the conditional quantiles of QoL data with responses missing at random. The proposed method makes use of the correlation information within the same subject from an auxiliary mean regression model to enhance the estimation efficiency and takes into account of missing data mechanism. The asymptotic properties of the proposed estimator have been studied and simulations are also conducted to evaluate the performance of the proposed estimator. The proposed method has also been applied to the analysis of the QoL data from a clinical trial on early breast cancer, which motivated this study.     

低分子肝素治疗D-二聚体升高支原体肺炎的有效性分析

目的分析低分子肝素治疗D-二聚体升高支原体肺炎的有效性。方法选取我院2018年1～12月收治的64例D-二聚体升高支原体肺炎患儿作为研究对象,按照数字盲选法将其均分为两组(n=32),对照组采用常规治疗,观察组在常规治疗基础上给予低分子肝素,对比两组治疗效果。结果治疗后,观察组的血小板(PLT)、D-二聚体水平明显低于对照组(P0.05);观察组的发热时间、住院时间均短于对照组(P0.05);观察组治疗总有效率明显高于对照组(P0.05)。结论将低分子肝素应用于D-二聚体升高支原体肺炎患儿的治疗中,可有效改善患儿体内的凝血系统功能,缩短病情恢复时间,提高治疗效果,促进其病情恢复。     

Treating obesity in patients with cardiovascular disease: the pharmacotherapeutic options

Introduction: Obesity is a growing health problem that has numerous comorbidities, including cardiovascular disease (CVD). The multi-disciplinary treatment of obesity now includes the use of pharmacotherapy. When treating patients with obesity and CVD, certain medications may be more appropriate than others.

Areas covered: Herein, the authors review the most commonly used FDA approved medications for the treatment of obesity, describing their mechanism of action, and the efficacy and safety of the medications as seen in recent studies, particularly in patients with CVD.

Expert opinion: In the population of patients with obesity and CVD, the medications orlistat, lorcaserin and liraglutide are considered the most appropriate options for their treatment, in terms of safety. Sympathomimetic medications, such as phentermine, should be avoided in this group. The recent CAMELLIA-TIMI 61 trial supports the safety of lorcaserin in patients with CVD. Until there are more studies, it is reasonable to extrapolate the findings of the LEADER trial, which found improved CV outcomes in subjects with type 2 diabetes taking liraglutide, to the population of nondiabetic patients being treated for obesity. Further cardiovascular outcomes trials (CVOT) are needed to assess the safety of other pharmacotherapeutic options for weight loss.     

Weight stigma and discrimination: Time for change!

The pervasiveness and negative impact of weight stigma and discrimination has highlighted the need to intervene across many levels of society. Instances of discrimination impinge on peoples’ human rights and societal values of equality, raising important questions for policymakers and legislators. The ingrained nature of weight stigma and discrimination throughout society means the systemic change that is warranted will not be easy or rapid. Within this article, several actions are suggested to reduce weight stigma and discrimination and in doing so, address this social justice issue. The article represents a long overdue call to end weight stigma and discrimination for the betterment of society.     

Diferencias epidemiológicas podrían explicar la mayor mortalidad infantil de Chile comparada con Cuba

IntroductionCuba has the lowest infant mortality rate in Latin America, while Chile has an infant mortality rate above the average of Organization for Economic Cooperation and Development (OECD) countries.ObjectiveTo compare the epidemiology of infant mortality between Chile and Cuba in order to find characteristics that may explain the differences found.MethodComparative analysis between Chile and Cuba of infant mortality rate, causes of mortality, live birth weight, and maternal age, in 2015.ResultsCuba had a lower infant, neonatal, early and late mortality than Chile, with no differences in post-neonatal mortality. Chile had a higher infant mortality due to, alterations of the nervous system, urinary system, chromosomal alterations, respiratory distress syndrome, and disorders related to the short duration of gestation. Chile had a higher frequency of mothers ≥ 35 years old and live births weighing <2,500 g. The possible effects of health inequities could not be analyzed due to lack of data.ConclusionsIt is possible to attribute the lower infant mortality rate in Cuba to: selective abortion due to congenital malformations and chromosomal anomalies, lower epidemiological risk of the Cuban pregnant population, and lower frequency of live births with low birth weight.     

Nutritional intervention during maxillomandibular fixation of jaw fractures prevents weight loss and improves quality of life

Maxillomandibular fixation (MMF) for the management of jaw fractures leads to compromised nutritional intake and consequent weight loss and poor quality of life (QoL). The present study aimed to evaluate the effectiveness of a home-based dietary plan to prevent weight loss, and its effect on the QoL of patients who underwent four weeks of MMF for the treatment of maxillofacial fractures. A total of 50 patients were randomised into nutritional intervention (Group1) and non-intervention groups (Group 2). Patients in Group1 were counselled by a dietitian and given a diet plan. Patients in Group 2 were advised to take a liquid diet of their own choice in the form of shakes, juices, and milk, along with protein supplements. Patients in Group1 lost significantly less weight than those in Group 2 (p=0.001) at week four of follow up. Group1 patients had significantly better oral health-related QoL in the ‘physical pain’ domain during the two weeks of MMF, and in the ‘physical discomfort’ and ‘psychological disability’ domains two weeks after the release of MMF. They had significantly better nutrition-related QoL in all the domains during the two weeks of MMF and, except for the ‘physical’ domain, also during the two weeks after its release. Individual home-based diet plans effectively helped the patients maintain their weight and improved QoL.