The Obesity Paradox: Body Mass Index Complication Rates Vary by Gender and Age Among Primary Total Hip Arthroplasty Patients

BackgroundHigh body mass index (BMI) has long been recognized as a risk factor for postoperative complication among total hip arthroplasty (THA) patients. However, recent studies showed mixed results in the effect of high BMI on surgical outcomes. Our study is to examine the association of preoperative BMI with complication incidence, stratified by age and gender.MethodsWe queried the American College of Surgeons National Surgical Quality Improvement Project database to identify patients who underwent elective primary THA between 2012 and 2016. We examined the associations between BMI as a continuous and a categorical variable and risk of 30-day postoperative complication, using 2 multiple polynomial logistic regression models. We also created predictive plots to graphically assess the relationship between BMI and complication by gender and age.ResultsIn total, 117,567 eligible patients were included in the analyses. The predictive probability of all-type postoperative complications showed a U-shaped relationship with continuous BMI values (range 10-65 kg/m²). The lowest complication risks occurred in patients with BMI between 35 and 40. Females had higher complication rate than males across all BMI values. This U-shaped relationship was only observed among patients younger than 60 years old, while the associations appear to be inversely linear among patients aged greater than 60 years.ConclusionOur results suggest that the current theory of a linear association between BMI and complication risk may not apply to elective primary THA. Strict BMI cutoffs may not minimize risk, especially among patients over 60 years old. Orthopedic surgeons should factor in patient-specific variables of age and gender when determining acceptable surgical risk given a particular BMI value.     

Development of a US trust measure to assess and monitor parental confidence in the vaccine system

Objective

To develop a Vaccine Confidence Index (VCI) that is capable of detecting variations in parental confidence towards childhood immunizations centered on trust and concern issues that impact vaccine confidence.

Immunogenicity and safety of a 2-dose hepatitis B vaccine,HBsAg/CpG 1018, in persons with diabetes mellitus aged 60–70 years

BackgroundHepatitis B virus (HBV) remains a major public health issue, although it is a vaccine-preventable disease. Adults with diabetes are at greater risk of contracting HBV than the general population. Commonly used 3-dose HBV vaccines have reduced immunogenicity in older individuals and in those with diabetes mellitus.MethodsIn this post hoc analysis of a phase 3 clinical trial, participants with type 2 diabetes mellitus aged 60–70 years received either 2-dose HBsAg/CpG 1018 (HEPLISAV-B®, n = 327) at 0 and 4 weeks and placebo at 24 weeks or 3-dose HBsAg/alum (Engerix-B®, n = 153) at 0, 4, and 24 weeks. Immunogenicity, including seroprotection rate (SPR) at week 28, and safety were assessed by subgroup (sex, body mass index, and smoking status). SPR was defined as antibody against hepatitis B surface antigen serum concentration ≥10 mIU/mL.ResultsThe SPR at week 28 was significantly higher with HBsAg/CpG 1018 (85.8% [235/274]) than with HBsAg/alum (58.5% [76/130]) in the per-protocol analysis, for an overall difference of 27.3% (95% CI, 18.0–36.8). SPRs with HBsAg/CpG 1018 were consistently markedly higher compared with HBsAg/alum, regardless of sex, body mass index, or smoking status. Adverse events and deaths were comparable between groups.ConclusionsTwo-dose HBsAg/CpG 1018 provides a higher level of seroprotection against HBV than does a 3-dose vaccine (HBsAg/alum) with a similar safety profile in patients aged 60–70 years with type 2 diabetes mellitus.Study identifier: NCT02117934.     

1990-2016年中国高BMI导致的糖尿病疾病负担研究

目的 分析1990-2016年中国高BMI导致的糖尿病疾病负担。方法 应用2016年全球疾病负担研究结果，分析1990-2016年中国各省份与高BMI具有病因学联系糖尿病的死亡资料以及疾病负担[包括伤残损失寿命年（YLD）、过早死亡损失寿命年（YLL）、伤残调整寿命年（DALY）]，以2010-2035年世界平均人口结构为标准，对死亡率进行标化，比较1990和2016年中国高BMI导致糖尿病死亡的变化情况。结果 2016年归因于高BMI的糖尿病死亡数为40 310例，较1990年的15 008例有大幅攀升。归因于高BMI的糖尿病标化死亡率从1990年的2.01/10万增至2016年的2.60/10万。高BMI导致的男性糖尿病患者标化死亡率的增长高于女性，15~49岁组糖尿病患者归因于高BMI的标化死亡率增幅最大。同期高BMI导致的糖尿病DALY从108.91万人年增长至330.02万人年，YLL和YLD也呈现增长趋势。15~49岁人群高BMI导致的糖尿病YLD的增长速度最快。2016年高BMI导致糖尿病死亡数占糖尿病总死亡数的26.01%，较1990年的18.66%增长了39.39%。与1990年相比，2016年中国几乎所有省份高BMI造成的糖尿病DALY均呈大幅增长，内蒙古自治区、新疆维吾尔自治区、浙江省、澳门地区、四川省和青海省DALY率的增长最为明显。结论 20余年间中国高BMI导致的糖尿病死亡病例显著增加，高BMI造成的糖尿病死亡率增幅显著。不同省份高BMI导致的糖尿病疾病负担差异很大。不同年龄段、不同性别归因于高BMI的糖尿病疾病负担的变化情况不同。作为糖尿病防治相对空白的人群，男性和15~49岁糖尿病患者的健康需求应给予足够的重视和卫生资源分配的倾斜。     

针灸治疗对脑卒中偏瘫患者总有效率的影响

目的:探究针灸治疗对脑卒中偏瘫患者总有效率的影响。方法:将2017年1月-2018年12月在我院接受治疗的58例脑卒中偏瘫患者作为研究对象,随机数字表法分为观察组与对照组,每组29例,分别给予针灸治疗与常规治疗,对两组患者治疗前后神经功能缺损评分(Neurological Impairment Score Scale,NIHSS)、日常生活能力(Barthel指数)以及临床治疗效果进行综合评价。结果:观察组患者治疗后的NIHSS评分明显降低,Barthel指数提高,与对照组比较差异有统计学意义(P<0.05);观察组患者治疗后总有效率与对照组比较,差异有统计学意义(P<0.05)。结论:针灸治疗脑卒中偏瘫患者,能够促进神经功能改善,提高患者日常生活能力,效果显著,值得推广应用。     

术前预后营养指数对肺癌术后并发症风险的预测价值

目的:探讨术前预后营养指数（prognostic nutritional index，PNI）对肺癌术后并发症风险的预测价值。方法:回顾分析2015年12月至2018年3月于我院行手术治疗的非小细胞肺癌患者180例，收集患者的临床资料以及术后并发症的发生情况，采用Logistic回归分析患者术后并发症的影响因素。结果:多因素Logistic回归分析表明，术前低PNI值是术后并发症Clavien-Dindo评分≥II级的独立危险因素（OR:1.10，95%CI:1.02~1.17，P=0.023）；根据术前PNI值将患者分为三组，分别为PNI≥50组（n=113）、45≤PNI<50组（n=47）、PNI<45组（n=20），各组术后并发症Clavien-Dindo评分≥II级以及Clavien-Dindo评分≥III级发生的比例分别为22.1%、40.4%、40.0%和6.2%、17.0%、25.0%，不同PNI值术后并发症发生率存在显著差异；PNI值可作为术后并发症发生风险及气胸、肺外感染的独立危险因素。结论:PNI值可作为肺癌患者术后并发症风险的有效预测因子。