体重指数对全麻患者麻醉诱导时按体重给药罗库溴铵药效学的影响

目的 研究体重指数(body mass index,BMI)对患者全身麻醉时罗库溴铵肌松作用的影响. 方法 择期行全麻手术患者80例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,80例,年龄20岁～60岁.根据BMI将患者分为3组:超重组(Ⅰ组)30例,正常体重组(Ⅱ组)30例和低体重组(Ⅲ组)20例.5s内推注罗库溴铵0.9 mg/kg,记录从推药到T1为0％的时间(起效时间)、无反应期(T1为0％的时间)和恢复指数(T1由25％至75％的时间). 结果 Ⅰ组、Ⅱ组和Ⅲ组的起效时间分别为(75±15)、(91±23)、(135±27)s,Ⅰ组的起效时间短于Ⅱ组和Ⅲ组(P＜0.01),Ⅱ组又短于Ⅲ组(P＜0.01).Ⅰ组、Ⅱ组和Ⅲ组的无反应期分别为(49±14)、(37±8)、(28±7) min,Ⅰ组的无反应期则长于Ⅱ组和Ⅲ组(P＜0.01),Ⅱ组又长于Ⅲ组(P＜0.01).3组的恢复指数的比较差异无统计学意义(P＞0.05). 结论 按体重静注罗库溴铵,BMI是影响该药起效时间和无反应期的重要因素之一.     

Body mass index is associated with altered renal hemodynamics in non-obese healthy subjects

BACKGROUND: Weight excess is associated with increased renal risk. Data in overt obesity suggest a role for altered renal hemodynamics. Whether body mass index (BMI) is also relevant to renal function in non-obese subjects is unknown. METHODS: We studied the relation between BMI and renal hemodynamics in 102 healthy, non-obese (BMI <30 kg/m2) subjects [59 males, 43 females, mean age 39 (18-69) years] in a post-hoc analysis of subjects evaluated as prospective kidney donors or as healthy volunteers in renal hemodynamic studies. RESULTS: Mean (+/-SD) BMI was 24.0 +/- 2.8 kg/m2, mean arterial pressure (MAP) 93 +/- 11 mm Hg, glomerular filtration rate (GFR, iothalamate clearance) 111 +/- 19 mL/min/1.73 m2, effective renal plasma flow (ERPF, hippuran clearance) 458 +/- 108 mL/min/1.73 m2, FF (GFR/ERPF) 0.25 +/- 0.04. On univariate analysis, BMI correlated negatively with ERPF/1.73 m2 body surface area (BSA) (r=-0.46; P < 0.001), GFR/1.73 m2 BSA (r=-0.24, P= 0.013) and positively with FF (r= 0.45, P < 0.001), and age (r= 0.47, P < 0.001). On multivariate analysis both BMI and age were independent predictors of ERPF/1.73 m2 BSA (negative) and FF (positive, all P < 0.05). Age was the only predictor of GFR/1.73 m2 BSA (negative). Analyzed for renal function indexed for height (h), BMI correlated negatively with ERPF/h (r=-0.274, P= 0.005), but not with GFR/h (r= 0.13, P= 0.899). On multivariate analysis both BMI (positive) and age (negative) were independent predictors for GFR/h (both P < 0.001). Age was the only predictor for ERPF/h (negative). Predictors for FF (BMI and age, both positive) were by definition unaltered. CONCLUSION: The impact of BMI on renal function is not limited to overt obesity, as in subjects with BMI <30 kg/m2 a higher BMI is associated with higher FF, that is, a higher GFR relative to ERPF. This suggests an altered afferent/efferent balance and higher glomerular pressure (i.e., a potentially unfavorable renal hemodynamic profile) that may confer enhanced renal susceptibility when other factors, such as hypertension or diabetes are superimposed.     

The rate for the use of hand-assisted laparoscopic methods is directly proportional to body mass index

Background

Hand-assisted laparoscopic (HAL) colorectal resection remains controversial. Critics believe HAL methods lead to decreased use of laparoscopically assisted (LA) methods. Proponents believe selective HAL use increases minimally invasive surgery (MIS) use rates. This study assessed general and body mass index (BMI)-specific HAL and LA colorectal resection use by surgeons who embraced both methods.

Methods

This study retrospectively investigated 1,122 patients who underwent colorectal resection during an 8-year period. Surgical method, type of colorectal resection, BMI, comorbidities, incision length, and short-term outcomes were collected.

Results

The surgical methods included LA (60 %), HAL (25 %), and open (OP 15 %) procedures. The HAL group mean BMI was higher than that of the LA group (P < 0.0001), and the HAL use rate varied directly with BMI. The HAL technique was used for 48 % of the rectal, 36 % of the sigmoid, and 4 % of the right colorectal resections. The incision length was directly proportional to BMI for all the methods. Although the HAL incision lengths were significantly longer than the LA incision lengths for a BMI lower than 40 kg/m², there was no difference when the BMI was 40 kg/m² or higher. The comorbidities were greater in the HAL group than in the LA sigmoid colorectal resection group (P = 0.001). The mean hospital length of stay (LOS) was similar for the HAL and LA patients but longer for the open surgery patients (P < 0.0001 vs HAL group). The major complications, reoperations, and 30-day mortality rates were low and comparable.

Conclusions

The HAL methods were used primarily for sigmoid and rectal colorectal resections and for higher BMI patients with more comorbidities. The mean incision length difference between the HAL and LA methods was 3.9 cm, but neither the LOS nor the major postoperative complications differed significantly. Selective use of HAL together with LA methods led to a MIS use rate of 85 % and facilitated MIS for high BMI patients. Together, the methods are complementary and may increase the number of minimally invasive surgeries performed.     

Lower body mass index and higher height are correlated with increased varicocele risk

To evaluate the anthropometric indexes in subjects with varicocele compared to controls and the incidence of varicocele in different body mass index (BMI) groups for the purpose of exploring the association between varicocele and anthropometric indexes. A comprehensive literature search was conducted by using PubMed, MEDLINE, EMBASE databases and Cochrane Library up to February 2019. A systematic review and meta‐analysis was conducted by STATA, and Newcastle–Ottawa Scale was utilised for assessing risk of bias. Ultimately, 13 articles containing seven case–control studies and six cross‐sectional studies with 1,385,630 subjects were involved in our study. Pooled results demonstrated that varicocele patients had a lower BMI (WMD = ?0.77, 95% CI = ?1.03 to ?0.51) and a higher height than nonvaricocele participants, especially in grade 3 varicocele patients. Subgroup analyses showed that normal BMI individuals had a higher risk of varicocele than obese or overweight individuals and a lower risk than underweight individuals. In conclusion, this study indicates that varicocele patients have a lower BMI and a higher height than nonvaricocele participants. Moreover, men with excess bodyweight have a lower incidence of varicocele compared to normal weight or underweight people. That is to say, high BMI and adiposity protect against varicocele and high BMI is associated with a decreased risk of varicocele.     

Suxamethonium administration prolongs the duration of action of subsequent rocuronium

BACKGROUND AND AIM: Rocuronium may be given to patients for intubation and also after they have received suxamethonium for intubation. The neuromuscular profile of rocuronium given after recovery from suxamethonium may not be identical to that when rocuronium has been given alone. The neuromuscular effects of suxamethonium and rocuronium, and their effects on intraocular pressure (IOP), heart rate (HR) and arterial pressure were also recorded. METHODS: Thirty patients were randomly allocated to receive either 0.6mg kg(-1) rocuronium (n = 15) or 1 mg kg(-1) suxamethonium (n = 15) for intubation. Anaesthesia was first induced using propofol 2.5 mg kg(-1) and fentanyl 2 microg kg(-1) and maintained with propofol 6-12 mg kg(-1) h(-1). The response of the thumb to supramaximal train-of-four (TOF) ulnar nerve stimulation at the wrist was measured using a mechanomyograph. In the suxamethonium group, when the first twitch of the TOF had recovered to 90%, rocuronium 0.6 mg kg(-1) was administered. Before administration of relaxant, baseline readings of HR, arterial pressure and IOP were measured until stable, then the appropriate relaxant administered. Thereafter, all readings were repeated at 30, 90, 150, 210 and 270 s. Tracheal intubation was performed 300 s after the intubating dose and all recordings repeated 30 s later. Mechanomyographic monitoring was continued until 70% TOF recovery. RESULTS: Suxamethonium had a more rapid onset than rocuronium (49s vs. 74s, P < 0.0001). The onset time of rocuronium after suxamethonium was significantly reduced (56 s) and the time to recover to a TOF of 70% following rocuronium was increased by previous suxamethonium administration (47 vs. 58 min, P < 0.05). Suxamethonium caused a marked rise in IOP (>30%) and HR (>10%) while rocuronium had little effect on either. CONCLUSION: Previous suxamethonium administration decreases the onset time and increases the duration of action of rocuronium. Unlike suxamethonium, rocuronium has few cardiovascular effects and causes little change in IOP.     

Low body mass index is associated with increased mortality in patients with pelvic and acetabular fractures

AimsFractures of the pelvis and acetabulum are often the consequence of high energy trauma in young individuals or fragility fractures in osteoporotic bone. They can be life-threatening or life changing injuries. No published data exists comparing body mass index (BMI) and mortality for this patient group. The aim of this study was to identify if low BMI (<18.5) was a predictor of morbidity and mortality for patients with these injuries.Patients and MethodsOf the 1033 patients with pelvic or acetabular fractures referred to a single level 1 major trauma centre (MTC) over a 4.5-year period (August 2015 - January 2020); we retrospectively analysed data for all admitted patients. Data was collected on demographics, injury pattern, operative intervention and complications. Comparison was made between patients that were underweight (BMI<18.5) and patients that were not. Both in-hospital and post discharge complications were recorded including pulmonary embolus (PE), deep venous thrombosis (DVT), ileus, infection, loss of reduction and mortality at 6 months.Results569 patients admitted to the MTC with a pelvic or acetabular fracture were included in our analysis. Underweight patients had a statistically significant increase in mortality both in-hospital (p = 0.019) and at 6 months post injury (p = 0.039) when compared to other BMI groups. No statistical significance was found between these BMI groups comparing morbidity: DVT (p = 0.712), PE (p = 0.736) nor ileus (p = 0.149). Covariate analysis showed that a low BMI was associated with triple the in-hospital mortality after correction for age and energy of injury (adjusted OR 3.028, 95% CI 1.059-8.659).ConclusionThis is the first published study that demonstrates a statistically significant increase in mortality in patients with pelvic or acetabular fractures who are underweight. Surgeons should carefully consider appropriate peri-operative optimisation for these patients. Further investigation into the effects of low BMI and response to trauma is required.     

Predicting success of metabolic surgery: age,body mass index,C-peptide,and duration score

BackgroundSurgery is the most effective treatment of morbid obesity and leads to dramatic improvements in type 2 diabetes mellitus (T2DM). Gastrointestinal metabolic surgery has been proposed as a treatment option for T2DM. However, a grading system to categorize and predict the outcome of metabolic surgery is lacking. The study setting was a tertiary referral hospital (Taoyuan City, Taoyuan County, Taiwan).MethodsWe first evaluated 63 patients and identified 4 factors that predicted the success of T2DM remission after bariatric surgery in this cohort: body mass index, C-peptide level, T2DM duration, and patient age. We used these variables to construct the Diabetes Surgery Score, a multidimensional 10-point scale along which greater scores indicate a better chance of T2DM remission. We then validated the index in a prospective collected cohort of 176 patients, using remission of T2DM at 1 year after surgery as the outcome variable.ResultsA total of 48 T2DM remissions occurred among the 63 patients and 115 remissions (65.3%) in the validation cohort. Patients with T2DM remission after surgery had a greater Diabetes Surgery Score than those without (8 ± 4 versus 4 ± 4, P < .05). Patients with a greater Diabetes Surgery Score also had a greater rate of success with T2DM remission (from 33% at score 0 to 100% at score 10); A 1-point increase in the Diabetes Surgery Score translated to an absolute 6.7% in the success rate.ConclusionThe Diabetes Surgery Score is a simple multidimensional grading system that can predict the success of T2DM treatment using bariatric surgery among patients with inadequately controlled T2DM.     

The prolonged duration of rocuronium in Chinese patients

We compared the potency and duration of action of rocuronium in Chinese and Caucasian patients during general anesthesia. Thirty-six women (18 Caucasian and 18 Chinese) and 36 children (18 Caucasian and 18 Chinese) were evaluated during the administration of propofol/fentanyl anesthesia. Patients in each age group were randomized into three subgroups to receive single doses of 0.06, 0. 12, or 0.18 mg/kg rocuronium (adults) or 0.12, 0.18, or 0.24 mg/kg rocuronium (children). Neuromuscular blockade was assessed by electromyography of the adductor pollicis after train-of-four (TOF) stimulation of the ulnar nerve. Dose response curves were constructed when maximum neuromuscular depression of the first twitch of the train (T(1)) was obtained. A second bolus dose of rocuronium was then administered to a total dose of 0.6 mg/kg. The times of spontaneous recovery to T(1) 10%, 25%, and 90% of control and to TOF 0.25, 0.50, and 0.70 were recorded. For both adults and children, recovery occurred later in Chinese than in Caucasian patients (P<0.05 for T(1) of 10%, 25%, 75%, and 90% and TOF to 0.7). The 50% effective dose was smaller in Chinese adults (125+/-63 vs. 159+/-66 microg/kg) and Chinese children (171+/-43 vs. 191+/-46 microg/kg) than in Caucasian adults and children, but the difference was not statistically significant. In adults, time to 25% T(1) recovery was 43+/-13 min in Chinese patients and 33+/-10 min in Caucasian patients (P<0.05). The corresponding values were more rapid for children: 30+/-10 and 24+/-6 min (P<0.05). We conclude that the recovery from rocuronium neuromuscular blockade was longer in Chinese compared with Caucasian patients and in adults compared with children.     

High bone mineral density is associated with high body mass index

Summary  High BMD is an infrequent finding. In this retrospective cohort study of women 50 years and older, we documented a strong association between high BMD and high BMI. Introduction  High bone mineral density (BMD) has been associated with genetic disorders and a variety of dietary, endocrine, metabolic, infectious and neoplastic diseases that in many cases warrant medical attention. Since body mass index (BMI) is closely correlated with BMD, we sought to explore the relationship between these two parameters in older women. Methods  We conducted a retrospective clinical cohort study of 16,500 women 50 years and older who underwent baseline BMD testing between May 1998 and October 2002. Mean T-scores and Z-scores, and the proportions of women with high BMD (T-score +2.5 or greater, Z-score +2.0 or greater), were assessed according to BMI category. Results  Higher BMI category was associated with higher mean T-scores and Z-scores at all sites (P < 0.001). The proportion of women with high BMD increased with each BMI category (P for trend <0.05). In women with a lumbar spine T-score of +2.5 or more, 43.5% were obese with BMI > 30 kg/m² (55.6% for the femoral neck and 73.1% for the total hip). For women with a lumbar spine Z-score of +2.0 or more, 37.2% were obese (42.0% for the femoral neck and 50.9% for the total hip). There was no evidence of a paradoxical increase in fracture rates in women with high BMD. Conclusions  High BMD is closely associated with elevated BMI in women. This should be taken into consideration prior to initiating extensive investigations for rare pathologies. This study was supported in part by an unrestricted educational grant from the CHAR/GE Healthcare Development Awards Programme.     

Post-parathyroidectomy serum phosphate kinetics is peculiar to female hemodialysis patients with a high body mass index

BACKGROUND: Persistent hyperphosphatemia is one of the most important factors in the development of secondary hyperparathyroidism (sHPTH). Recently, we demonstrated that a higher body mass index (BMI) and female gender could predispose to a larger phosphate (P) body burden, thereby influencing the severity of sHPTH. METHODS: This prospective study aimed to verify if these two risk factors, i.e. BMI and female gender, also influenced calcium (Ca) and P kinetics in the immediate post-parathyroidectomy (PTx) period in 42 consecutive adult Caucasian anuric hemodialysis (HD) patients referred for first PTx. Serum Ca and P were measured pre-PTx and on the 5 consecutive post-PTx days; serum immunoreactive parathyroid hormone (iPTH) and alkaline phosphatase (ALP) levels were measured pre-PTx and 3 days post-PTx. RESULTS: Ablation of parathyroid tissue determined a significant reduction in serum iPTH, ALP, Ca and P (p = 0.001). The stratification of the cohort into four groups according to the cut-off value of BMI = 25 kg/m(2) and according to gender showed the following: males and females with BMI >25 kg/m(2) (analyzed both separately and as a subgroup including males and females) had significantly higher pre-PTx serum P levels, when compared with the respective sub-groups with BMI <25 kg/m(2) (p < 0.01); a significantly higher mean area under the concentration curve (AUC) of serum P was observed in the high BMI group (males and females), when compared with the low/normal BMI group (p = 0.03); the serum P kinetics in the 5 post-PTx days did not differ between the two groups of male patients (low/normal BMI males vs. high BMI males), whereas a significantly higher mean serum P AUC was observed in the high BMI female patients, when compared with the low/normal BMI female patients (p = 0.003); finally, the serum P kinetics in the 5 post-PTx days did not differ between the two groups of low/normal male and female patients, whereas a significantly higher mean serum P AUC was observed in the high BMI female patients, when compared with the high BMI male patients (p = 0.006). A linear multiple regression analysis with the serum P AUC of each patient as a dependent variable and BMI, gender, age and dialysis duration as independent variables showed that BMI (p = 0.0001) and female gender (p = 0.001) were independent predictors of the serum P AUC. CONCLUSIONS: High BMI and female gender are associated with peculiar serum P kinetics in the immediate post-PTx period, suggesting the existence of a larger P body burden in high BMI female HD patients. The existence of a larger P pool exclusively based on serum P kinetics prompts the need for further studies to better understand such intriguing aspects of bone pathophysiology in response to parathyroid gland removal in chronically uremic patients.     

Ambulatory abdominoplasty tailored to patients with an appropriate body mass index

BackgroundThe office-based surgery setting potentially offers advantages to both the patient and the plastic surgeon, but some patients may not be considered good candidates for abdominoplasty or combined abdominoplasty/lipoplasty performed in the ambulatory setting.ObjectiveWe conducted a retrospective case review of 22 patients who underwent ambulatory abdominoplasty to correct diastasis recti during a 1-year period to evaluate the utility of body mass index (BMI) in patient selection for office-based abdominoplasty procedures using a tumescent technique.MethodsPatients selected for ambulatory abdominoplasty in an office-based setting had BMIs ranging from 22 to 34, with an average BMI of 27, and were American Society of Anesthesiologists (ASA) class I or II. Patients with a BMI that placed them in a “morbidly obese” category (BMI of 35 or above) received general anesthesia with an overnight hospital stay. In borderline cases involving obese patients, a qualified anesthesia provider was consulted to determine whether ambulatory surgery was appropriate, based on the patient's airway and an overall evaluation of the patient's history and physical examination. Patients who underwent ambulatory abdominoplasty received a tumescent anesthetic solution of 50 mL 1% lidocaine with 1 mg epinephrine per liter of normal saline, up to 35 mg/kg body weight. Lipoplasty of the lateral and epigastric regions was routinely performed at the end of all abdominoplasties. The length of surgery was 3 hours to 5.5 hours, depending on the number of regions undergoing lipoplasty.ResultsThere were no reportable surgical or anesthetic complications in any of our patients. Patients reported a high level of satisfaction with the results.ConclusionsBMI evaluation, and in some cases additional risk assessment by a qualified anesthesia provider, can be helpful in determining proper candidates for ambulatory abdominoplasty and combined abdominoplasty/lipoplasty procedures.     

In young adults with a low body mass index ultrasonography is sufficient as a diagnostic tool for ureteric stones

Study Type – Diagnostic (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Although CT has become the gold standard for stone diagnosis, this study provides data suggesting that ultrasonography (US) is sufficient as primary diagnostic method for ureteral stones avoiding high costs, unnecessary radiation and long‐term risk of cancer. To our knowledge the identification of additional factors affecting diagnostic accuracy of US for ureteral stone diagnosis has not been established to date.

OBJECTIVE

? To identify additional factors that might improve the diagnosis of ureteric stones using ultrasonography (US) as the primary diagnostic method.

PATIENTS AND METHODS

? We performed a retrospective study of 228 patients who underwent rigid ureterorenoscopy (URS) for obstructive ureteric stones. ? Patient age, sex, body mass index (BMI) and stone location and size were recorded. ? All patients underwent US for stone detection before surgery. ? If no cause of the flank pain was found by US, computer tomography (CT) was performed to confirm the absence of ureteric stones.

RESULTS

? In 57 (25%), 15 (6.6%) and 156 (68.4%) patients a stone was localized on the proximal, mid‐ and distal ureter, respectively. ? In 96 (42.1%), 122 (53.5%) and 10 (4.4%) patients the stone measured 0–5, 6–10 and >10 mm, respectively. ? The mean (range) BMI of the patients was 24.7 (17.3–37.2) kg/m². ? The overall stone detection rate using US was 86.4% overall, and 96.4% in adults ≤35 years. In 72/197 patients (36.5%) the stones found using US measured ≤5 mm and in 24/31 patients (77.4%) the stones found using CT measured ≤5 mm. ? Age (P= 0.008), stone size (P < 0.001) and BMI (P= 0.013) were factors that independently affected ureteric stone diagnosis using US.

CONCLUSION

? Although CT has served as the ‘gold standard’ for stone detection, its high costs and radiation dose, together with the high detection rate of US in the hands of experienced radiologists, lead us to conclude that US should be the first choice for primary diagnostic purposes, especially in young slim adults as no patient ≤35 years with a BMI ≤24 kg/m² needed unenhanced CT for ureteric stone diagnosis.     

Prostate cancer gene expression signature of patients with high body mass index

The goal of this study was to evaluate prostate cancer gene expression signatures associated with elevated body mass index (BMI). Global gene expression profiles of prostate tumor cells and matching normal epithelial cells were compared between patients with features of normal and high BMI at the time of radical prostatectomy. Knowledge-based analyses revealed an association of high BMI with altered levels of lipid metabolism and cholesterol homeostasis genes, such as stearoyl-CoA desaturase 1 (SCD1) and insulin-induced gene 1 (INSIG1), respectively, in prostate tumor cells. These genes were connected to known pathways of tumorigenesis revealed by the v-maf (musculoaponeurotic fibrosarcoma) oncogene homolog (MAF), notch receptor ligand, jagged 1 (JAG1) and the alanyl aminopeptidase (ANPEP/CD13) genes. This study highlighted that SCD1, a known target of statins, may have a mechanistic role in the recently noted beneficial effects of statin treatment in reducing biochemical recurrence of prostate cancer. An additional finding of our study is that some of the obesity-related genes were upregulated in tumor-matched normal cells within the high BMI group, when compared with normal cells within the normal BMI cohort.     

Association of body mass index and urine pH in patients with urolithiasis

Increase in body size increases the risk of renal stone formation. The mechanism explaining this relationship remains unclear. Urine pH is one of the important factors for urinary stone formation. The purpose of this study was to determine whether there is an association between urine pH and body mass index (BMI) in patients with urolithiasis. Medical charts review that included 342 urinary stone formers (248 men and 94 women). Data obtained included patient sex, age, BMI, urine pH at diagnosis, and stone composition. The patients were classified as normal weight (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 27), or obese (BMI ≥ 27). The mean urine pH of the normal body weight, overweight, and obese groups was 6.25, 6.14, and 6.00, respectively (P < 0.05). Urine pH is inversely related to BMI among patients with urolithiasis. Among patients with urolithiasis, higher BMI will have lower urine pH. This may explain why obesity is associated with an increased risk of nephrolithiasis. Weight loss should be explored as a potential treatment to prevent kidney stone formation. The prevention of urinary stone disease gives clinicians an additional reason to encourage weight reduction through diet.     

Increased body mass index is not a reliable marker of good nutrition in hemodialysis patients

OBJECTIVE: The aim of the study was to assess the body fat (BF) composition in hemodialysis (HD) patients using anthropometry and bioelectrical impedance analysis (BIA) and investigate relationships between BIA-determined BF composition and nutritional parameters in different weight groupings. DESIGN: Cross-sectional study. SETTING: A tertiary-care university hospital. METHODS: 164 HD patients (M/F: 89/75, mean age: 48.4 +/- 15.8 years, mean HD duration: 58.2 +/- 42.6 months) were divided into three groups according to body mass index (BMI): normal weight (NW: BMI 18.5-24.9), overweight (OW: BMI 25-29.9), obese (OB, BMI > or = 30). Biochemical parameters and BF composition using anthropometry and foot-to-foot BIA were compared between three groups. RESULTS: Ninety-six (59%) patients were NW, 40 (24%) were OW, and 28 (17%) were OB. Average mean skinfold thickness (p = 0.005), mid-arm circumference (p = 0.001), BF% (p = 0.001), and fat-free mass (FFM) (p = 0.03) were all significantly greater in the OB group than in the NW group. Compared to the NW patients, the OB group had significantly higher serum levels of glucose (p = 0.03), total cholesterol (p = 0.02), and triglycerides (p = 0.02), but significantly lower serum albumin (p = 0.05) and blood urea nitrogen (p = 0.05). The OB group also had significantly higher white blood cell count (p = 0.002) and serum CRP (p = 0.001) than the NW group. CONCLUSIONS: The results suggest that BIA-determined BF composition is correlated with body mass index. In addition, obesity is associated with elevated CRP and white blood cell count and lower serum albumin level in HD patients.     

Serum prostate‐specific antigen is better correlated to body surface area than body mass index in a population of healthy Korean men

It has been suggested that the larger vascular volume among obese men causes a dilution effect, decreasing the concentration of serum prostate‐specific antigen (PSA). However, plasma volume is proportional to body surface area (BSA) rather than to body mass index (BMI). We determined whether serum PSA level is better correlated to BSA than BMI in a population of ostensibly healthy Korean men. Data from 2604 men who visited our health promotion center were evaluated. All men underwent anthropometric measurements, digital rectal examination, serum PSA determination, and transrectal ultrasound examination. The correlation between serum PSA and other parameters was statistically analyzed. The mean age was 49.9 years and the mean serum PSA level was 1.14ng/mL. The multivariate analysis revealed that the serum PSA was positively correlated with age, prostate volume, and negatively correlated with BSA only and not with BMI. In addition, BSA, rather than BMI, was the significant factor in predicting the prostate volume. Our results suggest that men with larger BSA (rather than BMI), have larger prostate volumes, and lower serum PSA.     

Higher recipient body mass index is associated with post-transplant delayed kidney graft function

To examine whether a higher body mass index (BMI) in kidney recipients is associated with delayed graft function (DGF), we analyzed data from 11,836 hemodialysis patients in the Scientific Registry of Transplant Recipients who underwent kidney transplantation. The patient cohort included women, blacks, and diabetics; the average age was 49 years; and the mean BMI was 26.8 kg/m(2). After adjusting for relevant covariates, multivariate logistic regression analyses found that one standard deviation increase in pretransplant BMI was associated with a higher risk of DGF (odds ratio (OR) 1.35). Compared with patients with a pretransplant BMI of 22-24.99 kg/m(2), overweight patients (BMI 25-29.99 kg/m(2)), mild obesity patients (BMI 30-34.99 kg/m(2)), and moderate-to-severe obesity patients (BMI 35 kg/m(2) and over) had a significantly higher risk of DGF, with ORs of 1.30, 1.42, and 2.18, respectively. Similar associations were found in all subgroups of patients. Hence, pretransplant overweight or obesity is associated with an incrementally higher risk of DGF.     

Onset and duration of action of rocuronium in children receiving chronic anticonvulsant therapy

The onset and time course of action of rocuronium in normal children and children receiving anticonvulsant drugs for prolonged periods was characterized. A single bolus dose of 0.6 mg.kg-1 rocuronium was administered i.v. to seven nonepileptic patients on no medication, and eight patients on chronic anticonvulsant therapy consisting of either phenytoin, carbamazepine, or both who were age and weight matched. Neuromuscular transmission was monitored by the evoked compound electromyography of the thenar muscles using train of four stimulation every 20 s. Recovery times of the first twitch to 10%, 25%, 50%, 75% and 100% of baseline values and recovery index were obtained. The onset times were 1.05+/-0.5 and 1.41+/-0.5 min for the control and anticonvulsant groups respectively and were not significantly different. Children receiving chronic anticonvulsant therapy had significantly shorter recovery index than the control group (control 10.4+/-5.1 min, anticonvulsant 4.8+/-1.7 min, P<0.05). Furthermore, the duration of recovery to 10%, 50%, 75% and 100% of baseline T1 values was less in the anticonvulsant drug group. Our data confirm resistance to rocuronium in children on chronic anticonvulsant drugs.